Overview

Overview

gastroenterology

Our team of pediatric gastroenterologists and hepatologists care for children with problems of the gastrointestinal tract. We take care of children with a variety of gastroenterological conditions involving organs in the digestive system, including the esophagus, stomach, large bowel, small bowel, liver, gallbladder and pancreas.

Patient visits to the Pediatric Gastroenterology & Hepatology department number more than 10,000 per year. We are also one of the largest U.S. centers for pediatric inflammatory bowel disease.

Our 11 board-certified pediatric gastroenterologists sub-specialize in areas ranging from fatty liver disease and GI motility disorders to advanced endoscopy and IBD.

Multidisciplinary approach

Our pediatric gastroenterological patients have access to multiple specialties including pediatric surgery, pediatric radiology and pediatric anesthesia, as well as the full resources of the Cleveland Clinic. Taking the time to explain treatment options and plans to children and their families is a high priority for our pediatric GI specialists and hepatology team.

Pediatric gastroenterology and hepatology team members also encourage patients and families to actively participate in decision-making over the course of care. Our Pediatric Endoscopy Suite and Infusion Center features a new generation of high-definition endoscopes and monitors that permit direct visualization of the various digestive pathways. This superior visualization results in better detection of abnormalities.

Our team actively collaborates with other pediatric subspecialty providers in the treatment of pediatric obesity and its associated metabolic complications.

We offer specialized evaluations for children with conditions such as cyclic vomiting syndrome, myelomeningocele (spinal problem), feeding problems and children with GI problems associated with airway and lung disease.

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Specialized gastroenterological testing

We offer some of the most sophisticated and specialized tests needed to diagnose gastroenterological conditions.

In addition to diagnostic and therapeutic endoscopy we routinely perform wireless capsule endoscopy and advanced motility procedures with high resolution equipment including esophageal motility, antro-duodenal motility, rectal motility and colonic motility.

Innovative gastroenterological treatments

Our staff’s involvement in research has included research on new medications that dramatically improve the health of children with moderate to severe pediatric inflammatory bowel disease. Our unique Center for Functional and GI Motility Disorders is able to perform sophisticated motility testing not available at most children's hospitals.

Our pediatric psychology and pain therapy team help children with chronic GI diseases learn to cope with pain and other symptoms through biofeedback and other techniques. Pediatric liver transplantation, including living related transplantation and reduced size grafts, provide options for children with very serious liver disease and has excellent survival rates.

Small Bowel Transplantation can help restore intestinal function to those patients whose intestines do not absorb nutrients properly due to disease, injury or prior surgery. This is a new surgical technique and the members of the department can evaluate pediatric patients to see if they may be candidates for this procedure. In addition department members help to manage the complicated nutritional requirements of children with “short gut syndrome”, who one day may need a surgical procedure such as a bowel lengthening procedure or a small bowel transplant.

What We Treat

What We Treat

Digestive disorders gastroenterological conditions in children range from minor to life threatening, and short- to long-term or chronic. Following are just some of the pediatric gastrointestinal conditions our GI specialists treat and the services we provide:

Programs

Programs

Celiac Disease Program

Celiac disease is an immune-mediated systemic disorder that happens in genetically susceptible individuals and is triggered by a protein called gluten that exists in certain grains including wheat, rye and barely. It affects 1 in 100 individuals in the United States. It may present with wide spectrum of symptoms ranging from no symptoms to diarrhea and failure to thrive. Avoidance of gluten is the cornerstone of treatment.

Our Team

Celiac disease is managed by a designated multidisciplinary team of pediatric medical professionals and staff at Cleveland Clinic Children’s. The team includes:

  • Physicians (MD or DO).
  • Nurse Practitioner (CNP).
  • Experienced pediatric Registered Dietitian (RD).
  • Nursing.

Conditions We Treat

  • Children with suspected celiac disease.
  • Children with family history of celiac disease.
  • Follow up and counseling of children with established celiac disease and their families.

Appointments

Please call 216.444.9322 for a consultation.

