Training in Infectious and Immunologic Diseases of the Gastrointestinal Tract

Immunologic and infectious disorders represent important subsets of gastrointestinal diseases in pediatric patients and maturational and genetic factors play an important role in the occurrence of these disorders during infancy and early childhood. A basic understanding of the pathophysiology of these disorders will be attained primarily through didactic and other teaching sessions and independent reading.

At the end of training the trainee is expected to:

• Understand developmental changes in mucosal barrier function that may predispose to an immunologic reaction, such as changes in permeability or receptor expression
• Be familiar with the normal functions and compartments of the mucosal immune system and how these functions are altered during immunologic and immunodeficiency disorders
• Be familiar with the clinical features, evaluation, management and complications of systemic immunodeficiency disorders, other than human immunodeficiency virus, occurring in childhood. These include humoral deficiencies, cellular deficiencies, mixed humoral and cellular immunodeficiencies, and neutrophil defects. Specific disorders of importance include X-linked hypogammaglobulinemia, common variable immunodeficiency, severe combined immunodeficiency, selective immunoglobulin A deficiency, and chronic granulomatous disease
• Understand the clinical features, evaluation, and management of autoimmune enteropathies occurring in isolation or as part of a systemic autoimmune disorder such as autoimmune polyglandular syndromes
• Have a basic knowledge of the clinical features and manifestations of gastrointestinal involvement by systemic vasculitic processes, such as Henoch-Schonlein purpura, hemolytic uremic syndrome, Kawasaki disease, and dermatomyositis and mixed connective tissue disease
• Effectively diagnose and treat infectious disorders of the gastrointestinal tract
• Learn the age-related occurrence of these disorders as part of the differential diagnosis
• Recognize the value and cost-effectiveness of diagnostic testing
• Understand the use of information obtained from mucosal biopsies
• Get knowledge in the epidemiology and clinical manifestations of the most common viral enteric pathogen, such as rotavirus, caliciviruses, enteric adenoviruses, and astroviruses
• Understand the mechanisms of viral enteritis and which regions of the digestive tract are involved in viral infection
• Use the oral rehydration therapy as well as adjunctive therapies, such as probiotic agents and oral immunoglobulins
• Judge the efficacy of rotavirus vaccine
• Recognize the features of cytomegalovirus colitis, and its diagnosis and treatment
• Recognize features that distinguish between bacterial colitis and viral enteritis
• Recognize the clinical manifestations (including systemic complications), diagnosis, and treatment of bacterial infections that produce diarrhea, including Salmonella, Shigella, Campylobacter, Yersinia, Escherichia coli O157:H7, Clostridium difficile, Vibrio, and Aeromonas infections
• Understand the rationale for the use and avoidance of antibiotics in the treatment of specific infections
• Know the conditions associated with an increased risk of disseminated salmonellosis
• Be familiar with risk factors for acquiring these infections, including environmental, nosocomial, and zoonotic sources
• Acquire knowledge in public health issues relating to food-borne infections from these organisms
• Know the infectious causes of ileitis that may mimic Crohn’s disease
• Diagnose common parasitic infections including giardiasis and cryptosporidiosis
• Learn the clinical manifestations, diagnostic methods, and treatment options for these infections
• Learn the special circumstances of Cryptosporidium infection in immunocompromised patients
• Recognize colitis produced by E. histolytica and diagnose and treat it
• Understand the rationale for and composition of oral rehydration therapy, as well as the cellular mediators of intestinal absorption and secretion (Na+, K+-ATPases, apical transporters, and chloride channels)
• Learn the risks and benefits of agents that alter intestinal motility and secretion and that adsorb water
• Learn the use of, timing of, and need for refeeding after uncomplicated acute diarrhea
• Acquire expertise in the nutritional management of chronic diarrhea
• Recognize the gastrointestinal manifestations of acquired immune deficiency syndrome and the enteric pathogens encountered in patients with human immunodeficiency virus
• Understand the epidemiology, varied clinical features, extraintestinal manifestations of celiac disease (gluten-sensitive enteropathy), the use of noninvasive and invasive diagnostic studies, dietary management, long-term follow-up, and management of complications
• Learn the epidemiology and clinical features of protein-induced gastrointestinal inflammation of the upper and lower gastrointestinal tracts
• Acquire expertise in the use of oral challenge, serologic assays, and endoscopic procedures in diagnosis and the use of appropriate dietary alternatives in management
• Be familiar with the clinical features, evaluation, and management of the different forms of eosinophilic gastroenteropathy
• Build collaborative relationships with physicians with expertise in pathology, radiology, clinical immunology, clinical allergy, and rheumatology