Gastroenterology & Nutrition

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

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

Procedure Nurses
Lisa Missert, RN
Melissa Severyn, RN

Quality Assurance and Customer Service Coordinator
Erin Misener, LPN

Clinical Dietitians
Georgina Bojczuk, RD, CSP
Julie Hawn, MS, RDN, CDN