Endoscopy Suite and Infusion Center

New options for identifying and treating pediatric digestive disorders

Cleveland Clinic Children's is providing another level of service to care for the growing population of children with digestive disorders in the new, six bed Pediatric Endoscopy Suite and Infusion Center at Cleveland Clinic's main campus Crile building.

The sophisticated suite, which accommodates more than 750 to 1,000 procedures annually, features a new generation of high-definition endoscopes and monitors that permit direct visualization of the various digestive pathways. This superior visualization results in better detection of abnormalities.

Cleveland Clinic Children's currently serves one of the largest populations of pediatric patients in the United States who suffer from digestive disorders. Our renowned pediatric gastroenterologists are physician specialists who care for children with problems ranging from Colic to Crohn's Disease.

Eosinophilic Esophagitis (EOE)

Eosinophilic esophagitis is a complex disease that can affect up to 1/1,000 children.  It happens more often in boys.  The disease is characterized by a specific type of white blood cell called an eosinophil, a call type often associated with allergies, which collect in the esophagus.

EoE commonly causes symptoms including:

  • Difficulty swallowing.
  • Choking or gagging on foods.
  • Sensation of food sticking.

Younger children have symptoms of:

  • Weight loss.
  • Food refusal.
  • Vomiting.

The diagnosis and treatment of this disease involves evaluation by a combination of pediatric gastroenterologists, pediatric allergists and pediatric dietitians.  Treatment can include dietary therapy, medical therapy, or both.  Most patients may need an upper scope test (endoscopy) to make the diagnosis and for follow up of this condition.

Patients may also require additional testing such as evaluation of swallowing by x-ray or motility study and allergy skin testing, along with lab work.

Our Team

The multidisciplinary Eosinophilic Esophagitis Clinic at Cleveland Clinic Children's hospital brings together a team of experts including Pediatric Gastroenterology, Pediatric Allergy, and Pediatric Nutrition to evaluate and treat your child following diagnosis with Eosinophilic Esophagitis.  During your office visit, expertise from each subspecialty will occur over a 2 hour appointment with treatment that is individualized to your child.  Communication and patient-focused care is at the core of our clinic, with the convenience of meeting the providers in one location.  Cleveland Clinic's Pediatric Gastroenterology Program is nationally ranked and the top ranked gastroenterology division in Northeast Ohio.

Appointments

To schedule a consultation, please call 216.444.5348

Glycogen Storage Disease (GSD) Program

Glycogen Storage Disease (GSD) is a rare genetic disorder effecting 1 in every 100,000 newborns. The underlying problem in all GSD types is the inability to properly use and or store glycogen as individuals with the disease lack enzymes to store or release glycogen. Treatment and disease management includes assessment of metabolic control through laboratory findings, liver ultrasound, dietary changes, nutritional assessment and monitoring of disease progression and implementation of appropriate interventions.

Our Team

GSD is managed by a designated multidisciplinary team of pediatric medical professionals and staff at Cleveland Clinic Children’s. The team includes:

  • Physicians (MD or DO).
  • Nurse Practitioner (CNP).
  • Dedicated pediatric GSD Registered Dietitian (RD).
  • Vascular access.
  • Respiratory Therapy.
  • Nursing.
  • Nutrition Services.

Conditions We Treat

  • GSD Type 0.
  • GSD Type I.
  • GSD Type III.
  • GSD Type IV.
  • GSD Type VI.
  • GSD Type IX.

Appointments

Please call 216.444.9322 for a consultation.

Inflammatory Bowel Disease Program

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the digestive tract as the result of an abnormal immune response to the environment in a genetically susceptible individual. Cleveland Clinic Children’s Pediatric Inflammatory Bowel Disease Program is designed to provide personalized and exceptional care for children and young adults with IBD.

Metabolic Liver Disease Clinic

The Pediatric Metabolic Liver Disease Clinic multi-disciplinary team staff takes a comprehensive approach to preventing the onset and progression of cardiovascular disease and metabolic conditions in high-risk pediatric patients.

Capsule Endoscopy

Capsule endoscopy is an exciting technology that allows our Pediatric Gastroenterologists to look at the entire small bowel tract in a single day. With earlier diagnosis and intervention this test holds promise for lowering morbidity and mortality among adults and children with small bowel problems.

