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Gastroenterology

Mike Thomson

Our Department of Gastroenterological and Hepatological Medicine looks after patients aged 0-19 referred from all around the UK and internationally. We treat a wide range of problems from gastroesophageal reflux through to inflammatory bowel disease.

Conditions

  • Allergic gut disorders
  • Anal fissures
  • Bacterial overgrowth in the gut
  • Coeliac disease
  • Constipation
  • Crohn’s disease
  • Eosinophilic oesophagitis
  • Faltering growth
  • Feeding disorders
  • Fructose intolerance
  • Gastritis
  • Gastroesophageal reflux
  • Giardia
  • Gut blood loss and anaemia
  • Gut infections
  • Helicobacter pylori
  • Hirschsprung’s disease
  • Infant colic
  • Lactose intolerance
  • Liver disease
  • Nutritional problems
  • Pancreatitis
  • Peptic ulcer disease
  • Recurrent abdominal pain
  • Sucrose intolerance
  • Toddler’s diarrhoea
  • Ulcerative colitis

Investigations

The gut investigations we do include, but are not limited, to the following:

  • Abdominal MRI scans
  • Barium x-rays
  • Common gut-related blood tests
  • Examination of the drainage tract from the liver and the pancreas called ERCP and radiology called MRCP
  • pH studies
  • pH impedance studies
  • Faecal analyses
  • Enteroscopy involving the small bowel
  • Histopathology of biopsies with multi-disciplinary team meetings
  • Hydrogen breath tests
  • Ileocolonoscopy
  • Investigations for occult GI bleeding sources
  • Liver biopsy
  • Oesophageal pressure studies, manometry and motility
  • Pancreatic function studies
  • Radiological investigations such as abdominal ultrasound and abdominal x-ray
  • Upper GI endoscopy
  • Wireless capsule endoscopy
  • Wireless Bravo pH studies
Abdominal MRI scans

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 is very helpful for looking at structural abnormalities such as scarring and strictures (narrowing) of the gut. It can also help delineate the drainage channels from the liver and the pancreas – then it is called an MRCP.

Barium Swallow

A barium swallow is a test which is done to look at the oesophagus, not for function but for anatomy, to see if there are any areas of narrowing (or strictures as they are called). This is very helpful in children who are having swallowing difficulties. It is also helpful in looking for hiatus hernia. A barium swallow doesn’t tell us much about any inflammatory problems in the oesophagus, nor does it tell us a lot 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.

Bravo pH

This new device is a small clip that is placed at the bottom of the oesophagus during an endoscopy and leaves the area automatically after five to seven days. Its advantage is that it sends out wireless signals to a box that is held within six 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. It is a helpful technique for younger children and children with learning difficulties.

Colonoscopy

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.

Common gut-related blood tests

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 acute types of allergies such as those that cause rashes, asthma and hay fever, rather than necessarily helping with the longer term delayed reactions associated with gut-related food allergies. Although these tests can be helpful in finding out the cause of any problems if positive, they are less helpful when negative.

Faecal analyses

Faeces can be looked at for bacteria, viruses and the presence of parasites but 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. There is also now a test called Faecal Calprotectin which can look at inflammatory bowel conditions as a marker of these issues.

Hydrogen breath tests

These require your child to come to the Outpatients Department for three or more hours without having breakfast before arriving. This is because your child will have a drink containing an amount of sugar which will be tested for substances such as sucrose or lactose. 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.

Liver biopsy

This is not usually needed unless there is a problem with the liver. The biopsy is normally done under general anaesthetic where 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. A local anaesthetic is also used on the area so that when the child wakes up they don’t experience any significant discomfort. We will 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.

Oesophageal pressure studies, manometry and motility

These are a way of 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.

Examination of the drainage tract from the liver and the pancreas called ERCP and radiology called MRCP.

Pancreatic function studies

The easiest way to test for normal pancreatic function is via a stool sample but more formal pancreatic function studies may also be needed. This can be done by collecting the juice produced by the pancreas under direct vision by sucking it out during an endoscopy. This may take up to an hour. This is an unusual test that we don’t carry out very often.

pH impedance studies

A pH impedance study measures movement of liquid and air up and down the oesophagus (the food pipe between the mouth and the stomach).  The main purpose of the study is to enable doctors to see whether your child has reflux. Reflux is where acid from the stomach can travel back up the oesophagus causing discomfort and sometimes vomiting or choking. With this information, the team will be able to decide on how to manage your child’s condition.

pH studies

This is a 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 put in place during an endoscopy so the insertion does not cause any discomfort. 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 and is usually left for 24 hours and the patient is encouraged to have as normal a day as possible. It records the amount of acid entering the oesophagus and this information is downloaded onto a computer and event markers such as sleeping, feeding and discomfort experienced are also recorded. The event markers and the acid trace on the computer are used to determine the importance of any acid reflux causing problems and the extent and severity of the issues.

WCE - Wireless Capsule Endoscopy

This is a new and exciting technique to look at the area between the beginning of the jejunum, small bowel and the beginning of the terminal ileum which is the majority of the small bowel. This covers between one and three metres depending on the age 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 eight 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 causing anaemia or blood loss from the gut.

Nutrition

We work closely with our Dietetics colleagues and provide a one-stop shop for paediatric nutrition including gastrostomy insertion, feeding aversion studies such as video fluoroscopy. We often do procedures combined with our Respiratory and ENT colleagues such as bronchoscopy and laryngoscopy at the same time as upper GI endoscopy and reflux studies.

Many different types of milks are provided by a dedicated milk kitchen in the hospital.

Contact us

For current patients with concerning issues, the first point of contact would be our Gastroenterology nurses on 0114 271 7111 or 0114 271 7162.

But we would ask that any routine issues regarding clinical problems would be best left to discuss with the Gastroenterology doctors or nurses in their clinics.

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