Celiac disease (CD) is a lifelong intolerance to gluten, a protein found in wheat (gehu), oats, barley (Jau) and rye. Gluten damages the lining of the intestine, which can cause malabsorption and a variety of symptoms.
Symptoms include chronic diarrhea or constipation, bloating, flatulence, abdominal pain, anemia, inability to gain weight and height. The diagnosis is made using a blood test and endoscopy. The incidence rate is on the rise in Indian population.
Constipation is defined as either a decrease in the frequency of bowel movements or the painful passage of bowel movements. Children 1 to 4 years of age should have a bowel movement 1 – 2 times a day but many children go at least every other day. When children are constipated for a long time, they may begin to soil their underwear. This fecal soiling is involuntary, and the child has no control over it
How common is constipation?
Constipation is very common in children of all ages, especially during potty-training and in school-aged children. Of all visits to the pediatrician, 3% are in some way related to constipation. At least 25% of visits to a pediatric gastroenterologist are due to problems with constipation.
Why does constipation happen?
Constipation is often defined as being organic or functional. Organic means there is an identifiable cause such as colon disease or a neurological problem. 95 % patients have constipation which is functional meaning there is no identifiable cause.
In some infants, straining and difficulties in expelling a bowel movement (often a soft one) are due to their immature nervous system and uncoordinated defecation. Also, it should be remembered that some healthy breast-fed infants can skip several days without having a movement.
In children, constipation can begin when there are changes in the diet or routine, during toilet training, or after an illness. Occasionally, children may have phobia to unfamiliar toilet facilities.
Once the child has been constipated for more than a few days, the retained stool can fill up the large intestine (the colon) and cause it to stretch. An over-stretched colon cannot work properly, and more stool is retained. Defecation becomes very painful and many children will attempt to withhold stool because of the pain.
Concerns are:
In most cases there is no need for testing prior to treatment for constipation
How is constipation treated?
Treatment is on individual basis.
Some children may only require changes in diet such as an increase in fiber, fresh fruits, or in the amount of water they drink each day. Other patients may require medications such as stool softeners or laxatives. Stool softeners are not habit forming and may be taken for a long time without worrisome side effects.
It is often helpful to start a bowel training routine where the child sits on the toilet for 5 – 10 minutes after every meal. It is important to do this consistently in order to encourage good behavior habits. Praise your child for trying. If the child is not toilet trained yet, it is best to wait until constipation is under control.
VIDEO LINK : https://www.youtube.com/watch?v=SgBj7Mc_4sc
Diarrhea is defined either as watery stool or increased frequency (or both) when compared to a normal amount. It is a common problem that may disappear on its own or last longer when further interventions is required
Diarrhea may be:
Diarrhea in children may be caused by a number of conditions, including the following:
Bacterial infection, viral infection, food intolerances or allergies, parasites, reaction to medications, inflammatory bowel disease, functional bowel disorder, such as irritable bowel syndrome, result of surgery on the stomach or gallbladder. Many people suffer "traveller’s diarrhea" caused by a bacterial infection or a parasite, or even food poisoning.
Severe diarrhea may indicate a serious disease, making it important to consult your child's health care provider if any or all of the following symptoms persist:
What are the warning signs of severe diarrhea?
If your child is less than 6 months of age or presents any of the following symptoms:
Abdominal pain, blood in the stool, frequent vomiting, loss of appetite for liquids, high fever, weight loss, urinates less frequently (wets fewer than 6 diapers per day, frequent diarrhea, extreme thirst, no tears when crying, depressed fontanelle (soft spot) on infant's head.
Feeding disorders causes lots of concerns amongst parents. Gradually, it leads to growth problems and failure to thrive. Children often have specific aversions (refusal) to certain types of foods. Forceful feeding and gastro-oesophageal reflux can be a precipitating factor. Some kids are fussy eater, but they tend to grow well.
Failure to thrive is defined as decelerated or arrested physical growth (height and weight measurements fall below the fifth percentile or a downward change in growth across two major growth percentiles) and is associated with poor developmental and emotional functioning. Organic failure to thrive occurs when there is an underlying medical cause. Nonorganic (psychosocial) failure to thrive occurs in a child who is usually younger than 2 years old and has no known medical condition that causes poor growth.
It occurs when stomach contents flow back up (reflux) into the food pipe (esophagus). Regurgitation of feeds is very common, usually begins before the infant is 8 weeks old, but will become less frequent with time. It affects 4 in 10 infants on an average.
