It was a 12-year-old boy with HIV that introduced me to the field of pediatric gastroenterology. The patient was failing to thrive and had increasing viral loads due to his inability to take his medications. A percutaneous gastrostomy tube was subsequently inserted and 1 month later, he was 5 pounds heavier with improving CD4 counts. However, it wasn't until residency that I discovered the true variety of patients treated and managed by pediatric gastroenterologists.
In fact, gastrointestinal issues remain one of the most common causes for visits to the general pediatrician. Disease processes can range from acute and self-resolving to chronic, requiring daily life-long therapy. As such, the field of pediatric gastroenterology has evolved to include various subspecialties including nutrition, motility, and hepatology to name just a few.
Furthermore, the science of flexible endoscopy has also evolved. Therapeutic endoscopic techniques are currently being developed that may take minimally invasive surgery to the extreme. Such procedures include endoscopic cholecystectomies, endoscopic appendectomies, and even endoscopic fundoplications.
It is with much gratitude, as guest editor of this issue of Pediatric Annals, to present a variety of articles on a broad range of topics within the field of pediatric gastroenterology, hepatology, and nutrition. The articles discuss subjects ranging from common pediatric problems to complex disease processes requiring a multidisciplinary approach.
One of the most common issues to present to the general pediatrician is the toddler who is not gaining weight. Is the poor weight gain secondary to an organic etiology or secondary to psychosocial causes? What can the general pediatrician do to help differentiate this question as well as start the patient on appropriate treatment? Dr. Catherine Larson-Nath and myself provide a review of the literature and highlight the various causes and routine evaluations, as well as when additional expertise might be needed for further assessment of the pediatric patient.
Pancreatitis can range from a short hospitalization to a prolonged intensive care unit stay, requiring intubation and mechanical ventilation. In their article, Dr. Edgardo D. Rivera Rivera and colleagues discuss hereditary pancreatitis. In addition, they outline when genetic testing should be considered as well as describe the various genes that have been associated with this chronic disease.
With the increasing incidence of childhood obesity, Dr. Martin Duncan and colleagues provide insight into what has become the leading cause of elevated liver enzymes in children of all ages—nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. The article provides a detailed outline as to the differential diagnosis, evaluation, and treatment of this common pediatric disease process; they also define some of the potential complications of this progressive disease.
Inflammatory bowel disease (IBD) continues to be a multidimensional disease with some people experiencing only inflammation easily controlled with medication versus those with multiple complications including fistulas and strictures that require surgery. Although the disease has been known for close to a century, new treatments, which have changed the natural history of the disease, have only been around for the last 15 to 20 years and only approved in pediatrics in the last decade. Dr. Jonathan Cordova and colleagues outline the various presentations, systemic signs, and the latest treatment options for IBD, which is a potentially devastating disease. In addition, they describe a more common presentation of Crohn's disease (CD) in pediatrics—perianal CD.
Lastly, in her article, Dr. Vi Lier Goh discusses eosinophilic esophagitis, and illustrates the fact that this once rare disorder appears to be increasing in incidence. She outlines the diagnostic criteria, disease symptoms, and presentations, which seem to vary with age. Additionally, the various treatment modalities and potential treatment pitfalls are discussed, which illuminate why a multidisciplinary approach is needed for such a complex disorder.
In summary, I have attempted to choose topics that show the diverse nature of pediatric gastroenterology, hepatology, and nutrition. Additionally, I selected topics that are likely to be encountered within the general pediatrician's office. Although the field of pediatric gastroenterology continues to evolve, the various topics presented represent common and/or increasingly common disease processes in this specialty.
Thank you to all of the contributing authors for all their hard work and dedication to this project as well as special thanks to Dr. Praveen Goday (Children's Hospital of Wisconsin, Medical College of Wisconsin) who provided added oversight to this issue. Also, I would like to thank Dr. Joseph R. Hageman (University of Chicago, Pritzker School of Medicine) for this opportunity and all his hard work on this project. I hope the articles are a valuable tool and resource for these common pediatric disease processes.