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A comprehensive team approach to Gastroenterology, Hepatology, and Nutrition for children
The Pediatric Specialists of Virginia (PSV) Gastroenterology, Hepatology, and Nutrition team are dedicated to the care of infants, children, and adolescents with stomach, digestive, liver, and nutritional disorders. Our specialists are dedicated to caring only for children, which means we are also specialists in addressing the unique needs of children and families living with these disorders.
Families who come to PSV for treatment of stomach, liver, and nutritional issues have access to:
- Full spectrum of care. The team manages everything from a routine upset stomach to complex and chronic conditions that require ongoing care.
- Expertise in diagnosis. Our team has the experience and tools to make an effective diagnosis, the first step to a comprehensive treatment and management plan.
- Specialized care. Every member of your child’s team is a pediatric specialist. This allows us to tailor treatment plans to meet each child’s specific needs.
- Child-centered environment. We do everything we can to provide a safe, warm, and reassuring environment for children and their families.
It is important to involve the child, the family, their primary care provider, and any other needed specialists in a unified team approach to treatment and management of digestive, stomach, and liver issues. Additionally, the team emphasizes research-based treatment approaches, and assists families to connect with area clinical trials if they wish, to allow our care providers to continually learn more about these disorders in childhood and provide the best evidence based treatments for every patient.
Families who are affected by these disorders often find everyday life overwhelming and frustrating. To help them learn to manage day-to-day, the staff at PSV is dedicated to helping patients and families get the emotional and social support they need, including educational programs, parent advocacy groups, and local patient support groups.
Conditions treated range from common to complex, including:
- Abdominal pain: A child’s intestine has a complicated system of nerves and muscles that helps move food forward and carry out digestion. In some children, the nerves become very sensitive, and pain is experienced even during normal intestinal functions. The pain can be triggered by illness, stress, constipation, or other factors.
- Biliary atresia: a rare disease of the liver and bile ducts that occurs in infants, where bile flow from the liver to the gallbladder is blocked, causing the bile to be trapped in the liver. This causes damage to liver cells (cirrhosis), and eventually liver failure.
- Celiac disease: A lifelong genetic autoimmune disorder that affects both children and adults, in which consuming gluten, the protein in wheat, barley, rye, and oats, causes damage to the lining of the small intestine, interfering with nutrient absorption.
- Colic: A common condition in babies causing inconsolable crying and extreme fussiness. Typically colic starts by 3 weeks of age, lasts at least 3 hours a day, and occurs at least 3 days a week. These babies cry as if they are in pain, turning red and arching their back. Though there is no certain treatment, some approaches can minimize the impacts of this problem on parents.
- Constipation: A decrease in the frequency of bowel movements or the painful passage of bowel movements. Constipation can be organic or functional, and occurs for many reasons, including neurological, medical, and dietary.
- Encopresis: Occurs when the child’s colon is impacted with hard stool and the soft or liquid stool can leak out of the anus and stains the child’s underwear. Usually this is caused by chronic constipation. Less frequently, it may be a result of developmental or emotional stress.
- Diarrhea (Acute and chronic): An increase in the number of stools per day and/or more loose or liquid stools.
- Failure to Thrive (FTT): Describes children who have fallen short of their expected growth and development. FTT occurs when your child is either not receiving adequate calories or is unable to properly use the calories that are given, resulting in failure to grow or gain weight over a period of time. The causes can be divided into three categories: poor intake, poor utilization, or increased calorie requirements.
- Eosinophilic esophagitis (EoE): An inflammatory condition in which the wall of the esophagus becomes filled with large numbers of white blood cells called eosinophils. Because this condition inflames the esophagus, someone with EoE may experience difficulty swallowing, pain, nausea, regurgitation, and vomiting. Over time, the disease can cause the esophagus to narrow, which sometimes results in food becoming stuck, or impacted, within the esophagus
- Hepatitis (A, B, C, and autoimmune): Any inflammation of the liver that can result in liver damage. Hepatitis can have many causes, including viruses and autoimmune disorders.
