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Editor

Ron Shaoul

Practical
Algorithms in
Pediatric
Gastroenterology

An essential bedside tool


Unlike adult gastroenterology, pediatric gastroen- text which classifies common clinical symptoms
terology is characterized by developmental disor- and signs, laboratory abnormalities and issues of
ders; the approach to the same disease condition management in the expanding field of pediatric
may therefore be widely different, and there is gastroenterology as presented in daily practice.
an increasing need from pediatric gastroenter-
ologists and pediatricians for easy diagnostic Written by leading experts in the field of pediat-
tools. Algorithms provide a logical, concise and ric gastroenterology and surrounding fields, this
cost-effective approach to medical reasoning and book is aimed at an audience of general and fam-
help avoid excessive unnecessary procedures ily practitioners, pediatricians and trainees who
and testing. Practical Algorithms in Pediatric are not exposed on a day-to-day basis to pediat-
Gastroenterology is a simple, bedside pragmatic ric gastroenterology problems.

www.karger.com/papg
Algorithms provide a logical, concise and
cost-effective approach to medical
reasoning and help avoid excessive unnecessary
procedures and testing.

Other motility disorders P.E. Hyman · T. Zangen Dysphagia


Dysphagia
38 Medical and feeding history
Physical examination 

Difficulty initiating swallows Food stops in or sticks to the esophagus


associated with coughing or choking after swallowing

Oropharyngeal dysphagia   Esophageal dysphagia

Videofluoroscopy Upper GI endoscopy with biopsies


(modified barium swallow)

Mucosal lesion  Structural lesion Normal

Barium
swallow

Normal

Anatomic Neurological
Inflammatory bowel disease
Primary motility
D. Turner · A.S. Day Reflux symptoms Ulcerative colitis
abnormalities abnormalities disorder  Trial of PPI 

Dysphagia Dysphagia Manometry


Ulcerative colitis improves the same

Normal Motility disorder


64
Exacerbation Assessment of disease activity 
Developmental Cleft palate Hypoxic brain damage Oropharyngeal Reflux Stenosis Reflux Psychological Functional Achalasia
dysphagia Craniofacial Myasthenia gravis incoordination esophagitis Stricture disease dysphagia  dysphagia  Esophageal spasm
syndromes Congenital myotonic Cricopharyngeal EoE Web Scleroderma
dystrophyRemission achalasia Infectious Mild to mild-to-moderate
Foreign body Enemas of 5-ASA Dysautonomia
Moderate-to-severe to
(PUCAI <10 points) 
Head trauma esophagitisdisease Tumor (or steroids if intolerant severe disease
Neurodegenerative Vascular
(PUCAI 10–45 ring
points) of 5-ASA) used as adjuvant (PUCAI 50–85 points) 
Spontaneous disorders Dermatologic for both left-sided and
resolution Chiari malformation disorder extensive colitis should
be offered

Maintenance therapy with 5-ASA 70 mg/kg/day Prednisone 1 mg/kg once daily


5-ASA for all patients up to 4.8 g daily up to 40 mg + 5-ASA
50–70 mg/kg/day up to 4 g daily in 2 divided doses 70–80 mg/kg/day up to 4.8 g daily
in 2 divided doses 
in 2 divided doses

Response No response Response No response

Taper corticosteroids Admission for


over 8–10 weeks i.v. methylprednisolone
1–1.5 mg/kg up to 40–60 mg
in 2 divided doses

If disease is chronically active or


there are frequent flares, add
thiopurines (azathioprine ~2–2.5 mg/kg Response No response
once a day or 6-mercaptopurine with 3–5 days
1–1.5 mg/kg once a day)


Consider second-line therapy


based on the PUCAI score
If disease is still chronically Response (cyclosporine, tacrolimus,
active or there are frequent flares infliximab or colectomy)   
despite adequate thiopurine
treatment, consider
anti-TNF therapy (infliximab
or adalimumab) 
Contents

