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Whether your child's gastrointestinal issues are characterised by vomiting, diarrhoea, pain, or a combination of these, it can be a worry for any parent to see their child suffer. Children with gastrointestinal problems can also suffer from mental health problems, such as anxiety and depression, alongside their physical symptoms. However, gastrointestinal issues are actually very common in children and adolescents.
I provide consultations and treatments for children with a wide range of gastrointestinal conditions and diseases, including:
Cow's milk protein allergy (CMPA) is one of the most common food allergies seen in children. CMPA results from an immunological reaction to one or more milk proteins. CMPA may be immunoglobulin E (IgE) mediated or non-IgE mediated.
In IgE mediated cases symptoms generally appear within minutes after consumption of small amounts of milk protein, and usually manifest as urticaria (hives), angioedema (swelling of face and throat), vomiting, erythema (redness of the skin or mucous membranes), pruritus (chronic itchy skin), wheezing and/or coughing.
Non-IgE mediated allergy (T-cell mediated) presentation is often delayed (24-48hours) after consumption and typically affects the skin or gastrointestinal tract.
Breastfeeding remains the best method of infant feeding despite a diagnosis of CMPA. If symptomatic, the management of breast fed infants relies on reducing the maternal allergen load by eliminating the offending proteins from the maternal diet, as β-lactoglobulin can transfer to breast milk. For formula fed or mix-fed infants extensively hydrolysed formulas (EHF) or amino acid formulas (AAF) should be prescribed.
The protein in EHF is comprised of short peptides of mostly < 1500 Daltons, with casein based EHF being the most highly hydrolysed (Nutramigen 1 and 2). EHF vary in their allergenicity, lactose content, protein and fat source, and also palatability. They are however well tolerated by the majority of infants with CMPA and are often the first line treatment option.
AAF are comprised of free amino acids, and considered non-allergenic. AAF are the formula of choice for symptomatic breast fed infants, as small amounts of β-lactoglobulin is found in EHF, whereas they are absent in AAF. Other infants that may require AAF as first line treatment are those with severe atopic dermatitis or severe systematic reactions.
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Coeliac disease is an autoimmune genetic condition that can affect 2 in 100 children in some parts of the United Kingdom.
Symptoms include abdominal pain, bloating, diarrhoea (pale frothy stools), sometimes constipation and other gut symptoms. It is also at times associated with faltering growth and an irritable disposition.
If not diagnosed and treated early there is a risk of complications including impaired weight gain and growth problems, delayed puberty, iron deficiency anaemia, chronic fatigue and osteoporosis (weak bones).
We offer both a genetic test (Human Leukocyte Antigen (HLA) typing) as well as an endoscopy service (within four weeks) to come to a diagnosis quickly.
As per national and international guidelines: a gluten free diet should only begin once a child is formally diagnosed with coeliac disease by a healthcare professional.
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Gastro-oesophageal reflux is very common in babies and young children. Regurgitation of a small quantity of milk after a feed without any other symptoms (possetting) is harmless in young infants and doesn't need any investigations or treatment.
Reflux may be more severe and associated with other symptoms. The condition is usually diagnosed without the need for any additional tests, but some babies with more troublesome symptoms may be referred for further investigations.
There are a number of treatment options available including feed thickeners, anti-regurgitant milks, Gaviscon® and various medications. However, in the majority of cases, gastro-oesophageal reflux is a self-limiting condition and, with time, improves without any complications.
Gastro-oesophageal reflux disease (GORD/GERD) is considered when the following symptoms / signs are present:
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Recurrent (functional) abdominal pain (RAP) in children is defined as abdominal pain, which:
The initial approach and road mapping is crucial to successful management. It involves thorough history and examination skills, understanding and awareness of red flags which suggest organic pathology, and the knowledge and consulting style that offer a clear and empowering approach to patients, whilst avoiding unnecessary investigation.
We recognise that it can significantly impact the quality of life of the child and the family.
Evaluation will usually include baseline blood tests, stool tests and possibly the use of X-ray tests or Ultrasound scans. Only if the initial evaluation suggests an underlying organic pathology would more sophisticated tests, such as upper and lower gastrointestinal endoscopy, wireless capsule pH test, wireless capsule small bowel endoscopy and MRI / CT scans, be considered and expedited.
If the initial evaluation does not suggest an underlying organic cause then it’s likely that there is functional gut-brain interaction disorder (FGID) caused by altered feedback mechanisms between the gut and central pain pathways. This is then managed in a multi-disciplinary holistic fashion with the aid of a pain management team.
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To understand Inflammatory Bowel Disease (IBD) in children, it can help to know how the digestive system works.
The gastrointestinal (digestive) tract is like a long tube that starts at the mouth and ends at the anus. When we eat, food passes down the oesophagus and into the stomach, where gastric (digestive) juices break it down into a porridge-like consistency. The partly digested food then moves through the small intestine (also known as the small bowel). Here it is broken down even further so the nutrients (useful parts of food) can be absorbed into the blood stream. The waste products from this process - liquid and undigested parts of food - are then pushed into the colon (also known as the large intestine or large bowel). The colon absorbs the liquid, and the leftover waste forms solid stools (faeces). These collect in the last part of the colon and rectum until they are passed out of the body in a bowel movement.
Crohn’s Disease and Ulcerative Colitis both cause inflammation of the digestive system. These conditions are collectively known as Inflammatory Bowel Disease or IBD.
Inflammation is the body’s reaction to injury or irritation and can cause redness, swelling and pain. In Crohn’s Disease, this inflammation can be anywhere from mouth to anus – but is most common in the small intestine or colon. The areas of inflammation are often patchy, with sections of normal gut in between. Both the lining and the deeper layers of the bowel wall may be affected.
Ulcerative Colitis involves only the colon and rectum (together called the large bowel). In this disease, the inner lining of the large bowel becomes inflamed and tiny ulcers develop on its surface.
We offer specialist tests that can be used either as a screening tool or diagnostic tests for the above conditions. Depending upon the symptoms that the child presents with, these could include:
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IBD in children Professor Nimbal - Explorations in Crohns and Colitis comic