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Gastroenterology

Our program

Home Enteral Nutrition program

Is a program for children who medically require a semi-elemental or elemental formula (and tube supplies if needed) as a sole source of nutrition. The most common indication is for the treatment of Cow Milk Protein Allergy. 

 Polymeric formulas will be provided only for children with Crohn’s disease who require exclusive enteral nutrition therapy or have Crohn’s disease and have demonstrated impaired linear growth.

For more information see HEN website

For Professionals

Patients with complicated or difficult to manage feeding impairment, enteral nutrition or intestinal failure that require multidisciplinary care are felt to be the most appropriate patients for our CFNS team. 

Feeding impairment
Feeding impairment can be defined as the inability or the refusal to eat sufficiently to support growth and maintain adequate nutritional stores. They may be related to an underlying medical condition, swallowing difficulties, oral-motor difficulties, sensory food aversions, a poor appetite or behavioral challenges.

Enteral nutrition
We may provide consultative services or ongoing management of enteral nutrition in children with complex medical, nutritional and feeding needs, including but not limited to:  transition from enteral to oral nutrition complicated by a feeding disorder or feeding intolerance

Intestinal failure
We may provide consultative services or ongoing management of infants and children with or at risk for intestinal failure, including but not limited to:

  • Home parenteral nutrition (all infants and children on home parenteral nutrition are followed by the CFNS)
  • Congenital, acquired or functional short bowel syndrome
  • History of intestinal resections
  • History of intestinal atresia, gastroschisis, omphalocele

Failure to Thrive
We may provide consultative services or ongoing management of infants and children with failure to thrive that has not resopnded to ongoing nutrition intervention. 

If community supports are available, the CFNS will provide consultative services only or short-term medical management, nutrition counseling and feeding therapy to children with complex nutritional and feeding needs that are refractory to treatment or difficult to manage by the healthcare team. The child’s pediatrician and community supports must be aware and in agreement with a referral to the CFNS. The CFNS will work closely with the community to ensure that the child’s complex nutritional and feeding needs are met. 

If community supports are not available, the CFNS will provide ongoing medical management, nutrition counseling and feeding therapy to children with complex nutritional and feeding needs.

Patients who do not require a multidisciplinary team, who are eligible for community feeding therapists or teams but have not availed them, or who require only a diagnostic or medical procedure, (e.g. feeding tube insertion, Upper GI, videofluoroscopic feeding study, endoscopy) are less appropriate for our service. 

If felt appropriate, the Complex Feeding and Nutrition Service may redirect referrals to existing community resources. The referring physician will be informed.

Education

Education

The CFNS is committed to providing education and to supporting community resources within British Columbia. For further information regarding education opportunities, please contact us or by phone at (604) 875-2345, local 5886.

Practice guidelines

Practice guidelines

H. Pylori Guidelines

Evidence Based Guidelines from ESPGHAN and NASPGHAN for Helicobacter pylori Infection in Children - 2011

Celiac Guidelines

NASPGHAN - Diagnosis and Treatment of Celiac Disease in Children - Clinical Practice Guideline Summary - 

NASPGHAN - Diagnosis and Treatment of Celiac Disease in Children - Full Article - 2005

Constipation Practice Guidelines

Canadian Pediatric Society - Managing functional Constipation in children - Reaffirmed 2014

North American Society of Pediatric Gastroenterology, Hepatology and Nutrition - Evaluation and Treatment of Functional Constipation in Infants and Children: Evidence-Based recommendations from ESPGHAN and NASPGHAN - 2014

GERD Guidelines

NASPGHAN - Summary of the 2009 Pediatric Gastroesophageal Reflux Clinical Practice Guidelines

NASPGHAN - Full Article Pedatric GERD Clinical Practice Guidelines

NASPGHAN - GERD in the Neurologically Impaired Child

H. Pylori Guidelines

Evidence Based Guidelines from ESPGHAN and NASPGHAN for Helicobacter pylori Infection in Children - 2011


Our team

Physicians 

Kevan Jacobson, Division Head
Collin Barker, Program Director
Vishal Avinashi
Linda Casey 
Orlee Guttman 
David Israel 
Sally Lawrence
Rick Schreiber

Fellows

Meshari Al Aifan
Alice Foster
Quais Mujawar

Clerical staff

Deborah Finlay, Administrative Secretary 
Sonya Datt, New Patient Booking Secretary
Vicki Biring, Follow up Patient Bookings / Clinic Secretary
Remneet Sihota, Complex Feeding and Nutrition Service
Melissa Orgill, Endoscopy Booking

Research

Kevan Jacobson
Bruce Vallance

Dietitians 

Ali Boyle Complex, Feeding and Nutrition Service
Debbie Martins, Complex Feeding and Nutrition Service
Preeti Vekaria


Nursing

Kathi Evans, Nurse Clinician
Sonia Bosco
Meghan Good
Tania Ferraro
Lori Lonergan
Fran Starr, Complex Feeding and Nutrtion Service
Jessie Ahuja, Transplant Nurse

Social Work

Kathryn Urquhart, Complex Feeding and Nutrition Service

Occupational Therapy

Astrid St. Pierre, Complex Feeding and Nutrition Service
   


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SOURCE: Gastroenterology ( )
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