We have just completed the residency application interviews for pediatrics and medicine/pediatrics training programs and look forward to an exciting group of new first-year residents.
Our annual Spring CME program will be held on April 26, 2002. It will feature a "Mini Symposium on Adolescent Medicine" in the morning, with a potpourri of hot topics in the afternoon, including Vaccines, Autism, and Gun Safety. Please mark the date on your calendar and plan to attend. Registration forms will be mailed soon. If you need additional information, please call 913-588-6339. Hope to see you there.
Professor and Chair.
Abdominal pain and weight loss can present as very challenging problem in clinical practice. The usual diagnostic approach includes X-rays and endoscopy, blood, stool and urine tests, and perhaps a trial of H2 histamine receptor antagonists. In a certain percentage of patients who remain undiagnosed persistent symptoms, referral for more comprehensive workup is indicated.
Over the past 3 months the pediatric gastroenterology division at KU Medical Center reestablished its nationally-acclaimed programs in diagnostic intestinal motility and sensory testing in order to help providers address these complex problems.
We provide assessment of gastrointestinal physiology and brain-gut interactions tailored to the needs of the child and family. Patients who are referred to the division typically present diagnostic challenges. Examples include refusal to eat, abdominal pain preventing school attendance, and persistent soiling or constipation following otherwise successful surgical correction of Hirschsprung's disease.
We would like to highlight some of the specialized testing available through KU Pediatric Gastroenterology:
Antroduodenal manometry: With the child sedated, the team uses endoscopy to thread a thin plastic tube through the stomach into the first foot of small intestine. Once the child is fully awake and alert, contractions are recorded from the stomach and intestine for several hours during fasting, and after a meal. With fifteen years of experience with this study in children, the team is able to differentiate abnormal patterns and determine a cause for the child's problems.
Colon manometry: Inserting a thin plastic tube throughout the colon, the team records patterns of colonic motility for several hours. The motility patterns provide clear answers to the diagnostic problems left unsolved by other testing methods available in the community.
Barostat tests of gut sensitivity: When a patient suffers from abdominal pain without a clear source, sometimes the cause is neuropathic pain affecting the gastrointestinal tract. To clarify the problem, a small balloon at the end of a plastic tube is placed in the stomach or colon. A computer-driven air pump simultaneously measures pressure and volume within the balloon. This test can determine whether the patient has a reduced pain threshold with distention.
Children and their families derive a great deal of comfort when we provide answers to that all-important question, "What is wrong with me?" Once the problems are identified we offer a comprehensive approach to treatment. Our multidisciplinary approach utilizes a team comprising gastroenterology and child psychology specialists.
We will be delighted to answer whatever questions you might have. For more information or to refer a patient, please contact Paul Hyman, MD, José Cocjin MD, and Candace Parker RN, MSN, PNP at 913-588-6224.
Professor of Pediatrics
Chief of Pediatric Gastroenterology
Anxious parents visit you for the third time in two months with their four-month-old child who has a two-month history of infant colic. The infant is thriving, but she screams for several hours in the late afternoon and evening. The parents are frazzled by their inability to soothe their infant. It seems that the only thing that calms the infant is a car ride. They voice concern that so many days of pain so early in life may affect their infant's growth and development.
"What can we do to help her pain?" they ask.
You do a scrupulously careful, complete physical exam under their watchful eyes and pronounce the infant free of illness. Then you say, "I remember you saying that the only time the infant calms is when you take her for a car ride. Is that true? What happens when you come to a red light and stop the car?"
"She cries until we start to move again."
"Does abdominal pain recognize traffic signals?"
At this point in the visit the parents may be willing and able to accept the concept that their child does not have any disease involving her internal organs.
Many students of infant colic consider it a CNS regulatory disorder. During development we learn to filter out extraneous sensory input, and to focus on whatever is most important to us at that moment. The TV and washing machine are going, your spouse is gabbing, your children are cavorting about, but you are able to read your journal, because you have learned to selectively attend. In contrast, the infant is receiving stimuli from all senses simultaneously, but has not yet learned to focus her attention. After a day of unselected sensation there is overload, and the infant "crashes." She has not yet learned how to self-soothe, or even be soothed by others. Her cries of distress are ones of protest, not of pain.
Gastroenterologists tend to view colic as the earliest functional bowel disorder. However, there is no objective data to suggest that intractable fussing without failure to thrive in the second through fourth months of life is associated with a bellyache or has anything to do with digestion. Parents describe excessive flatus during colic episodes, but that can be ascribed to an epiphenomenon: an infant's distressed cries increase intra-abdominal pressure, so gas is expelled from the rectum. Infant colic may be confused with irritability from gastroesophageal reflux disease, milk protein allergy, or another illness. However, true illness should be associated with other signs and symptoms besides intractable fussing.
Professor of Pediatrics
Chief of Pediatric Gastroenterology and Child Psychology
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The University of Kansas Medical Center