# Mike Thomson | Paediatric Gastroenterologist > Expert Care for Children's Digestive Health --- ## Pages - [Gastric Isotope Emptying Scans](https://paediatricgastroenterologist.co.uk/gut-investigations/faecal-analysis-copy/): Gut Investigations Gut Investigation These would involve your child eating a small amount of radiolabelled meal such as scrambled egg... - [Meckel’s diverticulum isotope scan](https://paediatricgastroenterologist.co.uk/gut-investigations/meckel-s-diverticulum-isotope-scan/): Gut Investigations Gut Investigation This involves injection of a radio-isotope into a vein which then collects in particular tissues containing... - [About your visit](https://paediatricgastroenterologist.co.uk/about/about-your-visit/): Nutrition About your visit Please see the videos below which should answer most of your questions. Once you have spoken... - [Curriculum Vitae](https://paediatricgastroenterologist.co.uk/about/curriculum-vitae/): About Mike Thomson Curriculum Vitae D. O. B – 30. 6. 1962 Married, 3 daughters Qualifications MB ChB – 1985... - [Positions Held](https://paediatricgastroenterologist.co.uk/about/positions-held/): About Mike Thomson Positions Held Professor Mike Thomson has help a number of positions over the years. Below is a... - [Articles](https://paediatricgastroenterologist.co.uk/about/articles/): Nutrition Peer-Reviewed Original Publications 1. The effect of dexamethasone therapy on the pattern and incidence of infection in pre-term babies... - [Books and Chapters](https://paediatricgastroenterologist.co.uk/about/books/): Nutrition Books “Concise Paediatrics. ” pp1-546. Sidwell R and Thomson M. Greenwich Medical Media, Nov 2000. “Q-Base. Paediatric MCQs” Thomson... - [Nutrition](https://paediatricgastroenterologist.co.uk/nutrition/): Nutrition Types of milks commonly used in Paediatric GI practice As a guide formulas are reconstituted 1 fluid oz water... - [Common Drugs](https://paediatricgastroenterologist.co.uk/common-drugs/): Nutrition Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nulla massa lacus, vehicula eu interdum convallis, laoreet id lectus. Nunc... - [Drugs used in constipation](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-constipation/): Common Drugs Drugs used in constipation Docusate sodium Kleen Prep Lactulose Liquid Paraffin Movicol (also called Laxido and Cosmocol and... - [Docusate sodium](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-constipation/docusate-sodium/): Drugs used in constipation Gut Investigation Stimulant laxative and faecal softner. Indication: To prevent and treat chronic constipation. Formulation: Capsule... - [Kleen Prep](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-constipation/kleen-prep/): Drugs used in constipation Gut Investigation Stimulant laxative and faecal softner. Formulation: Oral powder Dose: Add contents of 1 sachet... - [Lactulose](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-constipation/lactulose/): Drugs used in constipation Gut Investigation A semi synthetic disaccharide that is not absorbed from the gastrointestinal tract. Indication: Treatment... - [Liquid Paraffin](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-constipation/liquid-paraffin/): Drugs used in constipation Gut Investigation Faecal softner Indication: Treatment of constipation Formulation: Oral emulsion Dose: 0. 5ml/kg BD (TITRATE... - [Movicol](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-constipation/movicol/): Drugs used in constipation Gut Investigation Treatment of chronic constipation Bowel prep prior to colonoscopy. Formulation: Powder for oral solution... - [Picolax](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-constipation/picolax/): Drugs used in constipation Gut Investigation Clearance of bowel prior to examinationby colonoscopy Weekend therapy for patients with chronic constipation... - [Senna](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-constipation/senna/): Drugs used in constipation Gut Investigation Treatment of constipation Bowel prep prior to colonoscopy Formulation: Tablets 7. 5mg/tablet as total... - [Sodium Picosulphate](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-constipation/sodium-picosulphate/): Drugs used in constipation Gut Investigation Stimulant Laxative Indication: Treatment of acute or chronic constipation Bowel clearance prior to colonoscopy... - [Drugs used in GORD](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-gord/): Common Drugs Drug therapy of gastro-oesphageal reflux Gastro-oesphageal reflux disease (GORD) occurs due to the inappropriate relaxation of the lower... - [Domperidone](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-gord/domperidone/): Drugs used in constipation Gut Investigation Used in some situations but its clinical evidence base is poor. Indication: Treatemnt of... - [Metoclopramide](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-gord/metoclopramide/): Drugs used to treat GORD Gut Investigation Anti emetic use only. Indication: Anti emetic use only. Formulations: Solution 1mg/ml Tablets... - [Omeprazole](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-gord/omeprazole/): Drugs used to treat GORD Gut Investigation Proton pump inhibitor Reduces gastric acid secretion Indication: Proton pump inhibitor Reduces gastric... - [Ranitidine](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-gord/ranitidine/): Drugs used to treat GORD Gut Investigation Reduces gastric acid secretion Indication: Reduces gastric acid secretion Formulations: Tablets 150mg, 300mg... - [Sucralfate](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-gord/sucralfate/): Drugs used to treat GORD Gut Investigation Prophylaxis of stress ulceration Indication: Prophylaxis of stress ulceration Formulation: Suspension 1g/5ml Tablets... - [Drugs used in paediatric IBD](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-ibd/): Common Drugs Drugs used in paediatric inflammatory bowel disease Adalimumab Azathioprine Budesonide (Entocort CR) Infliximab Infusion Mesalazine (Asacol®) Mesalazine (Pentasa®)... - [Adalimumab](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-ibd/adalimumab/): Drugs used in IBD Gut Investigation This is a human monochlonal antibody that is not likely to cause allergic reactions... - [Azathioprine](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-ibd/azathioprine/): Drugs used in IBD Gut Investigation Indication: Immunosuppresive therapy in Ulcerative colitis or Crohns disease. Formulation: Injection 25mg Tablet 25mg,... - [Budesonide (Entocort CR)](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-ibd/budesonide/): Drugs used in IBD Gut Investigation Indication: Mild to moderate Crohns disease affecting the ileum or ascending colon. Formulation: Capsules... - [Cyclosporin](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-ibd/cyclosporin/): Drugs used in IBD Gut Investigation Indication: Immunosuppressive therapy in Ulcerative colitis or Crohns disease. Formulations: Capsules 25mg, 50mg, 100mg... - [Infliximab Infusion](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-ibd/infliximab-infusion/): Drugs used in IBD Gut Investigation Infliximab is a monoclonal antibody which is used in the treatment of moderately to... - [Mesalazine (Asacol®)](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-ibd/mesalazine/): Drugs used in IBD Gut Investigation Indication: Treatment of mild to moderate Ulcerative colitis and Crohns disease Site of action:... - [Mesalazine (Pentasa®)](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-ibd/mesalazine-pentasa/): Drugs used in IBD Gut Investigation Indication: Treatment of mild to moderate Ulcerative colitis and Crohns disease Site of action:... - [Olsalazine](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-ibd/olsalazine/): Drugs used in IBD Gut Investigation Indication: Treatment of mild to moderate Ulcerative colitis and Crohns disease Site of action:... - [Prednisolone enemas](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-ibd/prednisolone-enemas/): Drugs used in IBD Gut Investigation Indication: Reduce inflammation in acute attacks of Crohns and Ulcerative colitis. Maintain remission of... - [Prednisolone](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-ibd/prednisolone/): Drugs used in IBD Gut Investigation Indication: Reduce inflammation in acute attacks of Crohns and Ulcerative colitis. Maintain remission of... - [Sulphasalazine](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-ibd/sulphasalazine/): Drugs used in IBD Gut Investigation Indication: Treatment of mild to moderate Ulcerative colitis and Crohns disease Formulation: Suspension 250mg/5ml... - [Methotrexate](https://paediatricgastroenterologist.co.uk/common-drugs/drugs-used-in-ibd/methotrexate/): Drugs used in IBD Gut Investigation This is used either orally or initially sub-cutaneously as an injection once a week... - [Bacterial overgrowth](https://paediatricgastroenterologist.co.uk/gut-problems/bacterial-overgrowth/): Gut Problems Gut Investigation Awareness of this as a gut related problem with gut related motility problems is becoming increasingly... - [Gastro-oesophageal reflux](https://paediatricgastroenterologist.co.uk/gut-problems/gastro-oesophageal-reflux/): Gut Problems Gut Investigation NICE sets out new advice to treat gastro-oesophageal reflux disease (GORD) more effectively. Healthcare professionals should... - [Pancreatitis](https://paediatricgastroenterologist.co.uk/gut-problems/pancreatitis/): Gut Problems Gut Investigation This is an inflammatory condition, usually of unknown origin which involves the pancreas gland which produces... - [Coeliac Disease](https://paediatricgastroenterologist.co.uk/gut-problems/coeliac-disease/): Gut Problems Gut Investigation Coeliac disease is a common problem occurring in 1:100 of the general population and if you... - [Giardia](https://paediatricgastroenterologist.co.uk/gut-problems/giardia/): Gut Problems Gut Investigation Giardia is a parasite which is very common in freshwater lakes, for instance, and can be... - [Recurrent abdominal pain](https://paediatricgastroenterologist.co.uk/gut-problems/recurrent-abdominal-pain/): Gut Problems Gut Investigation Chronic or recurrent abdominal pain (RAP) is one of the most commonly encountered events in childhood... - [Common liver problems](https://paediatricgastroenterologist.co.uk/gut-problems/common-liver-problems/): Gut Problems Gut Investigation Common liver problems in children in the UK usually are associated with viral infections and involve... - [Gut blood loss and anaemia](https://paediatricgastroenterologist.co.uk/gut-problems/gut-blood-loss/): Gut Problems Gut Investigation This problem is not particularly common but painless blood loss from the gut which can lead... - [Sucrose intolerance](https://paediatricgastroenterologist.co.uk/gut-problems/sucrose-intolerance/): Gut Problems Gut Investigation This is congenital and due to the absence of the enzyme sucrase isamaltase present in the... - [Common pancreatic problems](https://paediatricgastroenterologist.co.uk/gut-problems/common-pancreatic-problems/): Gut Problems Pancreatitis This is an inflammatory condition, usually of unknown origin which involves the pancreas gland which produces enzymes... - [Gut infections](https://paediatricgastroenterologist.co.uk/gut-problems/gut-infections/): Gut Problems Gut Investigation These are commonly called food poisoning and cause problems either due to toxins presented to the... - [Toddler’s diarrhoea](https://paediatricgastroenterologist.co.uk/gut-problems/toddlers-diarrhoea/): Gut Problems Gut Investigation Toddler’s diarrhoea is a diagnosis of exclusion when all other diseases have been excluded. It is... - [Constipation](https://paediatricgastroenterologist.co.uk/gut-problems/constipation-and-hirschsprung-s-disease/): Gut Problems Gut Investigation Normal bowel patterns are very variable in children of all age groups. Weaver and Steiner have... - [Infant colic](https://paediatricgastroenterologist.co.uk/gut-problems/infant-colic/): Gut Problems Gut Investigation This is a term used primarily to describe the discomfort felt by an infant and the... - [Ulcerative Colitis](https://paediatricgastroenterologist.co.uk/gut-problems/ulcerative-colitis/): Gut Problems Gut Investigation Please see the Crohn’s disease section. Ulcerative colitis usually presents with diarrhoea, abdominal discomfort and blood... - [Crohn’s disease](https://paediatricgastroenterologist.co.uk/gut-problems/crohns-disease/): Gut Problems Gut Investigation Crohn’s disease is a condition named after a doctor, who first described this and it is... - [Crohn’s disease, Ulcerative Colitis (Inflammatory Bowel Disease)](https://paediatricgastroenterologist.co.uk/gut-problems/inflammatory-bowel-disease/): Gut Problems Treatment is usually initially getting the condition under control with steroids such as Prednisolone followed by and in... - [Ulcers, gastritis and helicobacter pylori](https://paediatricgastroenterologist.co.uk/gut-problems/ulcers-gastritis/): Gut Problems Gut Investigation It is estimated that 50% of the developing world population are infected with this organism in... - [Eosinophilic oesophagitis](https://paediatricgastroenterologist.co.uk/gut-problems/eosinophilic-oesophagitis/): Gut Problems Gut Investigation Eosinophilic oesophagitis is a newer condition which has arisen in the last 15-20 years and is... - [Lactose intolerance](https://paediatricgastroenterologist.co.uk/gut-problems/lactose-intolerance/): Gut Problems Gut Investigation This is an absence of the enzyme lactase and is common in people from Mediterranean origin... - [Anal fissures](https://paediatricgastroenterologist.co.uk/gut-problems/anal-fissures/): Gut Problems Gut Investigation These are usually due to a child passing a hard bowel motion at some point and... - [Feeding disorders](https://paediatricgastroenterologist.co.uk/gut-problems/feeding-disorders/): Gut Problems Gut Investigation Feeding disorders are complex and do cause a lot of concern among parents. If they are... - [Nutritional problems](https://paediatricgastroenterologist.co.uk/gut-problems/nutritional-problems/): Gut Problems Gut Investigation For any straight forward nutritional issues please see an excellent text: The Food Doctor for Babies... - [Barium Meal and Follow Through](https://paediatricgastroenterologist.co.uk/gut-investigations/barium-meal/): Gut Investigations Gut Investigation Barium is a substance that shows up on x-ray and a barium meal is when your... - [Isotope white cell inflammatory scan](https://paediatricgastroenterologist.co.uk/gut-investigations/isotope-white-cell-inflammatory-scan/): Gut Investigations Gut Investigation This is now something that is rarely done but it has been used in the past... - [Upper GI endoscopy](https://paediatricgastroenterologist.co.uk/gut-investigations/upper-gi-endoscopy/): Gut Investigations Gut Investigation This is a way of looking at the oesophagus, stomach and duodenum and first part of... - [Barium Swallow](https://paediatricgastroenterologist.co.uk/gut-investigations/barium-swallow/): Gut Investigations Gut Investigation A barium swallow is a test which is done to look at the oesophagus, not for... - [Liver biopsy](https://paediatricgastroenterologist.co.uk/gut-investigations/liver-biopsy/): Gut Investigations Gut Investigation This is not usually needed unless there is a problem with the liver and in this... - [Wireless “Bravo” pH study](https://paediatricgastroenterologist.co.uk/gut-investigations/wireless-bravo-ph-study/): Gut Investigations Gut Investigation This is a new device which is very helpful because it is a small clip that... - [Colonoscopy](https://paediatricgastroenterologist.co.uk/gut-investigations/colonoscopy/): Gut Investigations Gut Investigation This is a simple test used to detect the presence of a number of diseases in... - [Common gut related blood tests](https://paediatricgastroenterologist.co.uk/gut-investigations/gut-related-blood-tests/): Gut Investigations Gut Investigation There are many different ways of looking at nutrition via blood tests such as iron levels,... - [Wireless capsule endoscopy](https://paediatricgastroenterologist.co.uk/gut-investigations/wireless-capsule-endoscopy/): Gut Investigations Gut Investigation This is a technique which allows us to look at the lining of the bowel between... - [Gut Problems](https://paediatricgastroenterologist.co.uk/gut-problems/): Children can experience a wide range of gut problems, from common issues like constipation and reflux to more complex conditions... - [Allergic gut problems](https://paediatricgastroenterologist.co.uk/gut-problems/allergic-gut-problems/): Gut Problems Gut Investigation These will manifest as problems with the movement of the gut, ie conditions such as allergic... - [Faltering growth](https://paediatricgastroenterologist.co.uk/gut-problems/faltering-growth/): Gut Problems Gut Investigation Failure to thrive is a term which is now a little outdated and the new term... - [Liver Disease](https://paediatricgastroenterologist.co.uk/gut-problems/liver-disease/): Gut Problems Gut Investigation Common liver problems in children in the UK usually are associated with viral infections and involve... - [Abdominal CT Scan](https://paediatricgastroenterologist.co.uk/gut-investigations/abdominal-ct-scan/): Gut Investigations Gut Investigation A CT scan is a sophisticated x-ray which involves older children lying still in a machine... - [Cranial MRI Scan](https://paediatricgastroenterologist.co.uk/gut-investigations/cranial-mri-scan/): Gut Investigations Gut Investigation This is particularly helpful for looking at the structures inside the head and particularly for the... - [Pancreatic function studies](https://paediatricgastroenterologist.co.uk/gut-investigations/pancreatic-function-studies/): Gut Investigations Gut Investigation The easiest way to test for normal pancreatic function is by a sample of stool but... - [Abdominal MRI Scan](https://paediatricgastroenterologist.co.uk/gut-investigations/abdominal-mri-scan/): Gut Investigations Gut Investigation An MRI scan is an excellent way of looking at the structures, not the function, of... - [ERCP & MRCP](https://paediatricgastroenterologist.co.uk/gut-investigations/ercp-mrcp/): Gut Investigations Gut Investigation The full name of this is endoscopic retrograde cholangio pancreaticography which is a way of looking... - [Per-cutaneous gastrostomy](https://paediatricgastroenterologist.co.uk/gut-investigations/per-cutaneous-gastrostomy/): Gut Investigations Gut Investigation This is a technique by which a small tube is passed via endoscopy straight through the... - [Abdominal Ultrasound](https://paediatricgastroenterologist.co.uk/gut-investigations/abdominal-ultrasound/): Gut Investigations Gut Investigation An ultrasound is something that happens regularly and frequently and does not involve radiation. It can... - [Faecal analysis](https://paediatricgastroenterologist.co.uk/gut-investigations/faecal-analysis/): Gut