Gastroenterology (Division of Gastroenterology and Nutrition)

The Division of Gastroenterology and Nutrition at the Montreal Children’s Hospital is a group of dedicated health professionals who care for children suffering from gastrointestinal or liver disorders. 

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Who we are

The Division of Gastroenterology and Nutrition at the Montreal Children’s Hospital is a group of dedicated health professionals who care for children suffering from gastrointestinal or liver disorders. Our team is made up of physicians, nurses, nutritionists, a psychologist and receptionists, and offers inpatient and outpatient consultation, as well as follow-up of children with complex gastrointestinal disorders. In addition, we perform a number of different medical procedures and tests that help in the diagnosis and management of children with specific conditions.

Our team

We have a team of seven pediatric gastroenterologists, five nurse-clinicians, three secretaries, two nutritionists, a psychologist and an endoscopy technician.

Physicians

Clinical Nurses

  • Hélène Bacha, BScN
  • Sandra Dilullo, BScN
  • Marie-Andrée Latrémouille, BScN

Endoscopy and Home Enteral Feeding Nurses

  • Josée Bourgela, BScN
  • Sandra Dilullo, BScN

Nutritionists

  • Karen Casey, P.Dt.
  • Marie-Josée Trempe, P.Dt.

Psychologist

  • Sepideh Zargarpour, PhD

Secretaries

  • Rita Biancospino, Administrative Secretary
  • Gabrielle Laderoute
  • Caroline Lamorgese

Endoscopy Technician and patient care attendant

  • Fern DeRosa

 

Our history

The Division of Pediatric Gastroenterology and Nutrition at the Montreal Children’s Hospital was founded in 1978. In October 1992, the Just For Kids Foundation funded the construction of our pediatric endoscopy suite, where we offer our patients state-of-the-art diagnostic and therapeutic procedures.

As our clinical population has grown, we have created several multidisciplinary clinics, bringing together professionals from different specialty areas, to help provide more comprehensive care to families with children suffering from gastrointestinal and liver disorders.

Programs and services

Our team is frequently called upon for consultation on a variety of gastrointestinal health problems for patients who are admitted to the hospital, as well as for patients who are referred on an outpatient basis to our general gastroenterology clinic. Examples of these problems include chronic abdominal pain and diarrhea, severe chronic vomiting, poor weight gain or growth, intestinal bleeding, and liver abnormalities. Patients who are diagnosed with a chronic gastrointestinal condition may be followed in one of our specialized clinics.

Specialized programs and clinics (see below for descriptions):

  • Celiac disease
  • Cystic fibrosis
  • Dysphagia
  • Esophageal atresia and tracheoesophageal fistula
  • Feeding disorders team and nutrition
  • Hepatology
  • Inflammatory bowel disease
  • Intestinal failure and advanced nutrition team (INFANT)
  • Motility
  • Pancreas
  • Polyposis syndromes
  • Reflux

We also offer a variety of diagnostic procedures to patients on site. These diagnostic procedures include: 

  • Endoscopy
  • Motility testing
  • pH probes
  • Wireless capsule endoscopy

Inflammatory Bowel Disease Clinic

Chronic inflammatory bowel disease (IBD) refers to a number of disorders such as Crohn’s disease or ulcerative colitis that cause inflammation in the gastrointestinal tract.

Our clinic follows over 300 patients suffering from IBD. We offer patients medical, nursing, nutritional and psychological support to help them deal with their illness. Patients benefit from the latest state-of-the-art diagnostic methods, treatment modalities and protocols to monitor disease. One of our nurse clinicians is assigned to each patient and family to provide out-of-hospital support, offer advice and help minimize the need for hospital visits. Our team is also involved in several educational events and research projects in IBD, working in collaboration with the McGill IBD research group.