Nonalcoholic Fatty Liver Disease Clinic

Nonalcoholic Fatty liver disease (NAFLD) has become the most common cause of chronic liver disease in children and adolescents in the United States affecting approximately 1 in 10 children and about 50% of children with obesity. More importantly, it is the second most common cause of liver transplantation among the adults in the United States. NAFLD initially starts with simple fat accumulation in liver (called hepatic steatosis) and can progress to liver injury (called nonalcoholic steatohepatitis) eventually leading to scarring (liver fibrosis) and advanced liver disease (cirrhosis). Up to 25% of the children with NASH can progress to fibrosis.

Therefore, the aim of our pediatric NAFLD clinic is to identify children and adolescents with NAFLD and to prevent them from progressing to fibrosis. The unique aspect of our clinic is noninvasive assessment of liver fibrosis through use of an ultrasound based technique called Tissue elastography which can be done on the same day of clinic with real time results. Weight loss currently remains the mainstay of treatment for NAFLD which can be achieved with lifestyle interventions. We also comprehensively screen for other associated comorbidities such as diabetes, hypertension, dyslipidemia and obstructive sleep apnea.

Our Team

Pediatric NAFLD is managed by a designated multidisciplinary team of pediatric medical professionals and staff at Cleveland Clinic Children’s. The team includes:

  • Physicians with expertise in hepatology.
  • Registered pediatric dietitians with experience in obesity and weight management in children.
  • Nursing.

Conditions We Treat

  • NAFLD.
  • NASH.
  • NAFLD induced liver fibrosis.

Appointments

Please call 216.444.9000 for a consultation.

Nutrition Support

Nutrition is a critical therapy for children of all ages especially those with medical conditions and chronic diseases. Proper nutritional support prevents malnutrition, assures appropriate physical growth and development, and helps to maintain a strong immune system. A pediatric, registered dietitian is a licensed health professional who specializes in the nutritional care of children and understands their specific nutritional needs.

Our Team

Cleveland Clinic Children’s has a team of registered dietitians, board certified in pediatrics, who collaborate with physician and multi-disciplinary teams to provide expert, evidence-based nutritional care for infants, children and adolescents. The dietitian provides individual counseling to assess each child’s nutritional needs, develop the most appropriate plan of nutritional support, and monitors nutritional status to ensure an optimal outcome. Through inpatient and outpatient settings, the Pediatric Nutrition Support Team at Cleveland Clinic Children’s offers: comprehensive individualized nutritional and physical assessments, evaluations of oral motor, sensory, and developmental feeding skills, in-depth family education related to nutritional needs and strategies, feeding techniques and equipment recommendations, home programming and community resources, and home monitoring and evaluation for patients receiving nutrition support as part of their therapies. In addition to 16 registered dietitians, the team also includes a physician (MD), and nurse practitioner (CNP).

Medical Areas We Support

Adolescent medicine, bone marrow transplantation, cardiology, cardiothoracic surgery and congenital heart defects, diabetes, feeding disorders, food allergies, general pediatrics, general surgery, genetics and metabolism, GI disorders, home enteral and parenteral nutrition support, nephrology, neonatology, neurology, oncology, physical medicine and rehabilitation, pulmonary, solid organ transplantation, weight management and wellness.

Pancreatic Disorders in Children and Adolescents

Over the past decade, there has been an increased awareness of pancreatic diseases in children and adolescents with both acute and chronic pancreatic issues. Acute pancreatitis can occur in a child who has another systemic illness or can be secondary to trauma, gallstones, medications, or from a congenital with the anatomy of the pancreas. In most children, however, a cause cannot be found.

The symptoms of pancreatitis are non-specific and can include abdominal pain and vomiting. Very young children can have crying and fussiness as the main symptom.

There is no single test to diagnose pancreatitis. Abnormal blood test results along with imaging findings can suggest inflammation of the pancreas. When there are two of the three criteria present, i.e. abdominal pain, elevated blood enzyme levels and/or imaging changes, a diagnosis of pancreatitis is made.

