Departments

Constipation is one of the most common reasons children visit a pediatric gastroenterologist. Our highly trained physicians offer family-centered, comprehensive care to children dealing with this uncomfortable issue. While medications are effective and often necessary at the start of treatment, dietary changes are key to establishing good health. Our doctors and dietitian work closely together to review the child’s dietary history and offer recommendations to improve the child’s health and well-being. We provide guidance in healthy food choices to treat and prevent constipation, and reduce the need for long-term laxative therapy.

We specialize in helping children with constipation who do not respond to commonly used treatments. Known as refractory constipation, this can be due to congenital anal malformations or problems with the muscles or nerves of the GI tract.

We provide expert, compassionate inpatient and outpatient care for children with a variety of gastrointestinal, liver, and metabolic disorders including inflammatory bowel disease, esophageal disorders, diarrheal disease, acute and chronic liver disease, and metabolic liver diseases, including lysosomal diseases. Our care team harnesses the expertise of gastrointestinal nursing, nutrition, radiology, surgery and genetics experts, as well as Yale’s programs in inflammatory bowel disease and liver transplantation. Our multidisciplinary approach for our patients with nonalcoholic fatty liver disease also includes a clinical psychologist, a dietician, and an endocrinologist.The program also offers selective shunts for patients with noncirrhotic portal hypertension. Gastrointestinal conditions we often manage include: Abdominal Pain Celiac disease Constipation/Encopresis Eosinophilic esophagitis/allergic bowel disease Failure to thrive Feeding problems/swallowing problems Helicobacter pylori infection Hirschsprung’s disease Lactose intolerance Malabsorption Pancreatitis Peptic ulcer disease Vomiting Our pediatric hepatologists treat a range of liver diseases. Some can be managed with medication, while others require surgery. For example,acute liver failure(ALF) occurs when many of the cells in the liver die or become very damaged in a short period of time. ALF has many causes, such as metabolic conditions or toxicity from incorrect dosages of acetaminophen.ALF can sometimes be treated with medication, if it is identified early, but about half of all children who develop ALF require a liver transplant. Biliary atresiais a disease of the liver and bile ducts that occurs in infants. In children with biliary atresia, bile—a liquid that helps the body digest fat—cannot properly drain from the liver. This damages liver cells and can lead to liver failure. Surgical procedures can correct bile flow problems, but the liver disease progresses and requires specialized care to improve growth, development, nutrition, and long-term outcome.A multidisciplinary team consisting of pediatric liver specialists, surgeons, and a dietician provides comprehensive care for patients with biliary atresia. Other hepatology conditions we treat include: Alagille syndrome Alpha-1-antitrypsin deficiency Autoimmune hepatitis Neonatal cholestasis Progressive Familial Intrahepatic Cholestasis (PFIC) Urea cycle defects Wilson's disease Primary Sclerosing Cholangitis Glycogen Storage Disease Viral hepatitis Hepatoblastoma Nonalcoholic fatty liver disease

In 2001, the Yale Inflammatory Bowel Disease Program was formed to address the challenges faced by patients with complex, lifelong, gastrointestinal, inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. Our team-based approach employs a gastroenterologist, physician assistant, and a team of nurses and medical assistants to share the responsibilities of our patients’ medical care. Following evidence-based guidelines, the IBD team will work closely together to plan and coordinate a comprehensive plan of care personalized to each patient, who will have the opportunity to meet the IBD team members during a visit. The key to effective management of the disease is coordinated care among specially trained, internationally recognized physicians with expertise in inflammatory bowel disease. Our experienced team also includes nutritionists, surgeons, radiologists, and pathologists. Our medical and surgical specialists are available at the same visit to provide comprehensive care. Our enterostomal nurses work with families to manage ostomy care and provide support. Treatment for ulcerative colitis or Crohn’s disease usually begins with medical therapy. While surgery can be a primary therapy for certain symptoms of IBD, it is usually reserved as a supplement to medical therapy. The goal of GI surgery is to restore function, using bowel-conserving surgery, including minimally invasive surgery where appropriate. In order to properly diagnose and treat patients with IBD, doctors must perform visual examinations of the gastrointestinal tract through procedures known as endoscopies. The three most common procedures are as follows: colonoscopy, upper endoscopy, and capsule endoscopy. Each procedure visualizes a different section of the gastrointestinal tract. Colonoscopy—Sigmoidoscopy: These procedures allow doctors to evaluate the entire large intestine and the end of the small intestine called the ileum. In patients with inflammatory bowel disease, a colonoscopy is required for evaluation of the disease activity and for colon cancer screening. Some patients may undergo a sigmoidoscopy, which only views the first third of the large intestine. Upper Endoscopy (EGD): This procedure allows evaluation of the esophagus, stomach, and duodenum. In patients with inflammatory bowel disease, an upper endoscopy evaluates disease involvement in the upper region of the digestive tract. Capsule Endoscopy: The newest diagnostic procedure, it allows evaluation of the small intestine not accessible by upper endoscopy and colonoscopy. A tiny camera contained in a capsule passes naturally through the digestive tract while transmitting video images to a data recorder. Images of the small bowel are downloaded to a computer and reviewed by a physician. Chromoendoscopy: Chromoendoscopy is a technique performed during colonoscopy to enhance the detection of pre-cancerous areas in the colon. It uses a blue dye that temporarily stains the colon wall du

