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T he tea m's most recent recr uit, Matthew Wyneski, MD, joined the group in June. He completed a residency in Pediatrics at Akron Children's and a fel- lowship in Pediatric Gastroenterology at the Cleveland Clinic. When the program was recruiting an additional provider, Dr.Wyneski welcomed the opportunity to return. "One of the best things about Akron Children's Hospital is that it's a stand- alone children's hospital where it really is all about the kids," says Dr. Wyneski. "We're all working with kids and for kids. And we've established a strong team in this department to better serve our patients' families." New Non-Invasive GI Lab Technolog y upgrades have been a major focus of Dr. Garcia. He is especially enthusiastic about Akron Children's new non-invasive GI lab. Equipped with the latest technology, the lab offers capsule endoscopy, pH impedance monitoring for gastroesopha- geal reflux, and breath tests for lactose intolerance and sugar malabsorption. Sophisticated manometry equipment allows measurement of dysmotility at either end of the digestive tract. "This high resolution manometr y equipment is very new and an important advance," says Dr. Garcia. Esophageal manometry is an outpatient procedure that measures the strength and muscle coordination of the esophagus during swallowing. The same equipment can also be adapted to perform anal/rectal manometry. Both procedures can be done in the office without sedation. Patients diag nosed w it h ga stric dysmotility who fail to respond to con- ventional treatments may find relief with a gastric stimulator. While the technology has been used in adults for some time, its use in children is relatively new. Akron Children's is reportedly the only program in Northeast Ohio offering endoscopic placement of a gastric stimulator. "If the patient responds well, surgeons can then perform a laparoscopic pro- cedure to place a permanent device," explains Dr. Garcia. "We are one of very few programs to offer this step first which means we avoid exposing children to surgery they may not need." Plans for a multidisciplinary clinic for gastric stimulation are currently underway. Developed in cooperation with Akron Children's pediatric sur- geons, this new GI clinic is expected to open later this year. New and Improved Endoscopy Program Akron Children's endoscopy program recently upgraded to advanced high reso- lution technology, allowing Dr. Garcia and his team to more safely and easily diagnose and treat a range of conditions, including eosinophilic esophagitis. "Eosinophilic esophagitis is an allergy- induced immune system disease that can seriously damage the lining of the esophagus," says Dr. Kassabian. "In infants, it can present as vomiting, reflux, refusal to eat or failure to thrive. Older kids may experience heartburn or abdominal pain. Adolescents may report having difficulty swallowing." Over time, the chronic inflammation and irritation caused by eosinophilic esophagitis can lead to narrowing of the esophagus. Accurate diagnosis requires both clinical and histological data. Treatment can include proton pump inhibitors, elimination diets (as many as 64 percent of patients with it are found to have a milk allergy), or steroids. An eosinophilic esophagitis clinic, which will involve Akron Children's pediatric allergy/immunology providers, will open this fall. When eosinophilic esophagitis or another chronic problem has been ruled out, but a child continues to experience vomiting, irritability or failure to thrive, the GI team may use a high-resolution pH impedance study to measure reflux. The 24-hour ambulatory test involves placing a small monitor in the lower part of the esophagus to evaluate acid concentration which corresponds to acidic ref lux and impedance which corresponds to non-acid ref lux. "In patients with acid ref lux, this test can tell us if we need to adjust me d ic at ion ," s ay s D r. K a s s a bia n. Eosinophilic esophagitis is a special interest of Dr. Sirvart Kassabian. 2 0 1 4 S E P T E M B E R /O C T O B E R ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 2 1