Prof Anupam SibalMD, FIAP, FIMSA, FRCP(Lon), FRCP(Glas), FRCPCH, FAAP

Group Medical Director, Apollo Hospitals Group

Clinical ProfessorFaculty of Medicine and Health Sciences Macquarie University, Sydney, Australia

Dr Vidyut Bhatia, Dr Akshay Kapoor, Dr Smita Malhotra,

Dr Karunesh, Dr Ishaq, Dr Ravi, Dr Aditi

Pediatric Gastroenterologists and HepatologistsApollo Centre for Advanced Pediatrics

Indraprastha Apollo Hospital

Evolution of Pediatric Gastroenterology

1833 William Beaumont published experiments and observations

on gastric juice and the physiology of digestion

1875 Victor Charles Hanot described cirrhotic jaundice and

other diseases of liver

Lancet 1957 : first report of intestinal biopsy of a child of celiac disease

1895 German Gastroenterological Society

1897 American Gastroenterological Association

1902Japanese Society

1932 American Society of Gastroenterology

1937 British Society of Gastroenterology

1949 AASLD

1958 First World Congress of Gastroenterology and World Gastroenterology Organization

1958 IASL

1966 EASL

1968

The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)

1973

Pediatric gut club morphed into North American Society for Pediatric Gastroenterology (NASPGHAN)

1974

The Latin American Society for Pediatric Gastroenterology and Nutrition (LASPGAN)

1984 Commonwealth Association of Pediatric Gastroenterology

and Nutrition (CAPGAN)London

1993 The Asian Pan Pacific Society of Pediatric

Gastroenterology (APPSPGHAN)Tokyo

2000

First World Congress was held in Boston

ESPGHAN, NASPGHAN, APPSPGHAN and LASPGHAN

Federation of the International Societies of Paediatric Gastroenterology, Hepatology and Nutrition (FISPGHAN) was created

1970s AIIMS and PGIMER CMC Vellore and Madras Medical College

1980s Osmania Medical College and Trivandrum Medical CollegeSGPGI, Lucknow

Events leading to the emergence of pediatric gastroenterology

Small intestinal biopsyIleocolonoscopyPercutaneous liver biopsyGut immunology and food allergyOral rehydrationParenteral nutritionMetabolic liver diseasePortoenterostomy (Kasai) procedure for biliary atresiaOrgan transplantation Liver Small bowel

1980s

PGI

MAMC

ICH, Chennai

1990s

Pediatric Gastroenterology SGPGI, Lucknow

Diarrheal disease research center at AIIMS, Delhi

Clinical and research services in pediatric liver diseases at AIIMS, Delhi

Apollo Centre for Advanced Pediatrics, New Delhi

2002

One year post-doctoral certificate course (PDCC) in Pediatric Gastroenterology at SGPGI, Lucknow

2009 DM in Pediatric Gastroenterology, SGPGI, Lucknow

2012 IAP Fellowship Apollo Hospital, Delhi Medanta, Gurgaon

2013 DM in Pediatric Hepatology

ILBS, Delhi

2014 FNB in Pediatric Gastroenterology

Apollo Hospital, Delhi

2015 DM in Pediatric Gastroenterology, PGI

IBD

Early onset IBD

Celiac disease

CMPA

Multiple food allergies

ICC

NCS

PFIC

PHT

MLD

Biochemical studies available TMS and GCMS for: Carbohydrate metabolism Urea cycle disorders Amino acid metabolism FAOD Organic acidemiasSuccinyl acetone urine and blood for tyrosinemia

Genetic studiesAlfa-1 antitrypsin deficiency: SERPINA-1 geneCF: CFTRGalactosemia: GALT, GALE (epimerase) and

GALK1 (kinase)GSD 1A and 1B: G6PC and G6PT1GSD 3: AGLGSD 4: GBE1GSD 6: PYGLHemochromatosis: HFE

MSUD: BCKDHANPC: NPC 1 and 2Cirtrin deficiencyAlagille: JAG1 and NOTCH2Tyrosinemia: FAHPFIC 1 – 3

Enzyme studies

GalactosemiaFructosemia Gaucher’sNPCFAODUrea cycle disorders

Specialized formulae available in India (on demand)

Galactosemia – lactose free/soy formula (Zerolac, Isomil, Galactomin 17)

MSUD – leucine, iso-leucine and valine free (MSUD diet powder, MSUD analogue)

Tyrosinemia – low tyrosine and phenylalanine powder (Tyrex, XPHEN TYR)

Fatty acid oxidation defects: modified fat and carbohydrate (ProViMin, Monogen)

Urea cycle disorders: non-essential aminoacid free (Cyclinex)

The watershed

No internet

1 TV channel

3 + 3 Airlines

$6 billion foreign reserves

1991 2016

350 million internet users

1790 TV channels

22 Airlines

$367 billion foreign reserves

2608

210

Liver transplants at Apollo

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