Q&A: Pediatric Food Allergies and GI Issues

Friday, August 01, 2014 3:19 PM comments (0)

tummy acheAre stomachaches and messy potty breaks frequent occurrences for little ones in your home? “Stomach problems” happen to everyone, and children are no exception. Sometimes an upset tummy is just an upset tummy, but children, just like adults, can suffer from food allergies and sensitivities, and just like adults these allergies and sensitivities can and should be addressed.

Vincent Biank, MD, Pediatric Gastroenterology at NorthShore, answers some common questions about GI food allergies and sensitivities in children: 

 Is there an easy, relatively non-invasive test to see which foods a child is allergic or sensitive to?
There are several simple blood tests for allergies but unfortunately we do not have simple tests for sensitivities that are accurate in children; therefore, we will commonly have to do an elimination diet.  We will remove one food item at a time for two weeks and then replace that food item after those two weeks, carefully documenting any changes in the symptoms. The two most common sensitivities are lactose and gluten. I would not recommend removing gluten from a child’s diet until they have been properly tested for Celiac disease otherwise you will just need to add it back in for one to two months before it can be accurately checked in the blood.

What foods are typically off-limits for child with soy and dairy allergies? Is it possible to eliminate these foods entirely from a child’s diet?
Soy and diary are in almost everything, so eliminating them is difficult. For this reason, we will have our pediatric dieticians work with families to make sure no soy or dairy in getting into a patient’s diet. Until then, check labels! Anything that has soy, soy protein, milk, milk protein, casein or whey in its label should be avoided.

Are children with GI food allergies more likely to develop other GI-related issues as young adults and adults? 
Unfortunately we don't have enough data to answer this question at this time. Although food allergy with typical symptoms of anaphylaxis, hives, trouble breathing etc. has been diagnosed and treated for many years, the majority of the GI manifestations of food allergy are recent in their discovery. For example it wasn't until 1995 that Eosinophilic Esophagitis was even considered a diagnosis and now we are diagnosing it one to two times per week. The result is we still don't have a clear idea of the natural history of GI food allergies over time.

Should children with stomach “issues” be given probiotics, as well as brought in for testing? 
The short answer is to go ahead and try probiotics prior to the visit. The long answer is that unfortunately we are only at the beginning of our understanding of what probiotics do, such as which varieties are best, how much to give and how long they should be taken.

What are some of the warning signs of GI issues in toddlers/children? Should a parent be concerned about frequent loose stools?
The biggest sign of GI issues is poor weight gain. Diarrhea can be a symptom of an underlying GI disorder but not always. We frequently see toddlers with loose stools with no additional systemic signs of disease, like poor weight gain; therefore, we will typically rule out some common GI-related problems. If tests are negative, we will then discuss how to thicken the stool.

Are the foods known to cause GI allergic reactions in kids the same as those that cause skin or more severe allergic reactions? What are the common foods for GI allergies?
Yes, for some individuals the foods that cause GI allergic symptoms could also cause skin and the typically more severe allergic reaction; however, this is not the case for everyone. Some individuals will only have GI symptoms and others will only have skin or respiratory symptoms. The most common foods for GI allergies are the “Big Six:” milk, soy, wheat, eggs, nuts and fish.

Does your child have a food allergy or sensitive that results in GI issues?


Coping with IBS: Can Mindfulness Help?

Thursday, May 29, 2014 3:55 PM comments (0)

stomachacheIrritable bowel syndrome (IBS) is a common disorder of the large intestine that can cause symptoms ranging from cramping and bloating to constipation and diarrhea. And while IBS does not cause the permanent damage of more severe intestinal diseases like Crohn’s or ulcerative colitis, it can and often does negatively interfere with one’s day-to-day life.  

There are many ways to control the symptoms of IBS. Treatment often focuses on learning to avoid trigger foods and making healthy lifestyle changes, from the times that you eat to how much and how fast. That’s not all you can do though. Learning to control stress can also make a big impact for those suffering from IBS. 

Alison Reynard, PhD, Psychology at NorthShore, discusses how stress, depression and anxiety can aggravate the symptoms of IBS and how changing the way you think might be able to help:

My gastroenterologist referred me to a psychologist. Does this mean my symptoms are all in my head?
Absolutely not. There are many myths about IBS and this is one of the most common. While IBS is not a psychological disorder, there are factors like stress and unhelpful habits, like eating rushed/unplanned meals, eating rapidly and lack of exercise, which can exacerbate your IBS symptoms. IBS can also impact your mood and other aspects of your life. 

