Live Oak Surgery Center (LOSC) services have developed a state-of-the-art Pediatric Gastrointestinal Endoscopy Unit. Pediatric gastroenterologists diagnose and treat conditions of the gastrointestinal (GI) system or digestive system. Pediatric Gastroenterology is the study of the esophagus, stomach, small intestine (duodenum, jejunum, and ileum), large intestine (colon, sigmoid, rectum, and anus), liver, pancreas, and gallbladder.
Pediatric Gastroenterologists
- Jack An, MD
- John Baker, MD
- Kendall Brown, MD
- Lillenne Chan, MD
- Aakash Goyal, MD
- Michael A. Russo, MD
- Mhammad Gaith Semrin, MD
- Annette E. Whitney, MD
Pediatric Gastroenterology Endoscopy Unit
LOSC utilizes the latest advanced technology for endoscopic diagnosis and treatment of digestive disorders. Our outpatient endoscopy suite is family and patient-centered to promote the pediatric patient’s unique needs such as reducing anxiety and provide age-appropriate anesthesia. The waiting area is child friendly with adequate seating for the patient, parent, or other accompanying children. Bathrooms are easily accessible in the waiting area and patient perioperative area.
Pediatric Gastroenterology
The pediatric gastroenterologists at Live Oak Surgery Center offer comprehensive, compassionate care utilizing the most advanced technology to provide testing, diagnosis, and individualized treatment plans for infants, children, and teenagers. Pediatric gastroenterology is a subspecialty that diagnosis and treats a wide range of gastrointestinal (GI) or digestive conditions of the GI system.
Diagnosing Pediatric Digestive Disorders
Since many pediatric digestive disorders have similar symptoms, diagnostic procedures may need to be performed to identify the problem or condition. Common diagnostic procedures utilize a endoscope, that is a thin flexible tube with a camera at the end to look at the lumen of the gastrointestinal system. The endoscope contains ports that include the camera, light, irrigation and instrument port for biopsies.
Endoscopic Testing performed at LOSC includes:
- Upper GI endoscopy, also called esophagogastroduodenoscopy (EGD): During an EGD, a small endoscope specifically suited for a child is gently guided down the throat to view the esophagus, the stomach, and the upper portion of the small intestine (duodenum). Biopsies may be taken to determine the presence of inflammation, infection, ulcers, Crohn’s disease, Ulcerative Colitis (UC) or Celiac disease. This minimally invasive procedure is performed while your child is under anesthesia. Be sure to follow the preprocedural instructions for upper GI endoscopy the night before your procedure.
- Lower GI endoscopy (colonoscopy): During a colonoscopy, a pediatric endoscope is guided through the anus to examine the large intestine. Biopsies may be taken to identify conditions like inflammation, polyps, ulcers, infection, Crohn’s disease, or bleeding. Your child is under anesthesia during this minimally invasive procedure. It is important for your child to follow his/her colon “bowel prep” cleansing instructions given the day before a scheduled colonoscopy procedure, which is lower GI endoscopy.
- Flexible sigmoidoscopy: This endoscopic procedure is similar to the colonoscopy, but differs only that it vies only the lower part of the colon known as the rectum and sigmoid colon.
The cleaning process of our endoscopes strictly adheres to the high-level disinfection endoscope reprocessing guidelines and practices established by the infection control community, endoscopy professionals, manufacturers and the Food and Drug Administration (FDA) stringent reprocessing guidelines.
Endoscopic Diagnosis
Diagnostic tests such as an EGD and/or colonoscopy can help your pediatric gastroenterologist determine the cause of symptoms such as:
- Stomach pain
- Diarrhea
- Vomiting
- Nausea
- Difficulty swallowing (dysphagia)
- Constipation
- Bloating
- Appetite problems
- Bleeding
Because many digestive conditions can affect a child’s development, correct diagnosis in a timely manner is crucial to restoring your child to optimum health.
