Paediatric Gastroenterology

The department of pediatric gastroenterology and nutrition of the Emma Children’s Hospital / Acadamic Medical Center is the referral center in the Netherlands for children with functional gastrointestinal disorders such as gastroesophageal reflux disease, functional abdominal pain and defecation disorders. Moreover, the department has specific knowledge regarding rare motility disorders such as achalasia, intestinal pseudo-obstruction and Hirschsprung’s disease. Another important topic is inflammatory bowel disease in adults and children, which has been a priority topic within our hospital. Since a few years, the outpatient clinic for feedingdisorders has developed into a national expertise center as well. Finally, the AMC has been designated as an official national centers of expertise in the field of intestinal failure and hereditary colon tumors in adults and children. Our goal is to continue our role as center of excellence in the these areas.

Research Topics

 

Gastro-esophageal reflux (disease) (GERD) and esophageal motility disorders

1. Unravelling mechanisms that underlie GERD, evaluating posture therapy in the treatment of GERD.

2. Establishing the Reflux Finding Score for Infants for the objective evaluation of signs of laryngopharyngeal reflux disease in infants.

3. Determining inter- and intraobserver reliability of application of the Reflux Finding Score in Infants on laryngoscopy as a diagnostic tool for infant laryngopharyngeal reflux disease.

4. Evaluating the possibility of salivary pepsin testing as a novel diagnostic tool for infant GERD by first establishing normative values of salivary pepsin in healthy infants.

5. Develop an international guideline for the diagnosis and treatment of GERD by systematic review of literature and consensus agreement.

6. Systematic review on definitions of and reported outcome measures of GERD in clinical trials in infants and children with GERD.

7. International collaboration in the development of a Core Outcome Set (COS) as a recommendation set of outcome measures for clinical trials in GERD. In addition, the prevalence of reflux is investigated and considers implementation and impact assessment instead of a number of non or less effective interventions (don'ts) in gastroesophageal reflux in children.

8. Review of current available literature on the (future) role of pH-impedance measurement in the diagnosis and management of GERD in infants and children (published as a chapter in pediatric motility book).

The use of combined 24-hour impedance-manometry measurement in the diagnosis of rumination

9. Evaluating novel combined impedance-manometry analysis methods (pressure flow analysis) in children in addition to the Chicago Classification V3 that is currently available for the diagnosis of motility disorders in adults only.

10. Establishing age-dependent cut-off values for the Chicago Classification to be specifically applied to children.

11. Determining the effect of different bolus consistencies (i.e. saline vs Gatorade) on key Chicago Classification analysis parameters.

12. Evaluating the additional diagnostic value of adding solid swallows to current protocol of the sole administration of liquid swallows.

13. Evaluating the additional value of the so-called ‘multiple rapid swallow test’ and determine normative values for this assessment in children.

13. Determining test-retest reliability of esophageal impedance-manometry tracings analyzed by both conventional and pressure flow analysis in healthy adults.

14.  Assessing pharyngeal motility in children with a known esophageal motor disorder by using conventional analysis and pressure flow analysis (specific interest in achalasia).

15. Evaluating inter- and intraobserver reliability for the diagnosis of esophageal motility disorders in pediatric patients.

16. Evaluating inter- and intraobserver reliability of the diagnosis of achalasia and its subtypes in pediatric patients.

17. Evaluating novel pressure flow analysis metric (bolus flow time and bolus presence time) in pediatric patients with achalasia.

Professors
Prof. dr. M.A. Benninga

Staff Members
Dr. M.M. Tabbers, Dr. M.P. van Wijk.

PhD Students
Maartje Singendonk
Nina Steutel

 

Functional abdominal pain

In the next years 2 RCTs will be performed for the treatment of functional abdominal pain in children? The first study will be nationwide multicenter trial evaluating the effect of Mebeverine. The second RCT will evaluate the efficacy of fecal transplant in therapy resistant adolescents and young adults with irritable bowel syndrome. Furthermore we will perform a study how to best Implement the recently published NVK guideline on functional abdominal pain in children. Furthermore we will evaluate the influence of stress and/or the microbiome in the etiology of children with abdominal pain. Lastly, in collaboration with countries in Europe, Asia and Africa we study the prevalence of abdominal pain and it’s possible relationship with physical violence, sexual abuse and neglect.

Professors
Prof. dr. M.A. Benninga

Staff Members
Dr. A. Vlieger
Dr. M.M. Tabbers
Drs. A.H. Teeuw
Dr. S.N. Brillenslijper-Kater
Dr. R.J.L. Lindauer

PhD Students
Judith Zeevenhoven
Thekla Bosschaart

Constipation and fecal incontinence

In the next years we will:

1) work on unraveling the mechanism underlying constipation and fecal incontinence using f MRI and colonic manometry and study the (influence of the) microbiome in children with constipation. Furthermore we evaluate the best ways to diagnose constipation?  

