On this page you will find the following information:

Explanations of the specialist services of the departments

Gastrointestinal conditions 

Hepatology (Liver conditions)

Complex Nutrition conditions

Specialised investigations (tests) and treatments/procedures:

• Endoscopy
• Liver investigations
• Procedures relating to liver disease or transplantation
• Gastrostomy tubes PEGS
  
• Gastroenterology Physiology
• Procedures for complex nutritional conditions

Coming to Hospital?

The Department of Gastroenterology and Clinical Nutrition

Our department provides specialist care for children and teenagers with diseases of the digestive system. We provide diagnosis and treatment of diseases of the gut, which can affect one or many parts of the gastrointestinal tract.                                                                                                                                                                                                                                                                                                                  

• Mouth
• Oesophagus
• Stomach
• Liver        
• Bile ducts and gallbladder 
• Pancreas
• Small intestine
• Large intestine

How can we help?

The Department provides a number of specialised services that are described below.  You may be referred to be seen in the clinic, or be admitted to hospital for a specialised test or treatment.

Gastrointestinal conditions

• Chronic refractory constipation: Constipation is a common condition in childhood that is usually well managed by a Paediatrician.  In some cases, if treatments are not working, some patients are referred to a Gastroenterologist.
•  Coeliac disease: In coeliac disease, the immune system reacts abnormally to gluten, a protein found in wheat, rye, barley and oats.  This causes damage to the lining of small intestine. Please follow the link to get in touch with Coeliac society. 

  https://www.coeliac.org.au/

•  Crohn’s disease: It is a chronic disease which causes inflammation of parts of the intestine, and can occur in all the layers of intestine wall.  Also known as inflammatory bowel disease.
• Cystic fibrosis associated gastrointestinal disease: Cystic fibrosis is an inherited disease that causes thick sticky mucous to build up in the lungs, liver, intestines, pancreas and reproductive organs.  It is the most common type of chronic lung disease in children and young adults, and can also results in significant pancreatic and nutritional problems, and can lead to significant liver disease.
• Eosinophilic gastrointestinal disorders: Eosinophils are a type of white blood cell important in the immune system.  For unknown causes, or sometimes in response to food allergies, or other allergies, more eosinophils than normal build up in the gut.  This can cause inflammation and other gastrointestinal symptoms, such as diarrhea or difficulty swallowing.
• Food allergy: An immune response to certain foods.  Common foods that people are allergic to are eggs, peanuts and milk. It can cause wheezing, stomach upsets, skin rashes and in severe cases, anaphylaxis.
• Gastroesophageal reflux disease: A condition in which stomach contents travel backward from the stomach to the oesophagus, rather than down through the digestive system. It can occur in both children and in adults.
• Helicobacter pylori: H. pylori is a bacteria responsible for most ulcers and many cases of inflammation of the stomach. This organism can weaken the protective coating of the stomach and duodenum (first part of the small intestines), allowing the damaging digestive juices to irritate the sensitive lining of these body parts.
• Inflammatory bowel disease (IBD): IBD is chronic inflammation of all or part of the intestinal tract.  Crohn's disease and ulcerative colitis are the most common conditions.
• Irritable Bowel syndrome (IBS):  Inflammatory Bowel Disease (IBD) is a chronic ( long-term) condition which affects various parts of the gastro-intestinal tract.  The 2 common types of IBD are Crohns Disease and Ulcerative Colitis 
• Malabsorption disorders: Malabsorption is difficulty in digestion or absorption of nutrients from food. Malabsorption can result from a wide range of diseases. Typically, malabsorption can be the failure to absorb specific sugars, fats, proteins, or vitamins, and can also be a general malabsorption of food.
• Motility disorders : A variety of disorders where the gut is not able to coordinate its usual muscular activity
•  Pancreatitis: Acute and chronic: It is an inflammation or infection of the pancreas. The pancreas is located behind the stomach. It releases the hormones insulin and glucagon and substances that help with digestion.
• Ulcerative colitis: Is a chronic disease which causes inflammation of the inner most lining of the colon.  Also known as inflammatory bowel disease.

