Pediatric Gastroenterology

Persistent digestive symptoms can affect a child’s eating, growth and daily life. MPGCARE helps arrange pediatric gastroenterology consultations at Medical Park and Liv Hospital in Türkiye. Hospital physicians decide which assessment, tests or procedures are appropriate; MPGCARE coordinates appointments and travel enquiries.

Consultation, investigations and procedures: different steps

A consultation reviews symptoms, growth, diet, medicines and medical history and includes examination. Investigations such as blood/stool tests, ultrasound or selected breath tests answer specific clinical questions. Upper endoscopy or colonoscopy is an invasive procedure that may involve biopsies and sedation/anaesthesia, with separate preparation, consent and risk assessment. Booking a consultation does not mean an endoscopy is needed or scheduled.

Which disease, which investigations?

Each condition is listed separately. The specialist selects tests after assessment; this is not a mandatory checklist for every child.

Disease / condition	Investigations that may be considered
Gastroesophageal reflux (GERD)	Clinical assessment first; selected pH/impedance monitoring or endoscopy if persistent symptoms or complications.
Oesophagitis	Upper endoscopy with biopsies when indicated, including assessment for different causes of inflammation.
Constipation	History and examination; targeted coeliac/thyroid tests or specialised studies only if indicated.
Functional abdominal pain	Clinical assessment and growth review; targeted tests for alarm signs, not automatic endoscopy.
Irritable bowel syndrome (IBS)	Symptom pattern and examination; selected blood/stool tests to investigate alternative causes.
Coeliac disease	tTG-IgA and total IgA; additional antibodies or duodenal biopsies according to specialist criteria.
Crohn’s disease	Blood count, CRP/ESR, albumin, stool infection/calprotectin; endoscopy with biopsies and selected small-bowel imaging.
Ulcerative colitis	Blood/inflammation tests, stool infection/calprotectin; colonoscopy with biopsies as part of specialist assessment.
Lactose intolerance	Diet/symptom review; hydrogen breath test when appropriate.
Food allergy, including milk-protein allergy	Allergy history; targeted IgE/skin tests or supervised elimination/reintroduction according to reaction type.
Malabsorption	Selected nutritional blood tests, coeliac serology and stool studies; biopsies if indicated.
Hepatitis	Liver enzymes, bilirubin, clotting and targeted viral/other cause tests; ultrasound when appropriate.
Fatty liver disease	Liver enzymes and metabolic assessment; selected imaging and exclusion of other liver diseases.
Gallstones	Ultrasound and selected liver/biliary blood tests.
Pancreatitis	Lipase and selected blood tests, ultrasound; further imaging according to clinical findings.

Reflux (GERD), oesophagitis and swallowing difficulties

History, feeding patterns and examination often guide initial care; every child with reflux does not need an endoscopy. Persistent symptoms, swallowing difficulty or suspected complications may lead to upper endoscopy with biopsies or selected pH/impedance monitoring. Feeding adjustments and medicines depend on age and diagnosis. Discuss recurrent vomiting or poor growth; do not give long-term acid-suppressing medicines without review.

Constipation, functional abdominal pain and irritable bowel syndrome

Record stool frequency, pain, withholding and soiling, together with growth and diet. Many children can be assessed clinically without routine imaging or endoscopy. Blood/stool tests or specialised studies are selected for alarm signs, persistent symptoms or an unclear cause. Treatment may include a child-specific bowel plan, prescribed medicines and support for daily routines. Functional pain is real and deserves care, even when tests are normal.

Coeliac disease

Chronic diarrhoea, bloating, anaemia or poor growth may prompt coeliac testing, commonly tTG-IgA and total IgA. Additional antibody tests or duodenal biopsies depend on the results. Some children meet specialist criteria for diagnosis without biopsy; this decision belongs to the pediatric gastroenterologist. Do not start a gluten-free diet before the diagnostic plan is agreed, because this may alter results. If gluten is already excluded, discuss it with the specialist rather than changing the diet independently. Confirmed disease requires a supported gluten-free diet and monitoring.

