Pediatric Annals

editorial 

Gastrointestinal Considerations

Stanford T Shulman, MD

Abstract

The day before writing this column, I encountered in clinic a 21/2-year-old girl who had been adopted from Hunan Province of China I1A years ago. The child's adoptive mother was convinced that her child had intestinal parasites because of "diarrhea" since the adoption, which was actually one mushy odorous stool per day. Thus, she made her way to our infectious diseases clinic, where we learned that the child had thrived and that four stool specimens during the past 12 months had been negative for ova and parasites. She had even received an empiric course of albendazole without improvement. While it seemed clear that this girl did not have a high probability of parasitic infestation, I realized that lactose intolerance, which is reasonably common in Chinese populations, and other conditions might explain this child's stool, and that these are not disorders that I knew much about.…

The day before writing this column, I encountered in clinic a 21/2-year-old girl who had been adopted from Hunan Province of China I1A years ago. The child's adoptive mother was convinced that her child had intestinal parasites because of "diarrhea" since the adoption, which was actually one mushy odorous stool per day. Thus, she made her way to our infectious diseases clinic, where we learned that the child had thrived and that four stool specimens during the past 12 months had been negative for ova and parasites. She had even received an empiric course of albendazole without improvement. While it seemed clear that this girl did not have a high probability of parasitic infestation, I realized that lactose intolerance, which is reasonably common in Chinese populations, and other conditions might explain this child's stool, and that these are not disorders that I knew much about.

Those who do are the pediatric gastroenterologists. It is remarkable how this and other pediatric subspecialties have matured over the past 1 to 2 decades, as highlighted by Dr. Steven Schwarz's introduction to this issue. From the first certifying pediatric gastroenterology subspecialty exam in 1990 to the present, the field has exploded with knowledge of the pathophysiology, epidemiology and therapy of pediatric gastrointestinal (GI) and liver disorders. The six reviews in this issue of Pediatric Annuals encompass a broad range of pediatric GI and liver issues that are important for primary care physicians for children to know about. Issues related to chronic functional abdominal pain, inflammatory bowel disease, gastroesophageal reflux, and celiac disease are fairly common in the pediatric office, while the neonate with liver disease and the increasingly recognized (but still underdiagnosed) older child with nonalcoholic fatty liver disease (usually in the overweight/obese patient) are important issues. The reviews of these topics in this issue are excellent and highly informative.

The stamps featured this month all relate directly or indirectly to pediatric GI/liver issues. The striking orange stamp from China symbolizes how hepatitis B vaccine can prevent hepatitis B virus' effect upon the liver, seen behind the shattering B. The white, blue, and ochre stamp from the Maldives commemorates the effort of the World Health Organization to emphasize the importance of clean water supplies, particularly for the health of children. Both the blue and green stamp from Mauritania and the multicolored stamp from Liberia highlight the critical role of oral rehydration therapy for infants and children with acute gastrointestinal infections, particularly in the developing world.

On a related note, rotavirus is the most important single cause of acute dehydration in infants worldwide, and the recent licensure of a new rotavirus vaccine in the United States in February 2006 will likely become a landmark in the fight against infectious diseases. As reviewed in the January 2006 issue of Pediatric Annals, rotavirus currently accounts for about 50,000 hospitalizations and 20 deaths annually in the US and for an estimated 2,000,000 hospitalizations and almost 500,000 deaths worldwide. Vaccine implementation will decrease morbidity and mortality, but we will need to find ways to extend vaccine availability to the developing world as well.

10.3928/0090-4481-20060401-03

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