Departments

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.

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

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.

Our team specializes in diagnosing, managing, treating, and researching cystic fibrosis. Our care teams are comprehensive and include nurses, registered dieticians, physical therapists, social workers, and respiratory cystic fibrosis specialists. We collaborate closely with our colleagues in the Yale Medicine Pediatric Cystic Fibrosis Center to assist adolescents and young adults in the transition from pediatric to adult care. In recognition of our commitment and accomplishments in improving care for people with cystic fibrosis, our program received a Quality Care Award from the national Cystic Fibrosis Foundation. Our services include sweat testing and blood testing for all known mutations related to cystic fibrosis. We offer a full range of treatments for all complications related cystic fibrosis, including those involving the respiratory, sinus, digestive, endocrine, and reproductive systems. Patients have access to comprehensive nutrition counseling and care, including pancreatic enzyme replacement therapy, screening for vitamin deficiencies, and the repletion of those vitamins. We also help patients manage cystic fibrosis lung disease with mucus clearance techniques, mucolytics, and preventive therapy for patients infected with pseudomonas.

Our program consists of dedicated experts and support staff committed to providing cutting-edge care to patients with disorders including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC). Other conditions that we treat include sarcoidosis, autoimmune mediated liver injury, cholestasis of unknown etiology, lupus, cholangitis, secondary cholangitis, and overlap syndromes. The program offers effective and personalized treatment for patients with these rare liver diseases. Our doctors are specialists in these conditions, with expertise in interpreting biopsy scans, medications, and more. Patients also have access to our clinical trials, any of which offers new treatment options otherwise unavailable to the general public. We are partnered with the Yale School of Medicine Liver Center, one of only four National Institutes of Health-sponsored liver research centers in the United States, and the only center in Connecticut that offers comprehensive patient care for individuals with autoimmune and cholestatic liver diseases. Our team includes three autoimmune and cholestatic liver disease program experts. Together, they provide care that integrates basic, translational, and clinical research. Our combined expertise allows us to discuss and treat difficult cases from many angles. The research conducted by the program is mainly patient driven and aimed at finding solutions that patients can benefit from. The key to effective therapy is collaboration—we work closely with specialists in adult and pediatric gastroenterology, advanced endoscopy, transplant hepatology, transplant surgery, pathology, diagnostic and interventional radiology, gastrointestinal surgery, rheumatology, endocrinology, and medical and surgical oncology within the Yale Medicine system to provide any additional support that patients may need.

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.

Eosinophilic gastrointestinal diseases (EGIDs) are a group of conditions in which a type of inflammatory cell, called an eosinophil, invades the lining of the gastrointestinal (GI) tract. Although these conditions are rare, they are becoming increasingly common. The most common form of EGID is eosinophilic esophagitis (EoE), in which the eosinophils attack the lining of the esophagus—the tube going from your mouth into your stomach. In rare cases, eosinophils can be found in the stomach, intestines, and colon. These conditions are diagnosed by obtaining a sample of tissue, called a biopsy, from the GI tract. Symptoms of EoE include difficulty swallowing, heartburn, abdominal pain, regurgitation, vomiting, and food impactions. Other EGIDs can also cause pain, diarrhea, anemia, and blood in the stool. People with other allergic conditions, such as asthma, eczema, seasonal allergies, and food allergies, are at higher risk. These conditions can be treated by eliminating certain foods from the diet, taking daily medication, or having weekly injections. Repeat biopsies are often required after starting a treatment to ensure it is working. Our Eosinophilic Esophagitis & Gastrointestinal Diseases Program consists of a team of gastroenterologists, nurses, and dietitians. Our team will work closely with our patients to make the proper diagnosis and guide them through their treatment options. After diagnosis, the team closely monitors our patients’ symptoms, growth and nutrition, and overall well-being.