Crohn’s disease and ulcerative colitis (IBD)

Persistent diarrhoea, blood in stool, weight loss, poor growth or night-time symptoms merit assessment. Selected tests may include blood count, CRP/ESR, albumin, stool infection testing and faecal calprotectin. Calprotectin alone does not establish the diagnosis. Upper endoscopy/ileocolonoscopy with biopsies and selected small-bowel imaging may be needed. Medicines and nutritional treatment are individualised, with monitoring of inflammation, growth and treatment safety.

Chronic diarrhoea, lactose intolerance and food allergy

The clinician reviews diet, infections, stool pattern and growth. Stool tests, blood tests or a hydrogen breath test may be selected. Lactose intolerance differs from milk-protein allergy. Suspected food allergy is assessed by an allergy-focused history; targeted IgE/skin tests or a supervised elimination/reintroduction plan depend on the type. A positive allergy test alone does not prove clinical allergy. Avoid broad exclusion diets or home food challenges after a serious reaction; dietitian/allergy support may be needed.

Feeding difficulties, malabsorption and poor weight gain

Growth records, feeding observation and diet history help distinguish inadequate intake from swallowing, absorption or other disease. Selected blood tests may assess anaemia, nutritional deficiencies or underlying disease; stool tests and endoscopy are requested only when indicated. Treatment may involve nutrition and feeding support or care for the underlying condition. Supplements, formula changes or tube feeding should follow a clinical plan.

Hepatitis, fatty liver, gallstones and pancreatitis

Jaundice, abnormal liver tests or persistent upper abdominal pain require assessment. Liver enzymes, bilirubin, albumin and clotting tests, targeted hepatitis tests, lipase and ultrasound may be selected according to the suspected condition; further imaging or biopsy is not routine for every child. Treatment depends on the cause and severity. Newborn jaundice with pale stools or dark urine needs prompt local assessment and should not wait for travel.

Do we need a previous endoscopy report?

If an endoscopy or colonoscopy was performed, prepare the dated procedure report, photographs, biopsy/pathology results and any recorded anaesthetic complications. Include laboratory/stool results, imaging reports, growth charts and the treatment tried. The report and the pathology result are separate documents. Do not repeat an invasive procedure just to make an enquiry; the receiving physician reviews whether the existing information is sufficient. Confirm translation and secure file transfer.

Who gives preparation instructions for the child?

The receiving pediatric gastroenterology/endoscopy team, together with the anaesthesia team when relevant, gives the child-specific written instructions after confirming the procedure, age/weight, health conditions and medicines. MPGCARE may relay only the instructions confirmed by that centre. This page does not prescribe fasting times, bowel-cleansing products/doses or medicine changes. Do not use an adult regimen or another hospital’s leaflet. If instructions are missing, unclear, or the child cannot complete them, contact the centre before proceeding.

Consent, risks and after-procedure care

Ask why the procedure is needed, what alternatives exist, whether biopsies are planned and who will provide anaesthesia. Risks can include bleeding, perforation and sedation/anaesthesia complications; they depend on the procedure and child. The centre confirms discharge criteria, eating/drinking, supervision, activity and warning signs in writing. An endoscopy does not guarantee a diagnosis or cure, and biopsy results may be available later than the visual findings.

Routine visit or urgent local care?

Severe or worsening abdominal pain, green vomit, vomiting blood, substantial bleeding or black tarry stools, inability to keep fluids down with dehydration, marked drowsiness, or food stuck with difficulty swallowing saliva require urgent local assessment. Breathing difficulty, collapse or severe deterioration needs emergency services. Do not wait for an MPGCARE reply or an overseas appointment. Persistent symptoms, unexplained weight loss or growth faltering also warrant timely clinical review.

How is follow-up planned?

Before leaving, agree who reviews biopsy/test results, how and when the family receives them, the written treatment and nutrition plan, and the next review. Follow-up timing varies with the diagnosis, procedure and symptoms. Care at home may continue if a local clinician accepts responsibility and receives reports, medicines, monitoring and emergency instructions. Confirm remote-review limits, local medicine availability and when a return visit is needed.

Arrange your child’s consultation

Prepare age, birth history, symptom duration, stool/vomiting details, diet, allergies, medicines, previous treatments and family history. Confirm the hospital, pediatric gastroenterologist, interpreter needs, available tests and written assessment scope with MPGCARE. Preliminary document review does not replace examination; clinical decisions remain with the hospital team.

Medical information sources: Liv Hospital · NIDDK · ESPGHAN · NHS