Conditions Commonly Treated by a Pediatric Gastroenterologist
Abdominal pain: Tummy pain in children is one of the most common conditions that result in a visit to your pediatric gastroenterologist. While often not a serious illness, abdominal pain can be due to a wide range of reasons such as gastroenteritis, urinary tract infection, constipation, or emotional stress. Organic abdominal pain is caused by damage within the gastrointestinal tract. Functional abdominal pain occurs when the discomfort interferes with the patient’s ability to function, yet the gastrointestinal tract is not damaged. Chronic abdominal pain is pain which lasts longer than 2 weeks, either in a persistent or recurrent manner. Acute abdominal pain is non-traumatic in origin and lasts less than 5 days.
Diagnosing abdominal pain can include keeping a pain journal, as well as diagnostic tests such as:
- EGD and/or colonscopy
- Urine, stool, and blood tests
- X-rays
- Abdominal ultrasound
- CT scan
Dysphagia (difficulty swallowing): Dysphagia, or difficulty swallowing, typically presents as a symptom of an underlying medical problem. Oral dysphagia involves difficulty using the lips, mouth, or tongue to control food/drink. Pharyngeal dysphagia involves problems within the throat during swallowing. Dysphagia can contribute to aspiration of food or liquids into the lungs. Conditions commonly associated with dysphagia include:
- Eosinophilic esophagitis
- Esophageal damage (such as from GERD)
- Large tongue or tonsils
- Sensory problems
- Cleft lip or palate
- Premature birth
- Vocal cord paralysis
- Esophageal atresia or tracheoesophageal fistula
- Dental problems
- Stroke
- Brain injury
- Cerebral palsy
- Neuromuscular diseases or disorders
Because children with dysphagia have difficulty eating enough food, they often experience growth problems. Diagnosing dysphagia may include testing/feeding evaluation such as:
- Upper GI endoscopy, also called esophagogastroduodenoscopy (EGD)
- Laryngoscopy
- Esophageal manometry
- Video fluoroscopic swallowing study (VSS)
- Fiberoptic endoscopic evaluation of the swallow (FEES)
Eosinophilic esophagitis (EoE): EoE is an inflammatory disorder, or chronic immune system disease, in which certain white blood cells (eosinophils) build up in the esophagus wall. EoE has become increasingly diagnosed in pediatric gastroenterology. EoE is typically a reaction to an allergen or acid reflux and can cause esophageal tissue to become inflamed. An upper GI endoscopy including biopsies is used to diagnose EoE.
Symptoms of Eosinophilic esophagitis (EoE) include:
- Dysphagia
- Vomiting
- Persistent heartburn
- Abdominal pain
- Food impaction
- Failure to thrive
Gastroesophageal reflux disease (GERD): When the valve at the end of the esophagus (lower esophageal sphincter) is not opening and closing properly, gastric acid can move up (reflux) from the stomach into the esophagus.
GERD can cause digestive and pulmonary problems, such as:
- Vomiting
- Heartburn
- Excessive burping
- Gagging while eating
- Choking, coughing, wheezing
- Poor appetite/weight loss
- Bad breath
- Frequent ear infections and/or upper respiratory infections
- Sore throat
Diagnosing GERD in children can include:
- Upper GI endoscopy
- Barium swallow (upper GI series)
- pH probe
- Technetium gastric emptying study
Cyclic vomiting syndrome (CVS): CVS is a condition in which a child has extremely intense vomiting episodes (typically 6-20 occurrences in a cycle) while completely symptom-free in between incidents. CVS can be mistaken as a stomach bug or food poisoning however, recurs often with a trigger such as an infection, lack of sleep, certain foods, migraines, or overexcitement. Diagnosing CVS can be difficult as it is sometimes accompanied by other common symptoms, including lethargy, stomach pain, headache, and diarrhea. Identifying triggers can help manage CVS.
Chronic constipation/fecal impaction: If a child has less than 3 bowel movements per week or is having painful or difficult stools to pass, he/she is considered to be constipated. Difficulty or infrequently passing stool can lead to fecal impaction, a condition in which dry, hardened stool is stuck within the rectum. Constipation can often be treated at home however, if the stool becomes backed up repeatedly, the large intestine can be stretched, diminishing nerve sensations. If fecal impaction occurs, manual disimpaction by your doctor may be required to remove the stool.
