1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 PEDIATRIC GASTROENTEROLOGY: THE REQUISITES IN PEDIATRICS ISBN: 978-0-323-03280-3 Copyright © 2008 by Mosby, Inc., an affi liate of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Rights Department: phone: (+1) 215 239 3804 (US) or (⫹44) 1865 843830 (UK), fax: (⫹44) 1865 853333; e-mail: This book is dedicated to the hard-working, conscientious medical staff of The Children’s Hospital of Philadelphia. These professionals include the physicians, nurses, fellows, residents, and medical secretaries who have devoted their lives to the care of ill children. Although the primary doctor typically receives praise from the patient and his or her family when an illness is correctly diagnosed and treated, many times proper medical care would not be possible without the effort and selfl essness put forth by the other members of the health care team. Contributors Robert Baldassano, MD Patricia A. DeRusso, MD, MS Director, Infl ammatory Bowel Disease Center, The Assistant Professor of Pediatrics, Division of Pediatric Children’s Hospital of Philadelphia; Professor of Gastroenterology and Nutrition, Johns Hopkins Pediatrics, University of Pennsylvania School of University School of Medicine, Baltimore, Maryland Medicine, Philadelphia, Pennsylvania Edwin deZoeten, MD Dorsey Bass, MD Attending Gastroenterologist, The Children’s Hospital Associate Professor of Pediatrics, Division of Pediatric of Philadelphia; Assistant Professor of Pediatrics, Gastroenterology, Stanford University School of University of Pennsylvania School of Medicine, Medicine, Stanford, California Philadelphia, Pennsylvania Vincent Biank, MD Rosalyn Diaz, MD Assistant Professor of Pediatrics, Department of Instructor, Department of Pediatrics, University of Pediatrics, Division of Gastroenterology and Pennsylvania School of Medicine; Attending Nutrition, Medical College of Wisconsin; Attending Physician, Department of Gastroenterology, Physician, Children’s Hospital of Wisconsin, Hepatology, and Nutrition, The Children’s Hospital of Milwaukee, Wisconsin Philadelphia, Philadelphia, Pennsylvania Dana Boctor, MSC, MD, FRCPC Udeme Ekong, MBBS, MRCP(UK) Clinical Assistant Professor, University of Calgary Assistant Professor of Pediatrics, Northwestern Faculty of Medicine; Gastroenterologist, Division of University Feinberg School of Medicine; Attending Gastroenterology and Nutrition, Alberta Children’s Physician, Pediatric Gastroenterology, Hepatology, Hospital, Calgary, Alberta, Canada and Nutrition Division, Children’s Memorial Hospital, Chicago, Illinois Joseph M. Croffi e, MD, MPH Associate Professor of Clinical Pediatrics, Indiana Karan M. Emerick, MD University School of Medicine; Director, Pediatric GI Attending Physician, Pediatric Digestive Diseases, Motility Laboratory, James Whitcomb Riley Hospital Connecticut Children’s Medical Center, Hartford, for Children, Indianapolis, Indiana Connecticut Vera De Matos, MD Joseph F. Fitzgerald, MD Fellow in Gastroenterology, Hepatology, and Professor of Pediatrics, Indiana University School of Nutrition, University of Pennsylvania School of Medicine; Director Emeritus, Section of Pediatric Medicine/The Children’s Hospital of Philadelphia, Gastroenterology, Hepatology, and Nutrition, James Philadelphia, Pennsylvania Whitcomb Riley Hospital for Children, Indianapolis, Indiana vii viii Contributors Jonathan Flick, MD Douglas Jacobstein, MD Clinical Associate Professor of Pediatrics, University Attending Physician, Division of Pediatric of Pennsylvania School of Medicine; Attending Gastroenterology and Nutrition, The Herman and Physician, The Children’s Hospital of Philadelphia, Walter Samuelson Children’s Hospital at Sinai, The Philadelphia, Pennsylvania Sinai Hospital of Baltimore, Baltimore, Maryland Alejandro Flores, MD Muralidhar Jatla, MD Professor of Pediatrics, Tufts University School of Instructor, Department of Pediatrics, University of Medicine; Chief, Division of Pediatric Pennsylvania School of Medicine; Fellow, Division of Gastroenterology and Nutrition, Floating Hospital for Gastroenterology, Hepatology, and Nutrition, The Children, Boston, Massachusetts Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania James P. Franciosi, MD, MS Fellow-Physician, Division of Gastroenterology, Binita M. Kamath, MBBC Hepatology, and Nutrition, The Children’s Hospital of Assistant Professor of Pediatrics, University of Philadelphia, Philadelphia, Pennsylvania Pennsylvania School of Medicine; Attending Physician, Division of Gastroenterology, Hepatology, Joshua R. Friedman, MD and Nutrition, The Children’s Hospital of Attending Gastroeneterologist, The Children’s Philadelphia, Philadelphia, Pennsylvania Hospital of Philadelphia; Professor of Pediatrics, University of Pennsylvania School of Medicine, Marsha Kay, MD Philadelphia, Pennsylvania Staff Physician, Department of Pediatric Gastroenterology and Nutrition, The Children’s Benjamin D. Gold, MD Hospital, Cleveland Clinic, Cleveland, Ohio Professor of Pediatrics and Microbiology and Marcus Professor and Director, Division of Pediatric Janice A. Kelly, MD Gastroenterology, Hepatology and Nutrition, Clinical Assistant Professor, Department of Pediatrics, Department of Pediatrics, Emory Children’s Center, University of Pennsylvania School of Medicine; Emory University School of Medicine; Chief, Attending Physician, The Children’s Hospital of Gastroenterology