Pediatric
Gastroenterology at KU "The Pediatric and Adolescent Gastrointestinal Motility and Pain Program" — that is quite a mouthful, which is why we often call ourselves "Peds GI". It just trips off the tongue a little easier.
Whatever the name, we help children and parents deal with a wide range of gastrointestinal (GI) problems: pain, vomiting, diarrhea, constipation, motility problems, feeding problems, and many more.
Meet the members of the Pediatric and Adolescent Gastrointestinal Motility and Pain program.
FFR is a symptom-based diagnosis defined by Rome criteria as: 1) passage of large stools < 2/wk over the past 3 months; and 2) retentive posturing. Current treatment guidelines (Baker et.al. JPGN, 1999) include brief education and disimpaction phases, followed by months of assuring defecation with daily osmotic laxatives. The aim of this prospective, controlled trial was to determine if omitting the disimpaction phase alters outcome. Treatment success 6 mo following first visit was defined as painless defecation without fear at least 2x/wk and no incontinence (in children >4 y) for 1 mo. We enrolled 26 subjects (11 male) age 4.9 ± 3.0 y (mean ± SD). Prior to and following the first visit, we asked parents to score their confidence that they could “solve their child’s poop problem” using a scale from 1 to 10 (10 = very sure). Parents scored 4.7 ± 3.2 before the visit. Following an explanation of FFR and its treatment, parents scored 8.8 ± 2.3, p<.001. Subjects >5 y were less likely than subjects <5 y to endorse painful defecation (p<.005) or fear of defecation (p<.001) using a scale from 0-10 (10=a lot). Subjects were treated with an osmotic laxative for 6 mo, in dosages titrated to assure painless defecation. All 15 subjects <5y achieved treatment success. In subjects >5, all were passing >2 BMs weekly but 8/11 continued to have intermittent fecal incontinence. Of 13 subjects (50%) with fecal impaction at the first visit, the impaction passed within 2 weeks in all, with no enemas, suppositories, or stimulant laxatives. Average family-clinician contact over 6 months included 4 clinic visits, 8 emails, and 4 phone calls. In summary, in FFR 1) an immediate, invasive disimpaction phase was unnecessary, 2) education improved parents' expectations for success by the end of the first visit, 3) child and family-friendly treatment is as successful as the current standard.
We recruited 21 subjects (6 male, 12 ± 3 y) meeting symptom-based Rome criteria for rumination syndrome (effortless regurgitation of recently ingested food with spitting out or reswallowing). Symptom duration ranged from 3 to 120 mo (median 12 mo) before diagnosis. Fourteen subjects (68%) had dyspepsia (pain or discomfort in the upper abdomen for 3 mo or longer). Weight loss was a feature in 5. Prolonged school absence >3 mo was a feature in 10 subjects. All subjects had negative endoscopy and evaluations by 2 or more clinicians prior to diagnosis. For the water load test, subjects drank as much water as they could in 3 min, or until they felt full. Using an ordinate scale from 0 to 10 with 10 being the most intense, subjects rated pain and nausea before and after drinking. Water load volume for all subjects was 484 ± 255ml (mean ± SD). Comorbitity of rumination and dyspepsia did not alter water load volume. Rumination occurred immediately following drinking in 7 subjects (33%). There was no significant difference in water load volume between those who ruminated after the test and those who did not. Pain increased from 2 ± 2 to 4 ± 2, p=.072, while nausea increased from 1 ± 2 to 4 ± 2, p<.001. These data show that 1) rumination often is associated with functional dyspepsia with or without weight loss in children and adolescents, and 2) water load testing provokes increased pain, nausea and rumination. Observing rumination in the office may help to convince the clinician, patient and parents of the rumination diagnosis.
The Pediatric Gastointestinal Motility and Pain Program comprises the Pediatric Gastroenterology division at the University of Kansas Department of Pediatrics. Please see the department website.
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The University of Kansas Medical Center