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Starship Paediatric Gastroenterology and Hepatology

Public Service

Description

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 New Zealand Liver Transplant Unit, providing a nationally based service for children requiring transplant.

Our team currently is made up of four consultant gastroenterologists & hepatologists, two paediatric liver & gastroenterology nurse specialists as well as many other staff including junior doctors, dietitians, pharmacists, psychologists, 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 (sometimes called TPN dependence)
  • Coeliac disease
  • Complicated gastro-oesophageal reflux
  • Gastrointestinal bleeding
  • Children with a risk of familial bowel cancer


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
  • Intestinal failure associated liver disease
  • Viral hepatitis (B and C)
  • Fatty liver disease & NASH
  • Alagille syndrome
  • Metabolic liver disease
     

Consultants

Hours

Clinics:

Gastroenterology clinics are held several times a week and the Liver Transplant Clinic is held weekly. Both of these are held at Starship Hospital.

A monthly Young Persons Liver Clinic is held jointly with the adult team at the New Zealand Liver Transplant Unit for young people moving between the children's and adult clinics. This takes place at Greenlane Clinical Centre.

Six monthly clinics are held for young people with inflammatory bowel disease transitioning between the paediatrics and the adult clinics within the greater Auckland area. These occur in various locations.

Regular visiting clinics currently also take place in Christchurch (liver transplant only) and most major towns in the North Island. Children living outside Auckland are generally seen in these clinics. South Island children are seen by the South Island Paediatric Gastroenterology service.

Referral Expectations

Many common childhood gastrointestinal problems such as gastro-oesophageal reflux, abdominal pain and constipation can be managed well by general paediatricians and GPs without needing input by the Paediatric Gastroenterology & Hepatology Service. Our service manages serious, long-term gastroenterology and hepatology conditions such as inflammatory bowel disease, liver disease, intestinal failure.

We have updated our referral criteria in 2014 for GPs and paediatricians.

REFERRAL OUTCOMES

Urgent assessment
If your child has an urgent problem they will be assessed in the Children's Emergency Department at Starship Hospital. Based on your child’s condition they may be admitted to Starship Hospital for ongoing care or follow-up arranged at 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 if needed.

Other assessment
If your child has a less urgent problem, a letter of referral is sent to our department. A senior doctor will look at the letter and a decision is made based on the information provided in the letter. We are not able to see all children referred to us and many conditions can be looked after by general paediatricians. Possible outcomes from referral include:

  • Outpatient clinic appointment:

An appointment will be offered. For most referrals this will be within a month. All children will be seen within 4 months. If your child is getting worse while waiting, please see your General Practitioner or paediatrician again.

  • More investigations are needed:

Sometimes, when we read the referral letter, we feel it would be useful for your child to have more tests, either before we see them, or to decide if we need to see your child. These tests may be blood, urine or faecal (stool) tests or X-rays. In this case, we will write to your referring doctor to arrange these and ask that they re-refer your child when the tests have been done.

  • Endoscopy:

For some conditions your child may be booked directly to endoscopy without being seen in clinic first. The reason for this is to decrease delay 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 via our secretary (extension 22292 at Starship Hospital) and we will see you in clinic to discuss things more fully. Endoscopy waiting times are currently 8-12 weeks.

  • Referral to another service:

Straightforward cases may be referred back to your referring doctor (as explained above) with written advice or we may suggest a more suitable service to see your child.

  • Referral return:

Sometimes your child may already be receiving appropriate management from their general practitioner or general paediatrician and we will not need to see them. In this case, an appointment is not made and we write back to the referrer. Should symptoms change, a re-referral to our service can be made.

Common Conditions / Procedures / Treatments

  • Gastroscopy/Upper Endoscopy

    This is a camera test which allows the doctor to see inside the oesophagus, stomach, and the first part of the small intestine (duodenum). … More

  • Colonoscopy

    This is a procedure which allows the doctor to see inside your child's large bowel and examine the surfaces directly and take biopsies (samples of tissue) if needed.  Treatment of conditions can also be undertaken.… More

  • Liver Biopsy

    The best way to establish what type of liver disease is present and the extent of the disease, is a biopsy.… More

  • Barium Meal

    This is an x-ray test of the small intestine. Your child will have to drink some special milk (barium).… More

  • MR Abdomen (magnetic resonance scan)

    This is a test where the abdomen is examined using an MR scanner.… More

  • pH/Impedance Study

    A pH/Impedance study is an investigation designed to see if your child has reflux [the contents of the stomach coming back out the stomach into the oesophagus (food pipe)].… More

  • Endoscopic Retrograde Cholangio Pancreatography (ERCP)

    A flexible tube with a tiny video camera attached (endoscope) is inserted through the mouth into the stomach and small intestine while your child is under anaesthesia sedation.  This is a rare examination in children.  A smaller tube is then moved through the first tube into the bile duct (the… More

  • Oesophageal Manometry

    This is a test to see how effective the oesophagus (swallowing tube) is at moving food and liquid from the mouth to the stomach.… More

  • Intestinal Failure

    Children who have intestinal failure are unable to take food normally either because their bowel is not working properly or because they do not have enough bowel because they have had some removed (short bowel syndrome).… More

  • Biliary Atresia

    Biliary atresia is a disease that affects children in the first weeks of life.… More

  • Autoimmune Hepatitis and Sclerosing Cholangitis

    Autoimmune hepatitis and sclerosing cholangitis are a group of 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.… More

  • Hepatitis B and C

    Hepatitis B and C are viruses that cause long-term damage to the liver.… More

  • Liver Transplant

    The Department of Paediatric Gastroenterology and Hepatology at Starship Children’s Hospital is part of the New Zealand Liver Transplant Unit.… More

  • Inflammatory Bowel Disease

    Inflammatory bowel diseases (IBD) are a group of conditions that cause long-term inflammation of the intestines (bowel).… More

  • Coeliac Disease

    Coeliac disease is a disease where there is a permanent intestinal intolerance of gluten.… More

  • Gastrointestinal Bleeding

    The presence of blood in vomit or in the stool is a common reason for children to be referred for endoscopy.… More

Other

Support Groups:

Kidshealth.org.nz (Family Information website)     

Crohn's and Colitis New Zealand (www.crohnsandcolitis.org.nz/)     

Kids Foundation (Charity supporting children with liver disease or intestinal failure)

Coeliac Society of New Zealand

Contact Details

Starship Child Health

Central Auckland

Outpatient appointments and surgical booking enquiries: (09) 638 0400 or scheduling@adhb.govt.nz 

2 Park Road
Grafton
Auckland 1023

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Street Address

2 Park Road
Grafton
Auckland 1023

Postal Address

Private Bag 92 024
Auckland Mail Centre
Auckland 1142

This page was last updated at 3:49PM on October 19, 2016. This information is reviewed and edited by Starship Paediatric Gastroenterology and Hepatology.