An episode of pancreatitis usually lasts about one week and seldom do patients develop complications of the acute episode such as a collection fluid around the pancreas. About 10% of children can have a recurrence of the pancreatitis, and if that is the case, then further testing is indicated to search for a possible underlying cause of recurrent acute pancreatitis. For most children, there is no way to prevent further episodes unless there is an underlying reason such as a gallstone, elevated lipid levels or an abnormality of the pancreatic duct.

Conditions We Treat

  • Acute and chronic pancreatitis.
  • Congenital abnormalities of the pancreas.
  • Pancreatic cysts.
  • Pancreatic endocrine and exocrine insufficiency.
  • Pancreatic masses or tumors.

Our Team Based Approach to Pediatric Care

The multi-disciplinary team is led by the Pediatric Gastroenterologist along with Pediatric specialists in Surgery, Endocrinology, Radiology, Psychology, and Pain Management.
Other team members include nursing care with both RN and CNP, registered dietitians, and vascular access team.

Treatment Options

  • Pain management.
  • Nutritional Counseling.
  • Endoscopic Procedures such as ERCP.
  • Surgical and Drainage procedures.
  • Total Pancreatectomy and Auto Islet Transplantation (TPAIT).

Appointments

To schedule a consultation, please call 216.444.KIDS (5437).

Pediatric Liver Transplant Program

The Cleveland Clinic Children's Pediatric Liver Transplant Program provides special care for children who suffer from various types of liver disease that require liver transplantation. Our multidisciplinary team stays with your child and your family from the time of referral to transplant, and more importantly all the way through long-term care after transplant if a transplant is required.

Our pediatric liver disease program treats infants and children covering the whole spectrum of pediatric liver disease. Once they age into young adults, we are able to maintain continuity of care by transitioning them to caregivers in collaboration with our adult liver transplant program. Whether your child’s illness can be managed with medications or surgery, we as a team will give them the best of care regardless of their needs.

Learn more about the Pediatric Liver Transplant Program

Our Doctors

Our Doctors

Appointments & Locations

Appointments & Locations

To make an appointment, please call 216.444.9000 or 800.223.2273, ext. 49000.

Locations

We see children at Cleveland Clinic Children's Outpatient Center, located at Cleveland Clinic's main campus, as well as at a number of our family health centers and community hospitals. Find a location near you below:

Pediatric Infusion Clinics

At Cleveland Clinic Children’s, we want to make leading edge treatment as convenient as possible for you and your child. As a way to maximize convenience and minimize family stress, all infusion rooms are private and you may be visited by someone from art therapy, music therapy or Child Life Services. 

We now offer expanded access to pediatric infusion for children and teens with Crohn's disease and other problems of the gastrointestinal tract when necessary. Please call to schedule an infusion appointment at the location of your choice.

Resources for Families

Resources for Families

Inflammatory bowel disease: attaining wellness and independence

The following educational videos will provide information on nutrition and exercise, emotional wellness, healthcare literacy, available resources and the world in adult IBD.

  1. Own Your IBD: Inspiring Wellness and Independence in Adolescents and Young Adults with IBD - Dr. Jacob Kurowski, MD
  2. Live Your Best Life: Nutrition & Physical Activity for IBD - Diana Schnee, MS, RD, CSP, LD
  3. Coping with IBD: Recognizing and Responding to Stress and Depression – Dr. Katherine Lamparyk, PsyD
  4. Resources to Help Manage Your IBD - Dr. Nila Mistry Ambani, MD
  5. Moving Towards Independence - Kathy Raig, RN
  6. Transitional Care for IBD: Welcome to the World of Adult Gastroenterology – Jessica Philpott, MD, PhD

Pediatric Gastrointestinal and Liver Disease, 6th edition

Written by forger chairman and current Cleveland Clinic Chief Medical Operating Officer Robert Wyllie, MD (Chief Editor) and current Chair, pediatric endoscopist Marsha Kay, MD (Associate Editor), Pediatric Gastrointestinal and Liver Disease is the leading text in the medical field for the diagnosing and treatment of pediatric gastrointestinal and liver diseases.

Additional resources for families