Journal of Paediatric Medicine & Surgery
Open Access

Pediatric gastroenterology; Celiac disease; Inflammatory bowel disease; GERD; Functional abdominal pain; Endoscopy; Nutritional therapy; Gut microbiome; Lactose intolerance; Pediatric hepatology

Introduction

Gastrointestinal diseases in childhood can significantly affect growth, development, nutrition, and quality of life. Pediatric gastroenterology involves the diagnosis and management of conditions involving the digestive tract, liver, pancreas, and associated nutritional disorders. Advances in non-invasive diagnostic tools, endoscopic techniques, and targeted therapies have improved detection and outcomes in conditions ranging from common functional GI disorders to chronic inflammatory diseases like IBD [1]. Growing awareness among clinicians and families has also led to earlier diagnoses and more comprehensive management strategies [2].

Description

Pediatric gastrointestinal disorders may present with a variety of symptoms including abdominal pain, vomiting, diarrhea, constipation, poor weight gain, and rectal bleeding. GERD is commonly seen in infants and young children, often presenting with regurgitation, irritability, and feeding difficulties. While most cases are physiologic, persistent symptoms warrant pH monitoring or upper GI endoscopy [3]. Celiac disease, an autoimmune reaction to gluten in genetically susceptible individuals, causes villous atrophy in the small intestine. It presents with diarrhea, bloating, failure to thrive, or atypical symptoms like anemia. Diagnosis is based on serologic testing (tTG-IgA) and duodenal biopsy. A strict gluten-free diet is the mainstay of treatment [4].

Inflammatory bowel disease, encompassing Crohn’s disease and ulcerative colitis, presents with chronic diarrhea, weight loss, abdominal pain, and delayed growth. Pediatric IBD often shows more extensive disease and rapid progression compared to adult-onset cases. Diagnosis relies on a combination of colonoscopy, imaging, and histopathology. Management includes corticosteroids, immunomodulators, and biologic therapies targeting tumor necrosis factor-alpha or interleukins [5]. Functional gastrointestinal disorders, such as functional abdominal pain and irritable bowel syndrome (IBS), are common in children and adolescents. These are diagnosed based on Rome IV criteria and are managed with reassurance, dietary modifications, probiotics, and psychological interventions like cognitive behavioral therapy [6].

Liver disorders, including biliary atresia, autoimmune hepatitis, and non-alcoholic fatty liver disease (NAFLD), are also within the scope of pediatric gastroenterology. Early surgical intervention (e.g., Kasai procedure) in biliary atresia improves outcomes. NAFLD is now recognized as the most common pediatric liver disease, strongly associated with obesity [7].

Results

Early recognition and dietary therapy have significantly reduced complications in celiac disease, while the use of biologics has changed the natural history of pediatric IBD, improving remission rates and reducing surgery [8]. Endoscopy remains a gold standard for diagnosis and has become safer with pediatric-specific protocols. Studies show that early nutritional intervention and exclusive enteral nutrition (EEN) in Crohn’s disease induce remission as effectively as corticosteroids, without systemic side effects [9]. Recent investigations into the pediatric gut microbiome have revealed its role in modulating immune responses, digestion, and susceptibility to GI diseases. Probiotic supplementation has shown benefits in specific conditions like antibiotic-associated diarrhea and infantile colic [10].

Discussion

Challenges remain in managing chronic GI diseases in children, especially in ensuring adherence to complex treatment regimens and coping with psychosocial impacts. Pediatric patients often require individualized care plans involving dietitians, psychologists, and school health professionals. Multidisciplinary care models improve adherence, nutritional status, and quality of life [6]. The rise in autoimmune GI conditions such as IBD and celiac disease is partially attributed to changes in environmental exposures, microbial diversity, and dietary patterns. Ongoing research aims to better understand the gut–brain axis and develop microbiome-modulating therapies. Non-invasive biomarkers (e.g., fecal calprotectin) and imaging (e.g., magnetic resonance enterography) are reducing reliance on invasive procedures [7]. In developing regions, GI infections, malnutrition, and helminthic infestations are more prevalent. Addressing sanitation, vaccination, and nutritional education remains crucial to reducing pediatric GI disease burden in these settings.

Conclusion

Pediatric gastroenterology plays a crucial role in the early detection and management of a broad range of GI and liver diseases that significantly impact children’s growth and development. Advances in diagnostics, therapeutics, and personalized medicine have enhanced care delivery. Continued research into gut microbiota, non-invasive testing, and holistic management approaches will further improve outcomes for children with GI disorders.