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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.




   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.




   Often asymptomatic.


   Chronic abdominal and epigastric pain.


   Nausea +/– vomiting.


   GI haemorrhage.


   FTT +/– anorexia.


   Iron deficiency anaemia.


   Perforation (very rare).



   C14 urea breath test (H. pylori).

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




   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.




   GI infection, e.g. giardiasis.


   Severe food hypersensitivity.


   Coeliac disease or IBD.


   Severe cardiac failure.


   SLE; graft vs. host disease.


   Polyposis or lymphatic obstruction.



There is hypoalbuminaemia +/– diarrhoea or abdominal pain.

Increased faecal A1-antitrypsin confirms the condition.


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.




Diarrhoea, steatorrhoea.




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).




Correct fluid and electrolyte disturbance.


Specific nutritional supplements; hydrolysed protein/elemental diets.




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 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).




Often asymptomatic.




Rectal polyp prolapse.


Protein-losing enteropathy.




Mucoid diarrhoea.



Gastroscopy and ileo-colonoscopy, barium radiology.


Endoscopic or surgical removal.


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


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