Liver conditions

• Acute liver failure: Is a medical emergency that causes rapid deterioration of liver function and damage of liver cells. There are multiple causes such as infection or medication overdose. 
• Alagilles syndrome: Is a genetic syndrome that causes the bile ducts inside the liver to be small and abnormal, it is also associated with problems in other parts of the body such as eyes, heart and blood vessels.   
• Alpha-1-antitrypsin deficiency: This is a genetic disorder that causes abnormal production of the protein alpha-1 antitrypsin.  Because the protein is developed abnormally, it can get ‘stuck’ in the liver cells, causing damage to the liver cells. There are different types of alpha-1 antitrypsin deficiency, some of these cause little or no damage to the liver, and others cause much more damage to the liver.
• Autoimmune hepatitis:  This is a chronic disease of the liver caused by the body’s own immune system to attack the liver cells, causing the liver to be inflamed and damaged.
• Biliary atresia: Is a rare disease in newborn infants where the bile ducts inside and outside the liver become damaged and sometimes completely blocked.  The cause of the damage is unknown.
• Cirrhosis: Scarring of the liver that can be caused by many diseases.
• Fatty liver disease:  Is a build-up of excess fat in the liver cells, which can damage the liver.
• Hepatitis: Hepatitis literally means ‘liver inflammation’.  It can be caused by infections from viruses (such as hepatitis A, B or C), alcohol, drugs, and occasionally immune cells in the body attacking the liver and causing autoimmune hepatitis.
• Hirschprung’s disease: Is abnormal development of nerve cells of the colon, and sometimes in some of or all of the small and large intestine.  Having no nerve cells results in the bowel being unable to use nerves to move digested food through the bowel.
• Metabolic liver diseases:  Metabolic liver diseases are genetic disorders in which abnormal chemical reactions in the body controlled by the liver, disrupt the body’s normal metabolism. 
• Oesophageal varices: Dilated veins in the oesophagus.  The walls of the vein are thin, and therefore they have a high risk of bleeding.
• Primary sclerosing cholangitis:  Is a disease that causes inflammation of the bile ducts both inside and outside the liver, the inflammation of the bile ducts continues until the bile ducts are scarred and damaged, leading to liver damage.
• Viral hepatitis: Inflammation of the liver caused by a virus.  
• Wilson's disease: Is a rare genetic metabolic disorder where copper is not excreted properly from the body, causing copper to build up in the liver and other areas of the body such as the brain.  Excess copper in the liver can cause liver damage and failure.

Complex nutrition conditions 

• Chronic intestinal pseudo-obstruction:  It is a rare disorder of abnormalities in the normal involuntary coordinated muscular contractions (peristalsis) of the gastrointestinal tract
• Intestinal failure: Occurs when a person’s intestines can’t digest food and absorb the fluids, electrolytes and nutrients required for normal growth.  It can be caused by many different diseases.
• Gastroschisis: Is a birth defect of the abdominal wall, where the newborn’s intestines are outside of the body through this hole in the abdominal wall.
• Short-gut syndrome: It is a condition of food malabsorption related to disease or the surgical removal of a large portion of the small intestine. 

Investigations and procedures

Endoscopy

• Diagnostic Gastroscopy – Under anaesthesia, an endoscope (narrow flexible tube with a small camera and light on the end) is inserted into the mouth to examine the oesophagus (swallowing tube), stomach and duodenum (first part of the small intestine).  Biopsies are taken to be examined under the microscope by a pathologist.
• Diagnostic Colonoscopy – Prior to this procedure, instructions will be given for bowel prep to clean the colon.  Under anaesthesia, an endoscope is inserted into the anus to examine the whole colon and if possible the ileum (last part of the small intestine) and biopsies are taken.
  Bowel washout brochure for families
  
  
• Balloon Dilatation of Strictures – A narrowing of the gut is visualised with an endoscope and a very narrow balloon is place at the narrowing via the endoscope.  The balloon is carefully inflated under vision to stretch the narrowing
• Removal of Foreign bodies – foreign objects that have passed beyond the reach of the surgical team can be retrieved by endoscopy
• Treatment of Oesophageal Varices – Children with chronic liver disease may develop abnormally swollen blood vessels around the oesophagus.  These can be treated endoscopically by applying a special band to occlude the vessel or in certain circumstances to inject a chemical into the vessel to occlude it
  
