Gastroenterology, Hepatology and Nutrition | Clinical | Specialized Clinical Services
Pediatric Liver Program
Now under the direction of Dr. Yumirle Turmelle, the division has established a unique center to provide comprehensive specialty evaluation and care for children with liver disease. Our specialized programs and services include pediatric liver transplantation as well as treatment for viral hepatitis, alpha-1-antitrypsin deficiency and metabolic liver disease.
Diagnostic resources through the program range from cholangiography to specialized interviews by child psychologists. The Ambulatory Procedure Center provides a family-focused environment to initiate oral or intravenous sedation and to perform diagnostic or therapeutic procedures including variceal banding. liver biopsy, and other specialized tests.
The Pediatric Liver Program also provides numerous educational resources for physicians, parents and patients. These resources include written teaching materials and videotapes explaining diagnostic tests, specific disease states, and complications of severe liver disease. In addition, patients and their families receive educational and emotional support through our Liver Support Group, which meets every two months. Topics covered include liver tests, the impact of liver disease on siblings and families, and liver transplantation experience.
Our liver program panel of subspeciality consultants includes: pediatric gastroenterologists, pediatric surgeons, transplant surgeons, interventional radiologists, pathologists, psychologists, statisticians, clinical nurse coordinators, dieticians, pharmacists and social workers. The staff of the Pediatric Liver Program has already made significant contributions to current medical knowledge, particularly to understanding the pathophysiology and treatment of Reye's syndrome, vitamin E deficiency in liver disease, safety and efficacy of TPGS Vitamin E, G-CSF therapy for neutropenia in glycogen storage disease lB, interferon treatment of hepatitis B, NTBC treatment of tyrosinemia, and liver disease in alpha-1-antitrypsin deficiency.
This program is part of a NIH-funded multicenter study to determine the prevalence of neonatal liver disease, specific causes of the neonatal hepatitis syndrome, and optimal use and timing of specific diagnostic studies. The program also includes studies designed to test several hypotheses for the pathogenesis of biliary atresia
The division has a long-standing interest in this genetic cause of liver disease in children. It is the most common genetic diagnosis for which children undergo liver transplantation. The division takes care of most of the patients in the midwest and consults on patients from across the country as well as from overseas. Research studies within the division are designed to determine the cause of liver injury in this disorder, to develop predictive diagnostic tests and specific treatment strategies.
Neonatal Hepatitis/Biliary Atresia
The division has established a protocol for evaluation of neonates with liver disease, particularly biliary atresia, designed to begin to determine the epidemiology, pathogenesis and management issues. This protocol has been the model for a multicenter nationwide initiative proposed to the Digestive Disease Branch of the National Institute for Diabetes, Digestive Diseases and Kidney Diseases, and the National Institute of Child Health and Development of the NIH as well as the American Liver Foundation. The research program is now examining the possibility that specific genetic mechanisms account for a subgroup of infants with biliary atresia and situs inversus.
Metabolic Liver Disease
This program focuses on the medical care and nutritional support of children with a wide variety of metabolic diseases that affect the liver. This includes galactosemia, glycogen storage disease, disorders of iron and copper metabolism such as Wilson's disease, tyrosinemia and several others.
Inflammatory Bowel Disease
Directed by Dr. Charles Samson, this program features a unique expertise in caring for children and adolescents with inflammatory bowel diseases. A multidisciplinary team of pediatric surgeons, dietitians, social workers and psychologists work with the pediatric gastroenterologists and their nurses to provide careful diagnostic evaluation, detailed management and attention to the emotional and developmental well being of each child.
A team of pediatric gastroenterologists, psychiatrists, social workers, and nurses coordinates a multidisciplinary program for children with abdominal pain. The goal of this program is to design cost-effective strategies for identification of the sub-group of these children with serious underlying diagnoses as well as for rapid, inexpensive treatment of the remaining children with psychophysiologic symptoms.
Our physicians have designed a clinical program for disorders of motility including Hirschsprung's disease, constipation, encopresis, and irritable bowel syndrome. This program brings together pediatric gastroenterologists, surgeons, and psychologists for clinical care and will begin to examine the recently identified genetic traits that determine susceptibility to Hirschsprung's disease and neuronal dysplasia syndromes.