We see children with a wide range of conditions as outlined below.
Common gastroenterological conditions which we evaluate and treat:
- 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
- Gut Dysmotility
- Failure to thrive and faltering growth
- Inflammatory Bowel Disease
- Eosinophilic Oesophagitis and Enteropathy
- Cyclical Vomiting Syndrome
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
- Portal Hypertension and Portal Venous Obstruction including children presenting with related Gastrointestinal Bleeding
- Recurrent and Chronic Pancreatitis
Our division provides a full range of endoscopy services for the assessment and management of children presenting with gastrointestinal problems.
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 both a useful diagnostic as well as therapeutic tool. It can be used in the investigation of children with a variety of gastrointestinal complaints such as Recurrent Abdominal Pain, Chronic Diarrhoea, Suspected Inflammatory Bowel Disorder, Suspected H. Pylori Infection, Gastrointestinal Bleeding and Malabsorption.
We also provide therapeutic endoscopy services for children presenting with Gastrointestinal Bleeding, Portal Hypertension due to either underlying Chronic Liver disease or Portal Venous Obstruction. This is in the form of Endoscopic Variceal Band Ligation (Using an endoscope to put an inert rubber band on the bulging veins, known as varices, in the oesophagus, under direct vision with a view to shrink them and reduce chances of bleeding) and Injection Sclerotherapy (endoscopically injecting the bulging varices with sclerosing agents under direct vision). Both these approaches help in management of bleeding from varices.
Endoscopic retrieval of ingested foreign bodies from the upper gastrointestinal tract is also carried out, if necessary.
Paediatric gastrointestinal endoscopy is performed in the hospital endoscopy suite, at least 2 sessions per week electively and can be done either on an inpatient or outpatient basis, for emergency situations. Intravenous sedation is used for paediatric endoscopy.
24-hour Oesophageal pH Monitoring and Impedance Studies
The pH-Impedance study is an investigation designed to evaluate for gastro-oesophageal reflux. This is especially useful in the child with atypical symptoms such as recurrent coughing, wheezing, chest discomfort and failure to gain weight. In addition, it can also check response to therapy in situations where the non-gastrointestinal symptoms are the primary complaint.
The Multi-channel Intra-luminal Impedance (MII) probe is able to measure fluids, solids and air in the oesophagus (food pipe). Combined MII and pH monitoring provides more information than simple pH monitoring as reflux events is not limited to just acidic reflux.
The pH-Impedance probe is a long, fine, flexible tube which is inserted through the nose and down the throat. One end of the probe is taped to the side of the face and the other end sits at the bottom of the oesophagus. A small box is attached to the tube. This records the results of the test which usually last 24 hours. A diary is kept by the parents of any food, sleep or symptoms that occur while the test is being carried out. The study is performed on an inpatient basis, and children are encouraged to consume a similar diet that they normally would at home.
Percutaneous Endoscopic Gastrostomy (PEG) Insertion
This procedure involves the insertion of a feeding tube into the stomach (gastrostomy) with the help of an endoscope. It is both a safe and rapid technique for the insertion of a special feeding tube for children with difficulties in swallowing or those who require an increased food intake. It can be performed using intravenous sedation or under general anaesthesia, depending on the clinical status of the child.
This is a procedure whereby a tiny piece of liver tissue is removed for microscopic examination. It is usually performed percutaneously under intravenous sedation. The child would require a period of close observation before being discharged after the procedure. Biopsies are usually performed when there is a need to clarify the cause of liver disease present in a child, whereby other measures have failed to do so.