Useful information and resources for patients and families may be found at:

Crohn’s and Colitis Foundation of Canada

Crohn’s and Colitis Foundation of America

GI Kids

McGill IBD Research Group

Celiac Disease Clinic

Celiac disease is an immune-mediated disorder (conditions that result from abnormal activity of the body’s immune system) in which a person’s intestine reacts to gluten, a protein found in most grains, including wheat, rye and barley. Our Celiac Disease Clinic provides comprehensive care to children diagnosed with this condition. Our team of gastroenterologists, a specialized nutritionist and a nurse clinician provides state-of-the-art diagnostic modalities, on-going follow-up and genetic screening for family members. Furthermore, we provide continuing education and up-to-date resources about gluten-free diets to our patients’ families. More information on this condition can be found through the Canadian Celiac Association or GI Kids.

Polyposis clinic      

Polyposis syndromes are hereditary conditions that cause polyps to form in a person’s gastrointestinal tract.The Polyposis Clinic provides comprehensive assessment to patients and their families, and provides recommendations for follow-up to the treating gastroenterologist. Children referred to this clinic are assessed by Dr. Terry Sigman, a pediatric gastroenterologist, Dr. William Foulkes, a genetics specialist, and several genetic counsellors. The team works to provide the patient’s family with a unified care plan.

Hepatology (Liver) Clinic

A variety of congenital (from birth) or acquired liver conditions can affect children of any age. Our Hepatology clinic offers a full range of diagnostic services, as well as consultation and follow-up treatment to patients with pediatric liver disease. The clinic’s multidisciplinary team includes gastroenterologists, nurses and nutritionists. Information and resources for patients and families can be found at the Canadian Liver Foundation or GI Kids.

Intestinal Failure and Advanced Nutrition Team (INFANT)

Our Intestinal Failure and Advanced Nutrition Team (INFANT) was created to provide care to children suffering from various forms of intestinal failure, which happens when the body cannot fully sustain growth through oral nutrition (eating by mouth). Examples of intestinal failure include short bowel syndrome and severe dysmotility of the gastrointestinal tract. Our multidisciplinary team is made up of pediatric gastroenterologists, pediatric surgeons, a general pediatrician, nurse practitioners, a nutritionist, a pharmacist, an occupational therapist, and a social worker. Together, these health professionals aim to improve the quality of care for our patients by providing intensive inpatient care and coordinated follow-up care on an outpatient basis.

Nutrition Clinic

Nutritional problems in children can occur as a result of other complex health conditions. Dr. Ana Sant’Anna provides consultation and comprehensive nutritional care to patients seen by other subspecialty services at the hospital, as well as patients seen by the Complex Care Service team and the Feeding Disorders team. The Feeding Disorders Team is a multidisciplinary group that includes psychologists, occupational therapists, a behavioural specialist and two nutritionists.

Reflux clinic

Contact: 514-412-4487

A regional referral centre for the management of children with refractory cases of extra-esophageal reflux disease.  The group includes otolaryngologists and gastroenterologists with a special expertise in disorders of laryngopahryngeal and gastroesophageal reflux.

The Complex Medical Dysphagia Clinic

Dysphagia refers to a condition in which swallowing is difficult. Children referred to our Complex Medical Dysphagia Clinic have feeding and swallowing difficulties that require coordinated care to best understand, diagnose, and optimize the treatment of their conditions. Specialists from multiple disciplines including Dr. Véronique Morinville from Gastroenterology, Dr. Sam Daniel from Otolaryngology, and others from Pediatrics, Psychology, and Occupational Therapy work together to assess and treat patients.

Cystic Fibrosis clinic

Cystic fibrosis (CF) is a multi-organ condition that may involve the gastrointestinal tract and liver. Dr. Véronique Morinville is the gastroenterology consultant to the Cystic Fibrosis team and provides expertise for CF children with more complex GI symptoms. More information on this condition can be found on the Cystic Fibrosis Foundation website.

