Gastroenterology

The Section of Pediatric Gastroenterology, Hepatology & Nutrition provides consultative inpatient care at Alberta Children’s Hospital and outpatient care for children in southern Alberta and eastern British Columbia with disorders of the gastrointestinal tract and liver including:

• Celiac disease
• Chronic constipation that failed recommended treatment by a Community Pediatrician
• Chronic liver and biliary disease
• Chronic pancreatitis
• Cystic fibrosis
• Enteral feeding
• Eosinophilic gastrointestinal disorders
• Foreign body and caustic ingestions
• Functional gastrointestinal and motility disorders
• Gastrointestinal bleeding
• Gastrointestinal polyps
• Gastroesophageal reflux disease
• Inflammatory bowel disease
• Intestinal failure
• Peptic ulcer disease

Pediatric Gastroenterology services are provided directly by distinct Clinics at two separate locations, which also support Virtual Telehealth Care when appropriate:

• Pediatric Gastroenterology Clinic at Alberta Children’s Hospital
• CHIRP Clinic (Children’s Hospital Intestinal Rehabilitation Program) at the Alberta Children’s Hospital
• Pediatric Gastroenterology clinic at the South Health Campus (servicing patients living in communities in southeast Calgary and southern Alberta)

Specialty programs and clinics are also offered in collaboration with other medical specialties including:

• Cystic Fibrosis Clinic
• Esophageal Atresia Clinic

Resources Available for Families:

• Understanding Common Lab Tests 
• Understanding Endoscopy
• Understanding Common Imaging

Children’s Hospital Intestinal Rehabilitation Program (CHIRP)

• The program, directed by Dr. Dana Boctor, is committed to supporting children with intestinal failure. The interdisciplinary team consists of pediatric gastroenterologist Dr. Gary Galante, surgeons, nurses, dietitians, and a social worker. 
• It provides specialized care to infants born with congenital defects or children who develop severe intestinal problems that can lead to intestinal failure.  This condition is characterized by absorptive capacity and/or poor motility, resulting in a dependence on parenteral nutrition support to sustain adequate nutrition and growth.
• Our team’s approach incorporates both traditional and novel therapies to optimize care.  This has resulted in a dramatic reduction in disease-related complications and increased patient survival.  The team’s research activities include examining quality of life, feeding, nutritional support, and therapies to improve the growth and function of the gastrointestinal tract.

Gastrointestinal Motility Centre  

• The Program is directed by Dr. Alfred Yeung, who completed additional subspecialty training in pediatric neurogastroenterology and motility disorders at Nationwide Children’s Hospital.
• The multidisciplinary team aims to provide the biopsychosocial model of care that is needed to successfully manage these disorders. It consists of:
  • Pediatric nursing staff experienced in motility testing
  • Child Psychology, Social Work, and Dietitian support
• Functional gastrointestinal and motility disorders are common in infants and children. They represent a group of conditions where there is no obvious structural or biochemical abnormality identifiable by conventional testing. Symptoms may include recurrent abdominal pain, bloating, abdominal distension, vomiting, constipation, diarrhea, and difficulties swallowing. The burden of illness from living with a functional gastrointestinal or motility disorder can be substantial and have a significant impact on daily quality of life for both the affected child and their family.  Although the treatment of these disorders can be challenging, recognizing the diagnosis and identifying the dysfunction in motility or sensation are the essential first steps in their management.
• The Gastrointestinal Motility Centre at Alberta Children’s Hospital offers comprehensive testing for the diagnosis of functional gastrointestinal and motility disorders in children. Our facility uses advanced techniques, including high-resolution manometry and impedance-manometry that are available at only a few other sites in North America.
• We are also actively involved in research studies both locally and with international collaborators in hopes of improving our understanding of these conditions and developing better treatments.
• Evaluation at the Gastrointestinal Motility Centre is available only by referral through the Pediatric Gastroenterology Clinic at Alberta Children’s Hospital. 

Pediatric Inflammatory Bowel Disease Program

• The Program is led by Dr. Jennifer deBruyn, with all other Gastroenterologists providing care to children and adolescents with inflammatory conditions of the gastrointestinal tract.  A supporting multidisciplinary team includes Nurses, Dietitians, Social Workers, and our Pharmacist.
• The Program includes Pediatric Inflammatory Bowel Disease Ultrasound. Bedside intestinal ultrasound is a non-invasive, safe, well-tolerated tool that is used at the bedside to monitor disease activity, including response to therapy, in children with IBD. Dr. Jennifer deBruyn has undergone intestinal ultrasound training through the International Bowel Ultrasound Group.
• The Pediatric Inflammatory Bowel Disease (IBD) Transition Program at Alberta Children’s Hospital for Adolescents with IBD (aged 14 years or older) was established to support adolescents with IBD to independently manage their disease after graduating from pediatric care.  This outpatient program is run by Dr. Jennifer deBruyn and Dr. Iwona Wrobel and involves close collaboration with adult IBD specialists at Foothills Medical Centre.
• Our program focuses on the needs of the patient and family, and emphasizes a proactive approach to managing chronic illness. We view transition as an evolutionary process rather than a transfer of care and facilitate the gradual shift of responsibility for disease management from the family to the adolescent.  Multiple educational tools are used to help improve the adolescent’s skills and confidence necessary for independent care, allowing the family to become supporters instead of the primary caregivers. Commonly encountered social, legal, financial, and insurance-related topics are discussed as well.
• We are actively involved in research studies locally, nationally, and internationally with collaborators in hopes of improving our understanding of IBD, improving care for children with IBD, and developing better treatments.

