Pediatric Gastroenterology providers

Inflammatory Bowel Disease, or IBD, is ongoing inflammation of all or part of the digestive tract. Most common types of IBD are ulcerative colitis or Crohn's disease. 

Irritable Bowel Syndrome, or IBS, is an intestinal disorder that causes pain in the belly, gas, diarrhea and constipation.

Symptoms include abdominal pain, bloating, diarrhea and constipation.

After an evaluation by our pediatric gastroenterology specialists, the care team will develop a care plan to address and manage the symptoms. Recommendations may include lifestyle modifications, diet adjustments, stress management, medication and/or counseling.

Reflux disease refers to chronic acid reflex. It's also referred to as  gastroesophageal reflux disease (GERD).

Reflux disease is a digestive disease in which stomach acid or bile irritates the food pipe lining. Acid reflux and heartburn more than twice a week may indicate GERD.

Symptoms include burning pain in the chest that usually occurs after eating and worsens when lying down.

Relief from lifestyle changes and over-the-counter medications is usually temporary. Stronger medication or treatment procedures may be needed.

Chronic diarrhea is when diarrhea lasts beyond a few days into weeks, usually indicating that there's another problem. Lasting diarrhea may occur for various reasons.

As diarrhea, especially for children, can quickly become dangerous as it can lead to dehydration and other issues. 

A pediatric gastroenterologist will do a thorough review of symptoms, medical history and diet history, as well as tests if needed, to determine the root cause of the issue. Once determined, an individualized treatment plan will be created.

Constipation is a condition in which a person has:

• fewer than three bowel movements a week
• stools that are hard, dry, or lumpy
• stools that are difficult or painful to pass
• or a feeling that not all stool has passed.
  

There are many different childhood liver conditions and problems, including those you may be familiar with for adults. Symptoms may vary but could include fatigue, jaundice, pale-colored stools and dark yellow urine. 

Conditions include, but are not limited to:

• Acute Liver Failure
• Alagille Syndrome
• Alpha-1 Antitrypsin Deficiency
• Autoimmune Liver Disease
• Biliary Atresia and Kasai
• Choledochal Cyst
• Effects of cystic fibrosis on the liver
• Hepatitis B and Hepatitis C
• Non-Alcholic Fatty Liver Disease
• Wilson's Disease

When we eat food, our bodies use muscular contractions to move food through the digestive system and ultimately expelled. This process is known as gastrointestinal motility (gastric motility).

When someone has a gastric motility disorder, these contractions do not occur normally, and food is not able to pass through the intestines properly. Motility dysfunction can occur in the esophagus or stomach, or the lower gut. 

Symptoms of esophagus or stomach motility dysfunction:

• Difficulty swollowing
• Vomiting
• Feeling full quickly

Symptoms of motility dysfunction in the lower gut:

• Abdominal pain
• Bloating
• Difficulty or pain passing stool
• Stool leakage

Celiac disease is when someone has an immune response from eating gluten. For someone with celiac disease, the body starts damaging and destroying the lining of the intestine, which can cause the body to not absorb vitamins and nutrients from food.

Common symptoms are diarrhea, decreased appetite, stomachache and bloating, poor growth and weight loss.

Many children are diagnosed with celiac disease when they're between 6 months and 2 years old, which is when most kids get their first taste of gluten in foods. However, allergies can present themselves at any time.

Eosinophilic esophagitis is an allergic condition occuring in the esophagus, causing it to become inflamed and not contract properly. 

The espohagus can get narrowed and develop rings or abscesses, which prevents proper digestion.

Childhood obesity is when a child is significantly overweight for his or her age and height. This can be based on BMI measurements, but will be fully assessed by a pediatric gastroenterology to include several other factors that may relate to a child's weight.

Childhood obesity can lead to diabetes, high blood pressure, high cholesterol and many other problems later in life. 

Pediatric gastroenterologists will conduct a thorough review of the child's medical history, risk factors, diet and lifestyle to determine potential causes and treatment recommendations.

Children are diagnosed with failure to thrive when their weight or rate of weight gain is significantly below that of other children of similar age and biological sex. Infants or children that fail to thrive seem to be dramatically smaller or shorter than other children the same age.

Failure to thrive can come from medical conditions or environmental factors. A specialist will be able to determine the cause of the problem and how to address it, whether through lifestyle changes, diet changes, medication or surgery.

Your child may need to see a specialist if a child is experiencing chronic or recurring abdominal pain.

Abdominal pain should first be discussed with your child's pediatrician or primary care provider if

• Abdominal pain has lasted 1 week or longer (even if it comes and goes)
• Severe abdominal pain that does not improve in 24 hours, or if your child is nauseous and vomiting with it.

Pancreatitis is the most common disease children may be affected by. Pancreatitis is the inflammation of the pancreas, which is a large gland behind the stomach. The pancreas secretes digestive enzymes into the small intestine to help digest fats, proteins and carbohydrates in food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. If enzymes produced by the pancreas become active inside the pancreas, they can start to "digest" the pancreas itself.

Acute pancreatitis usually begins with pain in the upper abdomen that may last for a few days, becoming severe or constant. The way it presents varies by child: pain may appear suddenly and intense or begin mildly but worsen when food is eaten.

Pain may present just in the abdomen, or it may reach to the back and other areas.  Someone with acute pancreatitis often looks and feels very sick.

Other symptoms may include:

• Swollen and tender abdomen
• Nausea
• Vomiting 
• Fever
• Rapid pulse

Children with other diseases, such as cystic fibrosis, may be at increased risk of devleoping pancreatitis.

