Specialized Clinical Services

The Division of Gastroenterology, Hepatology & Nutrition has a long-standing commitment to understanding and treating genetic liver disease in children—particularly the most common genetic condition leading to pediatric liver transplantation. As a recognized center of excellence, the division provides care for the majority of affected children across the Midwest and regularly consults on cases from across the United States and internationally.

Ongoing research within the division focuses on:

• Designing targeted treatment strategies to improve outcomes
• Uncovering the underlying mechanisms of liver injury in this disorder
• Developing predictive diagnostic tools

The Celiac Disease Center provides specialized care for children with celiac disease across the region. Our team offers comprehensive monitoring of:

• Disease activity
• Growth and developmental milestones
• Nutritional status and deficiencies
• Extraintestinal manifestations associated with celiac disease

Through proactive management and personalized care plans, we aim to support long-term health and well-being for every child and family we serve.

Our Eosinophilic Esophagitis Program provides specialized, multidisciplinary care in close collaboration with the teams from Allergy and Pulmonary Medicine. Together, we offer comprehensive evaluation and management for children with EoE, a chronic immune-mediated condition affecting the esophagus.

Treatment plans are tailored through:

• Ongoing clinical assessment
• Regular monitoring of symptoms and disease activity
• Thoughtful medication adjustments based on individual response

While swallowed fluticasone (Flovent) has long been a cornerstone of therapy, we now incorporate newer treatment options to better meet the needs of our patients and improve long-term outcomes.

Learn more about the Eosinophilic Gastrointestinal Disorders program (EGID):

The Esophageal and Anorectal Motility Program provides specialized care for children with complex motility disorders, including:

• Hirschsprung’s disease
• Constipation
• Encopresis
• Irritable bowel syndrome (IBS)

This interdisciplinary program brings together pediatric gastroenterologists, surgeons and psychologists to deliver comprehensive clinical care. In addition to current diagnostic and therapeutic services, the team is advancing research into genetic traits that influence susceptibility to Hirschsprung’s disease and neuronal dysplasia syndromes.

Diagnostic & therapeutic services include:

• Botulinum toxin (Botox) sphincter treatments
• Impedance pH testing – for evaluating reflux and esophageal function
• Esophageal and anorectal manometry – to assess muscle coordination and pressure

The Healthy Start Clinic provides specialized evaluation and treatment for children with obesity-related medical complications. We care for patients with body mass index (BMI) greater than the 95th percentile for age, particularly when obesity is associated with:

• Nonalcoholic steatohepatitis (NASH)
• Polycystic ovarian syndrome (PCOS)
• Hyperlipidemia
• Type 2 diabetes
• Hypertension
• Sleep apnea

Our multidisciplinary team offers a comprehensive adolescent bariatric surgery program, which includes:

• Ongoing support to promote long-term health and lifestyle changes
• Thorough pre-surgical assessment and eligibility evaluation
• Personalized metabolic and digestive management before and after surgery

The clinic’s goal is to address not only the physical complications of obesity but also to support sustainable wellness through coordinated, compassionate care.

The IBD Center at St. Louis Children’s Hospital provides expert, multidisciplinary care for nearly 500 children and adolescents living with ulcerative colitis and Crohn’s disease. Our team is dedicated to supporting long-term health and quality of life through personalized, evidence-based treatment.

We offer a full spectrum of services, including:

• Advanced imaging for diagnosis and monitoring
• Psychological support to address emotional and behavioral challenges
• Endoscopy and colonoscopy for evaluation and disease management
• Surgical consultation and intervention, when needed

The center is a proud and active participant in ImproveCareNow, an international collaborative network focused on improving outcomes and optimizing care for children with IBD through shared data, innovation and continuous quality improvement.

This specialized program provides expert medical care and nutritional support for children affected by a broad spectrum of metabolic liver diseases. Our multidisciplinary team works closely with families to manage complex conditions and support long-term health.

Conditions we treat include:

• Galactosemia
• Glycogen storage diseases
• Disorders of iron and copper metabolism, such as Wilson’s disease
• Tyrosinemia
• Other rare inborn errors of metabolism impacting liver function

Through individualized care plans, nutritional therapy, and ongoing monitoring, we aim to prevent complications, optimize growth and development and improve quality of life for each child.

The Division of Gastroenterology, Hepatology & Nutrition has developed a specialized evaluation protocol for neonates with liver disease, with a particular focus on biliary atresia. This protocol is designed to investigate key aspects of the condition, including:

• Epidemiology
• Pathogenesis
• Clinical management strategies

Recognized for its innovation and rigor, this protocol has served as the model for a proposed multicenter, nationwide initiative submitted to:

• The Digestive Disease Branch of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• The National Institute of Child Health and Development (NICHD)
• The American Liver Foundation

Current research efforts are exploring the role of specific genetic mechanisms in a subset of infants with biliary atresia and situs inversus, aiming to uncover new insights into disease origin and potential therapeutic targets.

The Pediatric Colorectal Center delivers expert, compassionate care for children with complex colorectal conditions, including:

• Hirschsprung Disease
• Anorectal malformations

Our multidisciplinary team—comprising pediatric surgeons, gastroenterologists, urologists and psychologists—works together to provide personalized treatment plans that address both medical and quality-of-life goals. Using state-of-the-art diagnostic and surgical technologies, we tailor care to each child’s unique needs.

A cornerstone of our approach is individualized bowel management, designed to help children achieve continence, reduce complications, and improve daily functioning. Our goal is to support both children and families in navigating these challenges with confidence and clarity.

The Pediatric Gastrointestinal Polyposis Center (PGPC) at St. Louis Children’s Hospital provides specialized, family-centered care for children with intestinal polyposis syndromes and related hereditary conditions. Our clinical providers and support staff bring deep expertise in evaluating and managing these complex disorders, while offering guidance and support to affected families.

While most gastrointestinal (GI) polyps in children are solitary and benign, certain polyposis syndromes may increase the risk of GI tract or other cancers. In many cases, these conditions are linked to identifiable genetic mutations, which may have implications for family members.

Conditions we treat

Led by David Rudnick, MD, PhD, a board-certified pediatric gastroenterologist with over 20 years of experience in managing pediatric intestinal polyps, the PGPC team collaborates with experts in pediatric oncology, genetics and surgery to care for children with:

• Familial adenomatous polyposis (FAP)
• Peutz-Jeghers syndrome (PJS)
• Juvenile polyposis syndrome
• Other hereditary GI polyposis and colon cancer syndromes

We also evaluate children with personal or family histories of intestinal polyposis who may not yet have a defined syndromic diagnosis.

Our commitment

The PGPC is dedicated to:

• Providing comprehensive, multidisciplinary care
• Offering genetic counseling and testing when appropriate
• Supporting families through education, surveillance, and treatment planning
• Staying at the forefront of research and emerging therapies

Our goal is to ensure that every child receives personalized care informed by the latest science, while empowering families with knowledge and support.

The Liver Care Center at St. Louis Children’s Hospital, now under the direction of Yumirle Turmelle, MD, provides expert care for children with all disorders of the liver and biliary system, from infancy through adolescence. Our team of hepatology specialists—each with advanced fellowship training—works in close collaboration with transplant surgeons to deliver seamless, multidisciplinary care.

Since its inception, the center has performed over 300 pediatric liver transplants, including 71 transplants in the past five years, reflecting both clinical excellence and deep experience in complex hepatology.

Specialized programs & services

We offer comprehensive evaluation and treatment for a wide range of liver conditions, including:

• Pediatric liver transplantation
• Viral hepatitis
• Alpha-1-antitrypsin deficiency
• Metabolic liver diseases