MALABSORPTIONMALABSORPTION MICHAEL WILSCHANSKIMICHAEL WILSCHANSKI

PEDIATRIC GASTROENTEROLOGY PEDIATRIC GASTROENTEROLOGY UNIT UNIT

HADASSAH UNIVERSITY HOSPITALHADASSAH UNIVERSITY HOSPITAL

FOURTH YEAR STUDENTS 2013

3 MAJOR TYPES of chronic 3 MAJOR TYPES of chronic diarrheadiarrhea

Impaired Intraluminal DigestionImpaired Intraluminal Digestion

Impaired Intestinal MalabsorptionImpaired Intestinal Malabsorption

Diarrhea due to FermentationDiarrhea due to Fermentation

CF Pancreatic Pathobiology

Cystic Fibrosis Pancreas

Plugged Duct

Inflammation

Fibrosis

Range of Pancreatic Function(% of Control Mean)

100%

Control

PI

PS

1-20

10-15% of patients Meconium ileus rare Diagnosis in

childhood/adulthood Nutritionally normal Milder lung disease Liver disease rare 15-20% pancreatitis

85-90% of patients 10-25% meconium ileus Diagnosis in infancy/

childhood Risk of malnutrition More severe lung disease 5-7% overt liver disease No pancreatitis

Pancreatic Function Status

Pancreatic Insufficiency Pancreatic Sufficiency

Porcine pancreatin Microencapsulated

Pancreatic enzyme preparationsPancreatic enzyme preparations

To allow for gastric To allow for gastric emptying together emptying together with meal nutrientswith meal nutrients

TTo prevent o prevent acidic acidic denaturationdenaturation

Administered with / at start of the meal In young children contents mixed with acidic food (apple sauce) < 10,000 U/kg!

Endoscopic FeaturesEndoscopic Features

The Celiac IcebergThe Celiac IcebergSymptomatic

Celiac Disease

Silent Celiac Disease

Latent Celiac Disease

Genetic susceptibility: - DQ2, DQ8 Positive serology

Manifest mucosal lesion

Normal +/- Mucosa

Celiac

Hepatology

OrthopedicsEndocrinology

Gynecology

Dermatology

Oncology

Dentistry

Neurology

Psychiatry

Involve the secondary dentitionMay be the only presenting sign of Celiac Disease

Dental Enamel DefectsDental Enamel Defects

Celiac Disease Complicated by Celiac Disease Complicated by Enteropathy-Associated T-cell Enteropathy-Associated T-cell

Lymphoma (EATL)Lymphoma (EATL)

Rubio–Tapia A et al. Gastroenterology NOVEMBER 2009;137:88–93

Increased Prevalence and Mortality in Undiagnosed Celiac Disease

Diagnostic Testing (cost-Diagnostic Testing (cost-effective )effective )

CBCCBC albumin, electrolytes , LFT, albumin, electrolytes , LFT, vitamin Evitamin E etc etc stool stool

wbc/rbc/fatwbc/rbc/fat

ova / parasitesova / parasites

elastaseelastase breath test/ sweat testbreath test/ sweat test

ThanksThanks

OBAMAS HEALTH PLANOBAMAS HEALTH PLANGastroenterological Gastroenterological

perspectivesperspectives