Paediatrics: Intestinal disorders

2021-03-04 12:00 AM

This disease is rare in children. It most commonly affects the duodenum.

Intestinal disorders

Gastritis and peptic ulcer disease

This disease is rare in children. It most commonly affects the duodenum.

Causes

  • Helicobactor pylori infection (strong familial link, associated with increased risk of adult gastric cancer).
  • Stress ulcers, e.g. post-trauma, HIE.
  • Drug-related, e.g. NSAIDs.
  • Increased acid secretion (Zollinger–Ellison syndrome, multiple endocrine neoplasia type I, hyperparathyroidism).
  • Crohn’s disease.
  • Eosinophilic gastroenteritis.
  • Hypertrophic gastritis.
  • Autoimmune gastritis.

Presentation

  • Often asymptomatic.
  • Chronic abdominal and epigastric pain.
  • Nausea +/– vomiting.
  • GI haemorrhage.
  • FTT +/– anorexia.
  • Iron deficiency anaemia.
  • Perforation (very rare).

Investigation

  • C14urea breath test (Hpylori).
  • Upper GI endoscopy and biopsy (Hpylorihistology and culture).

Treatment

  • Treat the underlying cause, e.g. eradicate Hpyloriwith 7–10 days oral Amoxycillin (clarithromycin), bismuth, metronidazole +/– omeprazole (quadruple therapy).
  • ‘fall’ gastric acid production, e.g. proton pump inhibitors (PPI), H2antagonists; sucralfate (cytoprotective).
  • Antacids, e.g. aluminium hydroxide.

Protein-losing enteropathy

This disorder is characterized by chronic intestinal protein loss.

Causes

  • GI infection, e.g. giardiasis.
  • Severe food hypersensitivity.
  • Coeliac disease or IBD.
  • Severe cardiac failure.
  • SLE; graft vs. host disease.
  • Polyposis or lymphatic obstruction.

Presentation 

There is hypoalbuminaemia +/– diarrhoea or abdominal pain.

Increased faecal A1-antitrypsin confirms the condition.

Treatment 

Treat the underlying disease; give nutritional support and albumin infusions as required.

Short bowel syndrome

Is due to severe intestinal disease or the surgical removal of a large portion of the small intestine. The condition manifests as malabsorption, fluid and electrolyte loss, and malnutrition.

Presentation

  • Diarrhoea, steatorrhoea.
  • FTT.
  • Dehydration, electrolyte loss (Na, K, Mg, Ca).
  • Cholestasis (bile salt loss).
  • Peptic ulcer disease (due to increased gastrin).
  • Specific (e.g. vitamin B12) +/– generalized malnutritional disorders.
  • Renal stones (oxalate).

Treatment

  • Correct fluid and electrolyte disturbance.
  • Specific nutritional supplements; hydrolysed protein/elemental diets.
  • PN.
  • Gastric acid-reducing drugs, e.g. PPI or H2antagonists.
  •  Anti-diarrhoeal drugs, e.g. loperamide.
  • Cholestyramine (chelates bile salts).
  • Parenteral somatostatin.
  • Oral antibiotics to reduce bacterial overgrowth.
  • Surgery to reduce GI motility or small bowel transplant.

Prognosis 

Prognosis is improving, with 90% 5yr survival. Retention of ileocaecal valve significantly improves prognosis.

Intestinal polyps

Most juvenile polyps are hamartomas, single, and located in the distal colon. Polyposis (multiple polyps) syndromes include:

  • Peutz–Jegher’s syndrome (mucocutaneous pigmentation).
  • Familial polyposis coli.
  • Gardner’s syndrome (GI polyps, osteomas and soft tissue tumours).

Presentation

  • Often asymptomatic.
  • Haematochezia.
  • Rectal polyp prolapse.
  • Protein-losing enteropathy.
  • Intussusception.
  • Mucoid diarrhoea.

Investigation 

Gastroscopy and ileo-colonoscopy, barium radiology.

Treatment

  • Endoscopic or surgical removal.

 Periodic colonoscopy surveillance is required in polyposis syndromes because of the significant risk of neoplasia.