Involuntary fecal soiling/encopresis (bathroom accidents): Chronic constipation can result in a stretching of the intestinal walls and nerves. In some cases, the nerves’ sensation diminishes, making it difficult to recognize the need to pass stool, and the child unknowingly passes soft stool into the underwear while the hard feces remains in place. Encopresis is not a matter of self-control or refusal to use the bathroom. The child may even be unable to smell the feces as the brain becomes accustomed to the odor. A treatment plan to keep the rectum and colon empty will help bowel function return to normal.
Chronic or severe diarrhea: If bowel movements are loose (runny or watery) for over 4 weeks, the condition is considered to be chronic diarrhea. Less than a week is considered acute diarrhea and is usually caused by food, medication, or infection. Chronic diarrhea can be caused by:
- Inflammatory bowel disease (IBD)
- Irritable bowel syndrome (IBS)
- Celiac disease
- Lactose intolerance
- Food allergies
- Encopresis
Dehydration is always a concern when a child has severe diarrhea. Keeping your child hydrated with plenty of liquids is a critical part of treating diarrhea. Other treatments for chronic diarrhea will depend on the cause of the condition.
Inflammatory bowel disease (IBD): IBD is a gastrointestinal condition which causes areas within the digestive tract to be chronically inflamed resulting in diarrhea that often contains blood and/or mucus. The cause of IBD is not always clear but may involve genetics and the body’s immune system acting against the intestines. Other symptoms of IBD can include:
- Abdominal pain
- Weight loss/growth delay
- Fatigue
- Unexplained fevers
The two main forms of inflammatory bowel disease are:
- Crohn’s disease (CD)- Crohn’s disease affects deep layers of the small or large intestine and sometimes other parts of the digestive tract.
- Ulcerative colitis (UC)-Ulcerative colitis affects only the lining of the large intestine (colon) and involves the immune system mistaking food for an invading substance. Inflammation can cause sores/ulcers which produce pus or mucus.
IBD is diagnosed with an upper and lower endoscopy with biopsy during which tissue samples are obtained from the esophagus, stomach, large intestine, and small intestine. Treatment goals include reduction of symptoms, as well as remission through the use of medications. In severe cases, surgical removal of a portion of the bowel can be necessary for relief of symptoms.
Irritable bowel syndrome (IBS): IBS is a GI disorder caused by changes in how the GI tract is functioning. IBS can present as constipation or diarrhea, along with abdominal pain (cramping). A child with IBS has frequent symptoms (at least once a week for at least 2 months) however, the GI tract is not damaged. Possible causes for pediatric IBS include:
- GI motor problems
- Abdominal hypersensitivity
- Brain-gut signal problems
- Bacterial gastroenteritis
- Anxiety
- Small intestinal bacterial overgrowth
- Genetics
Diagnostic testing (such as ultrasound, colonoscopy, and stool tests) is often performed to rule out other gastrointestinal disorders before identifying IBS.
Peptic ulcers: Sores or erosion of the stomach lining or small intestine can be caused by excessive stomach acid. Peptic ulcers in children are typically a result of:
- Nonsteroidal anti-inflammatory drug usage- NSAIDs, such as aspirin or ibuprofen, can cause bleeding and other gastrointestinal problems.
- Helicobacter pylori (H. pylori) bacteria- H. pylori bacterial infection can weaken stomach lining, allowing acid and bacteria to irritate the stomach which can result in an ulcer.
Peptic ulcers can cause vomiting (with blood), as well as blood in the bowel movements which can be unsettling to both parent and child, however, peptic ulcers can usually be treated with medication. Diagnosing the cause of a peptic ulcer will determine treatment. Diagnostic testing to identify H. pylori, as well as the presence of ulcers, can include:
- Barium swallow
- Upper GI endoscopy
- Stool test
- Blood test
- Breath test (although usually reserved for adults)
Failure to thrive (FTT): When an infant or toddler does not grow or gain weight as expected, swift action is recommended since brain development can be affected. Failure to thrive is usually due to one of three reasons:
- Insufficient nutritional intake
- Inadequate caloric absorption
- Excessive expenditure of calories
Treatment will depend on the cause of FTT. Regular well-child check-ups are the first line of defense against FTT, as slow growth can be identified and addressed early, avoiding long-lasting or permanent consequences.
