Paediatric Gastroenterology

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Paediatric Gastroenterology

• Dr Shoana Quinn
• September 2009
• Trinity College Dublin

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Paediatric Gastroenterology

• Recurrent Abdominal Pain of Childhood
• Constipation
• Gastroesophageal Reflux

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Recurrent Abdominal Pain of Childhood

• Very Common
• Especially 7-14 years
• Periumbilical
• Present all the time
• Missing school
• Sensitive, perfectionistic children

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RAP

• Severe, doubled over
• Pallor
• Persistent for months
• Well in between episodes
• No nocturnal symptoms
• Reassurance
• Minimal Investigation

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Constipation

• Very Common
• Hard, sore stools
• Frequency prior to toilet training is very
  variable
• Withholding
• Faecal overload and overflow
• Perianal tears

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History and Examination

• Withholding behaviour often mistaken for
  straining
• Bright red blood on stool or on wiping
• Children unaware of stool, not behavioural
• Faecal masses on palpation of abdomen
• Perianal inspection. Rectal examination should
  never be performed in paediatrics

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Constipation treatment

• Child needs to gain confidence
• Get rid of hard impacted stool
• Soften stool adequately so not sore
• Regular toileting with foot support
• Continue treatment through toilet training as
  this is often a time of trouble.
• Star charts and reinforcement

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Constipation treatment

• Bisacodyl (Dulcolax) for 3 days AM
• Liquid Paraffin at night
• Lactulose if younger than 1 year
• Movicol
• Suppositories should only be used as last resort
• Diet in children not a big contribution, excess
  milk can cause constipation and iron deficiency

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Ddx Constipation

• Hirschsprung Disease aganglionosis in
  intramuscular and submucous plexuses of the bowel
• Always involves anus and extends proximally
• Surgical treatment
• Risk of enterocolitis

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Gastroesophageal Reflux

• GOR a normal physiological event
• 50 children in first 3 months
• Fewer than 5 age 1 year
• Well, thriving, happy child
• Happy to feed post vomit

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GOR

• Clinical diagnosis
• pH probe probably only useful investigation but
  need consistent operator and acidic refluxate
• Barium studies are never appropriate

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Management of GOR

• Parental reassurance and centiles
• Lie flat after a feed
• Feed thickeners?
• No medications

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Gastrooesophageal Reflux Disease

• Completely different condition
• Characterised by food refusal, haematemesis,
  irritability and failure to thrive
• Clinical diagnosis unless suspicion of
  obstruction
• Trial of PPI then endoscopy and biopsy
• Fundoplication vs longterm PPIs