Investigations Gut Investigation Faeces can be looked at for bacteria, viruses, the presence of parasites but all these are... - [pH and pH/Impedance Studies](https://paediatricgastroenterologist.co.uk/gut-investigations/ph-acid-studies/): Gut Investigations Gut Investigation pH Study This is the way to look at the amount of acid entering the lower... - [Abdominal Xray](https://paediatricgastroenterologist.co.uk/gut-investigations/abdominal-xray/): Gut Investigations Gut Investigation An abdominal xray is very helpful to look for abnormalities such as significant and severe constipation.... - [Hydrogen Breath Tests](https://paediatricgastroenterologist.co.uk/gut-investigations/hydrogen-breath-tests/): Gut Investigations Gut Investigation These will require your child to be present at the Outpatient Department for a period of... - [Small bowel biopsy](https://paediatricgastroenterologist.co.uk/gut-investigations/small-bowel-biopsy/): Gut Investigations Gut Investigation A small bowel biopsy is particularly helpful when taken at endoscopy to exclude conditions such as... - [Gut Investigations](https://paediatricgastroenterologist.co.uk/gut-investigations/): At our clinics in London and Sheffield, we offer a comprehensive range of gut investigations for children, helping to diagnose... - [Practical Advice before Endoscopic Procedures](https://paediatricgastroenterologist.co.uk/gut-investigations/bowel-prep/): Gut Investigations Gut Investigation Bowel PrepThis is the term used to encompass the technique to clean the large bowel of... - [Cranial CT scan](https://paediatricgastroenterologist.co.uk/gut-investigations/cranial-ct-scan/): Gut Investigations Gut Investigation A cranial CT scan involves in a younger child an anaesthetic, and usually is performed in... - [Oesophageal motility and manometry studies](https://paediatricgastroenterologist.co.uk/gut-investigations/manometry-studies/): Gut Investigations Gut Investigation These are a way at looking at the movement of the oesophagus and pressure waves set... - [Data Protection Policy](https://paediatricgastroenterologist.co.uk/data-protection/data-protection-policy/): Meet Professor Thomson... Introduction The Information Commissioner’s Office (ICO) requires a clear direction on policy for security of information held... - [Privacy Policy](https://paediatricgastroenterologist.co.uk/data-protection/privacy-policy/): Patient Privacy Notice Executive summary As your child’s treating clinician and therefore custodian of personal information relating to your medical... - [About](https://paediatricgastroenterologist.co.uk/about/): About Prof Mike Thomson Professor Mike Thomson Consultant Paediatric Gastroenterologist and Interventional Endoscopist – Honorary Reader in Paediatric Gastroenterology. Professor... - [News](https://paediatricgastroenterologist.co.uk/news/) - [Contact](https://paediatricgastroenterologist.co.uk/contact/): How to find us Paeds Gastro UK Ltd The Portland Hospital Consulting Suite234 Great Portland StreetLondon W1W 5QTView on larger... - [Data Protection](https://paediatricgastroenterologist.co.uk/data-protection/): Data Protection Policy Privacy Policy - [Home](https://paediatricgastroenterologist.co.uk/): Professor Thomson – Consultant Paediatric Gastroenterologist in London Specialist in Children’s Gastrointestinal, Liver & Endoscopic Care READ MORE ABOUT PROFESSOR... --- ## Posts - [Prof Mike Thomson's 30th Anniversary](https://paediatricgastroenterologist.co.uk/blog/prof-mike-thomsons-30th-anniversary/): This month marks 30 years since I have worked at the Portland Hospital in Private Paediatric Gastroenterology, looking after all... - [Things That Summer Can Bring to Children From the GI Perspective!](https://paediatricgastroenterologist.co.uk/gut-investigations/things-that-summer-can-bring-to-children-from-the-gi-perspective/): Hay fever season is particularly noted for worsening allergic conditions involving the oesophagus, defined as eosinophilic oesophagitis, which is a... - [Button Battery Dangers](https://paediatricgastroenterologist.co.uk/blog/button-battery-dangers/): Watch the video below on the dangers of button batteries and what to do if your child ingests one: - [Professor Thomson attends the European Annual Paediatric Gastroenterology Meeting in Helsinki](https://paediatricgastroenterologist.co.uk/blog/professor-thomson-attends-the-european-annual-paediatric-gastroenterology-meeting-in-helsinki/): May was highlighted by Professor Thomson attending the European Annual Paediatric Gastroenterology Meeting in Helsinki, where he was stepping down... - [Professor Thomson is lecturing at the Annual European Meeting in Helsinki](https://paediatricgastroenterologist.co.uk/blog/professor-thomson-is-lecturing-at-the-annual-european-meeting-in-helsinki/): Professor Thomson is lecturing at the Annual European Meeting in Helsinki at the beginning of May on a development which... - [Interview with Prof Thomson](https://paediatricgastroenterologist.co.uk/blog/interview-prof-thomson/): Listen to the following ESPGHAN Spotify Podcast link where Prof Thomson discusses interventional endoscopy with Dr. Alex Knisely. https://open. spotify.... - [Button batteries are life threatening when swallowed by toddlers and young children](https://paediatricgastroenterologist.co.uk/blog/button-batteries-are-life-threatening-when-swallowed-toddler/): Button batteries are life threatening when swallowed by toddlers and young children – contact medical help immediately and go to... - [Professor Mike Thomson Facebook Question and Answer session](https://paediatricgastroenterologist.co.uk/blog/professor-mike-thomson-facebook-question-and-answer-session/): Professor Mike Thomson took part in a Live Facebook Question and Answer session in association with London Medical Concierge. Watch... - [The Need for Endoscopy in Children](https://paediatricgastroenterologist.co.uk/blog/need-endoscopy-children/): I have just published an article in Nature reviews of gastroenterology and hepatology which examines the need for endoscopy in... - [Gastroenteritis and associated problems](https://paediatricgastroenterologist.co.uk/blog/gastroenteritis-and-associated-problems/): Quite often we see gastroenteritis which then leads to a child’s gut being sensitised to various proteins such as cow’s... - [Dr Mike Thomson is now a Professor](https://paediatricgastroenterologist.co.uk/blog/dr-mike-thomson-now-professor/): My Professorship in Paediatric Gastroenterology is a very great honour. This doesn’t change the way I practice medicine but is... - [Managing constipation](https://paediatricgastroenterologist.co.uk/blog/managing-constipation/): Afzal NA – Clinical Research Fellow & Honorary Specialist Registrar in Paediatric Gastroenterology University College of London, Royal Free &... - [Gastro-oesophageal reflux](https://paediatricgastroenterologist.co.uk/blog/gastro-oesophageal-reflux/): Article written by Mr Thompson Introduction: Gastro-oesophageal reflux (GOR) is a symptom not a disease and refers to the involuntary... - [Recurrent abdominal pain](https://paediatricgastroenterologist.co.uk/blog/recurrent-abdominal-pain/): Chronic or recurrent abdominal pain (RAP) is one of the most commonly encountered events in childhood interfering in the normal... --- # # Detailed Content ## Pages Gut Investigations Gut Investigation These would involve your child eating a small amount of radiolabelled meal such as scrambled egg or drinking a small amount of radiolabelled fluid. Then a special detector called a Gamma camera would be placed over the abdomen for periods every half an hour or hour for around 3 hours until the isotopic trace has left the stomach. This is a non-invasive and accurate way to determine whether the stomach is emptying into the small bowel and the amount of Xray is minimal, similar to that which is encountered with standard x-ray procedures. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH reflux study Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless capsule endoscopy Meckel's diverticulum isotope scan --- Gut Investigations Gut Investigation This involves injection of a radio-isotope into a vein which then collects in particular tissues containing gastric lining acid producing cells. In a Meckel's diverticulum which is a remnant of the embryological development which is an out-pouching of the small bowel and present in 2% of the population, this can have an ulcer present in it because of gastric tissue which is not normally there producing acid. This will be highlighted as a hot spot on a special type of x-ray after injection of this radio-isotope. It requires a morning being set aside but no anaesthetic is necessary and it is like a simple x-ray, albeit it with an injection. The problem with Meckel's Diverticulum scan is that it is not particularly sensitive or reliable. These have generally been superseded by a wireless capsule endoscopy. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless capsule endoscopy Meckel's diverticulum isotope scan --- Nutrition About your visit Please see the videos below which should answer most of your questions. Once you have spoken to our excellent Practice Team, Kate, Justine or Stacy and organised a time for the outpatient clinic appointment, please arrive approximately 10-15 minutes beforehand so that your child can have weight and height performed by the nursing staff and we can fill out the necessary paperwork. We will endeavour to see you on time and you will then have as much time as you require to answer all the questions and to have the evaluation of the problem fully sorted with a plan in place. If there are any investigations, generally these will be done on the same day, and I would direct you to our investigation page of this website. Equally, if there are any other people that I need you to see, such as Dietitians or Speech & Language Feeding Therapists or Psychologists, then these will be arranged to occur as quickly as possible but probably on a separate day. Any inpatient or day case admissions for endoscopy would be organised by Kate and she is well versed in all the logistical arrangements. She will be able to help you with any questions you might have regarding insurance companies etc. The vast majority of admissions are as day case procedures and these would be electively planned around your schedules. Endoscopies occur on Mondays and some Tuesday evenings and any bowel preparation would be prescribed in the outpatient clinic.... --- About Mike Thomson Curriculum Vitae D. O. B - 30. 6. 1962 Married, 3 daughters Qualifications MB ChB - 1985 MRCP(Paeds) - September 1990 DCH - October 1987 FRCPCH - July 1997 MD - October 1999 FRCP - June 2002 Undergraduate Medical Education & Qualifications Medical SchoolAberdeen University Medical School - 1980-1985 Physiology merit - 1980 Anatomy merit - 1981 Present Consultant Post May 2004-ongoing Consultant Paediatric Gastroenterologist and Interventional Endoscopist Centre for Paediatric Gastroenterology Sheffield Children's Hospital NHS Foundation Trust Honorary Reader in Paediatric Gastroenterology Sheffield University Medical School Download full CV BOOK AN APPOINTMENT --- About Mike Thomson Positions Held Professor Mike Thomson has help a number of positions over the years. Below is a comprehensive list. Representative of BSPGHN on the Information Technology Committee of the British Society of Gastroenterology. Representative of BSPGHN on Joint Advisory Group on Training in Endoscopy. Member of BSPGHN sub-committee for BSG. Paediatric Representative on BSG Endoscopy Committee. Chairman of British Paediatric Endoscopy Steering Committee. BSPGHN representative on FISPGHAN World Congress Working Group on Advances in Paediatric Endoscopy and Other Diagnostic Tests. Co-opted Council Member of BSPGHN. Elect for gastroenterology representative on Childhood Specialist Advisory Committee for Higher Specialist Training for Royal College of Paediatrics and Child Health. Member of the Gastroenterology Council of ESPGHAN from 2005. Editorial Board Member of Journal of Pediatric Gastroenterology and Nutrition from 2005. Member of the European Working Group on gastro-oesophageal reflux. Member of the European Working Group on gastrointestinal motility. Secretary and Coordinator of the European Working Group on Paediatric Endoscopy. Course Director of European Summer School on Paediatric Endoscopy, 2007. Representative of CAPGAN on World Congress of Paediatric Gastroenterology Endoscopy Steering Committee. Executive Advisory Council Member of International Intraluminal Impedance in Children Working Group. Previous Secretary of Royal Society of Medicine for Paediatrics, remain as Council Member. Council-Elect of Harveian Society, now resigned. Previous country co-ordinator for Zambia of children's charity Child Advocacy International. External examiner for Paediatrics in Zambia. BOOK AN APPOINTMENT --- Nutrition Peer-Reviewed Original Publications 1. The effect of dexamethasone therapy on the pattern and incidence of infection in pre-term babies - a prospective controlled study. Ng F,Thomson M,Dear P. Archives of Disease in Childhood. Jan 1990. 2. Canine-human transmission of Gastrospirillum hominis. MA Thomson, P Storey, R Greer, Cleghorn GJ. Short report. The Lancet. 1994;343:1605-07. 3. Canine-human transmission of Gastrospirillum hominis. MA Thomson, P Storey, R Greer, Cleghorn GJ. The Lancet. 1994;344:1097-98. 4. Persistent wheezing and gastroesophageal reflux in infants. Eid N, Shepherd RW, Thomson MA. Pediatric Pulmonology. 1994; 18:39-44. 5. Measured vs predicted resting energy expenditure in infants: a need for reappraisal. Thomson M, Bucolo S, Quirk P, Shepherd RW. Journal of Pediatrics. 1995; 126:21-7. 6. Nutritional growth retardation is associated with defective lung growth in cystic fibrosis: a preventable determinant of progressive pulmonary dysfunction. MA Thomson , P Quirk, CE Swanson, BJ Thomas, PJ Francis, RW Shepherd. Nutrition. 1995; 11(4):1-5. 7. Control of group C meningococcal disease in Australian Aboriginal children by mass rifampicin chemoprophylaxis and vaccination. MC Pearce, JW Sheridan, DM Jones, GW Lawrence, DM Murphy, B Masutti, C McCosker, V Douglas, D George, A O'Keefe, M Thomson, B Gorman, D Hansman, PS Hill. The Lancet. 1995(July); 346:20-23. 8. The economic cost of traveller's diarrhoea. (Lead article). Thomson MA, Booth IW. Pharmacoeconomics. 1996;9(5):382-91. 9. Resting energy expenditure, pulmonary inflammation, and genotype in the early course of cystic fibrosis. MA Thomson, RW Wilmott, C Wainwright, B Masters, PJ Francis, RW Shepherd. Journal of Pediatrics. 1996;129:367-73. 10. Ileal lymphoid... --- Nutrition Books "Concise Paediatrics. " pp1-546. Sidwell R and Thomson M. Greenwich Medical Media, Nov 2000. "Q-Base. Paediatric MCQs" Thomson M and Sidwell R. Greenwich Medical Media, 2001. "MCQs for MRCP and DCH 2005" Sidwell R and Thomson M. "Endoscopy in children" Murphy M, Cadranel S, Mougenot J-F, and Winter H. (Associate Editor Thomson M). 2006. "Q-Base. Paediatric MCQs" Thomson M and Sidwell R. Cambridge Medical Press, 2008. "Concise Paediatrics. " pp1-583. Second Edition. Sidwell R and Thomson M. Greenwich Medical Media, 2009. "Easy Paediatrics" Sidwell R and Thomson M. Royal Society of Medicine Press, 2011. "Practical Pediatric Gastrointestinal Endoscopy" Gershman G and Thomson M. Wiley-Blackwell, 2012. "Disorders of the Esophagus and Stomach in Childhood" Thomson M, Khan K, Holger T, Foker J. BC Decker, 2012. Chapters "Disorders of the oesophagus and stomach in infants. " Chapter 2 in Bailliere's "Clinical Gastroenterology". 1997;11(3):547-72. Ed: J. A. Walker-Smith. "Dyspepsia in childhood. " for Bailliere's "Clinical Gastroenterology". 1998. 12(4) . "The Liver in Intensive Care. " N F Shah, M A Thomson. In: "A Manual of Paediatric Intensive Care". First Edition. Ed: Henderson and Fleming. Publishers: Edward-Arnold. 1999. "Esophagitis" for 3rd Edition of Pediatric Gastrointestinal Diseases. Ed Walker, Durie, Hamilton, Walker-Smith. Mosby. 2000. "Gastroenterology" in "Concise Paediatrics. " Sidwell R and Thomson M. Greenwich Medical Media, 2000. "Hepatology" in "Concise Paediatrics. " Sidwell R and Thomson M. Greenwich Medical Media, 2000. "Colonoscopy and Enteroscopy in Pediatrics" in "Endoscopy Clinics of North America" Ed V Fox. Saunders. 2001. "Diverticular Disease in the Young... --- Nutrition Types of milks commonly used in Paediatric GI practice As a guide formulas are reconstituted 1 fluid oz water plus 1 scoop of powder. 3 fluid oz of water plus 3 scoops = approximately 90mls. Specialised Formulas Lactose intolerance - Enfamil Lactofree, SMA LF, Glucose polymer, Galactomin17 (also for Galactosaemia) and Galactomin19 also Extensively hydrolysed formulas - Nutramigen, Pepti-junior, Pregestamil, Peptite, MCP Peptite and Althera Elemental Feeds - Neocate, Alfamino, Puramino Soya Feeds (not recommended for cow's milk protein intolerance) - Infasoy, SMA Wysoy, Isomil, Prosobee, Farley's soya formula, Fat malabsorbtion, liver disease, pancreatic dysfunction - Caprilon, Multiple malabsorption short bowel syndrome - modular feed Normal milks Breast feeding is the ideal in all circumstances but changes in maternal diet may be required in circumstances of cow's milk protein and also protein intolerance in the infant because small amounts of whatever the mother eats finds its way into breast milk. Weaning is now proposed at 4 months of age, rather than previously at 6 months of age exclusive breast feeding. Normal formulas are not dealt with in this section as they are not therapeutic for any particular reason and are merely constituted to create as close to as possible breast feeding. Certain older children will require a special diet, such as those with Crohn's disease in which case we may use exclusively with no food for 8 weeks followed by a graded reintroduction with a Paediatric Dietitian. The preparation such as Modulen IBD (Nestle) which is a casein whole... --- Nutrition Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nulla massa lacus, vehicula eu interdum convallis, laoreet id lectus. Nunc turpis elit, aliquam sit amet aliquam tincidunt, dapibus vel tellus. BOOK AN APPOINTMENT --- Common Drugs Drugs used in constipation Docusate sodium Kleen Prep Lactulose Liquid Paraffin Movicol (also called Laxido and Cosmocol and in other countries Macrogol) Picolax Senna (Senokot) Sodium Picosulphate BOOK AN APPOINTMENT --- Drugs used in constipation Gut Investigation Stimulant laxative and faecal softner. Indication: To prevent and treat chronic constipation. Formulation: Capsule 100mg Paediatric solution 12. 5mg/5ml, Adult solution 50mg/5ml Dose: 2. 5mg/kg tds Or < 1 year 12. 5mg (bd - tds) 1 - 4 years: 12. 5mg - 25mg (bd - tds) 5 - 12 years: 25 - 50mg (bd-tds) Max 200mg daily Counselling: Using milk or orange squash can mask the bitter flavour. Contra-Indications: Capsules should not be taken in the presence of abdominal pain, nausea, vomiting or intestinal obstruction. Side effects: Anal or rectal burning and pain, diarrhoea and rash. Interactions: Should not be used concurrently with mineral oil. Anthraquinone derivatives (e. g. senna) should be taken in reduced doses if administered with docusate sodium as their absorption is increased. Notes: Acts within 1 to 2 days. BOOK AN APPOINTMENT Drugs used in constipation Docusate sodium Kleen Prep Lactulose Liquid Paraffin Movicol Picolax Senna Sodium Picosulphate --- Drugs used in constipation Gut Investigation Stimulant laxative and faecal softner. Formulation: Oral powder Dose: Add contents of 1 sachet to 1 litre of water. Then 10ml/kg/hr for 30min then 20ml/kg/hr for 30min. If tolerated , increase to 25ml/kg/hr. Maximum volume is 100ml/kg or 4000ml (whichever is smaller) over 4 hours. Side effects: Nausea, abdominal fullness, bloating, abdominal cramps and anal irritation. Fluid overload or dehydration may occur. Electrolyte disturbance and hypoglycaemia (see notes) Urticaria and allergic reactions occur rarely. Interactions: Any medication given within one hour of administration of klean prep maybe flushed from the GI tract and not absorbed. Contra-Indications: GI obstruction or perforation, ileus, gastric retention, acute gastritis or intestinal ulceration, toxic colitis or megacolon. Caution in patients with impaired gag reflex or those with gastro-oesphageal relux. Caution in patients --- Drugs used in constipation Gut Investigation A semi synthetic disaccharide that is not absorbed from the gastrointestinal tract. Indication: Treatment of constipation Formulation: Syrup Dose: 1ml/kg BD (max 45ml BD) titrate to effect Counselling: Syrup can be taken with water or other drinks Contra-Indications: Galactosaemia where there is evidence of gastrointestinal obstruction. Side effects: Flatulence may occur but this disappears within a couple of days and diarrhoea may occur when using higher doses. Notes: May take up to 48 hours to work. Licensing status: Licensed for all ages. BOOK AN APPOINTMENT Drugs used in constipation Docusate sodium Kleen Prep Lactulose Liquid Paraffin Movicol Picolax Senna Sodium Picosulphate --- Drugs used in constipation Gut Investigation Faecal softner Indication: Treatment of constipation Formulation: Oral emulsion Dose: 0. 5ml/kg BD (TITRATE TO EFFECT) Counselling: Take at night but not immediately before going to bed. Contra-Indications: Nausea, vomiting and when abdominal pain is present. Side effects: Anal seepage and irritation may occur upon prolonged usage. Aspiration pneumonia Interactions: None Notes: May interfere with the absorption of fat soluble vitamins, though there is no evidence that it interferes with the absorption of fat soluble vitamin. BOOK AN APPOINTMENT Drugs used in constipation Docusate sodium Kleen Prep Lactulose Liquid Paraffin Movicol Picolax Senna Sodium Picosulphate --- Drugs used in constipation Gut Investigation Treatment of chronic constipation Bowel prep prior to colonoscopy. Formulation: Powder for oral solution Dose: Bowel prep < 10 years or < 35kg 1/2 sachet every 3 hours for 2 doses and then review > 10 years or >35kg 1 sachet every 3 hours for 2 doses and then review. For weekend therapy Currently there is no information regarding this. Paediatric gastroenterology are currently studying this. A general rule is 8 years 1 sachet sat/sun Counselling: Side effects: Abdominal distension and pain, nausea and fluid/electrolyte shifts. Contra-Indications: Intestinal perforation or obstruction due to structural or functional disorder of the gut wall, ileus, SEVERE inflammatory conditions of the intestinal tract such as Crohn's disease and ulcerative colitis (seek senior advice) and toxic megacolon. Interactions: No clinical interactions have been reported. Notes: Has an advantage over Klean-Prep in that less volume is required for administration. Each sachet should be dissolved in 125ml of water. The content of electrolyte ions per sachet when made up to 125ml of solution is as follows: Na+ 8mmol, K+ 0. 68mmol, Cl- 6. 6mmol and bicarbonate 2mmol. Licensing Status: Not licensed in children under 12 years of age. Website: movicol. co. uk BOOK AN APPOINTMENT Drugs used in constipation Docusate sodium Kleen Prep Lactulose Liquid Paraffin Movicol Picolax Senna Sodium Picosulphate --- Drugs used in constipation Gut Investigation Clearance of bowel prior to examinationby colonoscopy Weekend therapy for patients with chronic constipation Formulation: Oral powder. Active ingredients are sodium picosulphate 10mg with magnesium citrate formed in solution. Dose: < 1 year: None 1 - 4 years: 1/4 sachet 4 - 6 years: 1/2 sachet over 6 years: 1 sachet Counselling: Explain preparation of liquid Side effects: Griping pains may occur. Contra-Indications: Patients with undiagnosed abdominal pain or where intestinal obstruction is suspected. Interactions: Sodium picosulphate increases the rate of gastrointestinal transit and absorption of other oral medication may require modification during the treatment period. Notes: Provide dosage sheet. Low residue diet recommended for 2 days prior to administration. Liberal intake of clear fluids during treatment. Frequent bowel movements 3 hours after the first dose. Licensing status: Licensed in children of 1 year or above BOOK AN APPOINTMENT Drugs used in constipation Docusate sodium Kleen Prep Lactulose Liquid Paraffin Movicol Picolax Senna Sodium Picosulphate --- Drugs used in constipation Gut Investigation Treatment of constipation Bowel prep prior to colonoscopy Formulation: Tablets 7. 5mg/tablet as total sennoside Liquid 7. 5mg/5ml as total sennoside Dose: 1ml/kg (maximum 60ml daily) 1 to 2 tablets at night for children over 6 years of age. Counselling: Dose can be taken in the morning if necessary. Side effects: Griping pains Interactions: None reported. Notes: Liquid contains 3. 3g of sucrose in 5ml and 7%v/v alcohol. Licensing status: Syrup is licensed for children or children 2 years and above Tablets not recommended for children under 6 years of age. BOOK AN APPOINTMENT Drugs used in constipation Docusate sodium Kleen Prep Lactulose Liquid Paraffin Movicol Picolax Senna Sodium Picosulphate --- Drugs used in constipation Gut Investigation Stimulant Laxative Indication: Treatment of acute or chronic constipation Bowel clearance prior to colonoscopy Formulation: Liquid 5mg/5ml Dose: 2 - 5 years: 2. 5 - 5ml daily 5 - 10 years: 5 - 10ml daily >10 years: 10 - 15ml daily Counselling: Give doses at night if possible. Contra-Indication: Undiagnosed abdominal pain or suspected / proven intestinal obstruction. Side effects: Mild abdominal discomfort Interactions: Sodium picosulphate is broken down by bacteria in the large intestine so it is possible that patients taking broad spectrum antibiotics may experience some loss of laxative action. Notes: Onset of action is normally 10 to 14 hours after administration. Licensing status: Licensed for children over 2 years of age. BOOK AN APPOINTMENT Drugs used in constipation Docusate sodium Kleen Prep Lactulose Liquid Paraffin Movicol Picolax Senna Sodium Picosulphate --- Common Drugs Drug therapy of gastro-oesphageal reflux Gastro-oesphageal reflux disease (GORD) occurs due to the inappropriate relaxation of the lower oesophageal sphincter. This permits the contents of the stomach to pass into the oesphagus. Reflux may lead to oesphagitis which while disrupting oesphageal motility, can reduce sphincter tone further, thus leading to a worsening of reflux. Depending upon the severity of symptoms, the presence of complications and any associated illness, the active drug treatment of GORD generally begins after milk thickening agents and feeding advice have failed. Thickening agents for milk such as Carobel or Magic Mix may be helpful. Gaviscon can be helpful in simple reflux without complications. Pro-kinetic agents are generally not helpful, medications such as Domperidone have been proven to be particularly helpful. Proton pump inhibitors are sometimes introduced to patients who have severe disease in order to reduce gastric acid secretion. View more information on each drug Domperidone   PPI treatment Expand PPI therapy involves drugs such as Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole and Rabeprazole. In infants Omeprazole comes in liquid form which is easier to administer, especially before solid food weaning. Lansoprazole comes in an orodispersible form that melts in the mouth which can be helpful in certain circumstances. Esomeprazole can come in a sachet form for younger infants. All medications also come in dispersible form and tablet form for older children. Professor Thomson will determine what dose of medication your child will require and this can be anywhere from 0. 7mg/kg to 3. 5mg/kg per... --- Drugs used in constipation Gut Investigation Used in some situations but its clinical evidence base is poor. Indication: Treatemnt of GORD Formulation: Suspension 1mg/ml Tablet 10mg Suppository 30mg Dose: Oral 0. 2-0. 4mg/kg tds - qds (can increase to 0. 6mg/kg tds - qds) Rectal 1mg/kg (max tds) round to nearest possible dose Side-effects: Rash, extra pyramidal effects Interactions: Opiates decrease the effect of domperidone Antimuscarinics decrease the effect of domperidone Notes: Extra-pyramidalside effects may occur such as jerking or abnormal movements. BOOK AN APPOINTMENT Drug therapy of gastro-oesphageal reflux Domperidone Metoclopramide Omeprazole Ranitidine Sucralfate --- Drugs used to treat GORD Gut Investigation Anti emetic use only. Indication: Anti emetic use only. Formulations: Solution 1mg/ml Tablets 10mg Dose: 0. 1-0. 2mg/kg 6-8 hrly. Side effects: Increased gastric motility, extrapyramidal side effects, drowsiness and restlessness. Interactions: Increased effects of paracetamol Opiates and antimuscarinics decrease the effects of metoclopramide Increased risk of extrapyramidal effects with tetrabenazine. BOOK AN APPOINTMENT Drug therapy of gastro-oesphageal reflux Domperidone Metoclopramide Omeprazole Ranitidine Sucralfate --- Drugs used to treat GORD Gut Investigation Proton pump inhibitor Reduces gastric acid secretion Indication: Proton pump inhibitor Reduces gastric acid secretion Formulation: Dispersible tablet 10mg, 20mg Injection 40mg (named patient) Suspension 2mg/ml (special in 8. 4% sodium bicarbonate with a 30 day expiry if stored in the fridge) Dose: 0. 7-1. 4mg/kg (max 40mg) od to bd May increase to 3. 5mg/kg daily Twice daily dosing maybe more effective in some patients. 6yrs: 20mg od RFH may use quite aggressive doses in order to suppress acid secretion Side-effects: Rash, alopecia, diarrhoea, headache, nausea, constipation, flatulence and dizziness. Interactions: Warfarin, phenytoin and diazepam will have increased levels. Decreased levels seen in ketoconazole. BOOK AN APPOINTMENT Drug therapy of gastro-oesphageal reflux Domperidone Metoclopramide Omeprazole Ranitidine Sucralfate --- Drugs used to treat GORD Gut Investigation Reduces gastric acid secretion Indication: Reduces gastric acid secretion Formulations: Tablets 150mg, 300mg Dispersible tabs 150mg Syrup 15mg/ml Injection 50mg/2ml Dose: Oral 8 yrs 150mg bd Side-effects: Headache, rash, altered bowel habits and LFT changes. Interactions: None Notes: Liquid contains very tiny amounts of alcohol BOOK AN APPOINTMENT Drug therapy of gastro-oesphageal reflux Domperidone Metoclopramide Omeprazole Ranitidine Sucralfate --- Drugs used to treat GORD Gut Investigation Prophylaxis of stress ulceration Indication: Prophylaxis of stress ulceration Formulation: Suspension 1g/5ml Tablets 1g Dose: 0-2yrs 250mg 4-6hrly 3-12yrs 500mg 4-6hrly >12yrs 1g 4-6hrly Side-effects: Constipation, diarrhoea, nausea, indigestion, dry mouth, rash and dizziness Interactions: Decreased levels of tetracyclines, ciprofloxacin, phenytoin, cimetidine, digoxin, warfarin, thyroxine and ketoconazole. BOOK AN APPOINTMENT Drug therapy of gastro-oesphageal reflux Domperidone Metoclopramide Omeprazole Ranitidine Sucralfate --- Common Drugs Drugs used in paediatric inflammatory bowel disease Adalimumab Azathioprine Budesonide (Entocort CR) Infliximab Infusion Mesalazine (Asacol®) Mesalazine (Pentasa®) Methotrexate Olsalazine Prednisolone enemas Prednisolone Sulphasalazine   Other monoclonal antibody treatments Expand These include other medications when anti-TNF medications, such as Adalimumab and Infliximab fail and include Vedolizumab, Ustekinumab, Upadacitinib, and Risankizumab amongst others. Other Drugs used in Gastroenterology Expand Anti-diarrhoeal agents are not used commonly in children. Antibiotics can be used for gut infections and may include Ciprofloxacin and Metronidazole. Parasite treatments, Metronidazole can be used for Giardia, and sometimes Tinidazole if this fails. Worms and then put Standard Threadworms can be treated with Mebendazole, and the whole family should be treated at the same time as the first dose, and all sheets changed and then another dose should be given to the whole family 10 days later. If roundworms or tapeworms are suspected then other medications such as Albendazole or Invermectin may be used occasionally. Abdominal migraine can be treated with medications such as Sumatriptan or Zolmitriptan and if these are effective, prophylaxis with Propranolol or preferably Pizotifen. BOOK AN APPOINTMENT --- Drugs used in IBD Gut Investigation This is a human monochlonal antibody that is not likely to cause allergic reactions or tolerance as would Infliximab and is used as sub-cutaneous injection once every 2 weeks at a dose of 20-40mg. It can be uncomfortable and it is as effective as the 8 weekly infusions of Infliximab are. Both Infliximab and Adalimumab can be used for ulcerative colitis and Crohn's disease but NICE guidance is present only for Crohn's disease in children. BOOK AN APPOINTMENT Drugs used in paediatric inflammatory bowel disease Adalimumab Azathioprine Budesonide (Entocort CR) Cyclosporin Infliximab Infusion Mesalazine (Asacol®) Mesalazine (Pentasa®) Olsalazine Prednisolone enemas Prednisolone Sulphasalazine Methotrexate --- Drugs used in IBD Gut Investigation Indication: Immunosuppresive therapy in Ulcerative colitis or Crohns disease. Formulation: Injection 25mg Tablet 25mg, 50mg Dose: PO/IV 1-3mg/kg Dose between 2-3mg per kilogram is used, sometimes with initial 5 day intravenous duration. Manipulate oral dose to multiples of 25mg if possible to save handling broken or crushed tablets. Side-effects: Hypersensitivity, dizziness, fever, rigors, muscular pain, disturbed LFT's and hypotension. STOP DRUG Bone marrow suppression - dose related. FBC weekly for first eight weeks then decrease to monthly for 3 months and then to 3 monthly Interactions: Reduce dose of azathioprine by 25% if on concomittant allopurinol. Manufacturers report interaction with rifampacin. Notes: Thought that 5 day course of IV azathioprine will put patient into remission earlier than 4 to 6 weeks if course is started with oral medication. Infuse IV dose in dextrose/saline over 1-3 hours. Each patient on Azathioprine and their GP and, if appropriate Paediatrician, will receive an Azathioprine protocol sheet detailing side effects and investigations such as blood tests BOOK AN APPOINTMENT Drugs used in paediatric inflammatory bowel disease Adalimumab Azathioprine Budesonide (Entocort CR) Cyclosporin Infliximab Infusion Mesalazine (Asacol®) Mesalazine (Pentasa®) Olsalazine Prednisolone enemas Prednisolone Sulphasalazine Methotrexate --- Drugs used in IBD Gut Investigation Indication: Mild to moderate Crohns disease affecting the ileum or ascending colon. Formulation: Capsules 3mg EC Dose: 1-5 years 3mg OD 6-10 years 6mg OD >10 years 9mg OD Give for 8 weeks, reducing the dose over the last 2 weeks. Side effects: Rare but include the following; Dyspepsia, peptic ulceration, myopathy, osteoporosis, adrenal supression, hirsutism, weight gain, negative nitrogen and calcium balance, increased appetite, immunosupression, fluid and electrolyte disturbances. Interactions: Rare but include the following; NSAID's - increased risk of bleeding Carbamazepine, Phenobarbitone, Phenytoin - increased rate of metabolism of steroid. Cyclosporin - increased prednisolone levels with increased cyclosporin levels with high dose methylprednisolone. Diuretics - increased risk of hypokalaemia. Notes: The contents of the capsule may be emptied and swallowed whole. BOOK AN APPOINTMENT Drugs used in paediatric inflammatory bowel disease Adalimumab Azathioprine Budesonide (Entocort CR) Cyclosporin Infliximab Infusion Mesalazine (Asacol®) Mesalazine (Pentasa®) Olsalazine Prednisolone enemas Prednisolone Sulphasalazine Methotrexate --- Drugs used in IBD Gut Investigation Indication: Immunosuppressive therapy in Ulcerative colitis or Crohns disease. Formulations: Capsules 25mg, 50mg, 100mg Injection 50mg/ml Liquid 100mg/ml Enema (manufactured special) 50ml enema Dose: IV 1mg/kg BD adjust dosage according to levels Oral 2. 5mg/kg BD adjust dosage according to levels Rectal 5mg/kg of cyclosporin suspension (Neoral) in 50ml of suspending agent (the oral solution is added to the suspending agent prior to administration) Leave in for at least 60 mins OD or BD reducing frequency as necessary. Cyclosporin is absorbed so a level should be taken after 7 days Side-effects: Dose dependant increase in serum creatinine and urea. Fatigue, gingival hypertrophy, GI disturbances, burning sensation in hands and feet, tremor, headache, hypertension, weight increase, pancreatitis, dysmenorrhoea or amenorrhoea and neuropathy. Interactions: * Cyclosporin levels increased by concomittant administration of grapefruit juice, erythromycin, cimetidine, methylprednisolone, metoclopramide, tacrolimus (FK506), ketoconazole, itraconazole and fluconazole. * Cyclosporin levels decreased by concomittant administration of rifampicin, phenobarbitone, phenytoin, carbamazepine and heparin. * Nephrotoxicity is enhanced by concomittant administration of aminoglycosides, amphotericin, ciprofloxacin, diclofenac and frusemide. Notes: Cyclosporin injection contains polyethoxylated castor oil which has been associated with anaphylaxis. Observe patient for at least 30 minutes after starting infusion and at frequent intervals thereafter. Trough whole blood levels 100-150 microgram/L. Oral liquid should not be administered down NG tube nor mixed with grapefruit juice. Can be mixed with orange juice(or squash) or apple juice. Cyclosporin injection can be administered via a Y site with intralipid 10% or 20%. BOOK AN... --- Drugs used in IBD Gut Investigation Infliximab is a monoclonal antibody which is used in the treatment of moderately to severe Crohns for the reduction of signs and symptoms which have shown an inadequate response to conventional therapy. It is also indicated for the treatment of fistulising Crohns disease in the reduction of the number of draining enterocutaneous fistula(s). Infliximab acts by binding to and neutralising Tumour Necrosis Factor ( (TNF and so interrupts the inflammatory signalling pathways that are affected by this cytokine. Dosage and administration Patients with fistulising Crohns disease are prescribed infusions of 5mg/kg infliximab at 0, 2 and 6 weeks. The infliximab formulation does not contain a preservative and it is recommended that infliximab is administered to the patient immediately after reconstitution. The infusion should run for a minimum of 2 hours and a maximum of 3 hours. The treating doctor must be present for at least 10 minutes following the initiation of any infusion. Pre-medication The decision to pre-medicate is at the discretion of the medical staff. Consider chlorpheniramine, hydrocortisone and paracetamol. All prophylactic medication administered should be documented in the patients notes. Monitoring Blood Pressure Pulse Temperature Prior to infusion 4 4 4 Start infusion 30min 4 4 4 60min 4 4 4 90min 4 4 4 120 min 4 4 4 Stop infusion 30 min 4 4 4 60 min 4 4 4 90 min 4 4 4 120 min 4 4 4 Side-effects Flu like symptoms. Headache, hypotension, transient fever, chills. GI... --- Drugs used in IBD Gut Investigation Indication: Treatment of mild to moderate Ulcerative colitis and Crohns disease Site of action: Terminal ileum and proximal colon Formulations: - Tablets 400mg - Suppositories 250mg, 500mg Dose: - Acute 15mg/kg BD - or 10mg/kg TDS ( max 2. 4g as a total daily dose ) Doses will or should be adjusted to ensure ease of administration with the above formulations Side-effects: Nausea, vomiting, diarrhoea, abdominal pain, headache, exacerbation of colitis symptoms, rarely reversible pancreatitis, hepatitis and interstitial nephritis, bone marrow suppression, fibrosing alveolitis. Caution if salicylate hypersensitive Interactions: Lactulose may lower stool pH (? affecting release profile of Asacol) but this is not thought to be clinically significant. Notes: Indigestion remedies should not be taken at the same time. Tablets should be swallowed whole, never crushed. Tablets coated with a pH sensitive acrylic based resin. Patients should be advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during therapy. Blood count should be performed and therapy stopped immediately if there is a suspicion of a blood dyscrasia. BOOK AN APPOINTMENT Drugs used in paediatric inflammatory bowel disease Adalimumab Azathioprine Budesonide (Entocort CR) Cyclosporin Infliximab Infusion Mesalazine (Asacol®) Mesalazine (Pentasa®) Olsalazine Prednisolone enemas Prednisolone Sulphasalazine Methotrexate --- Drugs used in IBD Gut Investigation Indication: Treatment of mild to moderate Ulcerative colitis and Crohns disease Site of action: Duodenum, jejunum, ileum and colon. Formulations: Tablets 250mg, 500mg Enema 1g/100ml Suppositories 1g Dose: Acute 25mg/kg BD or 17mg/kg TDS ( max 3g-4g as total daily dose) Doses will be adjusted to ensure ease of administration with the above formulations Side-effects: Nausea, vomiting, diarrhoea, abdominal pain, headache, exacerbation of colitis symptoms, rarely reversible pancreatitis, hepatitis and interstitial nephritis, bone marrow suppression, fibrosing alveolitis. Caution if salicylate hypersensitive Interactions: None known Notes: Pentasa tablets disintegrate in the stomach to form coated slow release granules. Mesalazine is released from these granules at all the physiological pH values but is slower in the acidic conditions. Tablets can be dispersed in water but they should not be chewed. BOOK AN APPOINTMENT Drugs used in paediatric inflammatory bowel disease Adalimumab Azathioprine Budesonide (Entocort CR) Cyclosporin Infliximab Infusion Mesalazine (Asacol®) Mesalazine (Pentasa®) Olsalazine Prednisolone enemas Prednisolone Sulphasalazine Methotrexate --- Drugs used in IBD Gut Investigation Indication: Treatment of mild to moderate Ulcerative colitis and Crohns disease Site of action: Colon Olsalazine consists of two molecules of mesalazine bound together. Colonic bacteria cleave this bond to release mesalazine. Formulations: Capsules 250mg, 500mg Dose: Acute 20mg/kg BD or 13mg/kg TDS ( max 3g as a total daily dose ) Doses will be adjusted to ensure ease of administration with the above formulations Side-effects: Diarrhoea, arthralgia, rash and blood dyscrasias. Interactions: None known Notes: Gastrointestinal side-effects such as diarrhoea are the most commonest side-effects and these can be reduced if the dose is taken with meals. BOOK AN APPOINTMENT Drugs used in paediatric inflammatory bowel disease Adalimumab Azathioprine Budesonide (Entocort CR) Cyclosporin Infliximab Infusion Mesalazine (Asacol®) Mesalazine (Pentasa®) Olsalazine Prednisolone enemas Prednisolone Sulphasalazine Methotrexate --- Drugs used in IBD Gut Investigation Indication: Reduce inflammation in acute attacks of Crohns and Ulcerative colitis. Maintain remission of the above. Formulation: Predfoam (Foam enema 20mg - 14 applications) Predsol retention enema (20mg in 100ml - single nozzle application) Prednisolone soluble tablets 5mg Dissolve the dose in 20 to 50ml of water and administer rectally. (useful in pts with rectal stump - see below) Dose: Usually 10 to 20mg nocte or BD Side effects: Local irritation reported Interactions: None recorded Notes: Patients with a rectal stump will benefit from the use of the prednisolone soluble tablets rather than the high volume retention enema. Care must be taken with the nozzles in children. e. g. 1cm inserted for 1 to 2 years 2cm for 2 to 3 years Mesalazine enemas (Asacol) can also be effective for left sided distal colitic problems. BOOK AN APPOINTMENT Drugs used in paediatric inflammatory bowel disease Adalimumab Azathioprine Budesonide (Entocort CR) Cyclosporin Infliximab Infusion Mesalazine (Asacol®) Mesalazine (Pentasa®) Olsalazine Prednisolone enemas Prednisolone Sulphasalazine Methotrexate --- Drugs used in IBD Gut Investigation Indication: Reduce inflammation in acute attacks of Crohns and Ulcerative colitis. Maintain remission of the above. Formulations: Prednisolone Tabs 1mg, 5mg, 25mg Soluble 5mg Methylprednisolone succinate Inj 40mg, 125mg, 500mg, 1g Dose: Acute inflammation. Prednisolone 2mg/kg daily (max 40mg) (if used >7days, decrease over 14 days) Hydrocortisone is required to cover periods where the patient is to be nil by mouth or in the post operative period. Acute inflammation: 50mg qds Peri-operative cover: 20mg qds Side effects: Dyspepsia, peptic ulceration, myopathy, osteoporosis, adrenal suppression, hirsutism, weight gain, negative nitrogen and calcium balance, increased appetite, immunosupression, fluid and electrolyte disturbances. Interactions: NSAIDs - increased risk of bleeding Carbamazepine, Phenobarbitone, Phenytoin - increased rate of metabolism of steroid. Cyclosporin - increased prednisolone levels with increased cyclosporin levels with high dose methylprednisolone. Diuretics - increased risk of hypokalaemia. Notes: Methylprednisolone succinate is indicated for IV therapy, not methylprednisolone acetate. Converting methylprednisolone to prednisolone, reduce dose by 20%. BOOK AN APPOINTMENT Drugs used in paediatric inflammatory bowel disease Adalimumab Azathioprine Budesonide (Entocort CR) Cyclosporin Infliximab Infusion Mesalazine (Asacol®) Mesalazine (Pentasa®) Olsalazine Prednisolone enemas Prednisolone Sulphasalazine Methotrexate --- Drugs used in IBD Gut Investigation Indication: Treatment of mild to moderate Ulcerative colitis and Crohns disease Formulation: Suspension 250mg/5ml Tablets 500mg, 500mg E/C Dose: Acute 10-15mg/kg QDS (max 4-8g daily) Doses will be adjusted to ensure ease of administration with the above formulations Side-effects: Nausea, vomiting, diarrhoea, abdominal pain, headache, exacerbation of colitis symptoms, rarely reversible pancreatitis, hepatitis and interstitial nephritis, bone marrow suppression, fibrosing alveolitis. Anaemia, folate deficiency and reversible oligospermia. Stevens-Johnson syndrome, neurotoxicity, photosensitivity, proteinuria, haematuria, nephrotic syndrome. Urine and contact lenses maybe stained orange. Caution with G6PD deficiency and slow acetylators. Caution if salicylate hypersensitive Interactions: May reduce the absorption of folic acid and digoxin Notes: Blood and LFT's should be performed regularly at the start of therapy. BOOK AN APPOINTMENT Drugs used in paediatric inflammatory bowel disease Adalimumab Azathioprine Budesonide (Entocort CR) Cyclosporin Infliximab Infusion Mesalazine (Asacol®) Mesalazine (Pentasa®) Olsalazine Prednisolone enemas Prednisolone Sulphasalazine Methotrexate --- Drugs used in IBD Gut Investigation This is used either orally or initially sub-cutaneously as an injection once a week as an anti-inflammatory and is usually used as a treatment prior to the use of things like Infliximab and Adalimumab. BOOK AN APPOINTMENT Drugs used in paediatric inflammatory bowel disease Adalimumab Azathioprine Budesonide (Entocort CR) Cyclosporin Infliximab Infusion Mesalazine (Asacol®) Mesalazine (Pentasa®) Olsalazine Prednisolone enemas Prednisolone Sulphasalazine Methotrexate --- Gut Problems Gut Investigation Awareness of this as a gut related problem with gut related motility problems is becoming increasingly evident and this is due to an imbalance between the "good" bacteria (acidophilus and lactobacillus among others) versus the "bad" bacteria (Clostridium species, gram negative bacteria) and a dysequilibrium can occur after such things as bad gut infections. It is clear that repopulating the gut with the good bacteria using products which are concentrated forms of probiotics such as Yakult is a good way to promote good gut function and it is often a good adjunct to normal treatment of gut problems for these to be used. There is emerging evidence that high doses of these may help in gut function such as constipation and even as an adjunctive treatment in some forms of inflammatory bowel disease. This can be obtained at health food shops and pharmacy and one example is Biocare Acidophilus or Biocare Plus or Biokult. Bacterial overgrowth can often occur if somebody has had previous surgery and there was a stagnant loop of small bowel left. One way to diagnose this is by a breath test called a Lactulose breath test which is a non-invasive way of making this diagnosis. One commercial preparation of probiotics is called Biogaia which comes in an infant form and an older child's version as Biogaia Gastrus and Bioagaia Protectis. Other probiotics are usually as equally as good however. https://uk. biogaia. com/ Small intestinal bacterial overgrowth is usually over diagnosed significantly in... --- Gut Problems Gut Investigation NICE sets out new advice to treat gastro-oesophageal reflux disease (GORD) more effectively. Healthcare professionals should reassure parents that reflux is very common in well infants and does not require treatment, but should be alert to red flag symptoms which may suggest GORD or other disorders. Bringing up food is a common physiological process that usually happens after eating in healthy infants, children, and young people. It is most common in babies - affecting 4 in 10 infants - but can happen to almost everyone at some point in their lives. GORD refers to gastro-oesophageal reflux (GOR), which is so severe that medical treatment is required i. e. complications from GOR have arisen. However, it is difficult to differentiate between GOR and GORD, and the terms are used interchangeably by health professionals and families alike. GORD affects many children and families in the UK, who commonly seek medical advice and as a result, it places a health burden on the NHS. NICE recommends that parents and carers are given advice about GOR and are reassured that in well infants, effortless regurgitation of feeds is very common, usually begins before the infant is 8 weeks old, but will become less frequent with time and does not usually need further investigation or treatment. Health professionals should support and advise families on the difference between GOR and GORD. GOR and GORD in infants, children and young people, although common, can be very distressing. Parents and carers can feel helpless... --- Gut Problems Gut Investigation This is an inflammatory condition, usually of unknown origin which involves the pancreas gland which produces enzymes to help digestion. This can present with abdominal discomfort or vomiting/nausea and usually inflammation can be identified by a blood test, called amylase (this can also come from the salivary glands also and therefore if the amylase is raised we do a further test on this to check which is the origin of the rise in amylase), and also a lipase blood test can be helpful. An abdominal ultrasound is usually indicated and gall stones can be identified sometimes as a cause. Sometimes there is a background genetic inherited condition leading to recurrent chronic pancreatitis and a genetic blood test can help in its identification. Sometimes an MRI scan, called an MRCP can identify any anatomical abnormality in the pancreas, and very occasionally a sophisticated endoscopy called an ERCP may be necessary. Pancreatitis is difficult to treat and sometimes pancreatic enzymes need to be taken as supplements and also vitamin supplements if it is a chronic condition. It can be serious and require hospitalisation if it is acute and it is usually something which is identified by blood tests initially. BOOK AN APPOINTMENT Gut Problems Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux Pancreatitis Coeliac Disease Giardia Recurrent abdominal pain Common liver problems Gut blood loss and anaemia Sucrose intolerance Common pancreatic problems Gut infections Toddler's diarrhoea Constipation and Hirschsprung's... --- Gut Problems Gut Investigation Coeliac disease is a common problem occurring in 1:100 of the general population and if you have a first degree relative with this it increase to 1:25 as a possibility. Children may have no symptoms at all or may have growth problems or may present with diarrhoea, abdominal discomfort and bloating. They may have anaemia, and although they may have diarrhoea they may also present with constipation. There may or may not be a family history, and there may be a history of diabetes or thyroid problems. It is an auto-immune condition, which means the gut is attacked by its own body which gets confused between the protein which is in gluten, which is in cereals, and the body then makes antibodies which attack the gut lining causing inflammation. These antibodies can be detected at blood tests and these are called tissue transglutaminase and anti-endomysial antibodies. These blood tests, however, rely on a patient having a normal background IgA level and this is always checked as well and if this is low, which it is in some children, the blood tests are less reliable. The HLA DQ2 and DQ8 genetic tests are not genetic tests for Coeliac disease but they are often present in patients with Coeliac disease. However they are not good for discriminating because 30% of the general population have these genetic markers also. When the two tests are negative, they are very helpful though because the makes the diagnosis of Coeliac disease excluded... --- Gut Problems Gut Investigation Giardia is a parasite which is very common in freshwater lakes, for instance, and can be present on unwashed vegetables. Simple precautions when travelling are important but as the parasite can reside in the gut of children and adults for months if not years it is important to think of this in any child presenting with faltering growth, weight loss, diarrhoea, abdominal distension, etc. Giardia is difficult to detect and is only picked up by normal stool examination in about 20% of cases. Often we will treat with Metronidazole and if your child gets better then we can presume that this has been the case as it can be missed by the faeces test. BOOK AN APPOINTMENT Gut Problems Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux Pancreatitis Coeliac Disease Giardia Recurrent abdominal pain Common liver problems Gut blood loss and anaemia Sucrose intolerance Common pancreatic problems Gut infections Toddler's diarrhoea Constipation and Hirschsprung's disease Infant colic Ulcerative Colitis Crohn's disease Inflammatory bowel disease, Crohn's disease and ulcerative colitis Ulcers, gastritis and helicobacter pylori Eosinophilic oesophagitis Lactose intolerance --- Gut Problems Gut Investigation Chronic or recurrent abdominal pain (RAP) is one of the most commonly encountered events in childhood interfering in the normal lifestyle of up to 10-15 % of all children at some point and described first by Apley who emphasised the role of a thorough history and examination. (Apley 1958) A reasonable definition might be "at least 3 episodes of pain, severe enough to affect normal activity, over a period of greater than 3 months, and continuing in the year prior to investigation". Apley suggested that less than 10% had organic disease as a cause, especially if the site was peri-umbilical - however this has recently been challenged in light of the increased yield of specific organic diagnoses afforded by modern investigative tools and with the recognition of the potential importance of newly recognised aetiologies in its pathogenesis. (Farrell M 1993) The pyschogenic origin of the syndrome will be left to the next speaker and this review will concern itself with potential organic causes. Three clinical patterns have been described: 1) paroxysmal peri-umbilical or epigastric pain; 2) "dyspepsia", an ill-defined upper abdominal discomfort, frequently associated with bloating, nausea, early satiety, and occasionally vomiting; and 3) lower abdominal pains with alteration in bowel patterns. (Boyle J 1996) The latter may have some similarities with adult irritable bowel syndrome. (Hyams J 1995) Autonomic dysfunction may be an important participant in the path-aetiology of RAP and this may represent a common neural transmission disorder in children with migraine. (Battistella 1992)... --- Gut Problems Gut Investigation Common liver problems in children in the UK usually are associated with viral infections and involve transient inflammation. Hepatitis A, B and C can occur but generally children are now immunised against Hepatitis B, and if they are travelling abroad Hepatitis A. Other viruses can cause liver problems, such as the virus that causes glandular fever - the Epstein Barr virus. If your child presents with jaundice or with liver blood test abnormalities then Prof Thomson would see you and discuss the further investigations which might include abdominal ultrasound, liver excretion scan, further more sophisticated blood tests and other radiological imaging such as MRI scan. A liver biopsy is sometimes needed and this again will be discussed with you. The more rare liver conditions are best looked after by large liver centres, and these include things like biliary atresia, which presents early in life with jaundice, liver failure and other rarer liver conditions. BOOK AN APPOINTMENT Gut Problems Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux Pancreatitis