Contributors Gastroesophageal Stomach and intestine


Preface reflux and vomiting Protein-losing enteropathy
Z. Hochberg Neonatal vomiting B. Zeisler, F.A. Sylvester
R. Shaoul, N.L. Jones
Introduction Celiac disease
R. Shaoul Nausea and vomiting Y. Bujanover, R. Shaoul
P.S. Lemos, R. Shaoul
Helicobacter pylori
Various gastrointestinal Recurrent vomiting and/or N.L. Jones, B.D. Gold
conditions regurgitation
Gastrointestinal polyps
Y. Vandenplas, R. Shaoul
Abdominal pain B. Zeisler, F.A. Sylvester
R. Arnon, S. Misra Typical and atypical reflux
Intestinal malabsorption –
syndrome
Acute gastroenteritis Part 1: Pathogenesis and
Y. Vandenplas, R. Shaoul
A. Lo Vecchio, D. Turck, A. Guarino etiology
Recurrent vomiting and/or A. Guarino, E. Ruberto, Y. Finkel
Food allergy
regurgitation and
B. Wershil, F.A. Sylvester Intestinal malabsorption –
poor weight gain
Part 2: First diagnostic steps
Failure to thrive Y. Vandenplas, R. Shaoul
A. Guarino, E. Ruberto, Y. Finkel
A. Lahad, S. Reif
Cyclic vomiting syndrome
Chronic diarrhea Y. Vandenplas, B.D. Gold
Inflammatory bowel
Y. Finkel, A. Guarino
disease
Upper gastrointestinal Other motility disorders Inflammatory bowel disease
bleeding
Achalasia D. Turner, A.S. Day
C.G. Sauer, B.D. Gold
S. Nurko, Y. Vandenplas
Crohn’s disease
Lower gastrointestinal
Constipation D. Turner, A.S. Day
bleeding
S. Misra, H. Van de Vroot
F.A. Sylvester, D. Turck Ulcerative colitis
Dysphagia D. Turner, A.S. Day
Malnutrition
P. Hyman, T. Zangen
P.S. Lemos, B. Wershil

Perianal disease
Fecal incontinence Surgical conditions
A. Siddiqui, O. Eshach Adiv, S. Nurko
A.S. Day, N.L. Jones Abdominal mass
Hirschsprung’s disease R. Udassin, A. Vromen, E. Gross
Gastrointestinal foreign
P.E. Hyman, T. Zangen
bodies Right lower quadrant
I. Rosen, R. Shaoul Chronic intestinal pseudo- abdominal pain
obstruction I. Sukhotnik, P.S. Lemos
T. Zangen, P.E. Hyman
Peritonitis
Irritable bowel syndrome S. Peleg, R. Shaoul
E. Chiou, S. Misra, S. Nurko
Short bowel syndrome
Y. Finkel, I. Sukhotnik
Liver Autoimmune liver disease Pancreas
G. Mieli-Vergani, M. Samyn
Neonatal jaundice Acute pancreatitis
E. Fitzpatrick, A. Dhawan Sclerosing cholangitis M. Wilschanski, R. Arnon
G. Mieli-Vergani, M. Samyn
Acute hepatitis Chronic pancreatitis
Y. Bujanover, S. Reif Acute liver failure M. Wilschanski, R. Shaoul
G. Mieli-Vergani, M. Samyn
Hepatitis B Index
E. Granot Hepatomegaly Abbreviations
E. Fitzpatrick, A. Dhawan
Hepatitis C
E. Granot Gallstones Fields of Interest:
E. Broide, S. Reif Pediatrics, Gastroenterology,
Elevated aminotransferases Nutrition, Neonatology,
J. Garah, R. Shaoul Portal hypertension Hepatology, Immunology
R. Arnon, A. Dhawan
Elevated alkaline phosphatase
R. Shaoul, J. Garah Ascites
A. Ben Tov, S. Reif

Practical Algorithms in Pediatric Gastroenterology


Editor

R. Shaoul (Practical Algorithms in Pediatrics. Series Editor: Z. Hochberg)


Editor: Shaoul, R. (Haifa)
Practical VII + 110 p., 51 graphs, 9 tab., 2014
CHF 49.– / EUR 41.– / USD 58.00 (spiral bound)
Algorithms in CHF 59.– / EUR 49.– / USD 70.00 (online)
Online versions for institutional purchase
Pediatric Prices subject to change
EUR price for Germany,
USD price for USA and Latin America only
Gastroenterology ISBN 978–3–318–02509–5 (spiral bound)
Practical Algorithms in Pediatrics
e-ISBN 978–3–318–02510–1
Series Editor: Z. Hochberg

www.karger.com/papg

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