Pediatric gastroenterology

• ANATOMY OR SYSTEM AFFECTED: Abdomen, gallbladder, gastrointestinal system, intestines, liver, pancreas, stomach, throat

DEFINITION: The diagnosis and treatment of diseases and disorders of the digestive tract in infants and children.

Science and Profession

The pediatric gastroenterologist is a pediatrician who has received extra training in the diagnosis and treatment of gastrointestinal diseases and disorders. The full course of training requires a medical degree followed by three years of pediatric residency, plus an additional three years of solely studying children’s gastrointestinal diseases, nutrition, and hepatology. The six years of postdoctoral training are almost always conducted at a large teaching hospital.

The gastrointestinal tract extends from the mouth to the anus. It is responsible for the ingestion, digestion, and absorption of food and for the elimination of unusable waste from the diet. Its principal parts are the esophagus, the stomach, the small intestine and colon, and the liver, gallbladder, and pancreas.

Children experience the same wide range of gastrointestinal problems that afflict adults. Each age group, however, has its own unique set of problems. For example, children very rarely have stomach or colon cancer, but both are relatively common in adults. On the other hand, diarrhea is a very common cause of infant death worldwide, but is seldom life-threatening for adults.

Childhood gastrointestinal disease varies widely in its severity, from simple constipation needing only a change in diet to liver disease so severe that the child must undergo a liver transplant to survive. Common problems that a pediatric gastroenterologist might treat include gastroenteritis, constipation, chronic diarrhea, gastroesophageal reflux (especially in infants), and infections such as bacterial dysentery or viral hepatitis. Less common disorders include peptic ulcers, inflammatory bowel diseases (IBDs) such as ulcerative colitis and Crohn’s disease, celiac disease, food allergies or intolerances, and malabsorption disorders involving the ability of the intestines to absorb nutrients from digested food.

The liver, gallbladder, and pancreas are abdominal organs that connect directly with the gastrointestinal tract. They are important in the digestion and absorption of food and in the metabolism of the basic sugars, fats, and proteins that are absorbed by the intestines. The diagnosis and treatment of disorders of these organs are part of gastroenterology.

Anatomical anomalies of the gastrointestinal tract can occur, such as Meckel's diverticulum, intestinal malformations (atresia or stenosis), obstructions, imperforate anus, and congenital fistulas between the trachea and esophagus. They are generally treated both by the gastroenterologist and by a general or pediatric surgeon, who performs any necessary surgery.

Since the gastrointestinal tract is critical in the digestion and absorption of food, a pediatric gastroenterologist must have extensive knowledge about childhood nutrition. The physician will often prescribe the proper diet for a particular ailment. Occasionally, this program includes parenteral nutrition, in which a patient is fed intravenously with a complex solution of nutrients.

Most of a gastroenterologist’s time is spent in the clinic, examining patients, prescribing medications, or performing procedures, such as endoscopies of the stomach or colon. A minority of this specialist’s patients require hospitalization, a few of whom will be seriously or terminally ill.

A child’s intestinal disease, especially if serious, can be very stressful for the patient’s parents. The pediatric gastroenterologist must be able to communicate clearly with parents and support them emotionally during the child’s illness.

Diagnostic and Treatment Techniques

Much of a pediatric gastroenterologist’s work involves obtaining a thorough and detailed history of the ailment from both the child and their parent. Often, skillful questioning will lead to the proper diagnosis and best treatment. A careful physical examination of the entire child, not simply the abdomen, is also important.

The pediatric gastroenterologist conducts a wide variety of laboratory tests to evaluate the nature and severity of the illness, such as complete blood counts and liver enzyme measurements. Bowel movement specimens often provide important data, such as the presence of blood or infectious bacteria in the intestines.

The pediatric gastroenterologist performs several diagnostic and therapeutic procedures. Flexible endoscopy is the use of a thin, bendable tube of optic fibers to view the interior of the esophagus, stomach, or colon. The physician can obtain biopsies, small samples of gastric or intestinal tissue, through the endoscope and can remove benign intestinal growths called polyps. The gastroenterologist may place a pH probe, a small electrode on a wire, in the esophagus to test acidity levels for periods as long as twenty-four hours, called esophageal twenty-four-hour pH/impedance reflux monitoring. This probe is used to monitor acid reflux from the stomach into the esophagus. This disease, called gastroesophageal reflux, can lead to weight loss, recurrent pneumonia, or a scarred esophagus if left untreated. To diagnose conditions like celiac disease, Crohn's disease, or intestinal bleeding in children, a pediatric gastroenterologist may use a capsule endoscopy. This device is a small, swallowable camera capsule that provides an image of the entire small intestine with minimal discomfort. To diagnose conditions like choledochal cysts and biliary atresia in infants, as well as other conditions in the liver, gallbladder, pancreas, and bile ducts, a radiation-free imaging technique called magnetic resonance cholangiopancreatography (MRCP) may be used.

Liver transplantation may be necessary when a child develops irreversible liver failure as a result of severe hepatitis, congenital abnormalities, such as biliary atresia (failure of the bile ducts to form properly), or some disorders of the body’s metabolism. The pediatric gastroenterologist is an important member of the transplant team.

Perspective and Prospects

Subspecialties of pediatrics began to be recognized in the mid-twentieth century. The first organization for pediatricians interested in gastroenterology was formed in the early 1970s.

In adult gastroenterology, diagnostic tools such as endoscopy and therapies, including antirejection medications for transplantation procedures, improved rapidly in the last quarter of the twentieth century. Taking advantage of this new knowledge, pediatric gastroenterologists could also accurately diagnose more disorders in their own patients and treat them effectively.

Bibliography

Bishop, Warren P. “Acute Gastroenteritis.” Nelson Essentials of Pediatrics, edited by Karen J. Marcdante and Waldo E. Nelson, 9th ed., Saunders/Elsevier, 2023.

Cameron, Don. "Fifty Years of Australian Pediatric Gastroenterology." Journal of Gastroenterology & Hepatology, vol. 3, no. 24, Oct. 2009, pp. 75–80.

Cunningham, Carin L., and Gerard A. Banez. Pediatric Gastrointestinal Disorders: Biopsychosocial Assessment and Treatment. Scholars Portal, 2019.

Gershman, George, et al. Practical Pediatric Gastrointestinal Endoscopy. 3rd ed., Wiley-Blackwell, 2021.

Walker, W. Allan, et al., editors. Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. 6th ed., B. C. Decker, 2018.

Wang, Timothy C., et al. Yamada’s Textbook of Gastroenterology. 7th ed., John Wiley & Sons, 2022.

"What Is a Pediatric Gastroenterologist? " Cleveland Clinic, 17 Jan. 2025, my.clevelandclinic.org/health/articles/pediatric-gastroenterologist. Accessed 5 Sept. 2025.

"What Is a Pediatric Gastroenterologist?" WebMD, 7 Apr. 2024, www.webmd.com/a-to-z-guides/what-is-a-pediatric-gastroenterologist. Accessed 5 Sept. 2025.

Wyllie, R., et al. Pediatric Gastrointestinal and Liver Disease. 6th ed., Elsevier, 2021.