The Yale Medicine Gastrointestinal Motility Program is led by a team of gastroenterologists who subspecialize in motility disorders. We work in collaboration with radiologists, colorectal, surgeons, GI surgeons, thoracic surgeons, urologists, urogynecologists, and physical therapists to care for patients with complex motility disorders. As part of our multidisciplinary approach, our team meets monthly to discuss complex cases to ensure that each patient receives an individualized treatment plan. We strive to provide excellent care in a compassionate way. Our state-of-the-art services include: The Bravo pH Monitoring System, a catheter-free instrument that measures acidity levels in patients suspected of having gastroesophageal reflux disease (GERD). A small capsule is attached to the wall of the esophagus, which transmits data to a pager-sized receiver, which is worn for 48 hours. During this time, patients push a button whenever they experience symptoms, so we can determine if the symptoms correlate with incidents of acid reflux. When the test is over, data from the receiver is downloaded to pH analysis software, where it is analyzed. The SmartPill Capsule, a new technology available at only about a dozen medical centers around the country. The ingestible, wireless capsule measures pressure, pH, and temperature as it moves through the GI tract, allowing physicians to identify where abnormalities in intestinal transit are located. The SmartPill transmits information to a data receiver worn by patients. After the capsule has passed from the body, patients return the receiver to the physician, who is able to display and analyze the data within minutes. Impedance monitoring is a catheter-based system that enables doctors to diagnose nonacid reflux. Patients wear the monitoring system for 24 hours, and push a button whenever they experience symptoms. Physicians then download and analyze the data to determine whether the reflux is acidic or nonacidic, and whether the symptoms correlate with incidents of reflux.

At Yale Medicine, we specialize in a full range of digestive health care, from advanced endoscopy and colon cancer genetics to managing such conditions as inflammatory bowel disease and liver cancer. We treat complex gastrointestinal motility disorders, provide care for rare diseases, and support patients through liver transplants. Our dedicated team is committed to offering personalized and effective treatments for all aspects of gastrointestinal health. Specialized care is offered in the following areas: Advanced endoscopy: Specialized procedure using an endoscope to diagnose or treat complex issues in the digestive system. Colon cancer genetics: Study of genes that affect the risk of developing colon cancer. Gastrointestinal motility: The movement of food through the digestive tract. Inflammatory Bowel Disease (IBD): Chronic inflammation of the digestive tract. Liver cancer Liver transplant Lysosomal disease: A group of rare inherited metabolic disorders that result when lysosomes in cells cannot breakdown waste properly. Viral hepatitis: Liver inflammation caused by a virus, such as hepatitis A, B, or C, which can lead to liver damage.

An estimated 80,000 children suffer from inflammatory bowel disease (IBD) in the United States, and the disease is on the rise. We offer comprehensive care to children with IBD—which includes Crohn’s disease and ulcerative colitis—focusing specifically on young patients and their unique needs. We are dedicated to improving the physical and psychological health—and promoting optimal growth—for all children and adolescents with IBD. We are also proud that our remission rates in patients are higher than the national average. At our weekly clinic at Yale New Haven Children’s Hospital, patients can meet with IBD specialists, surgeons, nurses, social workers, and nutritionists who are ready to care for them with the most advanced available technology and medication. If surgery is needed, our skilled surgeons use methods, including laparoscopy, that allow for smaller incisions and quicker recovery. We have a transition plan for patients who are 21 and are ready to move into our IBD program for adults.

