Gastroenterology

A specialist paediatric gastroenterology service for the Norfolk and Suffolk area is based at the Jenny Lind Children’s Hospital. We provide local services to the NNUH catchment population and specialist services to patients in Norfolk and Suffolk as the eastern half of the East of England Paediatric Gastroenterology Network. We support patients from Queen Elizabeth Hospital , King’s Lynn, James Paget University Hospital , Great Yarmouth and Ipswich Hospital  in conjunction with their local services. We work closely with colleagues at Addenbrooke’s Hospital who deliver care to the Western half of the Network and have jointly developed a range of guidelines and information leaflets to support clinicians and patients. The majority of outpatients are seen in Jenny Lind Outpatients with outreach clinics being set up in some of the referring units. Investigations and surgical procedures are undertaken in paediatric areas of the hospital.

The services we provide

Inflammatory Bowel Disorder (IBD) The tertiary level paediatric gastroenterology service supports patients from across Norfolk and Suffolk. This includes approximately 100 children with inflammatory bowel disease including those who need biologic therapies (Infliximab or Humira) which are administered on the Children’s Day Ward. Weekly multidisciplinary IBD clinics are staffed by consultants, specialist nurses, specialist dietitians and our psychologist to deliver integrated multidisciplinary care and offer patients the chance to see the team members appropriate to them. A monthly evening transition clinic with joint consultations with our adult Gastroenterology colleagues is part of the individualised planning for transition offered to all patients. Joint consultations with paediatric surgical consultants occur whenever indicated.

Gastrointestinal Problems

The secondary care element of our service supports children with a wide range of gastrointestinal problems including chronic abdominal pain, gastro-oesophageal reflux, food intolerances and allergies, chronic diarrhoea and malabsorption, motility disorders and severe constipation, irritable bowel syndrome and post surgical conditions. We provide a second opinion to colleagues in general paediatrics when necessary.

Coeliac Disease

The team support over 120 children with coeliac disease from presentation through diagnosis and stabilisation on diet. Patients are then offered an annual review which is dietetic led with medical input and delivers a robust nutritional review with and include an update on and samples of gluten free foods. These clinics are popular with children and carers alike.

Complex Gastroenterological Disease

We provide support to patients with a wide range of complex paediatric gastroenterological diseases including liver disease and an increasing population with Intestinal Failure. The majority of these have had congenital GI abnormalities or problems resulting from prematurity so we work with our paediatric surgical and neonatal colleagues to support these infants from the start of their journey right through inpatient and onto outpatient care. We have excellent experience of working with national centres to support home parenteral nutrition (PN) patients or those undergoing liver or bowel transplantation in the minority of patients in whom these options are needed. We integrate clinical care with support with Paediatric Specialist Nurses, and access to psychology and other community and hospital based services for more complex difficulties.

Services

We usually have five consultant clinics per week, plus dietetic and psychology IBD clinics to provide specialist care to our local population and those from the wider network. These all have support from specialist nurses and specialist dietitians and in many cases there are joint consultations. Diagnostic and therapeutic paediatric endoscopy is conducted primarily in the Day Procedure Unit by the four core consultants. There is a dedicated paediatric ward and paediatric anaesthetic cover for all lists. Joint paediatric surgical and paediatric gastroenterology radiology and histology meetings facilitate optimal care. Patients with inflammatory bowel disease and other complex Gastrointestinal(GI) problems have telephone access to a specialist nurse and those with nutritional problems to the specialist dietitians. Our close knit multidisciplinary team works flexibly utilising a bespoke database to provide seamless patient focused care.

Research

The department is active in research currently participating in one large multicentre study and involving in developing further projects in basic science, clinical care and psychology. We are engaged in a number of audits of our practise both locally and as part of the East of England Paediatric Gastroenterology Network (EoEPGN).

Clinical Guidelines

• EoEPGN: Guideline for the management of azathioprine therapy in Children with gastroenterological conditions
• EoEPGN: Guidelines for use of SMOFlipid in Parenteral Nutrition
• Regional guideline on anti-TNF use in children with inflammatory disease
• EoEPGN: Guidelines for the management of paediatric coeliac disease
• NNUH: Methylprednisolone

Dietetic Resources

• EoEPGN: Guidelines for the dietetic management of paediatric inflammatory bowel disease

A wide range of dietetic leaflets are available by clicking here:

Useful Web Links
www.cicra.org.uk
www.nacc.org.uk
www.coeliac.org.uk
www.childhoodconstipation.com
www.childliverdisease.org

How you can access our services

Access to our services is via a referral from your GP or paediatric specialist.

Paediatric Gastroenterology Secretaries

Dr Graham Briars 01603 287174
Dr Mary-Anne Morris 01603 289936
Mr Ashish Minocha and Mr Thomas Tsang 01603 286356
Email: paediatricgastroenterology@nnuh.nhs.uk