Issue link: http://viewer.e-digitaledition.com/i/915879
GA STROINTE STIN A L PROBLEMS, LIK E abdomina l pa in, ref lux sy mptoms, chronic dia rrhea , bloating a nd gastroin- testina l bleeding a re a common compla int a mong pediatric patients. For most of these patients, the issue ca n be resolved w ith lit t le or no medica l inter vention, a nd does not indi- cate a serious condition. However, some of these pediatric patients may need a more comprehensive investigation a nd therapeutic approach. For example, chronic abdominal pain in pediatric patients can be particularly challenging to diagnose for a variety of reasons, including the difficulty for the patient to identify the area of discomfort. The use of both invasive and non-invasive gastroenterologica l procedures has become a critica l part of not only diagnosing, but also in some instances providing therapeutic care. Common invasive diagnostic procedures include upper and lower endoscopies. Newer, advanced high-resolution endoscopies aid the clinician to safely and easily diagnose and treat a range of conditions, including eosinophilic esophagitis (EoE). EoE is an allergy-induced immune system disease that can result in esophageal dysfunction. In infants, it can present as vomiting, refusal to eat and failure to thrive. Older children typically experience dysphagia and reflux symptoms. Over time, the chronic inflammation and irritation caused by EoE can lead to strictures of the esophagus. Accurate diagnosis requires both clinical and histological data. Regular monitoring via endoscopy is often necessary. Beyond diagnosing conditions, endoscopies can therapeutically be used to address a multitude of GI ailments, including gastrointestinal bleeding, esophageal strictures, polyps and placing gastrojejunal feeding tubes. Gastric stimulators can be endoscopically implanted to treat chronic gastroparesis that does not respond to conventional medical management. The temporary endoscopic placed gastric stimulator aids to predict the success of the laparoscopically implanted permanent gastric stimulation. On the other hand, non-invasive procedures are diagnostic tests performed in the office, without sedation or anesthesia for a variety of reasons. For example, breath hydrogen tests are used in patients with symptoms of malabsorption and abdominal pain. Anal manometries are used in the evaluation of constipation and retentive fecal soiling, while esophageal manometries are used in patients with esophageal dysphagia. For patients with reflux symptoms, pH impedance can be used for symptom correlation. Finally, capsule endoscopies are used in patients with suspected small intestinal bleeding or in the evaluation of inflammatory small bowel disease. New technolog y, once only available for adult patients, is now being adapted for the pediatric population. Smart pills are specially designed, wireless grape-sized capsules to evaluate gastric, small intestinal and colonic motility. The possibility of performing an upper endoscopic evaluation (especially esophageal) in the office is a fascinating area of development for GI. Small endoscopes are introduced to the nasal orifice to evaluate the esophagus and stomach without sedation or anesthesia. This will be available soon in multiple pediatric practices, mainly for the evaluation of eosinophilic esophagitis (EoE). Dr. Reinaldo Garcia-Naviero is the director of Pediatric Gastroenterology at Akron Children's Hospital. He is board certified in Pediatric Gastroenterology from the American Board of Pediatrics. Dr. Sirvart Kassabian is a pediatric gastroenterologist at Akron Children's Hospital. She also holds a Master of Health Services Administration degree. n Invasive and Non‑Invasive Gastro Procedures for Diagnosis and Treatment in Children BY REINALDO GARCIA-NAVIERO, MD, AND SIRVART K ASSABIAN, MD, MHSA 1 0 ❱❱❱❱❱ SP ECI A L CL INIC A L SECT ION: SURGER Y 1 0