Our team works closely with colleagues in the departments of surgery, diagnostic radiology, laboratory medicine, and pathology to provide state-of-the-art diagnosis and treatment of digestive diseases in a coordinated and comprehensive manner. Our diagnostic clinics offer both routine and specialized endoscopic and nonendoscopic procedures. Our highly skilled and highly trained gastroenterologists offer several specialized programs: Our Advanced Endoscopy Program focuses on diseases of the pancreas, biliary tract, and gastrointestinal tract. We evaluate patients with a variety of symptoms and diseases, many of whom require complex endoscopic procedures using specialized techniques and equipment. Our Inflammatory Bowel Disease Program focuses on helping patients who suffer from Crohn’s disease and ulcerative colitis. Our specialists can treat these complex, lifelong inflammatory diseases through our dedicated program focused on clinical care, patient education, and research. Our Gastrointestinal Motility Program brings together a team of gastroenterologists, surgeons, pathologists, and radiologists to provide the latest diagnostic and treatment services to patients with hard-to-diagnose gastrointestinal disorders. Services offered by Yale Medicine Gastroenterology include: Cancer screening, including colonoscopy and upper endoscopy Diagnosis and management of Irritable bowel syndrome Nutrition evaluation and treatment Diagnosis and management of GI bleeding, including reflux disease, gastritis, ulcers, and portal hypertension Treatment of chronic diarrhea and disorders of malabsorption Evaluations for women's gastroenterological issues Video capsule endoscopy

The Smilow Cancer Genetics & Prevention Program is a team of specialists, including physicians, geneticists, genetic counselors, genetics clinical coordinators, and advanced practice providers, who work together to provide cancer genetics education and coordination of genetic testing to inform cancer risk assessment, precision treatment for patients with cancer, and surgical management decisions. Patients seen in the Smilow Cancer Genetics & Prevention Program will typically first meet with a genetic counselor, a genetics clinical coordinator, or have a combined visit with one of our specialty providers and a genetic counselor. Genetic counselors are licensed medical professionals with advanced training in genetics who help patients understand and adapt to the medical, psychological, and familial implications of genetic contributions to diseases such as cancer. Genetics clinical coordinators are key team members who enable expedited evaluation and genetic testing for patients who meet the criteria for genetic testing as part of our novel Fast-Track Program. An initial pre-test visit in the program typically includes the following: Detailed review of a patient’s medical history and their family history of cancer Risk assessment of the chance that the cancer(s) in the family are hereditary Discussion of the risks, benefits, and limitations of genetic testing Coordination of genetic testing and detailed discussion of genetic test results Discussion of appropriate medical management recommendations, implications for family members, and support resources Coordination of cascade testing, which is genetic testing of blood relatives of individuals with genetic pathogenic variants identified Our specific goals include the following: Clinical: Provide patient-centered care and foster collaboration among health care providers Research: Advance the field of cancer genetics, risk prediction and prevention, and related treatment options Education: Provide clinical/didactic experiences for genetic counseling students, medical students, residents, fellows, and other providers Community Outreach: Promote awareness of hereditary cancer risk and provide broad-based education about cancer prevention options Who may benefit from a hereditary cancer genetics evaluation and testing? Someone with: A personal or family history of early-onset cancer (age 50 years or younger) Several family members on the same side of the family with cancer A personal or family history of breast cancer and Jewish ancestry A personal or family history of ovarian, pancreatic, triple-negative breast cancer, or metastatic prostate cancer at any age A personal or family history of multiple colon polyps A personal or family history of multiple cancer diagnoses within the same individual A personal or family history of a rare type of cancer/tumor (breast cancer in a male, medullary thyroid cancer, sebaceous carcinoma, or adenoma) A family history of a known gene pathogenic v

Weight management is a complex and multi-faceted challenge that can involve a wide range of health issues, with solutions that are different for every person. The Center for Weight Management, part of Yale New Haven Health (YNHH) and Yale School of Medicine, is a multidisciplinary practice offering a comprehensive range of services for patients needing help to achieve their target weight. The center provides assistance with weight and weight-related health conditions from many different perspectives, with personally tailored solutions based on each patient’s specific needs and goals. Weight management is a lifelong journey, and we are here to help. The center brings together renowned experts in both the medical and surgical treatment of obesity, as well as in such fields as psychology, nutrition, exercise physiology, orthopaedics, endocrinology, cardiology, liver disease, and more. The center doesn’t just focus on weight management, but also on the many health outcomes associated with excess weight, such as diabetes, fatty liver disease, heart disease, joint problems, and cancer. Successful weight management can significantly improve these conditions and reduce the chance of developing them in the first place. In short, the center provides services across the entire continuum of care for weight management, including everything from dietary advice to psychological counseling, medications, endoscopic interventions, and surgery. Having all of those services under one umbrella gives us the unique ability to care for any patient with weight management needs, regardless of size or treatment options. The center also has an alliance with the YNHH Department of Pediatrics, and since obesity tends to run in families, center administrators are planning an intergenerational clinic where the entire family can receive care. Currently, the center is situated at several different locations within the health system; in 2022, all of the components of the center are scheduled to move to a single location at 8 Devine St. in North Haven. Consultations are also available via telehealth. The Center for Weight Management has three physician-directors: John Morton, MD, MPH, medical director of bariatric surgery for the Yale New Haven Health System; Wajahat Mehal, MD, PhD, director of the Yale Weight Loss Program and an expert in obesity medicine and endobariatrics; and Ania Jastreboff, MD, PhD, an adult and pediatric endocrinologist with expertise in obesity medicine and weight management. The center has a fully integrated medical and surgical team. We have approximately 20 physicians, including 12 bariatric surgeons, who together have performed about 10,000 successful surgeries (Dr. Morton alone has performed about 4,000 successful bariatric surgeries). Other members of the team include nurses, dieticians, psychologists, social workers, and an exercise physiologist, as well as the many experts on weight-related health conditions who partner with the center.

At Yale Medicine, our Bariatric and minimally invasive surgery team specializes in surgical care for conditions affecting the digestive tract. Expert surgeons use the latest minimally invasive techniques designed to reduce scarring and minimize discomfort after surgery, providing a smoother and more rapid recovery. We recognize that it’s natural to experience various emotions and concerns before undergoing surgery. That's why our approach focuses on patient education and comprehensive care—we are here to provide clear, detailed answers to all your questions before, during, and after your procedure. About Us Specialized care is offered in the following areas: Abdominal wall reconstruction to treat complex hernias or trauma to the abdomen Laparoscopic surgery to treat severe (Class III) obesity Weight-loss surgery options: Roux-en-Y gastric bypass, in which a small stomach pouch is created to restrict food intake. LAP-Band® surgery, in which a band is placed around the upper part of the stomach to create a small pouch to hold food. The band limits the amount of food that’s consumed by making the patient feel full after eating small amounts. Sleeve gastrectomy, which involves removing about 85% of the stomach. The smaller-sized stomach holds less food, creating a feeling of fullness with significantly less food. All weight-loss surgery options include education and support from nursing, nutrition, and psychological service providers.

Each year, nearly 300,000 people in the United States are diagnosed with a type of gastrointestinal cancer. Many of these cancers are too complex or difficult to be treated with just one type of treatment. The Center for Gastrointestinal Cancers at Smilow Cancer Hospital and Yale Cancer Center provides patients with gastrointestinal cancers a comprehensive, multidisciplinary approach to the treatment of complex disease. As experts in the treatment of cancers of the esophagus, stomach, liver, pancreas, colon, bile ducts, rectum, and anus, we collaborate with diagnostic and interventional radiologists, gastroenterologists, and pathologists to provide the most up-to-date and effective treatments available. Our advanced diagnostic imaging services, including Endoscopic Retrograde Cholangiopancreatography (ERCP), MRI/MRCP (ERCP in conjunction with MRI), high-resolution CT scans, Endoscopic ultrasound (EUS), and EUS-guided fine needle aspiration, allow for patients to be comprehensively evaluated at the onset of their diagnosis. Surgical Oncology Surgery is commonly used to effectively manage certain types of gastrointestinal cancers, including malignant and premalignant tumors in the stomach, liver, bile ducts, pancreas, small intestine, and colorectum. Our team of surgeons incorporate a variety of state-of-the-art surgical techniques into procedures when necessary. These include: Laparoscopic and robotic surgery for stomach, small bowel, and colorectal tumors, as well as for primary and metastatic liver tumors and biliary tumors Cytoreduction and heated intraperitoneal chemotherapy Pancreatectomy (Whipple procedure, distal pancreatectomy, total pancreatectomy, central pancreatectomy, pancreas preserving enucleation) Medical Oncology In addition to chemotherapy, our medical oncology experts provide innovative nonsurgical treatment options including: Targeted Therapy, in which a special type of chemotherapy targets the changes in cancer cells that help them grow, divide, and spread Immunotherapy, which uses a patient’s own immune system to find and destroy cancer cells Yale Cancer Center emphasizes the importance of clinical trials for all stages of disease. Many of these drugs are exploring new types of therapy and new combinations of therapies, and many of our studies are available as part of our network of Care Centers. We perform state-of-the-art genomic profiling and laboratory explorations to determine the biologic weaknesses of the tumors and to develop better therapies for patients. Radiation Oncology Patients who need radiation oncology to treat their gastrointestinal cancers can feel confident that they are receiving the highest quality care from the most experienced team of radiation oncologists in Connecticut. We offer innovative therapies including: Three-dimensional Conformal Radiation: This technique may be used to target radiation to tumors by matching their particular shapes. Four-dimensional (4-D) CT simulation makes CT scans f