Stories about: Gastroenterology Hepatology and Nutrition

Clinical Consult: Celiac and other gluten-related disorders

Celiac-Weir

Interest in gluten—and in particular, avoiding it — continues to be on the rise. The gluten-free market has become a billion dollar business as more and more adults and children trial this restrictive diet. Many go gluten-free as a lifestyle choice.

However, many turn to a gluten-free diet for medical reasons and for relief of specific symptoms. It is estimated that roughly 10 percent of the population have gluten-related disorders. Figuring out whether an individual needs to be gluten-free and where she lies on the spectrum of gluten-related disorders can be hard, but is an important endeavor. …Read More

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Clinical Consult: Diarrhea in children

Diarrhea in children

Diarrhea is a very common problem. Almost every child has at least one episode of infectious viral gastroenteritis in his or her life (like rotavirus or norovirus) marked by fever, vomiting and watery diarrhea. While most diarrhea is self-limiting, it is important to recognize when testing is needed, when medical evaluation and fluid support may be helpful, and when to suspect a chronic problem that requires specialist testing and endoscopy to find the cause and direct specific treatments, be they drugs or special diets and supplements. …Read More

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Challenging case: Diagnosing Celiac Disease

celica biopsies

Diagnosing pediatric celiac disease, an autoimmune enteropathy triggered by ingestion of gluten (found in wheat, rye, barley and standard oats), can be challenging.  Despite its high prevalence, effecting approximately 1 percent of the population, many cases go unrecognized.

Presenting signs and symptoms of pediatric celiac disease are varied, ranging from gastrointestinal symptoms such as abdominal pain, diarrhea or constipation to extraintestinal symptoms, such as low energy, poor growth or delayed puberty. Symptoms can be subtle, intermittent or nonexistent. High-risk children include those with autoimmune disease (such as type 1 diabetes mellitus and thyroid disease) and with a family member with celiac disease.

Identifying which children need testing for celiac disease is the first step but is not the only part of the evaluation that can get complicated. Positive celiac serology, such as tissue transglutaminase IgA and endomysial IgA, are typically excellent predictors of celiac disease diagnosis. However, it is important to remember that children without celiac disease can have positive test results. For this reason, small bowel biopsy via esophagogastroduodenoscopy (EGD) before starting a gluten free diet, is still the gold standard for diagnosing celiac disease. …Read More

Clinical Consult: Evaluation and management of stomach pain

acheEvery child experiences stomach aches and pains. Identifying its cause is the tricky part.

According to Boston Children’s Hospital’s Lori Zimmerman, MD, a gastroenterologist with the Division of Gastroenterology, Hepatology and Nutrition, abdominal pain accounts for 2-to-4 percent of pediatrician visits, and 25 percent of pediatric GI referrals.

“In most cases, generalized abdominal pain without other red flags, is a manifestation of a other common conditions such as chronic constipationfunctional abdominal pain, or lactose intolerance,” Zimmerman says. “If the pain is chronic, it is also worth evaluating for other chronic gastrointestinal conditions, such as celiac disease.”

Dr. Zimmerman examines these conditions and offers tools to evaluate and manage pediatric stomach pain in the primary care setting. …Read More