Coeliac Disease Giardia Recurrent abdominal pain Common liver problems Gut blood loss and anaemia Sucrose intolerance Common pancreatic problems Gut infections Toddler's diarrhoea Constipation and Hirschsprung's disease Infant colic Ulcerative Colitis Crohn's disease Inflammatory bowel disease, Crohn's disease and ulcerative colitis Ulcers, gastritis and helicobacter pylori Eosinophilic oesophagitis Lactose intolerance --- Gut Problems Gut Investigation This problem is not particularly common but painless blood loss from the gut which can lead to anaemia can occur due to various problems in childhood. One of course is a condition known as polyps which are benign outgrowths of tissue in the gut. This is not cancer and bowel cancer is very, very rare in childhood. A diagnosis of polyps can be made at endoscopy and colonoscopy and these can be removed during this procedure. Other causes of bleeding might be a specific problem called a Meckel's Diverticulum which is a small pocket in the small bowel of stomach lining producing acid which can ulcerate. This is a remnant of the embryological development of the foetus and needs a special type of x-ray for this to be diagnosed. Vascular abnormalities in the gut are quite rare but do cause blood loss from the gut from time to time. Colitis which is inflammation of the colon usually causes other symptoms such as abdominal pain as well as blood loss. BOOK AN APPOINTMENT Gut Problems Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux Pancreatitis Coeliac Disease Giardia Recurrent abdominal pain Common liver problems Gut blood loss and anaemia Sucrose intolerance Common pancreatic problems Gut infections Toddler's diarrhoea Constipation and Hirschsprung's disease Infant colic Ulcerative Colitis Crohn's disease Inflammatory bowel disease, Crohn's disease and ulcerative colitis Ulcers, gastritis and helicobacter pylori Eosinophilic oesophagitis Lactose intolerance --- Gut Problems Gut Investigation This is congenital and due to the absence of the enzyme sucrase isamaltase present in the small bowel and responsible for digesting the sucrose which is present in refined sugar and also as a component of the sugars found in fruits. It has variable expression in that children can be mildly affected or badly affected depending on the amount of enzyme left. The condition manifests as gaseous distension and diarrhoea and gas production and explosive diarrhoea is often present. It can run in families and is helped by complete avoidance of sucrose with the help of a Paediatric Dietitian. Sucrase is available in a number of forms, including Sucraid®, Invertase® and also occasionally simple baker's yeast can be helpful. We are not sure how common this problem is. It can be diagnosed with a sucrose hydrogen breath test which is the best way as this does not involve any needles or invasive investigations. Please see the investigation section. BOOK AN APPOINTMENT Gut Problems Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux Pancreatitis Coeliac Disease Giardia Recurrent abdominal pain Common liver problems Gut blood loss and anaemia Sucrose intolerance Common pancreatic problems Gut infections Toddler's diarrhoea Constipation and Hirschsprung's disease Infant colic Ulcerative Colitis Crohn's disease Inflammatory bowel disease, Crohn's disease and ulcerative colitis Ulcers, gastritis and helicobacter pylori Eosinophilic oesophagitis Lactose intolerance --- Gut Problems Pancreatitis This is an inflammatory condition, usually of unknown origin which involves the pancreas gland which produces enzymes to help digestion. This can present with abdominal discomfort or vomiting/nausea and usually inflammation can be identified by a blood test, called amylase (this can also come from the salivary glands also and therefore if the amylase is raised we do a further test on this to check which is the origin of the rise in amylase), and also a lipase blood test can be helpful. An abdominal ultrasound is usually indicated and gall stones can be identified sometimes as a cause. Sometimes there is a background genetic inherited condition leading to recurrent chronic pancreatitis and a genetic blood test can help in its identification. Sometimes an MRI scan, called an MRCP can identify any anatomical abnormality in the pancreas, and very occasionally a sophisticated endoscopy called an ERCP may be necessary. Pancreatitis is difficult to treat and sometimes pancreatic enzymes need to be taken as supplements and also vitamin supplements if it is a chronic condition. It can be serious and require hospitalisation if it is acute and it is usually something which is identified by blood tests initially. BOOK AN APPOINTMENT Gut Problems Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux Pancreatitis Coeliac Disease Giardia Recurrent abdominal pain Common liver problems Gut blood loss and anaemia Sucrose intolerance Common pancreatic problems Gut infections Toddler's diarrhoea --- Gut Problems Gut Investigation These are commonly called food poisoning and cause problems either due to toxins presented to the gut by the bacteria or they are caused by viruses such as Rotavirus in infants or they are caused by parasites such as Giardia. They also can unmask disease such as inflammatory bowel disease and can cause persistent effects such as post-infective diarrhoea which may either be due to the infections continuing or the effect of the infection causing temporary damage to the small bowel and subsequent sensitisation to things like dairy produce and then this leading on to a decrease in the enzymes such as lactase. This has the effect of causing lactose not to be well absorbed and then diarrhoea ensues. Gut infections are usually self-limiting and do not require antibiotics except if they are severe such as amoebic dysentery. BOOK AN APPOINTMENT Gut Problems Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux Pancreatitis Coeliac Disease Giardia Recurrent abdominal pain Common liver problems Gut blood loss and anaemia Sucrose intolerance Common pancreatic problems Gut infections Toddler's diarrhoea Constipation and Hirschsprung's disease Infant colic Ulcerative Colitis Crohn's disease Inflammatory bowel disease, Crohn's disease and ulcerative colitis Ulcers, gastritis and helicobacter pylori Eosinophilic oesophagitis Lactose intolerance --- Gut Problems Gut Investigation Toddler's diarrhoea is a diagnosis of exclusion when all other diseases have been excluded. It is very common in children between the ages of 1 and 5 years of age and is of no consequence. It simply is a reflection of the increased speed of transit of food going through the gut. As long as the child is growing well and has a good appetite and no other symptoms then this is most likely to be the diagnosis. It also goes by the name of "Peas and Carrots syndrome" where often food particles are seen in the stool and up to 5-6 loose bowel motions per day can occur. Sometimes it can be helped by decreasing juices in the diet, increasing the amount of fat and decreasing the amount of fibre. It is rare for any anti-diarrhoeal agents to be used in children as they are associated with side effects and are not promoted for this reason. BOOK AN APPOINTMENT Gut Problems Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux Pancreatitis Coeliac Disease Giardia Recurrent abdominal pain Common liver problems Gut blood loss and anaemia Sucrose intolerance Common pancreatic problems Gut infections Toddler's diarrhoea Constipation and Hirschsprung's disease Infant colic Ulcerative Colitis Crohn's disease Inflammatory bowel disease, Crohn's disease and ulcerative colitis Ulcers, gastritis and helicobacter pylori Eosinophilic oesophagitis Lactose intolerance --- Gut Problems Gut Investigation Normal bowel patterns are very variable in children of all age groups. Weaver and Steiner have shown that 85% of 1 to 4 year olds pass stools once or twice a day and 96% do so three times per day to once every other day. When there is delay in defaecation with difficulty or distress, the child is said to suffer from constipation. Constipation has also been defined as passing less than 3 stools per week. A child is also said to be suffering from constipation if he or she has painful bowel movements (due to hard or large stools) and stool retention in spite of passing stools more than 3 times per week. Constipation is a common problem. It is said to account for 3% of all visits to a paediatric practice and 25% to a paediatric gastroenterology clinic. The percentage of children suffering from constipation is said to vary from 0. 3 to 8% according to different studies. The male female ratio is 1: 1 in young constipated children. There is a male pre-dominance in children > 5 years old with a reported ratio of 3-6:1. At follow up, twice as many boys than girls had soiling and 1. 8 times girls than boys were still constipated despite receiving laxatives. Presentation 97% of the children presenting with constipation are said to show stool-withholding manoeuvres e. g. crossing their legs or sitting up on their heels. Painful bowel movements have been shown to be present... --- Gut Problems Gut Investigation This is a term used primarily to describe the discomfort felt by an infant and the screaming that occurs, usually in the evening and often between the ages of 1-5 months. It is unclear whether this is a real phenomenon or whether it is discomfort due to a maturity problem of the enzyme lactase so that a child has gas production due to malabsorption of the sugar in dairy produce, lactose. It is also unclear whether there is air swallowing which might account for some of the colic or indeed whether gastro-oesophageal reflux is the prime cause of this problem. There is evidence on both sides of the argument to suggest that there is no significant difference between the crying of infants who are said to have colic versus that which is perceived by the mothers of children who are not perceived to have colic. It is a difficult area but if there are any significant problems other than the crying with the child's health then these should be investigated for problems such as gastro-oesophageal reflux. BOOK AN APPOINTMENT Gut Problems Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux Pancreatitis Coeliac Disease Giardia Recurrent abdominal pain Common liver problems Gut blood loss and anaemia Sucrose intolerance Common pancreatic problems Gut infections Toddler's diarrhoea Constipation and Hirschsprung's disease Infant colic Ulcerative Colitis Crohn's disease Inflammatory bowel disease, Crohn's disease and ulcerative colitis Ulcers, gastritis and helicobacter pylori Eosinophilic... --- Gut Problems Gut Investigation Please see the Crohn's disease section. Ulcerative colitis usually presents with diarrhoea, abdominal discomfort and blood in the stools and sometimes mucous. A calprotectin test of the faeces can be helpful in pointing towards the diagnosis which is made at endoscopy by ileo-colonoscopy and in ulcerative colitis there can be inflammation in the upper gut as well so an upper GI endoscopy is usually performed at the same time under a general anaesthetic. Blood tests can be helpful, looking at anaemia and looking at liver function abnormalities which can co-exist with ulcerative colitis and Crohn's disease, and looking at pancreatic inflammation which again can co-exist with these conditions. Treatment is usually initially getting the condition under control with steroids such as Prednisolone followed by and in conjunction with Azathioprine. Although there is evidence that non-steroidal anti-inflammatories which are aminosalicylates, such as Pentasa and Asacol (Mesalazine type preparations) can be useful in getting the condition under control. Sometimes dairy avoidance is advocated and probiotics have been advocated also. Further information can be gathered at www. cicra. org. BOOK AN APPOINTMENT Gut Problems Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux Pancreatitis Coeliac Disease Giardia Recurrent abdominal pain Common liver problems Gut blood loss and anaemia Sucrose intolerance Common pancreatic problems Gut infections Toddler's diarrhoea Constipation and Hirschsprung's disease Infant colic Ulcerative Colitis Crohn's disease Inflammatory bowel disease, Crohn's disease and ulcerative colitis Ulcers, gastritis and helicobacter pylori Eosinophilic... --- Gut Problems Gut Investigation Crohn's disease is a condition named after a doctor, who first described this and it is an inflammatory condition, particularly prevalent in certain sections of the community and has in some circumstances a genetic predisposition. It is an inflammatory reaction set up by the body's immune system which causes inflammation in the bowel. It may involve all parts of the bowel, including the oesophagus, stomach, small bowel and colon and often will present with symptoms such as abdominal discomfort, diarrhoea, anaemia and growth issues. Patients often have mouth ulcers, and they may have problems at the bottom end as well. Diagnosis is helped by a faeces test, called calprotectin, and also blood tests, including full blood count, ESR and CRP. If clinical suspicion dictates then the best way to make the diagnosis is by ileo-colonoscopy and upper GI endoscopy. Other tests such as wireless capsule endoscopy and abdominal MRI scan can be helpful and if the diagnosis is confirmed and the disease is widespread or confined to the small bowel and terminal ileum it is usually treated with nutritional therapy but if not then other anti-inflammatory medications such as Prednisolone and Azathioprine, which is particularly good for the colon, may be used and monitored. Nowadays, if the disease is more severe, injectable forms of anti-inflammatory medicines such as Infliximab and Adalimumab can be useful as a back up or occasionally as a first line treatment. Other classes of medications for Crohn's disease and Ulcerative Colitis now... --- Gut Problems Treatment is usually initially getting the condition under control with steroids such as Prednisolone followed by and in conjunction with Azathioprine. Although there is evidence that non-steroidal anti-inflammatories which are aminosalicylates, such as Pentasa and Asacol (Mesalazine type preparations) can be useful in getting the condition under control. Sometimes dairy avoidance is advocated and probiotics have been advocated also. Further information can be gathered at www. cicra. org. Crohn's disease Please see the Crohn's disease section. Ulcerative colitis Ulcerative colitis usually presents with diarrhoea, abdominal discomfort and blood in the stools and sometimes mucous. A calprotectin test of the faeces can be helpful in pointing towards the diagnosis which is made at endoscopy by ileo-colonoscopy and in ulcerative colitis there can be inflammation in the upper gut as well so an upper GI endoscopy is usually performed at the same time under a general anaesthetic. Blood tests can be helpful, looking at anaemia and looking at liver function abnormalities which can co-exist with ulcerative colitis and Crohn's disease, and looking at pancreatic inflammation which again can co-exist with these conditions. Useful Resources Below are useful resources to help children and young people understand a little more about their inflammatory bowel disease in language they can understand. Professor Nimbal - Download English Version Professor Nimbal - Download Arabic Version Professor Nimbal - Download Spanish Version Professor Nimbal - Download Portuguese Version Professor Nimbal - Download French Version Professor Nimbal - Download Hebrew Version Professor Nimbal - Download Dutch Version... --- Gut Problems Gut Investigation It is estimated that 50% of the developing world population are infected with this organism in the stomach lining. It is the organism responsible for the majority of duodenal ulcers in adults and children. It can cause inflammation of the stomach lining and ulceration and can be picked up by various means. A blood test simply tells the doctor that you have been exposed to the organism when they look for the antibody to the Helicobacter pylori and does not mean it is causing problems. This should not be relied upon for any clinical judgement as to whether it is causing problems or not. It can be picked up in the faeces now with a special test but again this does not tell you that there might be a problem associated with it as it may just reside in the stomach lining without causing problems. Thirdly it can be picked up by a special breath test but again this is useful to know whether this has been eradicated if it has been treated but is not terribly useful if one is looking to decide whether it is causing problems. The only real way to decide whether there is a stomach or duodenal related problem caused by the helicobacter is to do an endoscopy. See investigation section. Most recent guidance tells us that in simple abdominal pain Helicobacter pylori is not implicated and therefore should not be tested for. The only times to test for Helicobacter pylori... --- Gut Problems Gut Investigation Eosinophilic oesophagitis is a newer condition which has arisen in the last 15-20 years and is particularly prevalent in children with an allergy background in the family or allergy themselves, such as eczema, asthma or hay fever. It is inflammation of the oesophagus diagnosed at endoscopy and can present with discomfort or swallowing difficulties classically. Children will have symptoms which are typical of reflux and particular food stuffs may be implicated and can be tested by blood tests and skin prick tests and these include cow's milk protein, wheat protein, egg, soya, nuts and seafood and sometimes other foods as well. Initial treatment is with a proton pump inhibitor such as Omeprazole. If symptom relief is not provided within 1-2 months or if at repeat endoscopy the problem continues then we would generally move on to a non-absorbed swallowed viscous steroid called Budesonide mixed in 15mls sugary solution twice a day. Sometimes co-existent reflux can be treated with Omeprazole or equivalent anti-acids and occasionally dietary attempts to exclude the above foods will be helpful. Generally another endoscopy after 3 months of treatment would be needed and then follow up regularly. If untreated the inflammation can result in stricturing and scarring of the oesophagus which is not reversible easily. The European Guidelines now published: Diagnosis and management of eosinophilic esophagitis in children: An update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Amil-Dias J, Oliva S, Papadopoulou A, Thomson M et al. J Pediatr... --- Gut Problems Gut Investigation This is an absence of the enzyme lactase and is common in people from Mediterranean origin and those from the Indian sub-continent and also occurs in other populations. The best diagnosis is a hydrogen breath test (see investigations, and can be diagnosed with a test at endoscopy when a small piece of the small intestine