Starship's Gastroenterology/ Hepatology service provides assessment, diagnosis, treatment and long term follow-up for children and adolescents with a wide range of gastrointestinal and liver conditions. The service is part of the National Paediatric Liver Transplant Programme.

Our team currently is made up of three consultant gastroenterologist / hepatologists, two paediatric liver / gastroenterology nurse specialists as well as many others including dietitians, pharmacists, social workers, cultural support workers and play specialists.

What is Gastroenterology?
Gastroenterology is the branch of medicine concerned with the diagnosis and treatment of disorders of the stomach, small and large bowel and the pancreas.
Such disorders include:

• Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
• Intestinal failure / intravenous nutrition (IVN) dependence
• Coeliac disease
• Complicated gastro-oesophageal reflux
• Gastrointestinal bleeding

What is Hepatology (liver disease)?
Hepatology is the branch of medicine that is concerned with diseases of the liver.
Such disorders include:

• Liver transplantation
• Biliary atresia
• Autoimmune hepatitis and sclerosing cholangitis
• IVN related liver disease
• Viral hepatitis (B and C)
   

Your child will be assessed by your GP or a specialist before they can be referred to the Paediatric Gastroenterology / Hepatology or Liver Transplant Service at the Starship Hospital.

Urgent assessment
If your child has an urgent problem they will be assessed in the Paediatric Emergency Department at Starship Hospital. There they will be assessed by a senior member of the medical team. Based on your child’s condition they may be admitted to Starship Hospital for ongoing care or follow-up arrangement will be arranged through the outpatient clinics.

Patients from outside of Auckland will be assessed by their local paediatrician and discussion made with the on call paediatric gastroenterologist / hepatologist at Starship. Appropriate arrangements for transfer to Starship can then be made.

Other assessment
If your child has a less urgent problem, a letter of referral is sent to the department. A senior doctor will look at the letter and a decision is made based on the information provided in the letter. Possible outcomes include:

• Outpatients:

An appointment will be offered – for urgent issues this may be within a month, less urgent issues will wait longer than this. If your child is getting worse while waiting, please see your General Practitioner again.

• Endoscopy:

Our waiting times for clinics and for endoscopy are long. For some conditions your child may be booked directly to endoscopy without being seen in clinic first. The reason for this is to attempt to decrease the inevitable delays prior to treatment. Both you and the referring doctor will be sent a letter explaining this. If you have any concerns or questions please contact the team and we will see you in clinic to discuss things more fully.

• Referral to another service

This department receives more referrals in a month than we are capable of seeing. Straightforward cases may be referred back to your referring doctor with written advice or your referral may be passed over to a more suitable service to handle your child’s condition.
 

Support Groups:

Kidshealth
Kids Foundation

This includes information on:

Crohn’s & Colitis Support Group (CCSG)
Coeliac Society of New Zealand

More information:

• Intestinal failure / IVN dependence: children or infants who have lost small bowel due to disease or surgery to the extent that there isn’t enough left to absorb nutrients have Short Gut Syndrome. When this happens food may be given into a vein (intravenous nutrition (IVN). Children who have an ongoing need for IVN may be seen at Starship for assessment and to create a programme to maximise the potential for rehabilitation of the remaining bowel. Some children are born with problems in the way their intestine absorbs food or in the way the food is moved along the intestine. These children may also require long term IVN.
• Biliary atresia is a disease that affects children in the first weeks of life. The tubes which connect the liver to the intestine become damaged and blocked. Babies with biliary atresia will have jaundice (yellow eyes and skin) and pale coloured stool (poo). Babies usually look otherwise well. If your baby is jaundiced and has pale stool they require an urgent blood test. If the blood tests suggests they may have biliary atresia they will be admitted to hospital for further testing and possible surgery to help treat the problem.
• Autoimmune hepatitis and sclerosing cholangitis are a group of relatively uncommon liver conditions where the body’s own immune system begins to attack the liver and the bile ducts which drain bile into the intestine. Symptoms of autoimmune hepatitis or sclerosing cholangitis include jaundice (yellow eye or skin), itchy skin and tiredness. Diagnosis can be suspected based on blood test results but requires a liver biopsy for confirmation.
• Viral hepatitis: some viruses like Hepatitis B and C can cause ongoing damage to the liver. Symptoms of viral hepatitis include jaundice (yellow eyes or skin), and tiredness. Some forms of viral hepatitis get better without any treatment but some require ongoing care and medicine. These viruses are passed from person to person through body fluids.  For more information about Hepatitis B and C see www.hepfoundation.org.nz
• Liver transplant: the department of Paediatric Gastroenterology and Hepatology at Starship Children’s Hospital are part of the New Zealand Liver Transplant Service. The service provides liver transplant assessment, surgery and post operative care for all children in New Zealand requiring a Liver Transplant.
• Inflammatory Bowel Disease
  Inflammatory bowel diseases (IBD) are a group of conditions that cause ongoing inflammation of the intestines. The condition can affect only the large bowel (ulcerative colitis) or any part of the entire digestive tract, from the mouth to the anus (Crohn's disease).
  Symptoms of inflammatory bowel disease may include, frequent bowel motions that may contain blood or mucous, abdominal pain, fever, weight loss, and fatigue. The inflammation can also affect other parts of the body, such as the eyes or joints, and may cause a form of arthritis.
  Inflammatory bowel disease is treated with medications and sometimes with a change in diet. In some cases, surgery may be needed

• Coeliac Disease  Coeliac disease is a disease where there is a permanent intestinal intolerance of gluten. Gluten is part of wheat and other cereals and is found in a lot of foods including bread and pasta. It is relatively common, occurring in 1 in 100 people. Symptoms include diarrhoea (loose poo), poor growth or stomach bloating. An important proportion of people with coeliac disease have mild or no symptoms. This diagnosis is a common reason for referral.  Although there is a useful blood test which will suggest the diagnosis, duodenal biopsy is essential to confirm the diagnosis and needs to be performed before any diet is commenced.  This is performed by gastroscopy and is a day stay procedure.  It is important that endoscopy is done as the blood test is not good enough to start treatment on a disease that is life long. The treatment is to stop eating all foods with gluten in them, like bread and pasta. Sometimes the blood test may be only mildly abnormal and in this case, a repeat test may be necessary before referral to our service for endoscopy.

• Gastrointestinal Bleeding The presence of blood in vomit or in the stool is a common reason for children to be referred for endoscopy. The blood may be red or sometimes will become tarry black. The cause will depend on the age of the child and may include Oesophageal Varices, Oesophageal Reflux, H.pylori infection, Allergic Colitis, Polyps or Inflammatory Bowel Disease. The best method of finding the cause is a gastroscopy or colonoscopy.