It is the most common cause of vomiting during infancy. It may be a temporary condition (Happy spitters) or may become a long-term physical problem, often called gastroesophageal reflux disease (GERD)
GERD (Gastro-esophageal reflux disease) is a more serious and long-lasting complication of gastroesophageal reflux (GER). Symptoms prevent the child from feeding. It is also common for children and teens ages 2 to 18 years of age. The symptoms may include vomiting, gagging, coughing, and trouble breathing. Often your child will just have a bad taste in his or her mouth. Or your child may have a short, mild feeling of heartburn or sore taste in mouth.
1. What is a stomach or duodenal ulcer?
An ulcer is an open sore, or lesion, usually found on the skin or mucous membrane areas of the body.
2. What causes gastric and duodenal ulcers?
In the past, it was believed lifestyle factors, such as stress and diet caused ulcers. Later, researchers determined that stomach acids--hydrochloric acid and pepsin--contributed to ulcer formation.
Today, research shows that most ulcers develop as a result of infection with a bacterium called Helicobacter pylori (H. pylori).
It is believed that, although all of these factors--lifestyle, acid and pepsin, and H. pylori--play a role in ulcer development, H. pylori is considered to be the primary cause in most cases.
Factors suspected of playing a role in the development of stomach or duodenal ulcers include:
3. What are the symptoms of gastric and duodenal ulcers?
Although ulcers do not always cause symptoms, the most common ulcer symptom is a gnawing or burning pain in the abdomen between the breastbone and the navel. The pain often occurs between meals and in the early hours of the morning. It may last from a few minutes to a few hours. Less common ulcer symptoms include:
4. What are some complications from ulcers?
Without proper treatment, people with ulcers may experience serious complications. The most common problems include:
5. How are ulcers diagnosed?
Because treatment protocols may be different for different types of ulcers, it is important to adequately diagnose ulcer disease and H. pylori before starting treatment. For example, for an NSAID-induced ulcer, treatment is quite different from the treatment for a person diagnosed with an ulcer caused by the bacterium, H. pylori.
In addition to a complete medical history and physical examination, diagnostic procedures for ulcers may include:
6. What is the treatment for stomach and duodenal ulcers?
Specific treatment will be determined by:
Recommended treatment may include:
When treating H. pylori, these medications or procedures are often used in combination.
1. What is IBD ?
Crohn's Disease and Ulcerative Colitis (UC)
Ulcerative colitis is an inflammatory bowel disease (IBD) in which the inner lining of the large intestine (colon or bowel) and rectum become inflamed. Inflammation usually involves large intestine (mostly in UC ) but can involve entire GI tract ( as seen in crohn’s )
The inflammation causes diarrhea, or frequent emptying of the colon. As cells on the surface of the lining of the colon die and slough off, ulcers (open sores) form, causing pus, mucus, and bleeding.
2. What causes IBD ?
Crohn's Disease and Ulcerative Colitis (UC)
Ulcerative colitis is an inflammatory bowel disease (IBD) in which the inner lining of the large intestine (colon or bowel) and rectum become inflamed. Inflammation usually involves large intestine (mostly in UC ) but can involve entire GI tract ( as seen in crohn’s )
The inflammation causes diarrhea, or frequent emptying of the colon. As cells on the surface of the lining of the colon die and slough off, ulcers (open sores) form, causing pus, mucus, and bleeding.
Although many theories exist, none has been proven. A theory suggests that some agent, possibly a virus or an atypical bacteria, interacts with the body's immune system to trigger an inflammatory reaction in the intestinal wall.
There is little proof that IBD is caused by abnormalities of the immune system, emotional distress or sensitivity to certain foods or food products, or is the result of an unhappy childhood.
3. Who is affected by IBD ?
It affects males and females equally and appears to run in some families. It can affect anyone 2 years and above. There is a recent increase in very early onset IBD ( presents in < 1 year of age). Indians have shown increasing trend in IBD , which can be attributed to both increase in number of patients as well as modern methods to diagnose the conditions.
4. What are the symptoms of IBD?
The following are the most common symptoms for ulcerative colitis. However, each child may experience symptoms differently. Symptoms may include:
Sometimes children also experience:
5. How is IBD diagnosed?
A thorough physical examination, including blood tests to determine whether an anemic condition exists, or if the white blood cell count is elevated (a sign of inflammation), is part of the diagnostic process. Symptoms that suggest IBD may also be evaluated with the following procedures:
6. What is the treatment for IBD ?
Specific treatment will be determined by following:
While there is no special diet for ulcerative colitis, children may be able to control mild symptoms simply by avoiding foods that seem to upset their intestines.