Pancreas Clinic

The pancreas is a gland in the abdomen that helps digest food. The Pancreas Clinic offers consultation, diagnosis, treatment and follow-up to patients with both congenital (from birth) or acquired pediatric pancreatic problems. Our multi-disciplinary team consists of a gastroenterologist, a nurse and a nutritionist.  More basic information on this condition may be found at GI Kids.

Esophageal Atresia and Tracheo-esphageal Fistula Clinic

Esophageal atresia is a congenital (at birth) malformation of the digestive system, which happens when the esophagus has not developed properly and does not connect to the stomach. It can be accompanied by a tracheoesophageal fistula (TEF), which is an abnormal link between the trachea (where air goes in) and the esophagus (where food goes in).

Even though surgical treatments can be performed after a baby is born, complications over the long term can be varied. Our EA-TEF clinic offers patients and their families multidisciplinary expertise to optimize care and prevent problems in the future. The team is made up of general surgeons, a gastroenterologist, an otolaryngologist, a pediatrician, a respirologist, a nutritionist, an occupational therapist, a nurse and a feeding psychologist. More information can be found on the Association québécoise de l’atrésie de l’oeosophage  website and the Réseau québécois interuniversitaire d’étude de l’atrésie de l’oeosphage website.

Diagnostic and Therapeutic Endoscopy

An endoscopy is a procedure in which a small camera mounted on a tube is inserted into the digestive tract via the mouth (gastroscopy) or anus (colonoscopy). Our division provides inpatient and outpatient endoscopic procedures for infants and children in order to diagnose various gastrointestinal disorders. Examples of these disorders include celiac disease, inflammatory bowel disease, eosinophilic gastroenteritis, complicated esophagitis, and polyposis syndromes. In addition, we sometimes perform endoscopic procedures to treat a number of different conditions such as strictures, esophageal varices, gastrointestinal bleeding, foreign body ingestions or polyps. We perform over 800 endoscopies a year.

Wireless capsule program

Wireless capsule endoscopy is a non-invasive method of taking images of the small bowel. Patients swallow a pill-shaped camera measuring 21mm x 27mm which captures images of the small bowel every half second. Our division offers this procedure for certain patients who are being evaluated for Crohn’s disease, polyposis syndromes, celiac disease or occult bleeding (bleeding in the gastrointestinal tract).

pH probes

This procedure is used with some patients to assess the amount of acid in the esophagus. The procedure involves placing a soft flexible wire through an infant’s or child’s nose for 24 hours.

Teaching, training and fellowships

The Pediatric Gastroenterology training program in the Division of Pediatric Gastroenterology and Nutrition, Montreal Children’s Hospital, McGill University is a two-year residency training program in pediatric gastroenterology accredited by the Royal College of Physicians and Surgeons of Canada. Training is provided in the diagnosis and management of children with gastrointestinal, nutritional, hepato-biliary, and pancreatic disorders. An optional third year of training may be available for candidates wishing to develop a special expertise.

Training in Montreal

Montreal’s large and diverse population provides exposure to a wide variety of clinical problems and the ability to work in a culturally rich, bilingual environment. A working knowledge of French is an asset but not a requirement to enter the training program.

The training program

The training program provides flexibility in accommodating an individual’s training needs, and access to a variety of GI and liver expertise throughout the city. The program’s major strengths include extensive clinical exposure to and integration of both inpatient and outpatient care, as well as exposure to gastrointestinal procedures including:

  • Diagnostic upper and lower endoscopies and therapeutic procedures such as foreign body removal, polypectomies, esophageal dilations, variceal banding.
  • Esophageal pH recording, video capsule endoscopy and manometric studies

The Division participates in a variety of multidisciplinary specialized clinics including an Inflammatory Bowel Disease clinic, a Celiac Disease clinic, a Cystic Fibrosis clinic, as well as clinics devoted to the treatment of dysphagia, esophageal atresia, feeding disorders, intestinal failure / short bowel, polyposis, and reflux.

Clinical, research and academic rounds occur in conjunction with the departments of Surgery, Radiology and Pathology at the hospital and with the Adult GI Training Program at McGill University.