- Hirschsprung disease: Children with Hirschsprung disease are born without ganglion cells in the colon. In most cases, only the rectum is affected, but in some cases more of the colon, and even the entire colon, may be affected. Without these ganglion cells, the muscles in that part of the colon cannot push the stool out, which then builds up causing constipation and difficulty passing stool.
- Inflammatory bowel disease (Ulcerative colitis and Crohn's disease): children can have diarrhea, rectal bleeding, urgency with bowel movements, abdominal pain, sensation of incomplete evacuation, constipation. In addition, they may also have fever, loss of appetite, weight loss, fatigue, night sweats, joint pains and body aches. IBD is marked by an abnormal response by the body’s immune system, which causes harm to the gastrointestinal tract.
- Irritable bowel syndrome and other functional bowel diseases:
- Nutrition and obesity: Childhood obesity can in turn be a precursor to many health problems, from Type II diabetes to heart disease to non-alcoholic fatty liver disease (NAFLD). It is essential to provide your child proper nutrition and help him or her establish good eating habits that will last an entire lifetime.
- Pancreatitis: An inflammation, or swelling, of the pancreas. Causes of pancreatitis include gallstones and toxins such as excessive alcohol. In children, common causes include viruses and other infections, medications, congenital malformations and other inherited conditions, and trauma to the abdomen.
- Reflux and gastro-esophageal reflux disease (GERD): Reflux is very common and seen most often as spitting up in babies, and burping, stomachaches, and heartburn in older children. When reflux happens frequently and severely it can develop into GERD, which leads to failure to gain weight, bleeding, respiratory problems or esophagitis.
Treatments for stomach, digestive and liver disorders include both consultations on newly diagnosed disorders as well as ongoing care for long term conditions. The team offers many common treatments for a wide variety of gastrointestinal problems:
- Anorectal and esophageal manometry
- Breath hydrogen testing
- Dilation (Achalasia pneumatic, esophageal, pyloric, rectal), including Botox injections
- Endoscopy (Upper, video capsule, treatment of gastrointestinal bleeding)
- Esophageal varices treatments (sclerotherapy and banding)
- Flex sigmoidoscopy
- Foreign body removal
- Pancreatic function testing
- Percutaneous endoscopic gastrostomy (PEG) tube placement and care
- pH probe/impedance
- Rectal suction biopsy
- Single balloon enteroscopy
Specialized Clinics for Complex Conditions
- Inflammatory Bowel Disease (IBD) Clinic: Comprehensive care for children with Crohn’s disease and ulcerative colitis including diagnostic services, clinical management, patient and family education, nutritional guidance and counseling. The clinic’s goal is to improve the medical, surgical, psychological, and social care of all children with inflammatory bowel disease through tailored patient care and continued research. The team is also an active participant in the ImproveCareNow Network, a national network of 60+ care centers caring for 17,000 pediatric patients living with IBD.
- Enteral Feeding (GTube) Clinic: Provides medical, nursing, and nutritional care and support for infants and children with enteral feeding tubes which include gastrostomy tubes (GTube), nasogastric tubes (NG), gastrojejunostomy tubes (GJ), and jejunostomy tubes (J). The team evaluates, treats, and manages all aspects of your child’s enteral feeding tube, including assistance with school, insurance, and WIC paperwork.
- Eosinophilic and Autoimmune Gastrointestinal Disorders Clinic: Specialized care for children with eosinophilic esophagitis (EoE), eosinophilic gastroenteropathies, and autoimmune enteropathies. The clinic staff includes allergists, immunologists, gastroenterologists, dietitians, and other clinical support dedicated to the management and treatment of eosinophilic and autoimmune gastrointestinal disorders.
Each child and family are supported by a dedicated care team made up of:
- Board certified Gastroenterologists and Hepatologists
- Pediatric Nurse Practitioners
- Pediatric Registered Nurses
- Medical Assistants