• Polypectomy – In rare cases, children may develop polyps that can be removed at endoscopy and sent to a pathologist for examination
• Botox injection – Botulinim toxin can be injected into muscles to relax them and prevent them from contracting.  If a part of the muscle of the GI tract is too tight and cannot relax properly to allow food to pass through, botox may be injected by endoscopy

Liver investigations

• ERCP – Endoscopic retrograde cholangio pancreatography, is a technique to access the bile and pancreatics ducts, the tubes that connect the liver and pancreas to the intestine.  When the ducts are accessed, dye can be injected to look for any abnormalities, narrowings or obstructions and balloons or stents can be used to treat any obstruction
• Percutaneous Transhepatic Cholangiogram – PTC is another technique for accessing the bile ducts using a needle passed into the liver.  Again, dye can be used to look at the ducts, and balloons and stents can treat obstructions
• Fibroscan – A specialised ultrasound machine that sends sound waves into the liver to estimate how stiff or scarred it may be.
• Liver Biopsy – Under anaesthesia, and using ultrasound guidance, a specialist Radiologist uses a needle to take a tiny sample of the liver to send for examination by a pathologist.

Procedures relating to Liver disease or transplantation

• Liver transplantation - The liver transplant team is made up of Clinical Nurse Specialists, Gastroenterologists, Liver Transplant Surgeons from the Austin Hospital as well as a team of allied health professionals and junior doctors.  Children with severe liver disease may be undergo the process of being work-up for and listed for transplantation, which takes place at the Royal Children’s Hospital.
  Information for families: Food safety after transplantation
• Biliary Dilatation / Stents – Abnormalities, narrowing or obstruction of the bile ducts can be treated with balloons or stents as described above
• Venography or Angiography of Liver Vessels
• Surgical Portosystemic shunts
• Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Gastrostomy tubes (PEGS)

Percutaneous Endoscopic Gastrostomy Insertion (initial PEG insertion) – Using endoscopy to guide, and opening is made from the skin directly into the stomach, into which a tube is placed that provides semi-permanent access for nutrition or medication

• Gastrostomies booklet - All you need to know. By Gastroenterology Team,  December 2020
  
  

Gastroenterology Physiology

• Capsule Endoscopy – a small disposable camera, housed in a capsule the size of a large jelly bean is swallowed.  This camera takes images of the inside of the small intestine and transmits them to a special belt that is worn for the day and stores the images to be then reviewed.
• 24-hour oesophageal pH-monitoring – While awake, a very fine tube is passed into the nose down the back of the throat and into the oesophagus (swallowing tube).  This is taped in place and connected to a small monitor that records information from the acid sensors on the tube.
• 24-hour oesophageal pH and multiple intraluminal impedance monitoring (pH-MII, or known as Impedance monitoring) – The procedure is identical the one above.  The tube has additional sensors that can detect movement of fluid and air as well as acid.
  
  Motility Studies
  
  •  Oesophageal Manometry – a procedure lasting approximately one hour and performed awake that looks at the movement and pressures of the swallowing tube and stomach, to understand the function of the muscles and nerves.
  • Anorectal Manometry - a procedure lasting under one hour and usually performed awake that looks at the movement and pressures of the anus and rectum, to understand the function of the muscles and nerves involved in defecation.
    RCH Anorectal Manometry Fact Sheet V2.1 20.10.20
  • Colonic Manometry – a day procedure with the initial component under anaesthetic and the rest performed awake that looks at the movement and pressures of the colon, to understand the function of the muscles and nerves
  • Antroduodenal Manometry – a procedure lasting a day or overnight with the initial component under anaesthetic and the rest performed awake that looks at the movement and pressures of the small intestine, to understand the function of the muscles and nerves

Procedures for complex nutritional conditions

• Enteral Nutrition(see also: Gastrostomy; Jejunal tube insertion)
• Parenteral Nutrition
• Intestinal Transplantation

Coming to Hospital?

By: Prof Winita Hardikar, Dr Mark Safe, Di Simpson June2019

Reviewed by AProf George Alex, Carla Rogers July 2023

SA