The division sees approximately 8,500 outpatient office visits each year. Recurrent abdominal pain, constipation and complicated gastroesophageal reflux represent common referral complaints. Most new patient visits encompass one hour for thorough history and physical exam, review of potential diagnoses and design of a plan for evaluation and therapy.
Regular outpatient office hours are scheduled Monday through Friday. We are currently seeing patients within one week of referral but can arrange outpatient visits in our office immediately or within 24 hours, if necessary.
The GI division maintains several special interests. Our physicians have unique expertise in inflammatory bowel disease. Careful diagnostic investigation, meticulous management and attention to psychological, emotional, and physical development form the core of the program. When necessary, close consultation with pediatric surgeons, pediatric dietitians, social workers and psychologists adds to available resources.
Secondly, the division has special expertise in hepatic disorders. Decades of experience with common and rare hepatic diseases establish the foundation of this program. Ongoing clinical research concerns interferon therapy of chronic viral hepatitis and unique approaches to metabolic liver disease, particularly alpha-1-antitrypsin deficiency. A well-established liver transplant program continues the tradition of offering the most current therapies for liver disorders. We are now developing a unique center for evaluation and care of children with biliary atresia, including a multidisciplinary team of pediatric gastroenterologists, pediatric surgeons, pediatric radiologists, pediatric pathologists and the pediatric liver transplant surgery team with nurse coordinator, social worker and a panel of subspecialty consultants.
Thirdly, the division provides detailed analysis and care for global and specific nutritional deficiencies. Problems such as refusal or inability to eat, weight loss or failure to grow are often amenable to intervention. Special diets or nutritional support regimens such as tube feeding or parenteral nutrition can be designed. Indirect calorimetry is available to measure energy expenditure and allow for prediction of nutritional needs.
Invasive procedures are sometimes required for accurate diagnosis and therapy. In conjunction with St. Louis Children’s Hospital, the division provides a specially designed environment in the Ambulatory Procedure Center. Upper gastrointestinal endoscopy, colonoscopy, endoscopic retrograde cholangiopancreatoscopy, suction rectal biopsy, percutaneous liver biopsy, pH probe studies, motility studies and therapeutic procedures such as esophageal dilation are completed in this special unit. The pediatric nurses have extensive experience in relieving pre-procedure anxiety, establishing intravenous lines and monitoring of patients during and after the procedures. Most of these procedures can be completed during a half-day stay in the APC with subsequent discharge home.
Pediatric transplantation services began at St. Louis Children’s Hospital in 1984 and now include programs in heart, heart and lung, lung, kidney, bone marrow, liver and small intestine. At this time, 100 to 120 children are evaluated and more than 65 organ transplantations are performed annually. The Pediatric Liver Transplantation Program currently is responsible for the management of 60 children who have undergone liver transplantation at our center. Thirteen transplants have been done in the last 14 months. Live donor and split liver transplants have been done. Actuarial survival statistics for this program are excellent.
The division runs weekly conferences designed to develop a scholarly approach to diagnosis and management of common and complex pediatric gastrointestinal problems. These sessions include didactic thematic seminars and multidisciplinary presentations attended by faculty from the departments of Pediatrics, Pediatric Surgery, Radiology and Surgical Pathology. Other conferences are dedicated to the presentation and review of current research projects by fellows or faculty, to the presentation of a core curriculum which addresses basic gastrointestinal and hepatic physiology and to the discussion of research methods in a journal club format. The division also runs weekly liver transplantation case conferences with the liver transplantation program headed by Drs. Jeff Lowell and Ross Shepherd.
Additional opportunities available to members of the division include clinical and research seminars conducted as part of the Adult Gastroenterology Fellowship Program, clinical and research seminars within the Department of Pediatrics and Pediatric Grand Rounds.