Home Nutrition Support Program (HNSP) 

• Dr. Sharron Spicer works alongside a team of nurses and dietitians to assist families in managing their child's tube feeding at home. 
• The HNSP program provides nutrition support for approximately 600 pediatric patients in the catchment area who have specialized feeding needs.  These patients receive some or all of their feeds by tube in order to meet their nutritional needs.  Many of these patients require specialized liquid formulations (formula), or food blended at home for their tube feeds.
  • Families are taught how to use and care for their child’s tube.  The team supports families to obtain the supplies and formula to feed their child.
  • The HNSP nurses follow-up with the patients on a yearly basis to measure and change feeding tubes.  They are available as needed for any other problems with the tubes.
  • Dr. Spicer works closely with the child’s dietitian to monitor growth.
  • The team also works closely with other disciplines, including occupational therapy, physiotherapy, speech-language pathology and psychology to optimize feeding by mouth whenever possible.
• The HNSP team works collaboratively to inform families and other healthcare providers about feeding supports in the community.  More information is available at the Pediatric Eating and Swallowing (PEAS) website: https://peas.ahs.ca

Pediatric Liver Centre

• The Pediatric Liver Centre at Alberta Children’s Hospital offers comprehensive diagnostic testing of pediatric liver diseases. Our multidisciplinary team of experienced hepatologists (Dr. Simone Kortbeek and Dr. Simon Lam have special training in caring for children with liver disease), nurses, dietitians, social worker, and pharmacist ensures a well-rounded and individualized approach to treating patients with liver disease.
• Liver disease can affect the entire spectrum of the pediatric age group, from neonates to adolescents. Liver disease can be silent, but symptoms may include jaundice (yellowing of the eyes and skin), unexplained itching, and abnormal bleeding or bruising.  There are many causes of chronic liver disease including autoimmunity, infections, genetic conditions, and metabolic liver diseases. Sometimes, liver transplantation is required to treat patients with end stage liver disease.
• Our team actively participates in a number of national and international research studies for children with liver disease.  Dr. Kortbeek and Dr. Lam have both received awards at the national and international level, published peer reviewed research papers and have presented at international liver meetings.

Diagnostic investigations are coordinated through the Gastroenterology Lab and include:

• Endoscopy services

The Gastroenterology service offers a range of diagnostic investigations and therapeutic procedures for children with gastrointestinal disorders including:

• Upper endoscopy (esophagogastroduodenoscopy)
• Lower endoscopy (colonoscopy, sigmoidoscopy)
• Polypectomy
• Endoscopic esophageal balloon dilatation
• Endoscopic variceal ligation
• Endoscopic sclerotherapy
• Endoscopic foreign body removal
• Hydrogen breath testing
• pH impedance reflux monitoring

These studies are available to children admitted to hospital or as an outpatient by referral to the Gastroenterology service.

Further information, including how to prepare for your child’s test, can be found here.

• Gastrointestinal Motility Testing
• Hydrogen Breath Testing

A physician Referral is required for all Clinics.  Please contact your physician or family doctor.

The Section of Gastroenterology, Hepatology, and Nutrition is active in clinical, basic science, and translational research. Notable areas of interest and active research include:

• Clinical applications of non-invasive serological testing in celiac disease, and exploring disease risk in first degree relatives
• Epidemiology and molecular biology of eosinophilic gastrointestinal disorders
• Emerging therapies, genetics, immunization responses, intestinal ultrasound, therapeutic drug monitoring, and clinical outcomes in pediatric inflammatory bowel disease
• Health-related outcomes in pediatric liver transplantation
• Direct acting antiviral therapy for pediatric hepatitis C
• Microbial recognition by pattern recognition receptors in animal models of colitis
• Neurobiology of functional gastrointestinal disorders
• Therapies for gastrointestinal motility disorders
• Mechanisms of injury and biomarker discovery in pediatric onset autoimmune liver diseases
• Transient elastography in chronic liver disease
• Quality of life issues and feeding challenges in pediatric intestinal failure
• Quality Improvement projects

Research 

Education & Training

Dr. Dana Boctor 
Dr. Jennifer deBruyn
Dr. Gary Galante
Dr. Dominica Gidrewicz
Dr. Simone Kortbeek
Dr. Simon Lam
Dr. Helen Machida
Dr. Leanna McKenzie 
Dr. Sharron Spicer 
Dr. Christopher Waterhouse (Section Chief) 
Dr. Iwona Wrobel 
Dr. Alfred Yeung