lining is place in a special bedside lactose testing advice, and manifests as before). The activity of the enzyme lactase can be objectively looked at by taking a small piece of the lining of the duodenum at endoscopy. Equally sometimes using a lactose free milk to distinguish between cow's milk protein allergy and lactose intolerance due to the lactase enzyme deficiency can help, ie if lactose free milk is tolerated then it is not a cow's milk protein allergy because lactose free milks contain cow's milk protein. Equally if lactose free milk is not tolerated then it is more likely to be a cow's milk protein allergy than a lactose problem. BOOK AN APPOINTMENT Gut Problems Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux Pancreatitis Coeliac Disease Giardia Recurrent abdominal pain Common liver problems Gut blood loss and anaemia Sucrose intolerance Common pancreatic problems Gut infections Toddler's diarrhoea Constipation and Hirschsprung's disease Infant colic Ulcerative Colitis Crohn's disease Inflammatory bowel disease, Crohn's disease and ulcerative colitis Ulcers, gastritis and helicobacter pylori Eosinophilic oesophagitis Lactose intolerance --- Gut Problems Gut Investigation These are usually due to a child passing a hard bowel motion at some point and tearing the delicate anal margin and because faeces is passed through this area continuously it is often difficult for this to heal. Anal fissures can occur causing painful defecation and some blood which is usually bright red and usually coating the faeces. They are often associated with constipation and sometimes associated with infections in this region due to the bacteria that causes sore throats, streptococcus. In this circumstance treatment with antibiotics is effective. In other situations a simple anal fissure will resolve if the faeces are kept soft with laxatives and if local pain relief is applied with ointments. An increase in blood flow to the anal area for healing of the fissure may also help with a special type of paste. A significant portion of anal fissures are due to cow's milk protein allergy and can resolve with removal of dairy produce in a strict fashion with the input of a Paediatric Dietitian and a Paediatrician. BOOK AN APPOINTMENT Gut Problems Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux Pancreatitis Coeliac Disease Giardia Recurrent abdominal pain Common liver problems Gut blood loss and anaemia Sucrose intolerance Common pancreatic problems Gut infections Toddler's diarrhoea Constipation and Hirschsprung's disease Infant colic Ulcerative Colitis Crohn's disease Inflammatory bowel disease, Crohn's disease and ulcerative colitis Ulcers, gastritis and helicobacter pylori Eosinophilic oesophagitis Lactose intolerance --- Gut Problems Gut Investigation Feeding disorders are complex and do cause a lot of concern among parents. If they are severe then they can cause failure to thrive and problems with growth. Children often have specific aversions to different types of foods but it is important to distinguish the picky eater from the child with a pathological feeding aversion. This is the child who will not put different textures or consistencies or flavours into his/her mouth and has in some cases a sensitised oral cavity due to a bad feeding experience during infancy. Associated gastro-oesophageal reflux can precipitate this and then although the reflux may have disappeared the legacy of the problem may continue. A concerted effort to extinguish all ongoing reflux with a Paediatric Gastroenterologist, a desensitisation programme for the oral cavity with a feeding therapist and a behavioural feeding regime for both child and family will usually with a lot of hard work from therapists and parents alike eventually solve this problem. In addition with children with neurological problems such as cerebral palsy there may be a swallowing deficit and a coordination problem in the oro-pharyngeal region which can be distinguished by a special form of x-ray swallowing of a contrast medium which shows up on x-ray. This is called video-fluoroscopy. For further information please have a look at the following website. www. foodrefusal. co. uk BOOK AN APPOINTMENT Gut Problems Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux... --- Gut Problems Gut Investigation For any straight forward nutritional issues please see an excellent text: The Food Doctor for Babies and Children Vicki EdgsonCollin and Brown - ISBN: 1-84340-000-6 Children Who Say No James Windell,McMillan USA - ISBN: 0-02-861903-X Avoidant and Restrictive Food Intake Disorder (ARFID) or Extreme Fussy Eating Children with Avoidant and Restrictive Food Intake Disorder are notable especially with other problems such as autism or children who are on the autistic spectrum. Some children just have it as a very specific developmental issues, so they don't like different textures or tastes in the mouth and gag even when they see food coming towards them. In these circumstances psychology input and speech and language/feeding therapy input is important in a multi-disciplinary way. Any ongoing reflux needs to be treated and/or investigated and other causes such as poor coordination of swallowing may require a test called a video-fluoroscopy which is a special x-ray whilst the child swallows BOOK AN APPOINTMENT Gut Problems Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux Pancreatitis Coeliac Disease Giardia Recurrent abdominal pain Common liver problems Gut blood loss and anaemia Sucrose intolerance Common pancreatic problems Gut infections Toddler's diarrhoea Constipation Infant colic Ulcerative Colitis Crohn's disease Crohn's disease, Ulcerative Colitis (Inflammatory Bowel Disease) Ulcers, gastritis and helicobacter pylori Eosinophilic oesophagitis Lactose intolerance --- Gut Investigations Gut Investigation Barium is a substance that shows up on x-ray and a barium meal is when your child would swallow some liquid or solid containing barium and we would watch it go into the stomach, and then the intestine, and follow this through the intestine. It is very helpful to look for anatomical abnormalities such as a twist in the bowel, called malrotation, and abnormalities called strictures (although most of this information can now be gained by an abdominal MRI scan, which does not involve radiation). The barium meal however can be helpful in younger children as it doesn't involve any requirement for anaesthetic. The radiation is a reasonable amount and therefore if the barium meal is not going to help significantly with a diagnosis, we usually avoid its use. It is however, extremely useful for the diagnosis of malrotation when the gut is not formed in the correct direction. In this circumstance the bowel can twist and cause a significant problem. The main feature of this is vomiting, which doesn't necessarily need to contain the green substance called bile. Evidence in the literature suggests that abdominal ultrasound and abdominal MRI scan are much less helpful for making the diagnosis or excluding the diagnosis of malrotation than a barium meal, hence this remains the diagnostic test of choice for this indication. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies... --- Gut Investigations Gut Investigation This is now something that is rarely done but it has been used in the past where significant inflammation inside the intestine is suspected and involves a small amount of radiation by injecting the person's own white cells back into the body when they have been labelled with a radio isotope. This then shows up in areas of inflammation on a special camera called a gamma camera BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless capsule endoscopy Meckel's diverticulum isotope scan --- Gut Investigations Gut Investigation This is a way of looking at the oesophagus, stomach and duodenum and first part of the small bowel, called the jejunum by using a video on a micro-chip relaying images to a screen. It is useful for diagnosing conditions such as gastro-oesophageal reflux, gastritis (inflammation of the stomach lining), gastric and duodenal ulcers, problems with absorption in the small bowel such as Coeliac disease or cow's milk protein absorption problems and certain distributions of inflammatory bowel disease, ie Crohn's disease. Under a short general anaesthetic, the procedure which will last approximately 5-10 minutes, will occur with pictures and video being taken. Professor Thomson is the director of a pathology company to which he will be sending the biopsies for analysis. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless capsule endoscopy Meckel's diverticulum isotope scan --- Gut Investigations Gut Investigation A barium swallow is a test which is done to look at the oesophagus, not for function but for anatomy , looking to see if there are any areas of narrowing (or strictures as they are called), and this is very helpful in children who are having swallowing difficulties. It is also helpful in looking for hiatus hernia but doesn't tell us anything really about any inflammatory problem in the oesophagus, nor does it really tell us much about the actual function of the oesophagus and isn't useful for diagnosing reflux. It involves swallowing the barium which shows up by x-ray, and is usually mixed with some fluid. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless capsule endoscopy Meckel's diverticulum isotope scan --- Gut Investigations Gut Investigation This is not usually needed unless there is a problem with the liver and in this circumstance it occurs usually with a general anaesthetic and a needle is passed into the right side of the abdomen just above the edge of a the rib cage and a small core of liver tissue, approximately 1-2cm in length and 1mm wide is removed. This will be in conjunction with a general anaesthetic and also installation of a local anaesthetic on the area so that when the child wakes up there is no significant discomfort experienced. It would be necessary to keep your child in hospital overnight in order to observe them as very occasionally a blood vessel can be punctured and this may cause bleeding. This is now performed with ultrasound guidance by one of our Consultant Radiologists to increase the safety of the procedure. A blood count will be taken the next day to ensure that no significant blood less has occurred. Very, very occasionally the lung lining can be pierced causing what is called a pnuemo-thorax which is a recognised complication, albeit very rare, and this may cause breathing problems. Puncture of the gall bladder has been reported but is extremely rare. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen... --- Gut Investigations Gut Investigation This is a new device which is very helpful because it is a small clip that is placed at the bottom of the oesophagus at endoscopy that will leave this area automatically by being sloughed off after 5-7 days. Its advantage is that it sends our wireless signals to a box that is held within 6 feet of your child during the following 24-48 hours and gives information about acid reflux. This avoids the requirement for a tube coming out of the nostril, which can be irritating, and is very helpful for younger children who are unable to understand the need for a plastic tube to come out of the nose and also children with learning difficulties especially. Sometimes the application of the clip at the lower oesophagus causes the oesophagus to go into spasm, causing temporary discomfort. This usually settles with paracetamol for the next 24 hours. If this does not work then if Professor Thomson has advised this would be all right then non-steroidal anti-inflammatory drugs such as Nurofen or Brufen can help. If there is still discomfort 36 hours later then please contact Professor Thomson's office and we will either see you, arrange for you to be seen or discuss things on the telephone with a view to further medications and reassurance. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP &... --- Gut Investigations Gut Investigation This is a simple test used to detect the presence of a number of diseases in the large bowel, or 'colon', and in the part of the small bowel just above the colon, called the 'terminal ileum'. These problems can include ulcerative colitis and Crohn's disease which are collectively known as 'inflammatory bowel disease'. Other forms of inflammation exist such as those due to infections (e. g. salmonella) and allergy-induced inflammation. Sometimes causes of bleeding from the bottom can be identified e. g. benign growths called 'polyps' - if these are found then they can be removed safely and easily via the colonoscope. The risk is extremely small of a colonoscopy and is approximately 1 in 1000-5000 of making a hole in the bowel, or causing bleeding, and 1 in 100 if removal of a polyp is needed. Professor Thomson has not had any of these complications during colonoscopy involving diagnosis and biopsy, or polypectomy. The preparation for the colonoscopy is detailed in the previous section 'Planning for the procedure'. The average time of the colonoscopy for Professor Thomson is 9 minutes and he will come out to talk to you afterwards and requests that you stay close to the endoscopy suite to enable immediate feedback. Your child should have no problems at all - a small amount of blood may be seen in the 24 hours after the procedure in the bowel motions, which is normal and due to the taking of the very small... --- Gut Investigations Gut Investigation There are many different ways of looking at nutrition via blood tests such as iron levels, calcium levels and vitamin levels. There are many ways of testing for absorption problems such as Coeliac disease and there are many ways of looking for inflammation indirectly via blood tests. We can also look for anaemia and inflammation of the liver and the pancreas. Blood tests for allergies can also be used but these usually help in looking for the acute type of allergy such as that which occurs with rashes, asthma, hay fever rather than necessarily helping with the longer term delayed reactions associated with gut related food allergies. Although these tests if positive can be helpful, if they are negative they are less helpful. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless capsule endoscopy Meckel's diverticulum isotope scan --- Gut Investigations Gut Investigation This is a technique which allows us to look at the lining of the bowel between the extent reached by an upper endoscopy, ie the duodenum and the extent reached by a colonoscope, ie the terminal ileum. This can be anywhere between 100-500cm dependant on the age and size of the child. It is a small capsule, approximately 23mm by 11mm which is swallowed and then transmits images via radio frequency, which is perfectly safe, to a harness which is worn for a period of 8 hours. It is useful for looking for inflammation in the mid-small bowel or for any polyps that have not been seen before or for any areas of bleeding which may be occurring causing anaemia or blood loss from the gut. We have pioneered the paediatric use of this technique at the Portland Hospital and Sheffield Children's Hospital and it has proven extremely useful in diagnosis. The capsules are simply passed normally with faeces. This may indeed be the future for diagnostic purposes although biopsies as yet cannot be taken with this technique. An alternative capsule is now available for adolescents and we can send this out in the post for you to swallow and then these are simply collected and sent back to us and we can download the video. In younger children, certainly under the age of 8 and certainly under the age of 10 the video-capsule will be placed by endoscopy. BOOK AN APPOINTMENT Gut Investigations Practical advice... --- Children can experience a wide range of gut problems, from common issues like constipation and reflux to more complex conditions such as coeliac disease, inflammatory bowel disease (IBD), and eosinophilic oesophagitis (EoE). Early diagnosis and specialist care are key to managing these conditions effectively. At our London and Sheffield clinics, Professor Mike Thomson, an experienced Paediatric Gastroenterologist, leads the assessment and treatment of gastrointestinal symptoms. We offer a range of diagnostic investigations-including endoscopy, colonoscopy, breath tests, and lab-based analyses-to help identify the underlying cause and guide treatment. Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux Pancreatitis Coeliac Disease Giardia Recurrent abdominal pain Common liver problems Gut blood loss and anaemia Sucrose intolerance Common pancreatic problems Gut infections Toddler's diarrhoea Constipation Infant colic Ulcerative Colitis Crohn's disease Crohn's disease, Ulcerative Colitis (Inflammatory Bowel Disease) Ulcers, gastritis and helicobacter pylori Eosinophilic oesophagitis Lactose intolerance --- Gut Problems Gut Investigation These will manifest as problems with the movement of the gut, ie conditions such as allergic related gastro-oesophageal reflux, upper gut movement disorders and constipation. Cow's milk protein (and soya as there is up to a 40% cross sensitivity between these two proteins in children in the gut) allergy can account for up to 40% in different series of infantile gastro-oesophageal reflux and childhood chronic constipation. There is good evidence that a trial of exclusion of cow's milk protein and soya using special milks called hypoallergenic milks (Aptamil Pepti, Althera , Nutramigen, Pepti-Junior, Pregestimil) or elemental milks (Alfamino , Neocate, Neocate Advance, Neocate Junior, Puramino) can help substantially in determining whether children's problems are due to this issue or not. The trials of these milks would normally be 2 weeks and if a baby is being breastfed at the same time sometimes it is advised to continue to express breast milk so that the provision of breast milk is still present if the hypoallergenic trial after 2 weeks does not week. Sometimes breast feeding will continue at the same time and the child's mother is advised to exclude dairy and soya from her diet whilst a hypoallergenic milk is added if necessary Older children may indeed have symptoms similar to irritable bowel syndrome due to allergies such as those with cow's milk protein, soya or wheat and other food stuffs. This is often precipitated by a bad viral or other gut infection which then allows sensitisation... --- Gut Problems Gut Investigation Failure to thrive is a term which is now a little outdated and the new term which is used is faltering growth. Faltering growth is defined as a child whose weight or height is falling across centiles in a downward direction. More recently thrive lines have been introduced which in conjunction with the red book in the first few years of life can dispel many of the myths of children who do or do not have growth problems. Growth of course depends on the balance of calorie and protein intake and calorie and protein consumption and in broad terms poor weight gain or weight loss and then subsequently poor height gain (and in infants poor head circumference growth with attendant poor brain growth) can be due to either not enough calories and protein being consumed, or not enough of these nutrients being absorbed due to either problems with the small intestine absorption or in rarer cases pancreas and liver conditions, or lastly some disease which is turning over energy very quickly in the body such as cystic fibrosis, which is uncommon. The fourth component of growth is of course the hormonal mechanisms controlling growth and it is much less common to have a problem involving growth hormone or any of the other hormones such as thyroid hormone or the pituitary gland hormones which control energy and growth. For those who are interested in finding out about children's growth the Child Growth Foundation can be contacted at... --- Gut Problems Gut Investigation Common liver problems in children in the UK usually are associated with viral infections and involve transient inflammation. Hepatitis A, B and C can occur but generally children are now immunised against Hepatitis B, and if they are travelling abroad Hepatitis A. Other viruses can cause liver problems, such as the virus that causes glandular fever - the Epstein Barr virus. If your child presents with jaundice or with liver blood test abnormalities then Dr Thomson would see you and discuss the further investigations which might include abdominal ultrasound, liver excretion scan, further more sophisticated blood tests and other radiological imaging such as MRI scan. A liver biopsy is sometimes needed and this again will be discussed with you. The more rare liver conditions are best looked after by large liver centres, and these include things like biliary atresia, which presents early in life with jaundice, liver failure and other rarer liver conditions. Click here to view Professor Livewell's comic about Fatty Liver Disease.   