We provide expert evaluation and treatment to adult and pediatric patients across the entire spectrum of allergic and immunologic disorders. Our board-certified specialists have specific clinical and scientific expertise, and are highly capable of providing comprehensive, thoughtful care from the most common to the rarest conditions. Our physicians meet weekly to discuss the management of complicated cases. Yale has been the site of several key research breakthroughs in the field, including the discovery of new inherited immunological diseases and the development of a crucial understanding of the underlying causes of allergies. We offer comprehensive evaluation of both common and rare allergy and immunology conditions, including allergy skin and blood testing, oral food challenges, drug allergy testing, and contact dermatitis patch testing. We offer allergic rhinitis and asthma care through recommendations for environmental controls and pharmacological controller therapy, and biologic therapies for severe asthma, chronic rhinosinusitis with nasal polyposis, as well as chronic urticaria and hereditary angioedema. We have expertise in management of immune deficiencies with intravenous and subcutaneous immunoglobulin replenishment. We also provide consultations for drug allergy desensitization when needed. Among the conditions we treat are: Allergic rhinoconjunctivitis (nasal and eye allergies) Asthma Chronic rhinosinusitis Food allergy Insect sting allergy Medication allergy Urticaria (hives) Angioedema Hereditary angioedema Atopic Dermatitis Contact Dermatitis Common variable immunodeficiency Secondary immune deficiencies Our service has specific strength in the management of inherited immune deficiencies, with a dedicated service that closely collaborates with experts across other specialties. Through a long-standing collaboration with Yale Laboratory Medicine, patients have access to a broad array of state-of-the-art immunological testing. Our care for children and adolescents includes treatment for: Asthma Our doctors collaborate with colleagues in the Pediatric Asthma Program to ensure that our patients receive comprehensive asthma care, including: Evaluation, diagnosis, and management of childhood asthma for patients with varying degrees of severity Testing for allergic precipitants Mechanical analysis of respiratory function Outreach care at patients' homes when needed Allergy Testing for allergens, desensitization, and immunotherapy Allergic rhinoconjunctivitis Drug allergy Food allergy Insect venom allergy Urticaria (hives), mastocytosis, anaphylaxis Hereditary angioedema Primary Immunodeficiency and Recurrent Infections Testing for antibody deficiency, cellular immunodeficiency, and complement disorders Treatment of primary immunodeficiency diseases, including intravenous immunoglobulin therapy Evaluation and management of recurrent infections, including fungal infections

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

Integrative medicine focuses on the whole person, is informed by evidence, and seeks to complement cancer therapy with appropriate therapeutic and lifestyle approaches to achieve optimal health and healing. Smilow Cancer Hospital’s Integrative Medicine Program provides evidence-based guidance about a wide range of complementary therapies commonly used by cancer patients and survivors. Our program aims to address the serious physical and emotional symptoms often experienced by patients before, during, and after cancer therapy. Our team has expertise in the practice and evaluation of complementary medicine, and can guide patients to make effective decisions on integrative therapies throughout their treatment program and beyond. We collaborate closely with each patient’s oncology care team to provide safe and effective care. Integrative medicine consultations Integrative medicine clinical consultations provide guidance for the safe use of dietary supplements/natural products, acupuncture, massage, meditation, and other complementary therapies. Massage Experienced and licensed therapists are trained in oncology massage, focusing on mitigating side effects from cancer and its treatment. Research has shown that massage therapy may reduce pain, promote relaxation, and boost mood in cancer patients. Appointments may be made by calling 203-200-6129. We accept debit or credit cards for payment. $70 per 60-minute appointment $40 per 30-minute appointment Reiki Reiki is a complementary health approach in which practitioners place their hands lightly on or just above a person, with the goal of facilitating the person’s own healing response. This is to promote relaxation and produce stress-reduction effects. Appointments may be made by calling 203-200-6129. We accept debit or credit cards for payment. $70 per 60-minute appointment $40 per 30-minute appointment Nutrition Consultation The Integrative Medicine team offers guidance from our Oncology-certified Registered Dietitian to help individuals reach specific goals during or after completion of their treatment. Integrative Medicine Nutrition also supports the Supplement Clinic, where vitamins and supplements may be discussed to ensure they are safe and effective. They may also provide guidance on how to optimize their diet and obtain nutrients from foods whenever possible. Group Sessions Gentle yoga Group classes incorporate breathing techniques, physical postures, meditation, and relaxation, adapted to patient needs and limitations. T’ai Chi/Qigong T’ai Chi/Qigong is a centuries-old martial art and energy practice that uses gentle movement through postures to help promote mental focus, breathing, and relaxation. Students are taught the fundamentals of breath work, movement, and postures that develop into the T’ai-Chi form. The benefits are improved strength, mobility, alignment, pain control, and overall physical and mental rejuvenation. Meditation Meditation is a mind and body practice that has a long

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.