When treatment is necessary, it must be tailored for each case, because what may help one patient may not help another. Children are also given needed emotional and psychological support. Treatment may include the following:
There are several surgical options:
Jaundice (yellow- mellow) is a frequent entity in first few days of life. Most of the babies with this condition can get better with some or no intervention.
But, jaundice > 2 weeks duration in newborns or jaundice for any duration beyond 28 days period is a matter of concerns and warrants referral to Pediatric gastroenterologist and Hepatologist.
1. What is biliary atresia?
Biliary atresia is a chronic, progressive liver problem that becomes evident shortly after birth. Tubes in the liver, called bile ducts, normally allow a liquid produced by the liver called bile to drain into the intestines and kidneys. Bile aids in digestion and carries waste products from the liver to the intestine and kidneys for excretion. In biliary atresia, bile ducts in the liver are blocked. When the bile is unable to leave the liver through the bile ducts, the liver becomes damaged and many vital body functions are affected.
2. What causes biliary atresia?
The cause of biliary atresia is unknown. Some researchers and doctors believe that babies are born with biliary atresia, implying the problem with the bile ducts occurred during pregnancy while the liver was developing. Others believe that the disease begins after birth, and may be caused by exposure to infections or toxic substances.
Biliary atresia does not seem to be linked to medications the mother took, illnesses the mother had, or anything else the mother did during her pregnancy. Currently, there is not a genetic link known for biliary atresia. The disease is unlikely to occur more than once in a family.
3. How often does biliary atresia occur and who is at risk?
4. Why is biliary atresia a concern?
Biliary atresia causes liver damage and affects numerous processes that allow the body to function normally. Biliary atresia is a life-threatening disease and is fatal without treatment.
5. What are the symptoms of biliary atresia?
Infants with biliary atresia usually appear healthy at birth. Most often, symptoms develop between two weeks and two months of life, and may include:
Jaundice is a yellow discoloration of the skin and whites of the eyes due to an abnormally high level of bilirubin (bile pigment) in the bloodstream, which is then excreted through the kidneys. High levels of bilirubin may be attributed to inflammation or other abnormalities of the liver cells, or blockage of the bile ducts. Jaundice is usually the first sign, and sometimes the only sign, of liver disease.
Symptoms of biliary atresia may resemble other liver conditions or medical problems. Please consult your child's doctor for a diagnosis.
6. How is biliary atresia diagnosed?
A doctor or other health care provider will examine your child and obtain a medical history. Several diagnostic procedures are done to help evaluate the problem and may include the following:
The test that gives the most definitive diagnosis is a liver biopsy. A tissue sample is taken from your child's liver and examined for abnormalities, allowing biliary atresia to be distinguished from other liver problems.
7. What is the treatment for biliary atresia?
Biliary atresia is an irreversible problem. There are no medications that can be given to unblock the bile ducts or to encourage new bile ducts to grow where there were none before. Until that happens, biliary atresia will not be curable. However, two different operations can be done that will allow the child with biliary atresia to live longer and have a better quality of life. Your child's doctor can help determine whether either of these operations are an option:
After surgery, the new liver begins functioning and the child's health often improves quickly. After a liver transplant, children will need to take medications to prevent the body from rejecting the new organ. Rejection occurs due to one of the body's normal protective mechanisms that helps fight against invasion of viruses, tumors, and other foreign substances. Antirejection medications are taken in order to prevent this normal response of the body from fighting against the transplanted organ. Frequent contact with the hepatologist and transplant surgeon is crucial after a liver transplant.
The following is a list of some of the diseases that may cause chronic (long-standing jaundice usually > 2 months) hepatitis in children:
8. Metabolic liver disease :
Conditions that affect liver in 1st year of life and are life threatening:
PFIC 1,2 3 (progressive familial intrahepatic cholestasis)
Galactosemia
Fructosemia
Glycogen storage disease
Tyrosinemia
Neonatal hepatitis
Fatty acid oxidation defects
Organic acidemia
Amino acid metabolism defect .
Urea cycle defect
Maple syrup disease
Mitochondrial liver disease
Refsum’s disease
What is liver transplantation?