Eighteen months of the program are devoted to clinical training, including rotations in Nutrition, Adult Gastroenterology, and Adult Hepatology. The rotations in adult care allow for specialized training in important but rare GI and liver conditions for which trainees must become proficient. Independent longitudinal care and managerial skills are developed via the physician-supervised Resident Continuity Clinic which begins in the second half of the first year of training. A minimum of three months is devoted to research activities.Trainees have access to institutional clinical research resources as well as training (PHRESCA, CRC) to optimize the research experience. The remaining elective blocks are tailored to the individual trainee’s needs and may include electives in Radiology, Pathology, Motility, Advanced Endoscopy, McGill graduate courses in Epidemiology, and/or further clinical research. Residents emerge from the training program as capable, well-rounded clinical pediatric gastroenterologists with research experience.

Links

For more information on pediatric gastroenterology certification in Canada, please refer to:

For further information about our training program, please contact:

Valerie Cameron, Training Program Administrator:  valerie.cameron@muhc.mcgill.ca

  • Telephone: 514-412-4474
  • Fax: 514-412-4392

Dr. Véronique Morinville, FRCP(C), Training Program Director: veronique.morinville@muhc.mcgill.ca

 

How to refer a patient

All patients must be referred by their primary physician who should provide us with a detailed referral request including a copy of the child’s growth charts and previous test results. All consultations are reviewed by a physician and given priority according to the level of medical urgency.

Fax: 514-412-4392

Conditions treated

Our division treats children with the following conditions:

  • Achalasia
  • Acute and chronic pancreatitis
  • Autoimmune liver disorders
  • Biliary atresia
  • Celiac disease
  • Chronic viral hepatitis
  • Chronic metabolic liver disease
  • Complicated gastroesophageal reflux disease
  • Cystic fibrosis
  • Eosinophilic gastroenterointestinal disorders including eosinophilic esophagitis
  • Esophageal atresia
  • Hirshsprungs disease
  • Inflammatory bowel disease
  • Intestinal failure
  • Intestinal malabsorption
  • Polyposis syndromes

 

Research

Members of our division carry out research in a variety of areas:

  • Dr. Ernest Seidman, as Canada Research Chair in Immune-Mediated Gastrointestinal Disorders and Director of the McGill IBD Research Group, is actively involved in both clinical and laboratory research in the areas of immune mediated gastrointestinal disorders with a focus on inflammatory bowel disease.
  • Dr. Sylviane Forget has a Masters degree in clinical epidemiology, and is interested in clinical research in the area of IBD, quality in endoscopy, and ethical issues in gastroenterology. She is involved in the PHRESCA course, dedicated to teaching clinical research methods to residents and fellows at the Montreal Children’s Hospital.
  • Dr. Najma Ahmed is involved in several research projects in pediatric liver disease including, fatty liver disease and biliary atresia. She is a member of the Canadian Pediatric Hepatology Research Group.
  • Dr. Véronique Morinville is a member of the International Study Group on Pediatric Pancreatitis (INSPPIRE) and is involved in clinical research studies evaluating pancreatitis in children. She is also involved in trials on biliary atresia, portal hypertension, and gastroesophageal reflux.
  • Dr. Ana Sant’Anna is involved in projects that evaluate children with intestinal failure, in addition to reviewing methods of feeding in children in the home enteral feeding program and evaluating the use of appetite stimulants in conjunction with the Feeding Disorders team.
  • Dr. Dominique Levesque is involved in clinical research projects in the field of esophageal atresia and tracheo-esophageal fistulas.
  • Dr. Terry Sigman is involved in clinical research projects in the area of celiac disease, including a multicentre trial evaluating infant nutrition risk in the development of celiac disease.

 

How to reach us

Telephone: 514-412-4474

Fax: 514-412-4392

Refer a patient 

Room A 02.2227, Glen site

To make an appointment : 514 412-4474
Fax : 514 412-4392