2) participate in large therapeutical trials evaluating the effect of fibers and new drugs in children with constipation. Furthermore we evaluate the role of pelvic floor therapy in children with constipation. In collaboration with countries in Europe, Asia and Africa we study the prevalence of constipation and it’s possible relationship with physical violence, sexual abuse and neglect.

3) Evaluate implementation strategies of the international guideline constipation and develop an international set of outcomes for therapeutic trials.

4) Together with Rian Teeuw and Sonja Brillenslijper research will be performed into the prevalence of sexual abuse and physical violence in children with constipation and / or fecal incontinence at our outpatient clinic.

Professors
Prof. dr. M.A. Benninga
Prof. dr. P. Savelkoul (VUmc)
Prof. dr. C. Di Lorenzo (Columbus, Ohio, USA)
Prof. dr. R.A. de Bie, (Maastricht)

Staff Members
Dr. M.M. Tabbers
Drs. A.H. Teeuw
Dr. S.N. Brillenslijper-Kater
Dr. R.J.L. Lindauer

Postdocs
E.M.J. Bols (Maastricht)
PhD Students
T. de Meij
Sophie Wessel
Ilan Koppen
Thekla Bosschaart
Marieke van Engelenburg

Inflammatory bowel disease

Studies are going on regarding:

1)  The measurement of quality of life and life in children with Crohn's disease and ulcerative colitis.

2) The evaluation of the long-term effects of Infliximab.

3) Evaluating the effect of hypnotherapy in adolescents and adults with Crohn's disease and ulcerative colitis in remission and irritable bowel syndrome.

4) Evaluation the effect of low and high dose of Mesalazine in mild-to-moderate ulcerative colitis.

5) Studying the  long-term effects of  the treatment of Crohn's disease (20 years of follow-up).

6) Studying the effect of nutrition on the Crohn's disease.

7) Unraveling immunology, genetics and microbiome in Crohn's disease

8) Studying the prevention of irritable bowel syndrome in children with inflammatory bowel disease.

Professors
Prof. dr. M.A. Benninga
Prof. dr. G. D’Haens

Staff Members
Dr. A. Kindermann
Dr. A. Vlieger
Dr. M. Lowenberg
Dr. A. te Velde
Dr. J.E. Seppen

PhD Students
Tim de Meij
Daniel Hoekman
Kay Diederen

Obesity and the liver

Studies will be performed:

1. Evaluating  the diagnostic value of FibroScan for determining non-alcoholic fatty liver disease (NAFLD).

2. Detection of lipidomics as new markers for NAFLD

3. Studying the prevalence and risk factors for NAFLD in adolescents

4. Evaluating the long-term prognosis of NAFLD

5. Studying the role of maternal Chlamydia infections in biliary atresia

6. Studying the  effect of bile salt suppletion in Zellweger disease

Professors
Prof. dr. M.A. Benninga
Prof. dr. P.L.M. Jansen
Prof. dr. B.T. Poll-The

Staff Members
Dr. B.G. Koot

Feeding disorders in young children

Studies are going on regarding:

1. The measurement of quality of life of children and parents of children with feeding disorders

2. Evaluating the emotional capability of parents of young children with feeding disorders

3. Evaluating the long-term effects and growth in children with pathological food refusal and after successful hunger provocation

Professors
Prof. dr. M.A. Benninga

Staff Members
Dr. A. Kindermann

PhD Students
Hilde Krom

 

Microbiome and e-nose

1. Evaluation of the role of fecal organic compounds and intestinal microbiota as an early biomarker for necrotizing enterocolitis (NEC), and sepsis in premature infants

2. Standardization and optimization of fecal odor analysis with an electronic nose: evaluation of the impact of external variables measured odor profiles

3. Evaluation of effect of time of administration of antibiotics to the mother around a caesarean section on the intestinal colonization of the newborn

Professors
Prof. dr. M.A. Benninga

Staff Members
Drs. T. de Meij
Dr. N. de Boer

PhD Students
Daan Berkhout

 

Improvement quality of care

Delivering quality is an essential part of the professional responsibility of the care provider. Studies will  be performed to:

1. Improve quality of care by carrying out a systematic literature studies

2. Participate in the development of various international guidelines (including endoscopy, parenteral nutrition and GOR (Z)

3. Start active implementation instead of several directives, both at national and international level

4. Develop  several sets of outcome measures for therapeutic studies

Professors
Prof. M.A. Benninga

Staff Members
Dr. M.M. Tabbers
Dr. M.W. Langendam

PhD Students
Maartje Singendonk
Nina Steutel
Sophie Wessel
Dr. A. Kindermann

RESEARCHERS section Paediatric Gastroenterology:

Professors
Prof. dr. M.A. Benninga

Staff Members
Dr. M.M. Tabbers
Dr. B.G. Koot
Dr. A. Kindermann
Dr. M.P. van Wijk

PhD Students
M.M.J.  Singendonk
T.F. Bosschaart
S. Wessel
I.J.N. Koppen
D.R. Hoekman
K. Diederen
H. Krom
M.J. Smits

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