BOOK AN APPOINTMENT Gut Problems Allergic gut problems Faltering growth Liver Disease Anal fissures Feeding disorders Nutritional problems Bacterial overgrowth Gastro-oesophageal reflux Pancreatitis Coeliac Disease Giardia Recurrent abdominal pain Common liver problems Gut blood loss and anaemia Sucrose intolerance Common pancreatic problems Gut infections Toddler's diarrhoea Constipation Infant colic Ulcerative Colitis Crohn's disease Crohn's disease, Ulcerative Colitis (Inflammatory Bowel Disease) Ulcers, gastritis and helicobacter pylori Eosinophilic oesophagitis Lactose intolerance --- Gut Investigations Gut Investigation A CT scan is a sophisticated x-ray which involves older children lying still in a machine for around 30-60 minutes but sometimes less time and younger children would probably need an anaesthetic to keep them still. The CT scan of the abdomen involves an amount of radiation, which is relatively significant and therefore a CT scan is not performed very often for abdominal investigation and generally we tend to move towards an abdominal MRI scan (please see MRI scan section). A CT scan can help, however, in determining the structures of intraabdominal organs, including the gut, and can also help show up blood vessels if we suspect a bleeding area in the gut. Intravenous medicine to help with that can sometimes be helpful, which is administered via an intravenous cannula. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless capsule endoscopy Meckel's diverticulum isotope scan --- Gut Investigations Gut Investigation This is particularly helpful for looking at the structures inside the head and particularly for the drainage system for cerebral spinal fluid to make sure there is no blockage and also for any tumours within the brain. It can be helpful to determine whether there is any raised pressure within the brain also. In younger children it involves an anaesthetic and in older children they just need to lie still inside the machine, which can be quite noisy. It can be a helpful investigation in certain circumstances in children who are presenting with vomiting for instance. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless capsule endoscopy Meckel's diverticulum isotope scan --- Gut Investigations Gut Investigation The easiest way to test for normal pancreatic function is by a sample of stool but more formal pancreatic function studies may occur via collection of the juice produced by the pancreas under direct vision by sucking this out by endoscopy and this may take up to an hour. This is an unusual test to be needed however. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless capsule endoscopy Meckel's diverticulum isotope scan --- Gut Investigations Gut Investigation An MRI scan is an excellent way of looking at the structures, not the function, of the intestinal tract and the rest of the organs in the abdomen and it is very helpful for looking at structural abnormalities such as scarring and strictures of the gut. It can also help delineate the drainage channels from the liver and the pancreas, and then it is called an MRCP. If we are looking for small bowel inflammatory bowel disease we will need your child to swallow liquid in order to distend the bowel and this is called a Magnetic Resonance Enterography. For younger children it will require a general anaesthetic, but for older children who can usually lie still - especially with the open MRI scan at the Portland - it can be easily performed in a 30-60 minute period of time. There aren't any side effects and it doesn't involve radiation. It is a very helpful adjunct to helping in diagnoses such as strictures and scarring due to Crohn's disease. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless... --- Gut Investigations Gut Investigation The full name of this is endoscopic retrograde cholangio pancreaticography which is a way of looking at the drainage of the liver and the pancreas for any abnormalities such as gall stones impacted in the biliary tree which is the drainage system of the liver or any evidence to suggest inflammation in the pancreas due to congenital anatomical abnormalities for instance. It is like a normal endoscopy but includes x-rays and a dye passed by a small tube into these drainage systems which drain in to the second part of the small bowel called the duodenum. There is a 5% chance of initiating inflammation of the pancreas by this technique and hence this is the technique which usually involves an overnight stay after the procedure. Increasingly MRCP, which is an x-ray technique without endoscopy, is being used in adults to look for abnormalities involving these two drainage systems but as yet the sensitivity and detail allowed by these techniques in children is probably not superior to ERCP. If stones are found in the biliary tract they can be removed during this technique. The patient is usually covered by antibiotics during the procedure. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through... --- Gut Investigations Gut Investigation This is a technique by which a small tube is passed via endoscopy straight through the abdominal wall into the stomach cavity and a plastic tube is left there in order that feeds can be administered to promote good nutrition. This is particularly helpful for children with very bad feeding problems or an inability to use the normal routes of feeding to promote good nutrition. This happens in children such as those with cerebral palsy or those who have a requirement for calories which is much greater that their normal capacity to provide them, eg cystic fibrosis or significant feeding disturbances. If your child's swallowing is unsafe because food or drink is tipping over into the lungs then this is another indication for a gastrostomy insertion. In some circumstances, which are much rarer, a per-cutaneous jejunostomy can occur where a tube is placed into the small bowel, rather than the stomach. The tube is usually 4-5mm in diameter and is made of an inert plastic. It has a flange on the inside which keeps it in place and usually some fixation device at the skin level. After a 3-4 month period it can be changed for a balloon device where a balloon inside can be inflated with water and this is flush on the outside of the abdomen with the skin. These devices can stay for a long period of time or they can be removed after a short period of time and when they are... --- Gut Investigations Gut Investigation An ultrasound is something that happens regularly and frequently and does not involve radiation. It can be helpful for looking at the structures of the abdomen, including the pancreas, liver and to a certain extent the intestine. It is not helpful for reflux, nor for any inflammatory conditions involving the gut but it can be helpful for conditions such as pyloric stenosis in babies. It involves just a short 15-20 minute attendance in the hospital but it may involve some fasting, so it would usually be something that is performed on an pre-arranged day. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless capsule endoscopy Meckel's diverticulum isotope scan --- Gut Investigations Gut Investigation Faeces can be looked at for bacteria, viruses, the presence of parasites but all these are not particularly reliable. Faecal elastase is a test which can look for pancreatic function. There are other tests to look for blood loss and inflammation. In general, however, faecal analysis is not particularly helpful. There is also now a test called Faecal Calprotectin which can look at inflammatory bowel conditions as a marker of these issues. You will be given bottles to collect the stools in and a form and then return this back in the post to the lab address on the form - The Doctors Laboratory, 76 Wimpole Street, London W1G 9RT Tel: 0207 307 7373. It is better to send these samples to the lab on a Monday, Tuesday or Wednesday by first class post or drop them to the lab so they are not left over the weekend. Please note the laboratory require all pots to have a name, date of birth and date of sample on them or they cannot process these, they also require the request form to be sent along with the samples. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper... --- Gut Investigations Gut Investigation pH Study This is the way to look at the amount of acid entering the lower part of the oesophagus which might cause problems due to reflux. It is a thin plastic tube placed usually at endoscopy so the insertion does not cause any discomfort and the tip lies about 3-4 cm above the junction of the oesophagus and the stomach. It is attached to a small box the size of a iPod type device and is usually left for 24 hours and the infant or child is encouraged to have as normal a day as possible. It records the amount of acid entering the oesophagus and this information can then be downloaded onto a computer and event markers such as sleeping, feeding and discomfort experienced can be recorded and then used in conjunction with the acid trace on the computer to determine the importance of any acid reflux causing problems and to determine the extent and severity of the gastro-oesophageal present. We generally prefer to perform the wireless Bravo pH study now. pH/Impedance Study If we want to look at a time association between respiratory symptoms and reflux we will sometimes perform a pH/impedance study which involves a thin plastic catheter similar to the standard pH catheter but this gives us information not just on acid reflux but on volume and non-acid reflux and is exactly the same as a normal pH study. This can't be performed wirelessly however. Technical Principle - gastric pH <... --- Gut Investigations Gut Investigation An abdominal xray is very helpful to look for abnormalities such as significant and severe constipation. It does involve some x-ray exposure but this is relatively minimal and it can also be helpful in looking for other issues such as kidney stones and can help in also looking at the spine. It is a simple thing that is often performed at the time of the consultation and doesn't come with any significant risks. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless capsule endoscopy Meckel's diverticulum isotope scan --- Gut Investigations Gut Investigation These will require your child to be present at the Outpatient Department for a period of 3 or more hours without having breakfast before arriving. This is because a drink involving an amount of the sugar to be tested for such as sucrose or lactose will be drunk and then if this is not absorbed properly into the gut it will be passed through into the large bowel where normal bacteria present will use the sugar for their growth and as a bi-product use hydrogen. This hydrogen will be absorbed via the gut lining and then it will leave the body in the child's breath. This can be detected by simply collecting one breath every 30 minutes or so and analysing it for the amount of hydrogen. This is a non-invasive way for looking for sugar malabsorption of various types. Information for parents A hydrogen breath test is a way of measuring whether your child is intolerant to certain substances, mainly different types of sugars. What will happen? The day before the test your child should not eat any of the following:- Onions Leeks Cabbage Beans Pickled vegetables Chewing gum Vitamins Laxatives Your child should not have antibiotics in the four weeks prior to the test. Your child should not eat anything after supper the night before the test. Your child should brush their teeth thoroughly the morning of the test. At the outpatients department When your child arrives at the department to have their hydrogen... --- Gut Investigations Gut Investigation A small bowel biopsy is particularly helpful when taken at endoscopy to exclude conditions such as Coeliac disease and other inflammatory conditions involving the small intestine and it is extremely safe with no significant side effects. Your child would have this done at endoscopy and then the biopsies are looked at under the microscope and the results would be discussed with you the following week. The majority of children with Coeliac disease require this to occur to substantiate or exclude the diagnosis. Professor Thomson is the director of a pathology company to which he will be sending the biopsies for analysis. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless capsule endoscopy Meckel's diverticulum isotope scan --- At our clinics in London and Sheffield, we offer a comprehensive range of gut investigations for children, helping to diagnose and manage a variety of gastrointestinal conditions. Common symptoms we assess include abdominal pain, bloating, diarrhoea, constipation, and unexplained weight loss. Led by Professor Mike Thomson, a leading Paediatric Gastroenterologist, our services include tests such as endoscopy, colonoscopy, pH and impedance studies, breath tests, and laboratory analysis. Each investigation is selected based on your child's specific symptoms to ensure an accurate diagnosis and effective treatment plan. Practical Advice before Endoscopic Procedures Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH and pH/Impedance Studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless capsule endoscopy Meckel's diverticulum isotope scan Gastric Isotope Emptying Scans --- Gut Investigations Gut Investigation Bowel PrepThis is the term used to encompass the technique to clean the large bowel of faeces prior to doing a colonoscopy. It will require that your child comes into hospital with you in the late afternoon prior to the colonoscopy and at that junction the nurses will give two types of medicines which work as strong laxatives to clear the bowel. This will usually be given at 6pm and then again early in the morning prior to the procedure. This will result in diarrhoea which unfortunately is necessary to clear the bowel out properly. If your child's bowel motions are not clear approximately 1 hour before the procedure then an enema will be administered in order to clear the rectum out effectively. What happens during admission You will come in either the night before the procedure for colonoscopy and more complicated endoscopic procedures or on the morning of the procedure and you will have had an opportunity to talk to Kate King, Practice Manager, and Professor Thomson prior to coming in to the hospital regarding what this will involve. In essence no solid food will be given if you come in the night before for bowel preparation for colonoscopy and no foods or milk should be given after 2. 30am on the morning of the procedure before an endoscopy. For an endoscopy you will be expected to be in the hospital by no later than 7. 30am and clear fluids may be given up until... --- Gut Investigations Gut Investigation A cranial CT scan involves in a younger child an anaesthetic, and usually is performed in older children when lying still, and we look with special x-rays on the computer to determine whether there are any abnormalities within the head. It is particularly helpful for looking for abnormalities involving any abnormal structures, such as the collecting system of cerebral spinal fluid and also for any tumours and any raised pressure inside the head, but generally we have moved over to MRI scan which doesn't involve radiation for indications noted here. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless capsule endoscopy Meckel's diverticulum isotope scan --- Gut Investigations Gut Investigation These are a way at looking at the movement of the oesophagus and pressure waves set up by normal movement of the oesophagus and are quite unusual to be required. They are not particularly pleasant to undergo and therefore we do not use them very frequently in Paediatrics. BOOK AN APPOINTMENT Gut Investigations Practical advice before procedure Cranial CT scan Oesophageal motility and manometry studies Abdominal CT Scan Cranial MRI Scan Pancreatic function studies Abdominal MRI Scan ERCP & MRCP Per-cutaneous gastrostomy Abdominal Ultrasound Faecal analysis pH acid studies Abdominal Xray Hydrogen Breath Tests Small bowel biopsy Barium Meal and Follow Through Isotope white cell inflammatory scan Upper GI endoscopy Barium Swallow Liver biopsy Wireless "Bravo" pH study Colonoscopy Common gut related blood tests Wireless capsule endoscopy Meckel's diverticulum isotope scan --- Meet Professor Thomson... Introduction The Information Commissioner's Office (ICO) requires a clear direction on policy for security of information held within the practice and provides individuals with a right of access to a copy of information held about them. The practice needs to collect personal information about people with whom it deals in order to carry out its business and provide its services. Such people include patients, employees (present, past and prospective) and other healthcare professionals and providers. The information we hold will include personal and health information. In addition, we may occasionally be required to collect and use certain types of such personal information to comply with the requirements of the law - for example:- a)there is a statutory basis for disclosure or court order, or b)there is a public interest justification for disclosure,6,7 or c) there is another basis in law for disclosure. No matter how it is collected, recorded and used (e. g. on a computer or on paper) this personal information must be dealt with in accordance with ICO regulations. The lawful and proper treatment of personal information by the practice is extremely important to the success of our business and in order to maintain the confidence of our service users and employees. We ensure that the practice treats personal information lawfully and correctly. This policy provides direction on security against unauthorised access, unlawful processing, and loss or destruction of personal information.   