SPED Activities

Pediatric Gastroenterology is a Pediatric sub-specialty recognized by Portuguese Medical Organization (Ordem dos Médicos) since 2004, accessible to Pediatric and Gastroenterologist specialists through a training period of two years.

Thirty years ago some pediatricians began to dedicate special attention to digestive pathology and performed the first technical examinations in children like intestinal and hepatic biopsies and pHmetry. Next years they introduce endoscopic digestive examination in medical pediatric practice, in collaboration with their friends Gastroenterologists, first in adolescent patients and with the appearance of the ultrathin endoscopes, in all ages after birth. Today all diagnostic and therapeutic endoscopic examinations disposable are done in every Child, with the necessary adaptations for age and weight. The development of pediatric Anesthesia, also give an important contribution for the utilization of endoscopy in children.

At present we have seventeen pediatric gastroenterologists, working in nine pediatric public departments, in number between two and five in each one, distributed for all country and with different degrees of autonomy. All of them perform consultation as the more important activity, some one with specific consultations for celiac disease, inflammatory bowel disease and hepatology, treatment of inpatients, and performance of diagnostic examinations, like upper and lower endoscopy, pHmetry, hepatic biopsies and functional studies and therapeutic procedures, dilations, sclerosis, hemostasis, PEG, introduction of gastric balloon for obesity, foreign bodies extraction. Bioimpedance, manometry (esophageal and anorectal), wireless capsule endoscopy and CPRE are executed in only more advanced centers. In some Pediatric Gastroenterologic Services collaborate pediatricians specialized in hepatology and nutrition, with important activity in these fields. Only four centers have regularly emergency activity. The majority of the centers are involved in clinical research and some of them participate in teaching of medical students and pediatric training.

Most services are integrated in public hospitals with significant Pediatric departments, including Pediatric Surgery, Pediatric Intensive Care Services and with permanent collaboration of the Radiology and Pathology Services. All this public hospitals have an important Gastroenterology Department that offers good collaboration to the Pediatric Gastroenterology Services, specially in the more difficult technical diagnostic examinations like CPRE, endoscopic ultrasonnography, enteroscopy (double or single balloon) and in more unusual and difficult pediatric therapeutic endoscopic attitudes like stents or mucosectomy.

The Portuguese Pediatric Gastroenterologists have three official organizations: one included in the National Medical Society, responsible for elaboration of training programs and definition of specialized national needs (Departments, number of professionals) and evaluation of the training capacities of the different units, other as a section of the National Endoscopic Society dedicate to de development of pediatric endoscopy and for implementation of the collaboration with adult Gastroenterologists and another one integrating the Pediatric National Society with the aim of establishing contacts with other pediatric specialized areas and responsible for the organization of the two days annual national meeting.

At present the training program of Pediatric Gastroenterology is of two years duration, 40 hours week, in full dedication, with a selection for admission after the differenciation in Pediatrics or Gastroenterology. It is composed by a theoretical preparation and practical training in the most important diagnostic technics of the field for whish is established minimal numbers and a practical evaluation (upper endoscopy, colonoscopy, wireless capsule endoscopy, pHmetry, manometry, hepatic biopsy, polipectomy, gastrostomy, dilation …) The trainees must do some periods of work with Radiology, Pathology and Nutrition departments. There is a valuation program with a continuing component during the two years training and a final one composed by curricular discussion, theoretical evaluation and practical case discussion.

Fernando Pereira, MD, SPED Councillor