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Chapter: Paediatrics: Gastroenterology and nutrition

Paediatrics: Intestinal disorders

This disease is rare in children. It most commonly affects the duodenum.

Intestinal disorders

 

Gastritis and peptic ulcer disease

 

This disease is rare in children. It most commonly affects the duodenum.

 

Causes

 

   Helicobactor pylori infection (strong familial link, associated with increased risk of adult gastric cancer).

 

   Stress ulcers, e.g. post-trauma, HIE.

 

   Drug-related, e.g. NSAIDs.

 

   Increased acid secretion (Zollinger–Ellison syndrome, multiple endocrine neoplasia type I, hyperparathyroidism).

 

   Crohn’s disease.

 

   Eosinophilic gastroenteritis.

 

   Hypertrophic gastritis.

 

   Autoimmune gastritis.

 

Presentation

 

   Often asymptomatic.

 

   Chronic abdominal and epigastric pain.

 

   Nausea +/– vomiting.

 

   GI haemorrhage.

 

   FTT +/– anorexia.

 

   Iron deficiency anaemia.

 

   Perforation (very rare).

 

Investigation

   C14 urea breath test (H. pylori).

   Upper GI endoscopy and biopsy (H. pylori histology and culture).

 

Treatment

 

   Treat underlying cause, e.g. eradicate H. pylori with 7–10 days oral amoxycillin (clarithromycin), bismuth, metronidazole +/– omeprazole (quadruple therapy).

 

   ‘fall’ gastric acid production, e.g. proton pump inhibitors (PPI), H2 antagonists; sucralfate (cytoprotective).

 

   Antacids, e.g. aluminium hydroxide.

 

Protein-losing enteropathy

 

This disorder is characterized by chronic intestinal protein loss.

 

Causes

 

   GI infection, e.g. giardiasis.

 

   Severe food hypersensitivity.

 

   Coeliac disease or IBD.

 

   Severe cardiac failure.

 

   SLE; graft vs. host disease.

 

   Polyposis or lymphatic obstruction.

 

Presentation 

There is hypoalbuminaemia +/– diarrhoea or abdominal pain.

Increased faecal A1-antitrypsin confirms the condition.

Treatment 

Treat the underlying disease; give nutritonal support and albu-min infusions as required.

 

Short bowel syndrome

 

Is due to severe intestinal disease or the surgical removal of a large por-tion of the small intestine. The condition manifests as malabsorption, fluid and electrolyte loss, and malnutrition.

 

Presentation

 

Diarrhoea, steatorrhoea.

 

FTT.

 

Dehydration, electrolyte loss (Na, K, Mg, Ca).

 

Cholestasis (bile salt loss).

 

Peptic ulcer disease (due to increased gastrin).

 

Specific (e.g. vitamin B12) +/– generalized malnutritional disorders.

Renal stones (oxalate).

 

Treatment

 

Correct fluid and electrolyte disturbance.

 

Specific nutritional supplements; hydrolysed protein/elemental diets.

 

PN.

 

Gastric acid reducing drugs, e.g. PPI or H2 antagonists.

 

Anti-diarrhoeal drugs, e.g. loperamide.

 

Cholestyramine (chelates bile salts).

 

Parenteral somatostatin.

 

Oral antibiotics to reduce bacterial overgrowth.

 

Surgery to reduce GI motility or small bowel transplant.

 

Prognosis 

Prognosis is improving, with 90% 5yr survival. Retention of ileo-caecal valve significantly improves prognosis.

 

Intestinal polyps

 

Most juvenile polyps are hamartomas, single, and located in the distal colon. Polyposis (multiple polyps) syndromes include:

Peutz–Jegher’s syndrome (mucocutaneous pigmentation).

 

Familial polyposis coli.

 

Gardner’s syndrome (GI polyps, osteomas and soft tissue tumours).

 

Presentation

 

Often asymptomatic.

 

Haematochezia.

 

Rectal polyp prolapse.

 

Protein-losing enteropathy.

 

Intussusception.

 

Mucoid diarrhoea.

 

Investigation 

Gastroscopy and ileo-colonoscopy, barium radiology.

Treatment

Endoscopic or surgical removal.

 

Periodic colonoscopy surveillance is required in polyposis syndromes because of significant risk of neoplasia.

 

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