Information to be posted.

Hirschsprung's disease is a condition of the large intestine (colon) that causes difficulty passing stool. Present from birth, children with Hirschsprung's disease are missing nerve cells in the muscles of part or all of the large intestine (colon). 

The main symptom is that a newborn is unable to have a bowel movement within 48 hours after birth. Other symptoms include a swollen belly and vomiting.

Surgery is needed to bypass the affected part of the colon or remove it entirely.

Our Division has a full-service GI laboratory. Testing includes the following:

• disaccharidase determination
• pancreatic enzyme determinations (pancreatic insufficiency)
• fecal alpha-1 antiprypsin analysis (protein-losing enteropathy)
• endomysial antibody with tier (serum test for celiac disease)
• anti- neutrophil cytoplasmic antibodies (P-ANCA and C-ANCA)
• H. Pylori antibody testing (ELISA method); H. Pylori (CLOTEST)
• hydrogen breath testing for lactose intolerance and/or bacterial overgrowth

The UBMD Pediatrics GAINS Clinic is pleased to offer comprehensive gastrointestinal and nutrition support services for children from birth to 18 years of age with a wide variety of medical conditions with nutritional needs. Our pediatric GI specialists will evaluate your child’s unique needs and create an individualized medical and nutritional care plan to ensure they are receiving the nutrients necessary for optimal health, growth and development.

Specialized care for a growing child:

Services include advanced pediatric GI treatment from an experienced multidisciplinary team that includes physicians, nurse practitioners, nurses, and dietitians. We work in partnership with parents, primary care providers and support staff from our WNY medical community to develop an individualized treatment plan for each child. We specialize in treating children with complex feeding challenges and medical conditions who need close monitoring of their nutrient intake to promote appropriate growth. Additionally, our GAINS clinic offers the highest level of family support and expert nutrition management for children requiring short or long-term tube feeding at home.

Examples of services provided by GAINS clinic:

• Evaluation for patients with different medical conditions such as slow poor weight gain, celiac disease, inflammatory bowel disease, eosinophilic esophagitis, short bowel syndrome, and others.
• Evaluation and management of GI-related medical issues that may be contributing to your child’s poor eating or altered growth pattern.
• Ongoing care for children dependent on a feeding tube with specialized equipment available for anthropometric measurement (measurement of growth) for children in wheelchairs.
• Clinical recommendations and assistance with procurement and insurance reimbursement of medically necessary nutritional formulas and/or supplements for your child.
• Monitoring of nutritional adequacy of your child’s intake, including nutritional blood-work on an as needed basis to detect and address possible deficiencies in your child’s diet.
• When indicated we can advocate and assist your child with referrals to community services, such as WIC, Early Intervention, feeding therapists, homecare vendors, community nursing providers, etc.

Anorectal Manometry

• Indications:
  • Chronic idiopathic constipation not responding to usual treatment (concern for inappropriate relaxation of internal anal sphincter)
  • Post-surgical intervention when symptomatic – imperforate anus, IASA, HD
  • Evaluate if candidate for IAS Botox
  • Evaluate spinal cord compromise leading to leakage/constipation
  • Evaluate defecation dynamics and need for biofeedback
• Diagnostic Capabilities:
  • Primary goal: Evaluate for Hirschsprung's disease or internal anal sphincter achalasia
  • Evaluate for rectal tone
  • Evaluate for dyssynergia
  • Evaluate for squeeze
  • Evaluate for rectal distension/compliance
• Additional Information:
  • Can be performed at any age – however, ages 0-4 are often difficult to evaluate for RAIR because they squeeze and cry through the study. Families should bring distractions and be prepared for the test to not work due to behavior
  • Takes about 10 minutes from start to finish if patient cooperates
  • Patient does not need to be NPO

Esophageal Manometry

• Indications:
  • To diagnose primary and secondary esophageal motor disorders
  • To diagnose motility abnormalities associated with symptoms including dysphagia, choking with feedings, globus sensation, vomiting, chest pain, refractory heartburn, or regurgitation
  • To diagnose anatomic abnormalities such as a hiatal hernia and esophageal compression from rings
  • To evaluate for esophageal obstruction in post-fundoplication or other surgical patients
  • When associated with impedance, to evaluate the association between motility abnormalities and esophageal transit
  • To assess for motility abnormalities and esophageal stasis associated with signs such as pneumonia and aspiration
  • To evaluate esophageal function before therapeutic procedures
  • To diagnose rumination syndrome
• Additional Information:
  • Age: This requires someone to be calm and actively participate, typically over age 7, but depends on child
  • Takes about 20 minutes from start to finish with proper cooperation
  • Involves placing a catheter into the esophagus via the nares (similar to NG tube)
  • We use a topical lidocaine in the naris prior to insertion to ease placement
  • Patient drinks salty water, followed by a Jello-like solution, followed by crackers/cookie
  • NPO for 6 hours prior to study
  • If there is a food that causes symptoms, please bring with on the day of the study

Division Manager
Dawn Arnold

Clinical Secretaries
Kimberly Cummings
Rebecca Yeates 
Julianys Felix

Nurse Practitioners
Stephanie Amdur-Clark, NP
Norine Boyd, CPNP, AE-C, PMHS
Anita Crawley, RN, CPNP
Laura White, FNP-BC, MSN, RN

Registered Nurse
Rachel Rainey, RN

Procedure Nurses
Lisa Missert, RN

Procedure Coordinator
Michele Carroll

Clinical Dietitians
Georgina Bojczuk, RD, CSP