Gastroenterology and Hepatology

All Articles in the Category ‘Gastroenterology and Hepatology’

Functional Abdominal Pain in Children: A Q&A With Dr. Nicole Pattamanuch, Plus a New Algorithm for Providers

More than 100 new patients are referred to Seattle Children’s GI program each month for functional abdominal pain, with an average wait time to be seen of typically 3 to 5 months. To help PCPs manage these patients longer in primary care so they can get care sooner and identify situations and red flags that indicate specialty care is needed, our GI doctors developed an algorithm for chronic abdominal pain that is now available on our website at

We spoke with Dr. Nicole Pattamanuch, director of our General GI program, to learn more about caring for kids with functional abdominal pain.


Q: What are the most common causes of functional abdominal pain, by age group?

Functional abdominal pain is one of the most common complaints we see in GI. The exact cause isn’t known; usually it’s multifactorial. We know emotional distress plays a role, by exacerbating gut/brain axis disorders  and making it more difficult for a child or teen to cope with the pain signals their body is sending.

We tend to see functional abdominal pain in school-age children and adolescents. For younger, preschool-age children who are reporting belly pain, I’d be less suspicious of functional abdominal pain and instead consider a more serious pathology.

For a quick introduction to the gut-brain interaction, two articles I recommend are:


Q: What are the red flags for functional abdominal pain?

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GI Has 3,000 Referrals in Scheduling Queue; Please See Patients With Constipation in Primary Care Whenever Appropriate

Gastroenterology (GI) has approximately 3,000 referrals waiting to be scheduled, with limited appointment slots available to see new patients. This means nonurgent general GI referrals without red flags, including constipation (which is one of the more common referrals received by GI), are currently scheduling three to five months out.

While GI is continuing to accept patient referrals for constipation at this time, program leaders are encouraging PCPs to manage their patients with constipation in primary care whenever possible and appropriate to ensure the most timely care. This also helps Seattle Children’s maintain access for patients who most need specialty care.

To assist PCPs in caring for patients with constipation, Seattle Children’s offers a detailed functional constipation clinical protocol and algorithm on our website. In addition, the GI Refer a Patient webpage offers:

Patients with constipation who have red flags (see protocol and/or algorithm) or who have attempted the treatment protocol without success are appropriate to be seen by GI and should be referred. Please clearly describe the treatment that has been tried already to help us properly triage and schedule your patient.

The Seattle Children’s GI team acknowledges the excellent work of PCPs in the community who are managing constipation in primary care and encourage you to let us know if there are ways we can improve the resources we are providing (above) in support of your care.

Hospital Capacity and Other Important Updates

Hospital capacity

Seattle Children’s is beginning to experience some relief from the extremely high capacity constraints of recent months. We do, however, continue to see high winter volumes.

  • Overall hospital census remains high, and the Emergency Department (ED) is still seeing extremely high patient volumes.
  • The wave of patients experiencing mental and behavioral health crises is not slowing down.
  • Seattle Children’s remains in active Code Yellow status, although at a lower level of response; we continue to monitor the situation and enact solutions to address the challenges we are facing.

Other important updates from Seattle Children’s

New Division Chief Evelyn Hsu, MD, Brings Big Changes to Gastroenterology/Hepatology

Evelyn Hsu

Seattle Children’s is pleased to announce that Dr. Evelyn Hsu accepted the position of division chief of Gastroenterology and Hepatology, following a year as acting division chief and a very competitive national search. She also has served as program director of the Transplant Hepatology Fellowship and medical director for Liver Transplantation.

“I’m excited to join this group in an official capacity. My priority is to expand our staff and open up our services to care for more children in our region, while implementing a service model that allows us to scale up in size while continuing to provide excellent care.,” says Hsu. Read full post »

Teduglutide and Transplants: Moving the Field of Pediatric Intestinal Rehabilitation Forward

The Intestinal Rehabilitation Program at Seattle Children’s, the only program of its kind in the Pacific Northwest, is dedicated to reducing transplantation rates through innovative research that improves intestinal failure management.

Seattle Children’s was one of the largest recruiters for the first 12-week trial evaluating the efficacy and safety of the investigational drug teduglutide for patients with long-term TPN dependence related to short bowel syndrome. Already approved for short bowel syndrome treatment in adults, teduglutide is designed to reduce the need for TPN.

“Teduglutide is the first drug to be introduced to the commercial market that has a sound theoretical basis, as well as supportive preclinical and adult clinical studies, to improve intestinal adaptation above and beyond what can be achieved with the best standard of care,” says Dr. Simon P. Horslen, director of the Intestinal Rehabilitation Program and medical director of Solid Organ Transplantation at Seattle Children’s, and professor of pediatrics with UW Medicine. “Anything that has the potential to wean a child from TPN or even reduce the amount of TPN they receive will improve quality of life.”

Results from the initial 12-week trial were promising. Among 42 children ages 1 to 17, the treatment was associated with overall reductions in TPN, in some cases as significant as 41%. Four children were weaned from TPN entirely during the study.

Horslen and his co-investigator, Dr. Danielle Wendel, gastroenterologist at Seattle Children’s and assistant professor at UW Medicine, are awaiting results from a recently completed 24-week study.

“Teduglutide is a huge step forward in the management of intestinal failure,” Horslen says. Read full post »

Innovative Research Driving Change for Children With Hepatologic Challenges

At Seattle Children’s, the Pacific Northwest’s only dedicated pediatric hepatologists are actively engaged in research consortiums and working to improve treatments for pediatric liver diseases.

Two of these physicians, Dr. Evelyn K. Hsu, program director of the Advanced/Transplant Hepatology Fellowship at UW Medicine and Seattle Children’s, and Dr. Karen F. Murray have spearheaded a number of innovative studies that have improved children’s access to lifesaving transplants and medications. Read full post »

Seattle Children’s Launches New Celiac Disease Program

A Q&A with Dr. Dale Lee

Seattle Children’s recently launched a new Celiac Disease Program within its Gastroenterology Division. This program gives patients access to physicians and registered dietitians specially trained and experienced in working with pediatric patients with celiac disease.

Dr. Dale Lee, director of the Celiac Disease Program, addresses questions related to celiac disease, the new program and services it offers.

Thank you to Dr. Wendy Sue Swanson, a pediatrician at The Everett Clinic in Mill Creek, a member of Seattle Children’s medical staff and executive director of Digital Health, and author of the Seattle Mama Doc blog, for submitting these questions.

There is certainly public interest in gluten-free diets. Help us put in context those who seem to feel healthier and happier off gluten, and those who must be off gluten.

Gluten is commonplace in our modern diet and individuals can have a variety of conditions related to gluten.

  • Celiac disease is an immune-mediated hypersensitivity to gluten that results in intestinal inflammation/damage that can occur in certain genetically susceptible individuals.
  • Wheat allergy is different than celiac disease, but is also immune-mediated and can result in a variety of symptoms including rash, abdominal pain, vomiting or breathing difficulties.
  • Non-celiac gluten sensitivity (also referred to as “gluten intolerance”) does not involve an immunological response, but the symptoms can be similar to celiac disease, such as abdominal pain, vomiting or diarrhea.

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