Gastroenterology

The pediatric gastroenterologists of Riley Hospital for Children, Indiana University Medical Center offer complete evaluation, diagnosis and treatment for children with illnesses of the digestive tract, liver and pancreas. Our pediatric team also develops the guidelines for treatment of children and adolescents with inflammatory bowel disease and chronic liver disease.

GI Motility

We were pioneers in the performance of esophageal manometry back in 1980. Dr. Joseph Croffie, Director of the Pediatric GI Motility Laboratory began performing anorectal manometry in 1995. He has a national reputation in this area and in the performance of biofeedback training for patients with difficulties passing stool. The addition of stomach, small intestine and colonic motility studies became available in our Motility Laboratory in early 2000. Dr. Marian Pfefferkorn also performs anorectal manometry and biofeedback training.

GI Procedures

Physicians of the Division of Pediatric Gastroenterology at Riley Hospital possess years of experience in performing endoscopies and related procedures in infants, toddlers, children and adolescents. The procedures are performed with care, expertise and compassion towards the child and the family, with a focus on comfort and safety for the child. Some of the services we offer are:

• Upper GI endoscopy: This procedure is done under anesthesia in the endoscopy suite. A flexible tube equipped with a camera will be inserted through the mouth to examine the upper GI tract. The physician may take small pieces of tissue (called biopsies) to examine under a microscope. This procedure is also used for removal of foreign objects, dilations of strictures (abnormal narrowing), and for management of bleeding in the GI tract.
• Lower GI endoscopy ("Colonoscopy"): This procedure is similar to the upper GI endoscopy and is also done under anesthesia. The flexible tube with a camera is inserted through the anus to examine the large intestine (colon). Biopsies may be collected to examine under a microscope. This procedure may also be used to remove polyps and to manage GI bleeding.
• G-Tube: Placement of feeding tube through skin directly into the stomach ("G-button")
• pH probe studies including Bravo®: These procedures help examine for reflux of stomach acid into the esophagus.
• Capsule endoscopy ("camera endoscopy"): This allows examination of the small intestine using a small video capsule that is about the size of a large vitamin. The camera captures pictures as it travels naturally through the small intestine and transmits images to a small device outside the body. After the procedure is completed, the images can be downloaded and reviewed by the physician. The capsule passes out in stool.
• Percutaneous liver biopsy: A liver biopsy will allow the physician to examine a small piece of liver tissue for injury or damage to the organ. A few days before the procedure, the patient will need to have blood tests. The test is done under anesthesia using a thin biopsy needle. The child is observed for several hours or overnight after the procedure.
• Rectal biopsies and manometry: The physician may use different tests to evaluate for constipation. These include:
  • Rectal suction biopsy - this procedure can be done in clinic and does not require sedation. A small instrument inserted into the rectum takes a small painless biopsy.
  • Rectal punch biopsy - this procedure is done under anesthesia.
  • Anorectal manometry - this procedure is done by placing a device with three small balloons in the rectum and taking pressure measurements.
• Motility studies to examine the motility of the GI tract: These include esophageal motility study, antroduodenal manometry, and colonic motility study. These studies are done by placing catheters with special pressure sensors in the esophagus, stomach, upper small intestine and large intestine, respectively, to examine contractions in these areas of the body. These tests may be performed in children with longstanding swallowing problems, abdominal distention or feeding intolerance and chronic constipation, respectively, to see if their symptoms are due to a motility problem.

Liver Program

The Pediatric Liver Program provides expert diagnosis and management of children with a variety of liver diseases. Rapid and efficient evaluation of infants with jaundice can be accomplished within this program. Studies are underway for treatment of chronic viral hepatitis B and chronic hepatitis C. We have a special interest in metabolic liver disease and work closely with the Division of Metabolism. The Division offers families a pediatric liver support group, which meets quarterly, as well as a liver library for the use of patients and families. A variety of seminars for nurses, physicians in training and staff physicians are offered and educational materials are being developed.