Care at NUH

Paediatric Gastroenterology Nutrition Hepatology and Liver Transplantation

2024/07/09

The Division of Paediatric Gastroenterology, Nutrition, Hepatology and Liver Transplantation provides comprehensive care for young patients with a range of conditions, from common gastrointestinal issues to complex liver, pancreatic and nutritional disorders. 

We specialise in paediatric gastrointestinal endoscopy and manage cases requiring liver transplantation. Our paediatric care is complemented by adult gastroenterology and hepatology services, facilitating advanced diagnostics, therapies and a smooth transition from paediatric to adult care.
International patients may self-refer (initiated by the families directly) or be referred by their doctor.
Our Team

We are committed to providing comprehensive and holistic care, ensuring service continuity for both inpatient and outpatient needs. Our out-of-hours coverage guarantees emergency care, led by our consultant team.

Head of Division & Senior Consultant
Emeritus Consultant
Senior Consultant
Consultants
Specialty Nurse
  • Nurse Clinician Pamela Tan
Our Services

We treat a broad spectrum of gastroenterological conditions in children, including:

  • Vomiting and colic in babies
  • Gastroesophageal reflux disorder
  • Recurrent abdominal pain
  • Constipation and soiling
  • Gastritis including Helicobacter pylori-related gastritis
  • Chronic diarrhoea
  • Food intolerance
  • Feeding difficulties in children, including children with neurological and neuromuscular disorders
  • Gut dysmotility
  • Failure to thrive and faltering growth
  • Inflammatory bowel disease (IBD)
  • Malabsorption
  • Eosinophilic oesophagitis and enteropathy
  • Cyclical vomiting syndrome

Our care also encompasses liver and pancreatic disorders, including:
Acute liver failure
Chronic liver disease due to various conditions including biliary atresia, autoimmune liver disease (Autoimmune Hepatitis and Sclerosing Cholangitis), viral hepatitis and other chronic cholestatic disorders including Alagille Syndrome and Progressive Familial Intrahepatic Cholestasis (PFIC).
Metabolic liver diseases including Wilson's Disease, Glycogen Storage Disease, Alpha-1-antitrypsin deficiency and other genetic disorders involving liver
End stage liver failure – Assessment for liver transplantation
Gallstones
Portah Hypertension and portal venous obstruction including children presenting with related gastrointestinal bleeding
Recurrent and chronic pancreatitis
 
Endoscopy Services
Our division provides a full range of endoscopy services for diagnosing and managing gastrointestinal issues in children. Performed at the NUH Endoscopy Centre, these services provide paediatric patients with access to the latest diagnostic and therapeutic endoscopy technologies. 
An endoscope is a flexible tube with its own lens and light source. It can be passed through the mouth, or through the anus, such that the upper gastrointestinal tract (Oesophagoduodenoscopy or Upper Gastrointestinal Tract Endoscopy) or lower gastrointestinal tract (Ileo-colonoscopy) can be studied respectively.
Endoscopy is utilised for a variety of gastrointestinal symptoms, such as recurrent abdominal pain, chronic diarrhoea, suspected IBD, H. pylori Infection, gastrointestinal bleeding and malabsorption conditions. 
Our therapeutic endoscopy capabilities include management of gastrointestinal bleeding to portal hypertension, employing techniques like endoscopic variceal band ligation and injection sclerotherapy. We also perform endoscopic retrieval of ingested foreign bodies from the upper gastrointestinal tractwhen required.
Paediatric endoscopies are performed routinely and in emergency settings, using intravenous moderate sedation overseen by paediatric intensivists for a safer and quicker recovery, avoiding the need for general anaesthesia. 
 
24-hour Oesophageal pH Monitoring and Impedance Studies
The pH-Impedance study is designed to evaluate for gastro-oesophageal reflux, particularly beneficial for children exhibiting atypical symptoms such as recurrent coughing, wheezing, chest discomfort and poor weight gain. It can also monitor the effectiveness of treatments when non-gastrointestinal symptoms predominate.
The Multi-channel Intra-luminal Impedance (MII) probe detects fluids, solids and air within the oesophagus, offering a more comprehensive analysis than simple pH monitoring alone by identifying both acidic and non-acidic reflux events.
During the pH-Impedance test, a slender, flexible tube is inserted nasally into the oesophagus, with one end secured to the face and the other positioned at the oesophagus’ lower end. A recording device attached to the probe captures test data over a 24-hour period. Parents are asked to maintain a diary of the child’s diet, sleep or any symptoms during the test. This inpatient study encourages maintaining normal dietary habits for accurate results.
 
Percutaneous Endoscopic Gastrostomy (PEG) Insertion
PEG insertion is a safe and efficient technique for placing a feeding tube directly into the stomach using endoscopic guidance. This procedure is ideal for children who have difficulty swallowing or require nutritional support. It can be performed under intravenous sedation or general anaesthesia, based on the child’s needs.
 
Liver Biopsy
Liver biopsy involves extracting a small sample of liver tissue for microscopic examination and is usually performed percutaneously with intravenous sedation. Post-procedure, the child is closely monitored prior to discharge. This diagnostic step is crucial when other tests have not conclusively identified the cause of liver disease.
Transition Clinics

Our transition clinics are designed to ensure a seamless transition from paediatric to adult care for our patients, particularly for paediatric liver transplant recipients and those with chronic liver or bowel conditions. We provide comprehensive support through sessions aimed at equipping adolescents and their parents for independence within the familiar NUH environment. Clinics include:

  • Adolescent and Young Adult Liver Transplant Transition Clinic
  • Adult-IBD Transition Clinic
    Paediatric Feeding and Nutrition Clinic

    Feeding and swallowing difficulties in children can significantly impact their health and development. In addition, difficulties faced during the feeding process can strain the relationship between caregiver and child.

    Our Paediatric Feeding and Nutrition Clinic addresses these challenges with a multidisciplinary and collaborative approach, tailoring assessments and interventions to each child’s needs. 
     
    Learn more about our clinic here.
    What To Expect At Your First Appointment

    We prioritise prompt and thorough assessment of children and teenagers, offering same-day evaluations for urgent cases. In our family-friendly clinic, we engage with patients and their families to discuss health concerns, conduct examinations and initiate necessary tests for early diagnosis and management.

    Our Support Group and Programme
    Singapore Paediatric Liver Transplant Programme
    The Singapore Paediatric Liver Transplant Programme, established at the Khoo Teck Puat – National University Children's Medical Institute since 1990, offers pre- and post-transplant care for children with end-stage liver disease.
    These children are cared for by a multidisciplinary team consisting of paediatricians, surgeons, paediatric intensivists, radiologists, histopathologists, psychiatrists, physiotherapists, dietitians and social workers specialising in gastroenterology, hepatology, nutrition and liver transplantation services. Specialty nurses and transplant co-ordinators are also actively involved in the programme.

    Liver Transplant Support Group
    The Liver Transplant Support Group offers support, encouragement and medical advice for patients affected by liver diseases and their family members, fostering a community of care and promoting organ donation awareness.
    For more information on this support group, please contact National University Centre for Organ Transplantation.
    Find Us
    Khoo Teck Puat - National University Children's Medical Institute
    For directions to the Khoo Teck Puat – National University Children’s Medical Institute, including access via MRT, drop-off points and parking information, click here.
    For more information on our paediatric clinic or contact details, click here.
    To make an appointment online, click here. 
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