Pediatric gastroenterology
Pediatric gastroenterology developed as a sub-specialty of pediatrics and gastroenterology. It is concerned with treating the gastrointestinal tract, liver and pancreas of children from infancy until age eighteen. The principal diseases it is concerned with are acute diarrhea, persistent vomiting, gastritis, and problems with the development of the gastric tract.
History
Pediatric gastroenterology has grown greatly in North America and Europe. It began with the speciality of pediatrics, which was developed along with children’s hospitals in the 19th century. The concept of specialists concentrating on organ specific specialties started around the same time. A person who contributed to the development of the specialty was Dr.
Margot Shiner, who in 1956 invented a biopsy tube that could be used to diagnose intestinal disease in children, particularly celiac disease, has been credited with initiating the emergence of pediatric gastroenterology as a distinct clinical specialty.[2][3][4]
Centers of pediatric gastroenterology
Centers for gastrointestinal disorders in children began being established in the 1960s in Great Britain, Australia, and continental Europe. The first centers for pediatric gastroenterology were established by Dolf Weijers and the biochemist Van de Kamer. Pediatricians and biochemists were crucial to the development of such specialty since they created the ability to calculate the fat in the feces of celiac patients with or without gluten. A clinical and research program in pediatric gastroenterology and a gastroenterological research were established in the 1960s at the Royal Children’s Hospital in Melbourne by
Centers of pediatric gastroenterology in North America
North America has also been a center for the development of pediatric gastroenterology. A pediatric gastroenterology program focusing on researching
Many more centers have been developed in multiple places including Sydney, Adelaide, Brisbane, Jerusalem, São Paulo, Santiago, Taipei, and Tokyo.[1]
Education
The specialty of pediatric gastroenterology requires four years of undergraduate courses at a college or university in order to obtain a BS, BA, or other bachelor's degree. During these four years a student studying pediatric gastroenterology can also take a pre-med course. Afterwards, the student needs four years of medical school in order to obtain an MD or DO degree and become a general doctor. Afterwards the student needs to take a specialty in pediatrics consisting in three more years of education called residency. Afterwards pediatrics sub-specialize in a more specific area such as pediatric gastroenterology. The time to sub-specialize is called post-residency training also known as a fellowship. It can take from one to three or more years consisting in a total of fourteen years or more. In the United States, the committees to certify pediatric gastroenterologist were created in the 1980s. This gave rise to sub-specialty boards in pediatric gastroenterology in 1990 under the leadership of American board of Pediatrics and its Pediatric Gastroenterology and Nutrition subspecialty sub-board, led by Bill Kish. A formal training program was created later in 1997 by the sub-specialty advisory committee for pediatric gastroenterology of the royal college of pediatrics and child health in Great Britain.[1]
Nutrition
The correct function of the gastric tract and the internal health is related to the nutrition that the child or its mother receives. From the prenatal period, correct nutrition can affect the developing of the system, short bowel syndrome (the most common one), necrotizing enterocolitis, gastroschisis or omphalocele to the postnatal period with diseases such as diarrhea.[5][6]
One of the principal problems of a newborn is an iron deficiency, which will generate anemia. This is caused when the only food that the baby receives is maternal milk which does not fulfill the baby’s nutrition. There is no treatment for this in this period because iron will reach normal levels with the weaning process. The weaning process consists in transitioning from feeding the baby low density food such as maternal milk to start feeding it more complex foods such as meat, fish, or chicken. (uniped) If the weaning process is not carried out correctly or if the child rejects the transition of food the iron deficiency will generate an anemia or even create allergies to certain food. In such cases gastric pediatricians, and not regular pediatricians, should be consulted to treat the anemia because they will now how to recover the correct iron levels without causing any secondary effects in the digestive system.[7]
The most common nutrition problems during the childhood are being overweight or underweight, both caused by an imbalance in the number of calories consumed versus the number burned. Both in children should be treated by a gastric pediatrician and a pediatric nutritionist at the same time to help the child recover his normal weight without secondary effects (hypertension, gastritis, etc.). The nutritionist will regulate the eating habits of the child, however, the pediatric gastroenterologist will be the one checking how the change in food habits affects the correct functionality of the digestive system.[5]
Diseases
A pediatrician can provide treatment to many gastric diseases, but chronic diseases, related with the nutrition of the children, the pancreas or the liver needs to be treated by a specialist. The following are two of the most common ones. Acute diarrhea is one of the most common. Globally, each of the 140 million children born annually experience an average of 7-30 episodes of diarrhea in the first 5 years of life. Some of the causes are infections, lower levels of zinc or problems with some gastric cells.[5]
Infant regurgitation is caused by a central nervous system reflex involving both autonomic and skeletal muscles in which gastric contents are forcefully expelled through the mouth because of coordinated movements of the small bowel, stomach, esophagus, and diaphragm. Diagnosis requires that the child be between 1 and 12, the regurgitation must be two or more times per day for three or more weeks, and there is a strong involuntary effort to vomit, hematemesis, aspiration, apnea, failure to thrive, or abnormal posturing. This is transient problem, possibly cause to the immaturity of gastrointestinal motility.[6]
References
- ^ PMID 12612197.
- ISBN 978-1-55009-038-3.
- .
- ^ "Margot Shiner". Munk's Roll, Volume XI. Royal College of Physicians. p. 519. Retrieved 13 May 2017.
- ^ a b c "Gastroenterologia pediatrica". 2013. Retrieved 19 April 2013.
- ^ a b Weber, Rasquin (1999). "Childhood functional gastrointestinal disorder". Retrieved 19 April 2013.
- ^ "ablactacion http://www.unidaddepediatria.com.mx/pdf/Ablactacion.pdf=".
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