Liver transplantation is an operation performed when a person’s liver condition has deteriorated to the point that they are experiencing life-threatening problems. It is performed by surgically removing the diseased liver and replacing it with part of a liver or a whole liver from another person. The new liver is obtained from either a person who is legally brain dead or from an adult living person who donates a part of his/her liver. The person who has received the transplant will then need to take medication indefinitely to prevent his/her body from rejecting the new liver. In India most of the paediatric liver transplant donors are one of the patient’s blood relatives.
What causes liver failure?
Children can develop either acute (sudden onset) or chronic (persisting for months or years) liver disease that may require liver transplantation. Although many chronic conditions can be treated with medications, sometimes the liver fails in spite of this. Causes of acute liver failure include viral infections, drug induced liver failure and inborn error of metabolism (since birth). Sometimes the cause of liver failure is unknown.
Chronic liver disease can occur for many reasons. In babies, biliary atresia (absence of open bile ducts) and genetic problems are the main causes. In children, chronic viral hepatitis (inflammation of the liver caused by a virus), autoimmune liver disease (when a person’s antibodies attack the liver due to an abnormal immune response) or genetic disorders are reasons for liver failure that may require transplantation. Certain liver tumors can also be treated by transplantation
What are the symptoms of liver failure?
In acute liver failure, the child will develop yellow eyes (jaundice), bleeding due to poor blood clotting, and eventually lethargy, confusion and even coma. In chronic liver disease, the child may have poor growth, severe itching, fluid in the abdomen (ascites), an enlarged spleen, and bleeding from swollen veins (varices) in the esophagus. How are decisions made about donor livers? There is a nonprofit, scientific national organization (United Network of Organ Sharing, UNOS) which maintains the national waiting list for donor organs. Their goals are fairness to all and good outcomes for as many people as possible. Patients are evaluated by their transplant center, and depending on how sick they are and the probability of their disease being successfully treated with transplantation, they are matched by UNOS to donor organs as they become available. Patients are treated equally, regardless of ethnicity, gender or economic status. In the case of living donation, a healthy adult who wants to donate will undergo testing to determine if they are a suitable candidate
How is a liver transplant performed?
When the donor is a live person, one group of surgeons will remove part of the healthy liver from the donor while the other group is removing the diseased liver from the child. When the donor is deceased, the child is admitted to the hospital while the liver is transported there. The healthy liver will be placed in the child’s abdomen, and the surgeon reconnects all of the blood vessels and bile ducts. The child is then given medications to prevent the rejection of the new liver. In uncomplicated cases, the child may be in intensive care for 2-3 days and in the hospital for 7-14 days. The main risks right after surgery are bleeding, clotting of the artery to the liver, and poor function of the new liver.
What is life like after a liver transplant?
The child is expected to live a normal life except that he/she needs to take daily medication to prevent rejection. Regular doctor visits to monitor the liver function and watch for medication side effects are also very important. A few special precautions are necessary to avoid infections. Long term risks are rejection of the liver, infections, and an unusual cancer of the lymph glands called post-transplant lymphoproliferative disease (PTLD). Most of these complications are treatable if discovered early which is why good medical follow up is so important. When transplanted children become teenagers, they need to start learning how to assume responsibility for life-long care of their gifted organ
The pancreas is an organ in the middle of the upper abdomen. It produces specialized proteins called enzymes that are important in the digestion of proteins, fats, and sugars. The pancreas also produces insulin and other hormones important in maintaining normal blood sugar levels.
What is pancreatitis?
Pancreatitis is an inflammation of pancreas. Causes of pancreatitis include gallstones, viruses and other infections, medications, congenital malformations, inherited conditions, and trauma to the abdomen.
What are the symptoms of pancreatitis?
Inflammation of the pancreas is often associated with pain in the upper abdomen and/or the back, which may develop slowly, be mild and short of duration, or be sudden in onset, more severe and longer lasting. Nausea and vomiting are very common. Fever and jaundice may be present.
How is pancreatitis diagnosed?
Raised amylase and lipase
An abdominal ultrasound (sonogram)
MRI/ MRCP (magnetic resonance cholanglopancreatography)
ERCP (endoscopic retrograde cholangiopancreatography)
How is pancreatitis treated?
Treatment mainly consists of putting the pancreas to rest (i.e. no eating or drinking) and relieving any associated pain. A nasogastric tube may be placed to suck fluid from the stomach. Most people, children in particular, recover within a week, with no permanent damage to the pancreas.
All Gastro-intestinal Disease
