Emerging Disease Concerns Pediatric Gastroenterologist
Eosinophilic esophagitis and non-alcoholic fatty liver disease are increasingly being seen in children.
MetroHealth pediatric gastroenterologist Reema Gulati, MD, has special interest in and background with diagnosing and treating both of these conditions.
Eosinophilic esophagitis (EoE) — essentially allergies in the esophagus — is an increasingly recognized disease in children. Prevalence in children in the United States is estimated to be about 4.3 in 10,000.
About two-thirds of the children will have a history of concomitant allergic disease like eczema, asthma and food and/or environmental allergies.
Symptoms are nonspecific, varied and include:
- Chronic vomiting, often occurring with meals
- Chronic heartburn and GER symptoms which do not improve with conventional acid-lowering therapy
- Failure to thrive (especially in younger children)
- Refusal to eat
- Dysphagia/swallowing problems (in older children and adolescents)
- Food becoming lodged within the esophagus.
Definitive diagnosis requires an upper endoscopy with biopsy, with that showing increased numbers of eosinophils (typically greater than 15/hpf) along with other features like epithelial eosinophilic microabscesses and basal cell hyperplasia.
“If you have been treating a child for reflux repeatedly and it’s not working, a pediatrician should suspect this because the main symptoms mimic gastroesophageal reflux disease (GERD),’’ said Dr. Gulati.
Physicians and parents may also overlook symptoms because they believe symptoms may be related to behavioral issues, such as eating too quickly or not chewing carefully. Such patients should be referred promptly to a gastroenterologist.
Nonalcoholic fatty liver disease has emerged as the most common cause of chronic liver disease in children in the United States, said Dr. Gulati. The cause is obesity, a growing problem of epidemic nature in children and teens in the United States.
The liver disease is found in about one out of six obese children, and can lead to chronic inflammation and scarring of the liver (cirrhosis) and, possibly, the need for transplantation as an adult.
Dr. Gulati’s special areas of expertise also include:
- Inflammatory bowel disease (IBD), including Crohn’s and ulcerative colitis
- Other liver diseases including biliary atresia, autoimmune liver disease, Alpha 1 antitrypsin deficiency and liver failure
- Therapeutic endoscopies.
- Controlling upper GI bleeds
- Percutaneous endoscopic gastrostomy tube placements to treat failure to thrive in infants
- Capsule endoscopies to evaluate small intestine pathology
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