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Achalasia and Other Motor Disorders

The term esophageal motor disorder is commonly used to describe abnormal motility patterns demonstrated during esophageal manometry studies. Some of these disorders, such as esophageal achalasia, have well-defined abnormalities of esophageal motility, which correlate with clinical symptoms. However, other esophageal motility disorders have an abnormal contraction pattern on manometry, but their clinical significance is not always clear. The advent of high-resolution manometry (HRM) and the Chicago…

Gastroesophageal Reflux

Abbreviations BAL bronchoalveolar lavage CMPA cow’s milk protein allergy ENT ear nose throat GERD gastroesophageal reflux disease H 2 RA H 2 receptor antagonist LES lower esophageal sphincter LLM lipid-laden macrophage NERD nonerosive reflux disease PPI proton pump inhibitor TLESR transient lower esophageal sphincter relaxation Introduction Comprehensive guidelines for the diagnosis and management of gastroesophageal reflux (GER) and GER disease (GERD) have been developed by the…

Congenital Malformations of the Esophagus

Congenital Lesions of the Esophagus Congenital lesions of the esophagus fall into three categories: congenital esophageal stenosis, the variants of esophageal atresia and tracheoesophageal fistula, and laryngotracheoesophageal clefts. congenital esophageal stenosis Congenital esophageal stenosis presents in three variants: esophageal webs or diaphragms, fibromuscular stenosis, and stenosis due to cartilaginous tracheobronchial remnants. These lesions, collectively, are rare, occurring in 1 in 25,000 to 1 in 50,000 live…

Developmental Anatomy and Physiology of the Esophagus

The esophageal functions are to transport food from the mouth to the stomach and to prevent reflux of gastric contents. Main manifestations of esophageal disease are either feeding intolerance or regurgitation. The esophagus is a complex organ and should not be regarded as simply a conduit between the pharynx and the stomach. Abnormalities of esophageal function occur frequently and can be confined primarily to the esophagus…

Caustic Ingestion and Foreign Bodies

Ingestion of Caustic Agents Epidemiology According to the most recent Annual Report from the American Association of Poison Control Centers there were 2,159,032 human exposures in the year 2016. Of these exposures, 46% of them occurred in children 5 years of age and under. While it is difficult to extrapolate how many of these exposures were true caustic ingestions, 12.8% of children less than 5 years…

Ascites

Acknowledgment We would like to acknowledge Michael J. Nowicki and Phyllis R. Bishop, authors of the previous edition’s chapter. Overview Ascites is the pathologic accumulation of fluid within the peritoneal cavity. The word ascites originates from the Greek words askites and askos , meaning “baglike” or “bladder.” Ascites has been documented since the time of Hippocrates (circa 400 BC) when he suggested that leakage of hepatic…

Jaundice: Unconjugated Hyperbilirubinemia

The term jaundice originated from the French jaune, which means “yellow.” Jaundice, or icterus (from the Greek ikteros ), refers to the yellow discoloration of the skin, sclerae, and other tissues caused by deposition of the bile pigment bilirubin. Jaundice is a sign that the serum bilirubin concentration has risen above normal levels (approximately 1.4 mg/dL after 6 months of age; 1 mg/dL = 17 mmol/L).…

Eating Disorders in Children and Adolescents

Eating disorders are life-threatening biopsychosocial illnesses that affect children, adolescents, and adults across the life span. Pediatricians, parents, and others who take care of children are recognizing disordered eating attitudes and behaviors in children as young as 2 years, and these occur well into the geriatric years. With the publication of the Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM-5), in 2013, clarification…

Obesity

The Surgeon General, the Institutes of Medicine, and the World Health Organization have classified childhood obesity as an epidemic in need of immediate and wide-reaching attention. The prevalence of childhood obesity has nearly tripled over the past 20 years; 18.5% of children now have obesity and 1.9% have class 3 obesity, the most severe form. , Pediatric health care providers have previously focused on prevention of…

Functional Constipation and Fecal Incontinence

Constipation and fecal incontinence represent common problems in children. Beyond the neonatal period, only a minority of children have an organic cause for their constipation and the etiology remains not well understood. Constipation rarely leads to life-threatening complications but can cause emotional and physical distress and concerns for children and their families, ultimately impairing health-related quality of life (HRQoL). The hallmarks of constipation are infrequent painful…

Colic and Gastrointestinal Gas

Gastrointestinal Gas Increased gassiness is a complaint frequently encountered by physicians. Although 10% to 30% of the general adult population report symptoms related to excessive gastrointestinal gas, its prevalence in children remains unknown. , The investigation of gas-related complaints is challenging because of the difficulty of measuring the volume or composition of gastrointestinal gas and verifying its relation to symptoms. In addition, it has been suggested…

Diarrhea

Definition and Epidemiology Diarrhea is a symptom, not a disease, resulting from a variety of pathologic or nonpathologic conditions. It can be separated into acute (≤4 weeks) and chronic (>4 weeks) diarrhea, with different etiologies suspected based on patient’s age at presentation, comorbidities, exposures, etc. The World Health Organization (WHO) defines diarrhea as passing more than three liquid stools per day ; however, most patients describe…

Vomiting and Nausea

Acknowledgments The current author would like to acknowledge B U. K. Li and Katja Kovacic for their significant contributions to the previous version of this chapter. It is accepted that the ability to vomit developed as a protective mechanism to rid the body of ingested toxins. Unfortunately, vomiting also frequently occurs unrelated to the ingestion of noxious agents, a circumstance that produces several clinical challenges. First,…

Approach to the Child with a Functional Gastrointestinal Disorder

† Deceased Functional gastrointestinal disorders (FGIDs, also known as disorders of gut–brain interaction) are common in children of all ages. More than half of new patients attending a pediatric gastroenterology clinic meet symptom-based criteria for an FGID. FGIDs are associated with functional disability, impaired quality of life, and a cost burden. Every clinician should know how to relieve the physical and emotional suffering in children and…

Chronic Abdominal Pain of Childhood and Adolescence

Introduction Chronic abdominal pain, generally defined as long-lasting intermittent or constant abdominal pain, is a common complaint in children and adolescents. For the majority of children with chronic abdominal pain, the pain is functional in nature rather than the result of an underlying organic disease. Apley and Naish first described recurrent abdominal pain in a cohort of 1000 school children in 1958, defining recurrent abdominal pain…

Gastrointestinal Mucosal Immunology and Mechanisms of Inflammation

The portion of the immune system resident within the intestine faces significant challenges. A single layer of epithelium separates the majority population of the host’s immune cells from a massive number of bacteria. It is therefore probably not surprising that the mediation and control of intestinal immunity follow rules distinct from those governing systemic immune reactivity. The challenges faced by the intestine not only include achieving…

The Gut Microbiome in Pediatrics

Introduction The human gastrointestinal (GI) tract represents one of the largest interfaces between the host, environmental factors, and antigens. In addition to food and liquids, an abundance of environmental microorganisms and xenobiotics pass through the GI tract daily, posing a potential threat on intestinal health. The collection of bacteria, fungi, viruses, and yeasts in the GI tract, termed gut microbiota, can be considered a microbial organ…

Bile Acid Physiology and Alterations in the Enterohepatic Circulation

Introduction Bile acids are essential in the processing of dietary lipids and serve at least four major functions: (1) Bile acids aggregate and form micelles in the upper small intestine, which help to solubilize lipolytic products, cholesterol, and fat-soluble vitamins, thereby facilitating absorption across the intestinal epithelium. (2) Bile acids stimulate bile flow during their secretion across the biliary canaliculus. (3) Bile acids are major regulators…