1. 0 Data Protection Principles We support and comply fully with the ICO... --- Patient Privacy Notice Executive summary As your child's treating clinician and therefore custodian of personal information relating to your medical treatment, I must only use that information in accordance with all applicable law and guidance. This Privacy Notice provides you with a detailed overview of how I will manage your/your child's data from the point at which it is gathered and onwards, and how that complies with the law. I will use your/your child's personal information for a variety of purposes including, but not limited to, providing you with care and treatment, sharing it with other medical professionals and research/clinical audit programmes. In addition, you have a number of rights as a data subject. You can, for instance, seek access to your medical information, object to me using your information in particular ways, request rectification of any information which is inaccurate or deletion of information which is no longer required (subject to certain exceptions). This Privacy Notice also sets out your rights in respect of your personal information, and how to exercise them. For ease of reference, this Notice is broken into separate sections below with headings which will help you to navigate through the document. Introduction This Privacy Notice sets out details of the information that I, as a clinician responsible for your child's treatment (and including my medical secretaries), may collect from you and how that information may be used. Please take your time to read this Privacy Notice carefully.   About me In this Privacy Notice I... --- About Prof Mike Thomson Professor Mike Thomson Consultant Paediatric Gastroenterologist and Interventional Endoscopist - Honorary Reader in Paediatric Gastroenterology. Professor Mike Thomson MBChB DCH FRCP FRCPCH MD was trained firstly in Paediatrics then in the sub-speciality of Paediatric Gastroenterology and also focused widely on Paediatric Hepatology and Paediatric Nutrition. He was a Consultant at the Centre for Paediatric Gastroenterology and Nutrition at the Royal Free Hospital for nearly 10 years before moving in 2004 to the Centre for Paediatric Gastroenterology at Sheffield Children's Hospital. Mike: I trained in medicine in Aberdeen between 1980 and 1985 and then moved to Yorkshire to do my first four or five years of medicine and Paediatrics which was coming home as this was where I was brought up. Paediatric Gastroenterology training started in 1988 in Leeds and then I moved to Brisbane to the Centre of Paediatric Gastroenterology there and this is where I did my research for my Medical Doctorate in Nutrition and Energy expenditure in Cystic Fibrosis. I also trained in endoscopy and all other facets of Paediatric Gastroenterology, Hepatology and Nutrition with a lot of exposure and responsibility for the Paediatric Liver Transplant Programme which is one of the finest in the world. I then returned to the UK in 1994 and spent about 2 years at the Birmingham Children's Liver Transplant Unit and then in November 1995 took up the post at the Royal Free Paediatric Gastroenterology Unit set up by Professor John Walker-Smith, one of the fathers of Paediatric... --- How to find us Paeds Gastro UK Ltd The Portland Hospital Consulting Suite234 Great Portland StreetLondon W1W 5QTView on larger map Practice Manager: Kate KingMedical Secretaries: Marshall and Stacy PartonTelephone: 0207 390 8315Fax No: 020 3137 1685Email: profthomson@hcaconsultant. co. uk The Paediatric Consulting Rooms at 234 Great Portland Street are directly opposite the Portland Hospital. There are two nearby car parks; the NCP in Carburton Street or Union Carparks in Devonshire Row Mews. There is also meter parking in the surrounding streets. There is also meter parking in the surrounding streets. The forecourt of the hospital is available for arrival and collection of patients only. Great Portland Street Station and Regents Park Station (5 min walk) Appointments An outpatient clinic is held at the Portland Hospital Consulting Rooms, 234 Great Portland Street, London W1 (Tel: 020 7390 8315) all day on a Tuesday and all day on a Wednesday between 9-10am until 6-7pm. A referral from your general practitioner or Paediatrician is usually the best way forward to make an appointment to ensure that Professor Thomson has any relevant medical information or test results that may have been performed on your child. As clinics usually book a little in advance, you are very welcome to telephone to make an appointment prior to a referral letter being received to ensure a convenient time is held for you, the referral letter can then be sent to us by your doctor or alternatively you can bring this with you to the appointment. To... --- Data Protection Policy Privacy Policy --- Professor Thomson - Consultant Paediatric Gastroenterologist in London Specialist in Children's Gastrointestinal, Liver & Endoscopic Care READ MORE ABOUT PROFESSOR THOMSON Professor Mike Thomson MBChB DCH FRCP FRCPCH MD was trained initially in Paediatrics before specialising in Paediatric Gastroenterology. His expertise also extends across Paediatric Hepatology and Paediatric Nutrition, giving him a broad understanding of children's digestive, liver and nutritional disorders. He began his consultant career at the Centre for Paediatric Gastroenterology and Nutrition at the Royal Free Hospital, where he worked for nearly 10 years. In 2004, he moved to the Centre for Paediatric Gastroenterology at Sheffield Children's Hospital, where he has continued to advance the field through clinical care, teaching, and research. Today, Professor Thomson provides private consultations for a wide range of gut problems in children and offers access to advanced gut investigations including diagnostic endoscopy, capsule endoscopy and nutritional assessments. His practice is dedicated to delivering personalised care for children and families, supported by decades of clinical and academic excellence. CONTACT PROFESSOR THOMSON Professor Thomson has worked at The Portland Hospital in Central London for the last 30 years and now does so three days a week. He also works at Thornbury Hospital in Sheffield outside normal NHS working hours. Common Gut Problems in Children Does your child suffer from abdominal pain, reflux, constipation, diarrhoea, inflammatory bowel disease, or nutritional difficulties? Professor Thomson offers expert diagnosis and management for a wide range of paediatric digestive issues. EXPLORE GUT PROBLEMS VIEW GUT INVESTIGATIONS Specialist Gut Investigations Advanced... --- --- ## Posts This month marks 30 years since I have worked at the Portland Hospital in Private Paediatric Gastroenterology, looking after all types of problems from the simple to the complex, for children with gastro-intestinal disorders, nutrition problems and liver problems. I have also worked with my Practice Manager, Kate, for 28 of those years, which has been a marvellous partnership. One of my PAs, Justine, has been with us for 6 years and sadly moves on to other pastures now and we wish her the best of luck. We still retain Stacy, who is excellent, and will welcome back Michelle, who will again be a vibrant force in our team. Read the September 25 Newsletter here --- Hay fever season is particularly noted for worsening allergic conditions involving the oesophagus, defined as eosinophilic oesophagitis, which is a bit like eczema of the oesophagus. This classically presents with reflux-type symptoms or sometimes swallowing difficulties, especially for solid food. If this happens then it is best to see a doctor, and with the swallowing difficulties especially, a referral to a specialist would be necessary for further investigation... Read the August 25 Newsletter here --- Watch the video below on the dangers of button batteries and what to do if your child ingests one: --- May was highlighted by Professor Thomson attending the European Annual Paediatric Gastroenterology Meeting in Helsinki, where he was stepping down as the Chair of the European Paediatric Endoscopy Committee. The Society was kind enough to give him a personalised award and a look back at his endoscopy training career. Read the June 25 Newsletter here --- Professor Thomson is lecturing at the Annual European Meeting in Helsinki at the beginning of May on a development which is now feasible to treat appendicitis by using a colonoscope rather than an operation and this is being done now in quite a lot of children outside the UK, and is something we are looking to expand into in the UK. Read the May 25 Newsletter here --- Listen to the following ESPGHAN Spotify Podcast link where Prof Thomson discusses interventional endoscopy with Dr. Alex Knisely. https://open. spotify. com/episode/79q4PmKA1WfPGxmVDnjdCX 'Dr. Alex Knisely is talking today to Dr. Mike Thomson of Sheffield (England), a gastroenterologist whose true love is endoscopy – interventional endoscopy. Mike has contributed substantially to systematising approaches to upper endoscopy in the setting of acute haemorrhage in children : As always, the indications differ between children and adults. Not only that, too few persons, whether paediatric or adult gastroenterologists, are trained well enough to manage such haemorrhage efficiently, which calls for centralisation (with patient transfer) of this aspect of paediatric endoscopy services. Mike takes us through prevention of button-battery ingestion, as a cause of catastrophic haemorrhage all too common; guideline establishment; training regimens ... and, finally, yes, veterinary endoscopy. No, really ! But you have to listen all the way through to hear that. ' --- Button batteries are life threatening when swallowed by toddlers and young children - contact medical help immediately and go to hospital if this occurs - see video --- Professor Mike Thomson took part in a Live Facebook Question and Answer session in association with London Medical Concierge. Watch the video here. --- I have just published an article in Nature reviews of gastroenterology and hepatology which examines the need for endoscopy in children, including upper GI endoscopy and ileo-colonoscopy. The diagnostic positive yield, or another way of putting it is the number of children who have endoscopy in whom positive results are found, varies in different studies, but probably around 40% or so of positive diagnoses is about right. In other words if you are doing too many then this would be a lower figure, if you’re not doing enough this would be a higher figure because you are missing cases of children with various diseases. However it must be remembered that a significant negative result is also helpful because this can show the parents and the child that everything is all right. Doing a full procedure and having a look at all of the bowel, including taking biopsies, is very important in children because in Crohn’s disease, for instance, often just sits in the last part of the small bowel, called the terminal ileum and it’s really important to be able to access this area in children. This comes with experience and skill and this is where the training centre that I run in Sheffield for Paediatric Endoscopy has it place in increasing the skills of trainees and also sometimes those that are already trained. For more information please visit my page https://www. paediatricgastroenterologist. co. uk/inde... --- Quite often we see gastroenteritis which then leads to a child’s gut being sensitised to various proteins such as cow’s milk protein, wheat protein, soya protein, egg protein or others and this can cause an irritable bowel syndrome-type picture in a child with crampy abdominal pain and what we call motility, which is disrupted in a child’s bowel, So the child’s bowel can alternate with diarrhoea or constipation and crampy abdominal discomfort. Essentially it is not working as it should in a normal rhythmic fashion to move things from the top to the bottom and this leads to problems. Sometimes the constipation needs to be addressed, sometimes the diarrhoea needs to be sorted out and the symptoms of crampy abdominal discomfort needs to treated with spasmodic medicines. Exclusion diets can be helpful for a short period of time, usually for about a month, and one food at a time is usually good practice. Usually this gets better with time. Occasionally gastroenteritis can precipitate a child who is susceptible tipping over in to full blown inflammatory bowel disease such as ulcerative colitis or Crohn’s disease but this is much less usual. Investigations usually involve faeces examination, blood tests and only very occasionally endoscopy and colonoscopy. An abdominal ultrasound or x-ray can show if there is any loading of the colon with faeces. --- My Professorship in Paediatric Gastroenterology is a very great honour. This doesn’t change the way I practice medicine but is just a recognition of many years if academic work. It is something which is peer-reviewed and I am delighted to have made this leap and it, I suppose, does make me sound a bit old but really hasn’t changed anything but my title. It is always nice to be recognised by ones colleagues for academic achievements, education and training and I look forward to carrying on with side of my job. --- Afzal NA – Clinical Research Fellow & Honorary Specialist Registrar in Paediatric Gastroenterology University College of London, Royal Free & Chelsae and Westminister Hospitals Thomson MA – Consultant Paediatric Gastroenterologist and Honorary Senior Lecturer Royal Free Hospital and University College of London Constipation and Hirschsprung’s disease Normal bowel patterns are very variable in children of all age groups. Weaver and Steiner have shown that 85% of 1 to 4 year olds pass stools once or twice a day and 96% do so three times per day to once every other day. 1 When there is delay in defaecation with difficulty or distress, the child is said to suffer from constipation. 1 Constipation has also been defined as passing less than 3 stools per week. A child is also said to be suffering from constipation if he or she has painful bowel movements (due to hard or large stools) and stool retention in spite of passing stools more than 3 times per week. 2 Constipation is a common problem. It is said to account for 3% of all visits to a paediatric practice and 25% to a paediatric gastroenterology clinic. 3,4 The percentage of children suffering from constipation is said to vary from 0. 3 to 8% according to different studies. 3 The male female ratio is 1: 1 in young constipated children. 3 There is a male pre-dominance in children > 5 years old with a reported ratio of 3-6:1. 3 At follow up, twice as many boys than girls... --- Article written by Mr Thompson Introduction: Gastro-oesophageal reflux (GOR) is a symptom not a disease and refers to the involuntary retrograde flow of gastric contents into the oesophagus. It is present in the majority of infants and is illustrated by a spectrum from occasional physiological reflux through to the infant with haematemesis, oesophageal stricture formation, failure to thrive, apnoea, wheezing and even sudden infant death syndrome (SIDS). (Vandenplas 1993) However, despite the recent expansion in diagnostic investigation tools available, most infants have uncomplicated GOR without a definite anatomical, metabolic, neurological or infectious cause, nor an association with serious complications of the GOR itself. Determining which infants would benefit from investigation and treatment to avoid these complications is important to avoid unnecessary and potentially invasive procedures in those in whom physiological reflux would just resolve with time. Approximately 80-85% of infants who have GOR have resolved by 18 months of age and 95% by 2 years of age. Signs, symptoms and diagnosis: General common symptoms include irritability, infants labelled with “colic”, feeding refusal, failure to thrive, excessive re-gurgitation and vomiting. Specific symptoms include haematemesis/melaena, anaemia, aspiration, wheezing, apnoea, stridor, torticollis, and even apparent life-threatening events and SIDS. Small amounts of rumination or possetting are common in infancy, but those suffering from significant reflux or vomiting with pathology outside the GI tract (eg. UTI’s, raised intracranial pressure, deliberate poisoning, metabolic conditions etc. ) should not be missed. It is important to realise that there is no clear relationship between symptoms and the... --- Chronic or recurrent abdominal pain (RAP) is one of the most commonly encountered events in childhood interfering in the normal lifestyle of up to 10-15 % of all children at some point and described first by Apley who emphasised the role of a thorough history and examination. (Apley 1958) A reasonable definition might be “at least 3 episodes of pain, severe enough to affect normal activity, over a period of greater than 3 months, and continuing in the year prior to investigation”. Apley suggested that less than 10% had organic disease as a cause, especially if the site was peri-umbilical – however this has recently been challenged in light of the increased yield of specific organic diagnoses afforded by modern investigative tools and with the recognition of the potential importance of newly recognised aetiologies in its pathogenesis. (Farrell M 1993) The pyschogenic origin of the syndrome will be left to the next speaker and this review will concern itself with potential organic causes. Three clinical patterns have been described: 1) paroxysmal peri-umbilical or epigastric pain; 2) “dyspepsia”, an ill-defined upper abdominal discomfort, frequently associated with bloating, nausea, early satiety, and occasionally vomiting; and 3) lower abdominal pains with alteration in bowel patterns. (Boyle J 1996) The latter may have some similarities with adult irritable bowel syndrome. (Hyams J 1995) Autonomic dysfunction may be an important participant in the path-aetiology of RAP and this may represent a common neural transmission disorder in children with migraine. (Battistella 1992) Abdominal migraine is an... --- ---