Is stress causing my IBS symptoms?
IBS is not caused by stress but stress can aggravate its symptoms. Keep in mind that many people do develop abdominal discomfort during times of stress; however, people with IBS tend to be more reactive to stress than others since they already have a hypersensitive gut. The research has also shown that IBS symptoms can get worse during episodes of stress. 

Is it true that my doctor won’t be able to identify the cause of my symptoms?
Research has established that there is a medical cause for your symptoms. IBS is a real disorder related to heightened gut motility (i.e., muscle contractions), sensations, or both. Triggers for symptoms can be widespread and may include factors like food, hormones and stress. 

Doesn’t severe pain mean this must be a medical cause?
We have learned that there are many factors that are responsible for our experience of pain. Pain can be worsened with anxiety, arousal and increased attention. If we become focused on our pain, it tends to make our pain worse. There are many behavioral techniques that can help manage pain including distraction and relaxation techniques. 

Can IBS cause depression and anxiety?
IBS may cause depression and anxiety because it can be difficult to manage a chronic and unpredictable disorder. A lot of people with IBS may begin to avoid social situations because they have anxiety about their symptoms “acting up” in public. This isolation can cause depression and may prevent symptoms of anxiety from improving. 

Can seeing a health psychologist help with my IBS? 
Taking care of our health involves paying attention to not only our physical health but also to our emotional well-being, including how our habits influence our health and well-being. We know that there are many factors that impact IBS (e.g., food, stress, hormones, activity, sleep, gut bacteria). Therefore, there is not one specific thing, including medication, which will eliminate symptoms. A health psychologist can help you identify how some of these factors are impacting you and how you can better manage them to improve your symptoms.

How can my thinking affect my IBS?
Sometimes we can think in ways that make it difficult for us to cope with IBS symptoms. One common thinking pattern we can get ourselves into is called emotional reasoning. This occurs when we assume that the way feel must be true. For example, if you tell yourself that you’d love to go to that new restaurant that just opened up down the street but that you could never go because your symptoms might act up, this is a problem-thinking pattern that might not be helping you.

Have you practice mindfulness to relieve gastrointestinal issues?


Colon Cancer Prevention: Screening is Key

Thursday, March 01, 2012 8:41 AM comments (0)

Colon Cancer ScreeningColon cancer is one of the most preventable cancers in the United States—nearly 90% preventable with colonoscopy. Despite this, it is the second leading cause of cancer death, affecting more than 29,000 men and women in this country each year.

NorthShore Gastroenterologist, Monica Borkar, MD,  provides a list of risk factors that affect the development of colon polyps—and thereby, colon cancer—including:

Colon cancer starts as a polyp, or growth, in the colon.  These polyps grow slowly over many years, and larger ones are more likely to be dangerous.

In most cases people do not have symptoms, although common symptoms of colon cancer include:

  • Change in bowel habits
  • Unintentional weight loss
  • Weakness
  • Abdominal pain
  • Blood in the stool
  • Age  - Most people who develop colon cancer and colon polyps are over 50 years old.
  • Genetics - A family history of colon cancer imparts a greater risk of developing polyps and cancer; people are usually screened earlier than 50 and are advised to return at shorter intervals if colon cancer has affected someone in their immediate family.
  • Diet - A diet high in red meat and low in dietary fiber may lead to colon cancer development.
  • Exercise - A sedentary lifestyle may be associated with colon cancer so exercise at least one hour three times per week.
  • Personal history of colon polyps - Individuals who have a history of colon polyps are more likely to develop them in the future.
  • Personal history of colon, endometrial, breast or uterine cancer.
  • Certain genetic conditions - Specific types of colitis or inherited diseases can make colon cancer more likely.

National guidelines recommend that individuals with a lack of the risk factors listed above undergo colonoscopy at age 50. Colonoscopy for colon cancer screening—a 20-minute procedure—is the most important test to check for polyps and cancer, even before symptoms arise, and leads to prompt diagnosis and treatment with an excellent survival rate.

Are you surprised by any of the risk factors listed above?

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