HY 01/06: Serious Stomachaches | Lehigh Valley Hospital

With the right care, children can cope with gastrointestinal problems

Every child has the occasional upset stomach, vomiting or diarrhea. Often, it’s caused by a viral infection and goes away on its own. But sometimes the discomfort is a sign of a more serious condition.

“If symptoms last longer than a few days or come back often, or if there is severe pain, fever or blood in the stool, the child may need to see a gastrointestinal specialist,” says Puneet Gupta, M.D., pediatric gastroenterologist at Lehigh Valley Hospital and Health Network.

Gupta and his colleague, Naser Tolaymat, M.D., work with the family and their primary doctor to get to the root of the problem. “Stress at home or school may contribute, or the child may be sensitive to a particular food,” Tolaymat says. “If it’s been going on a while, the whole family is probably frustrated, and the child’s school and social life may suffer. Just getting the diagnosis can be a huge relief.”

The two specialists use a variety of diagnostic tools including blood tests, stool cultures, X-rays, and endoscopy or colonoscopy (viewing the inside of the gastrointestinal tract using a slender tubular instrument). Here are some of the more common con-ditions they diagnose:

Gastroesophageal reflux disease (GERD) — Reflux occurs when a weak muscle allows stomach contents to flush back up into the esophagus. About 7 million children, mainly babies, suffer from it. Babies with reflux spit up or vomit frequently, but “there’s no cause for concern if the baby is happy and growing well,” Tolaymat says. While babies typically outgrow the condition in their first year, older children and adolescents can develop chronic reflux.

The condition becomes a problem when complications set in. The signs include pain, crying, poor sleep, bad breath, vomiting blood, heartburn, weight loss, swallowing or breathing problems, hoarseness, and sinus and ear infections. Medications and dietary changes can ease the symptoms.

Celiac disease — Once considered rare, celiac disease is now thought to affect as many as one in 130 people. It’s caused by sensitivity to gluten, a protein in wheat, rye, oats and barley that damages the small intestine in people with this disease. Symptoms include chronic diarrhea or constipation, bloating, gas, irritability, poor weight gain, slow growth, anemia, bone fractures and skin rashes. In some cases there are no symptoms. Children with type 1 diabetes or celiac disease in the family are at higher risk. “You never outgrow the condition,” Gupta says, “but most patients who avoid foods, drinks and medications with gluten are completely healed.”

Inflammatory bowel disease (IBD) — The two types of IBD are ulcerative colitis and Crohn’s disease. The lining of the intestines becomes inflamed and irritated, causing diarrhea (sometimes with blood and mucus), abdominal pain, loss of appetite, weight loss, unexplained fevers, tiredness and slow growth. While there’s no cure, symptoms usually can be controlled with medication.

Liver disorders — Many liver disorders (including cirrhosis and hepatitis) affect children, some requiring liver transplantations. Symptoms can include anorexia, fatigue, weakness, fever, jaundice, nausea, skin changes and poor weight gain.

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