Celiac disease (CD): Celiac disease is a result of an allergy to gluten, a mixture of proteins that is present in cereal grains such as wheat. Because gluten is used in many foods, children with celiac disease may experience nutritional problems until the condition is diagnosed and treated. Consuming gluten can also damage the small intestine in children with CD. Celiac disease keeps the body from absorbing essential nutrients often causing the patient to become malnourished. Other symptoms of celiac disease can include:
- Chronic diarrhea
- Abdominal pain and bloating
- Gas
- Constipation
- Irritability
- Skin rash
- Fatigue/anemia
- Bone or joint pain
- Mouth ulcers
- Muscle cramps
Gluten avoidance is the treatment for celiac disease, and once gluten is removed from the diet, symptoms typically subside quickly. A physical exam and blood test can be used to help diagnose CD, however an upper endoscopy with biopsy may be used to confirm the condition.
Food allergies and intolerances: Food allergies are a result of the immune system mistaking certain foods as harmful substances and releasing antibodies to fight off the allergen. This antibody release creates an allergic reaction which can range from mild to life-threatening and can include:
Mild
- Skin rash
- Congestion or runny nose
- Diarrhea/nausea/vomiting
- Coughing/sneezing
- Tingling sensation in lips, tongue, or throat
Severe (anaphylaxis)
- Swelling of lips, tongue, or throat
- Wheezing/shortness of breath
- Swallowing difficulty
- Blood pressure drop/fainting/weakness
- Chest pain
- Loss of consciousness
A food intolerance has some similarities to the symptoms of mild allergies however, the immune system is not involved. Food intolerance can cause gas, indigestion, diarrhea, and other gastrointestinal problems but is rarely dangerous. Food avoidance is the best, most successful treatment option for food allergies, as well as intolerances.
Colic in babies: Colic occurs when an otherwise healthy baby exhibits prolonged periods of fussiness and crying (more than 3 hours per day) for 3 or more days a week for at least 3 weeks. The cause of colic is not known but dietary changes in mothers who breastfeed can sometimes ease symptoms. Gas is also associated with colic however, it is not clear whether the gas is a symptom of swallowing air while crying or a contributor to colic. Treatment for colic can involve various ways of consoling your infant ranging from vibrating motion (increasing stimulation) to creating a soothing environment (decreasing stimulation). If your baby exhibits additional symptoms with colic, contact your pediatrician.
Pancreatic insufficiency: When the pancreas is unable to produce or transport a sufficient amount of digestive enzymes, food cannot be broken down properly in the small intestine. Pancreatic insufficiency can result in malnutrition, malabsorption, or vitamin deficiency. Symptoms can include:
- Gas/abdominal bloating and pain
- Chronic diarrhea
- Fatigue
- Inability to gain weight
Diagnosing pancreatic insufficiency may involve:
- Lab tests
- Endoscopy
- Ultrasound
- MRI
- CT scan
Treatment typically involves enzyme supplements and nutritional changes.
Removal of foreign body: If your child swallows an object that is dangerous to pass through the digestive system on its own (such as sharp items or small batteries). Pediatric gastroenterologists are highly trained, qualified, and experienced in foreign body removal, allowing our patients to return to normal play as quickly as possible.
If your child is experiencing symptoms of a digestive disorder, the pediatric gastroenterologists associated with LOSC offer expert, comprehensive care for all manners of gastrointestinal conditions for children of all ages.
Disclaimer: These pages are not intended to provide medical or surgical advice or physician instruction on medical care or treatment. If you are a patient, consult with your doctor about treatment options that may be appropriate for your medical condition.
Diagnosing Surgical Conditions of the Digestive System
If your child is diagnosed with a surgical condition, the pediatric gastroenterologist will refer them to pediatric gastrointestinal surgeons trained and skilled in the most advanced surgical techniques available. They offer laparoscopic and/or robotic options for many of the procedures they perform. Single-incision pediatric endoscopic surgery is also available to provide their patients with virtual scarless treatment.
Esophageal atresia: Esophageal atresia occurs when the top of the esophagus ends with a pouch rather than being joined to the lower portion of the esophagus that connects to the stomach. In many cases, the esophagus can be surgically connected into the proper position. When the esophagus is too short, a gastronomy can be performed, allowing tube feeding until the child grows enough to connect the two ends of the esophagus.
