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"If some of their ref lux is non-acid and they have significant symptoms, it can help us determine if we need to ma ke lifest yle changes or consider surgical options. Managing Celiac Disease and IBD Celiac d isea se is a ch a l leng ing disorder, mainly due to its ability to mimic other illnesses. "Symptoms such as abdominal pain, diarrhea, weight loss and vomiting can be similar to irritable bowel syndrome, acid reflux, or even lactose intolera nce," says Dr. Wyneski. Sometimes erroneously thought to be an allergic reaction, celiac disease is actually an immune system reaction to consumption of wheat, rye or barley. The Akron Children's GI team uses highly sensitive lab tests to either rule out the disease or determine which children are candidates for biopsy. "If the lab work is positive, we typically do a biopsy to confirm the diagnosis because the lifestyle and dietary changes required to manage celiac can be pretty dramatic for families," says Dr. Wyneski. For children suspected of having an inflammatory bowel disease (Crohn's disease or ulcerative colitis), a biopsy is usually required. Although there are dif- ferences between IBD and celiac disease, both involve immune system dysfunction resulting in chronic inflammation of all or part of the digestive tract. Symptoms may be dramatic, such as abdominal pain, bloody diarrhea, rashes or joint pain, or they may be subtle such as failure to grow. Using equipment specifically designed for children, the Akron Children's GI team may perform colonoscopy, upper endoscopy, advanced capsule endoscopy, CT, MRI or any combination of these to identify IBD. The majority of cases can be medically managed, but in some cases surgery is necessary. Not all gastrointestinal conditions require significant intervention, and the Akron Children's team is skilled at know- ing when to recommend low-tech options. An increasingly popular approach for chronic stomach aches — the most common GI complaint — is the low sugar FODMAP (Fermentable Oligo- Di-Monosaccharides and Polyols) diet. "When we cut out certain carbohydrates, we often see kids start to feel better very quickly," says Dr. Wyneski. For patients with complex disorders such as cystic fibrosis, short bowel syn- drome, or complex liver disease, the GI team works closely with other Akron Children's pediatric specialists to provide comprehensive, ongoing management and aggressive intervention, as needed. A Center of Reference With so much going on — and more coming down the pike — all three GI phy- sicians say this is an exciting time to be in gastroenterology at Akron Children's. "We want to be a center of reference," says Dr. Garcia. "We understand the importance of having a comprehensive pediatric gastroenterology program, and we will continue to expand our pediatric GI services to meet the needs of children in this community." For more information about Akron C h i l d r e n's D i v i s i o n o f P e d i a t r i c Gastroenterology, Hepatology and Nutrition visit akronchildrens.org. To refer a patient, call 330-543-4488. ■ Advanced capsule endoscopy is one of the diagnostic tests performed at Akron Children's new GI lab. Dr. Matthew Wyneski is shown here holding the capsule. 2 2 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ S E P T E M B E R /O C T O B E R 2 0 1 4