Service, and Medical Director, Philadelphia, Philadelphia, Pennsylvania Gastroenterology Endoscopy and Diagnostic Phillip P. Le, MD, PhD Laboratory, Children’s Healthcare of Atlanta, Egleston Resident, Doheny Eye Institute, Los Angeles, Children’s Hospital Campus, Atlanta, Georgia California Andrew B. Grossman, MD Chris A. Liacouras, MD Instructor, University of Pennsylvania School of Co-Director of Pediatric Endoscopy and Attending Medicine; Fellow, Division of Gastroenterology, Gastroenterologist, The Children’s Hospital of Hepatology, and Nutrition, The Children’s Hospital of Philadelphia; Professor of Pediatrics, University of Philadelphia, Philadelphia, Pennsylvania Pennsylvania School of Medicine, Philadelphia, Barbara A. Haber, MD Pennsylvania Associate Professor of Pediatrics, University of Kathleen M. Loomes, MD Pennsylvania School of Medicine; Attending Assistant Professor of Pediatrics, University of Physician, Division of Gastroenterology, Hepatology, Pennsylvania School of Medicine; Attending and Nutrition, The Children’s Hospital of Physician, The Children’s Hospital of Philadelphia, Philadelphia, Philadelphia, Pennsylvania Philadelphia, Pennsylvania Analice S. Hoffenberg, MD David Mack, MD Clinical Instructor, University of Colorado School of Professor, Department of Pediatrics and Biochemistry, Medicine, Denver, Colorado Microbiology, and Immunology, University of Ottawa Edward J. Hoffenberg, MD Faculty of Medicine; Head, Pediatric Associate Professor of Pediatrics, University of Gastroenterology, Hepatology and Nutrition, Colorado School of Medicine; Attending Physician, Children’s Hospital of Eastern Ontario, Ottawa, The Children’s Hospital, Denver, Colorado Ontario, Canada Contributors ix Petar Mamula, MD David A. Piccoli, MD Assistant Professor of Pediatrics, University of Professor of Pediatrics, University of Pennsylvania Pennsylvania School of Medicine; Director, Pediatric School of Medicine; Chief, Division of Endoscopy, The Children’s Hospital of Philadelphia, Gastroenterology, Hepatology, and Nutrition, The Philadelphia, Pennsylvania Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Asim Maqbool, MD Assistant Professor of Pediatrics, University of Michael Posencheg, MD Pennsylvania School of Medicine; Attending Assistant Professor of Clinical Pediatrics, University of Physician, Division of Gastroenterology, Hepatology, Pennsylvania School of Medicine; Associate Medical and Nutrition, The Children’s Hospital of Director, Intensive Care Nursery, Hospital of the Philadelphia, Philadelphia, Pennsylvania University of Pennsylvania, Philadelphia, Pennsylvania Jonathan E. Markowitz, MD Attending Physician, Center for Digestive Health, Elizabeth Rand, MD Greenville Children’s Hospital, Greenville, South Director, Pediatric Liver Transplant Program and Carolina Attending Gastroenterologist, The Children’s Hospital of Philadelphia; Associate Professor of Pediatrics, Maria Mascarenhas, MBBS University of Pennsylvania School of Medicine, Associate Professor of Pediatrics, University of Philadelphia, Pennsylvania Pennsylvania School of Medicine; Section Chief, Nutrition, Division of Gastroenterology, Hepatology, Matthew R. Riley, MD and Nutrition, The Children’s Hospital of Pediatric Gastroenterologist, Legacy Emanuel Philadelphia, Philadelphia, Pennsylvania Children’s Hospital and Providence St. Vincent’s Medical Center, Portland, Oregon Peter Mattei, MD Assistant Professor of Surgery, University of Leonel Rodriguez, MD, MS Pennsylvania School of Medicine; Attending Instructor in Pediatrics, Harvard Medical School; Physician, Division of General, Thoracic, and Fetal Director, Pediatric Gastrointestinal Motility Program, Surgery, The Children’s Hospital of Philadelphia, and Medical Director, Pediatric Intestinal Philadelphia, Pennsylvania Rehabilitation Program, Massachusetts General Hospital, Boston, Massachusetts Randolph P. Matthews, MD, PhD Assistant Professor of Pediatrics, University of Colin D. Rudolph, MD, PhD Pennsylvania School of Medicine; Attending Professor of Pediatrics, Medical College of Wisconsin; Physician, Division of Gastroenterology, Hepatology, Chief, Division of Pediatric Gastroenterology and and Nutrition, The Children’s Hospital of Nutrition, Children’s Hospital of Wisconsin, Philadelphia, Philadelphia, Pennsylvania Milwaukee, Wisconsin Michael L. Nance, MD Anil Rustgi, MD Associate Professor of Surgery, University of T. Grier Miller Professor of Medicine and Genetics Pennsylvania School of Medicine; Attending Surgeon and Director, Center for Molecular Studies in and John and Josephine Templeton Endowed Chair in Digestive and Liver Disease, University of Pediatric Trauma, The Children’s Hospital of Pennsylvania School of Medicine; Chief, Philadelphia, Philadelphia, Pennsylvania Gastroenterology Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania Peter F. Nichol, MD, PhD Assistant Professor, University of Utah Department of Matthew J. Ryan, MD Surgery; Pediatric Surgeon, Primary Children’s Assistant Professor of Pediatrics, University of Medical Center, Salt Lake City, Utah Pennsylvania School of Medicine; Attending Physician, Division of Gastroenterology, Hepatology, Gilberto Pereira, MD and Nutrition, The Children’s Hospital of Professor of Pediatrics, University of Pennsylvania Philadelphia, Philadelphia, Pennsylvania School of Medicine; Neonatologist, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania