Departments

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

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.

The breadth of experience among our doctors is reflected in their unique approach to patient care, management of complex medical cases, expertise in imaging guidelines and unwavering commitment to clinical excellence. Magnetic resonance imaging (MRI) is a noninvasive medical test that physicians use to diagnose and treat medical conditions. It uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. An MRI does not use radiation. A computed tomography scan, more commonly known as a CT scan, is a diagnostic medical test that produces multiple images of the inside of the body. The cross-sectional images generated during a CT scan can be reformatted in multiple planes, and can even generate three-dimensional images of internal body structures. We also specialize in fluoroscopic imaging—real-time moving pictures displayed on a monitor. This specialized technology helps us detect conditions that affect the gastrointestinal as well as the urinary and reproductive (genitourinary) tracts. Our experts perform esophagrams, upper GI series and barium enemas to look for swallowing and digestion conditions. In addition, we do a variety of other imaging tests, including cystograms to detect voiding issues and hysterosalpingograms, which help us see if a woman’s fallopian tubes are open or blocked.

Hereditary Hemorrhagic Telangiectasia (HHT) is a genetic disorder that causes some blood vessels to develop improperly. Yale radiologists are developing guidelines for the evaluation of blood vessel malformations in the lungs (pulmonary arteriovenous malformations) in children with HHT. This innovative approach will replace CT scans, avoiding the successive and often unnecessary radiation exposure for children who have no symptoms. We are also developing guidelines for the diagnosis and treatment of malformed blood vessels in the brain (cerebral arteriovenous malformations), and aim to have these guidelines become part of the standard of care. Our physicians are also examining potential liver transplant guidelines for patients with HHT in heart failure. We are continuously analyzing existing data and conducting evidence-based research to develop new treatment methods that can impact the lives of patients in our care.

Avoidant/restrictive food intake disorder (ARFID) is a feeding disturbance characterized by extreme patterns of avoidant and restrictive eating. Children with ARFID will avoid or restrict eating due to three differing but potentially overlapping reasons: sensory/texture sensitivities, concern about GI discomfort, or lack of appetite or interest in eating. ARFID is different from other eating/feeding disorders (such as anorexia nervosa) in that children do not avoid or restrict eating due to body image concerns or a desire to lose weight. The purpose of the Yale GI ARFID Program is to evaluate and treat ARFID symptoms in children with Disorders of Gut Brain Interaction (DGBIs). We have found that with early detection and treatment of ARFID symptoms, we are better able to improve patients’ quality of life and reduce the need for unnecessary testing and intervention. DGBIs, formerly known as functional GI disorders, are a group of disorders related to a dysfunction of the gut-brain axis. Examples include but are not limited to the following: Irritable bowel syndrome Functional dyspepsia Functional heartburn Rumination syndrome Functional abdominal pain ARFID symptoms are commonly seen in children with DGBIs, as the symptoms of their gastrointestinal condition make it challenging for them to eat adaptively. Children and adolescents with DGBIs will commonly report difficulties eating due to a fear of causing GI discomfort. Common symptoms of ARFID in GI populations include: Avoidant/restrictive eating due to fears of GI discomfort, choking, or vomiting Unintentional weight loss due to avoidant/restrictive eating patterns Loss of appetite due to a shift in eating patterns Lack of interest in eating The GI ARFID Program is an interdisciplinary team of specialists here to treat each child’s ARFID symptoms in the setting of their GI concerns. Each patient’s family will attend an initial evaluation with our team of specialists and will be offered an individualized treatment plan based on their child’s needs. Our team includes a pediatric gastroenterologist specializing in neurogastroenterology and motility, a pediatric GI psychologist, a pediatric dietician, and a pediatric social worker.

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.

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.

At any time and every day of the year, our highly trained specialists are equipped with the knowledge and skills needed to prevent, diagnose, and manage a vast array of acute illness and injuries among infants, children, and adolescents. We collaborate with pediatric medical and surgical specialists to bring the best emergency care to infants and children. Each year, the Pediatric Emergency Department at Yale New Haven Children’s Hospital, a Level I trauma center, treats more than 40,000 children from infancy to age 20. The state-of-the-art, dedicated children’s department features 16 rooms and two major treatment/trauma rooms. It is in close proximity to but distinctly separate from the adult emergency department, and is staffed by physicians and nurses skilled in caring for children. Full-time pediatricians, each of whom has completed additional training in pediatric emergency medicine, oversee patient care. Our staff is ready for any medical emergency, but common conditions we treat include: Respiratory and gastrointestinal illnesses Poisoning, including environmental toxins Major and minor trauma, including head injury Suspected child abuse and neglect Abdominal emergencies Behavioral and psychiatric emergencies In addition to our attending emergency medicine physicians, our team includes fellows, physician assistants, pediatric residents, nurse practitioners, nurses, social workers, sexual assault nurse examiners, and forensic experts. Our patients have 24-hour access to experts from all pediatric specialties, including toxicology and critical care. Child life specialists and pediatric social workers are also ready to ease the emergency room experience for children and families. Our team is expert in the fields of bedside ultrasound, injury prevention, and disaster preparedness.

Internationally known for clinical excellence and cutting-edge research, we provide promising treatment options for adult and pediatric patients. Our program was one of the nation's first, and has evolved into one of the most active and advanced in the world.Yale is internationally recognized as a leader in innovative treatment for medically intractable and new onset epilepsy. We treat patients in outpatient settings, at a six-bed adult epilepsy monitoring unit, a two-bed pediatric epilepsy monitoring unit, and a technologically advanced operating suite. We are also equipped with state-of-the-art technology for continuous brain and video monitoring of seizures in children and infants. We evaluate patients in phases to precisely determine concordance of electrophysiology, cognitive testing, history, as well as physical and neurological examination with advanced imaging, using MRI, SPECT, and PET techniques. Doctors treat each surgical patient as an individual, determining which procedure or combination of procedures is appropriate.

The Pediatric Epilepsy Program studies and treats epilepsy and seizure disorders. The program is equipped with state-of-the-art technology for continuous electroencephalographic and video monitoring of seizures in infants and children. This facility represents one component of a comprehensive evaluation and treatment program for children with epilepsy. Recognizing that 6% of the pediatric population experiences at least one seizure in a lifetime, Pediatric Neurology is committed to understanding the nature of seizure disorders in children. Our team of dedicated experts offers a multidisciplinary approach to care that integrates the expertise of colleagues in neurosurgery and diagnostic imaging to deliver leading-edge evaluation, diagnosis, and patient care to children with varying forms and degrees of seizure and epilepsy. Our Program provides intensive audiovisual and electroencephalography (EEG) monitoring for diagnosis and localization of the affected area, to tailor care for each patient. Patients receive comprehensive inpatient and outpatient services, and a full range of medical and surgical treatment options, including ketogenic diet and vagus nerve stimulator programs for the treatment of children with complex epileptic conditions, as well as investigative therapies and approaches that are not widely available.

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.

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.