Tracheoesophageal fistula (TEF): Often occurring in conjunction with esophageal atresia, tracheoesophageal fistula is an abdominal opening or connection between the esophagus and the trachea (windpipe). As these tubes are not normally joined, surgical intervention is necessary to close the fistula between the windpipe and the esophagus.
Esophageal varices: Abnormally large veins in the lower portion of the esophagus can rupture and bleed. Often a symptom of liver disease, esophageal varices may develop when liver blood flow from the intestine, spleen, and pancreas is blocked. Surgery can involve a procedure to prevent rupture, as well as any treatment required if a liver condition is involved. Your gastrointestinal surgeon will work in conjunction with a team of pediatric experts to provide the best treatment available for your child’s unique needs.
Intestinal atresia: A congenital malformation of the small or large intestine can occur, causing an improper connection or an absence of part of the intestine. The blockage is treated shortly after birth by connecting the obstructed portion of the intestine to the healthy part, bypassing the obstruction.
Malrotation of the intestines/volvulus: During fetal development, the intestines can become twisted in such a way to cause obstruction, and in some cases, cut off blood supply. Surgery includes untwisting the intestines, repairing abnormalities when possible, and removing any damaged portions of the intestine.
Pyloric stenosis: This blockage occurs when the opening between the stomach and the small intestine (pylorus) narrows, blocking food from exiting the stomach normally. During a pyloromyotomy, your surgeon opens the blockage to enable the stomach to empty.
Hirschsprung’s disease: Some children are born without nerve cells in the muscles of the colon (ganglion cells), causing digestive and bowel movement problems. Because food is not properly moved through the body, the intestines can become obstructed in newborns, or in older infants, the bowel can become enlarged. Surgery can be performed to remove the abnormal portion of the colon. In some cases, a colostomy is required to allow stool to pass outside the body as the intestines heal. Later, a second surgery can be performed to reconnect the intestine to the anal opening.
Imperforate anus: When the anal opening is malpositioned, absent completely, or a fistula (abnormal opening) occurs in the bowel, corrective surgery is necessary. The surgical procedure performed will depend on the type of imperforate anus present and can include:
- Surgical reconstruction
- Opening the membrane
- Stretching the opening
- Temporary colostomy with reconnective surgery later
- Fistula closure
Treatment may require more than one surgery if multiple anomalies are present.
Necrotizing enterocolitis (NEC): Tissue in the large intestine (colon) can become injured or inflamed (especially in premature infants with an underdeveloped intestine), damaging the intestine to the point that it is unable to hold waste. Bacteria can then pass into the bloodstream. Surgery may be necessary to remove the damaged or ruptured portion of the intestine and repair the intestinal wall.
Choledochal cysts: Problems within the bile ducts can cause dilation or pouch formation, hindering bile from flowing properly to the gall bladder and small intestines. Surgical removal followed by reconnection of the bile duct to the intestine is typically the recommended treatment.
Gallstones: Bile within the gall bladder can become crystallized, forming gallstones which can block normal bile discharge into the intestines. A cholecystectomy (gall bladder removal) may be recommended to prevent future gallstones from forming. Afterward, the liver discharges bile into the intestines directly.
Gastroesophageal reflux disease (GERD): In severe cases of GERD, an anti-reflux surgery (fundoplication) can tighten esophagus muscles and prevent food and stomach acid from flowing back up. The procedure is often performed in conjunction with hiatal hernia repair. Pyloroplasty to widen the opening between the stomach and small intestine may also be recommended.
Hiatal hernia: When a portion of the stomach pushes through the diaphragm, food/acid can back up into the esophagus. Large hiatal hernias may require surgery to pull the stomach down, make the diaphragm opening smaller, remove the hernia sac, or reconstruct the esophageal sphincter.
Inflammatory bowel disease (IBD): Inflammatory bowel disease encompasses a group of digestive conditions that cause inflammation and are often associated with autoimmune system abnormalities. Crohn’s disease and ulcerative colitis fall into the IBD category. When medications and nutritional therapies are unsuccessful in controlling symptoms, surgical removal of the diseased area can help the patient achieve and maintain normal quality of life.
Our expert staff is committed to providing every patient and family with a successful outcome while offering compassionate, individualized care.
