Gastroenterology, Hepatology & Nutrition

Consultation clinic held within the CF Clinic. Alternates weekly between SickKids and St. Michael’s Hospital. Evaluation of CF patients with nutritional, pancreatic gastrointestinal and hepatobiliary disorders. 

A multidisciplinary clinic that sees infants, children and adolescents with medically based swallowing problems.

Enteral Feeding Clinic (weekly)

Children are assessed approximately eight weeks post enterostomy tube insertion. Problems related to feeding intolerance, and skin/stoma issues are addressed. Nutrition assessment is provided in collaboration with a clinical dietician and nurse practitioner. Insertion of low-profile gastrostomy tubes may be done in clinic eight weeks post initial tube insertion. 

Pre-op G-Tube Clinic (weekly)

Patients who are referred for enterostomy insertion by outside pediatricians are assessed in clinic by a CNS/NP and paediatrician. Patient history is reviewed to determine if enterostomy placement is clinically indicated. Parents are given information about enteral feeding, and method of tube placement in the Image Guided Therapy Department. 

Pre-op Teaching Class (weekly)

Education is provided to families/caregivers of children undergoing enterostomy tube insertion. Parents are given instruction on general care of the tube and stoma, as well as information about the method of tube insertion in the Image Guided Therapy Department. 

Consultation clinic assessing patients with symptoms and diagnostic test results suggestive of nutritional problems related to failure to thrive/ obesity/ neuromuscular handicap patients /short-gut/intestinal failure. 

Consultation clinic assessing patients with symptoms and diagnostic test results suggestive of nutritional problems related to failure to thrive/ obesity/ neuromuscular handicap patients /short-gut/intestinal failure. Children in the Home Parenteral Nutrition Program are also seen. 

Consultation clinic assessing patients with symptoms and diagnostic test results suggestive of gastrointestinal disease. There is a special interest in patients with diseases of the pancreas (e.g. Shwachman Diamond, acute and chronic pancreatitis, etc.).

See contact details and location of the Gastroenterology clinic on our Clinics Directory.

Consultation clinic assessing patients with symptoms and diagnostic test results suggestive of gastrointestinal and/or hepatobiliary disease. There is a special interest in children with transplantation problems. 

Consultation clinic assessing patients with symptoms and diagnostic test results suggestive of hepatobiliary disease. 

Children in the Home Parenteral Nutrition Program are also seen. 

Follow-up of children and adolescents with Inflammatory Bowel Disease (e.g. Crohn’s disease and ulcerative colitis.) 

Follow-up of paediatric liver and small bowel transplant recipients. Consultation of potential liver and small bowel transplant candidates 

• Yaron Avitzur, MD Staff Gastroenterologist 
• Robert Bandsma, MD, PhD, Staff Gastroenterologist 
• Peter Church, MD, Staff Gastroenterologist 
• Tanja Gonska, MD,  Staff Gastroenterologist 
• Anne Griffiths, MD, Staff Gastroenterologist 
• Nicola Jones, MD, PhD, Staff Gastroenterologist 
• Aleixo Muise, MD, PhD, Staff Gastroenterologist 
• Vicky Ng, MD, Staff Gastroenterologist 
• Philip Sherman, MD, Staff Gastroenterologist 
• Catharine Walsh, MD, PhD, Staff Gastroenterologist  
• Thomas Walters, MBBS, MSc, Staff Gastroenterologist 
• Jessie Hulst, MD, PhD, Staff Gastroenterologist 
• Amanda Ricciuto, MD, PhD, Staff Gastroenterologist 
• Eric Benchimol, MD, Staff Gastroenterologist 

• Carol Durno, MD, Gastroenterologist 
• Paul Kortan, MD, Gastroenterologist 
• Gary May, MD, Gastroenterologist 
• Paul Pencharz, MD, Staff Nutritionist 
• Stanley Zlotkin, MD, Staff Gastroenterologist 

• Dr. Al-Qasim Al-Bahlani 
• Dr. Andreas Entenmann 
• Dr. Daniel Mulder 
• Dr. Inna Spector 
• Dr. Kristen Bortolin 
• Dr. Lorraine Stallard 
• Dr. Mary Flanagan 
• Dr. Michael Shpoliansky 
• Dr. Michelle Gould 
• Dr. Mohammed Ayoub 
• Dr. Natascha Silva Sandy 
• Dr. Rebecca Little 
• Dr. Rilla Schneider 
• Dr. Saleh AlQahtani 

• Amrita Mundh- NP Clinic Nurse 
• Karen Frost - BScN, RN(EC), MN, NP 
• Krista van Roestel - MN, NP-Peds Liver/Intestinal Transplant Program 
• Maria de Angelis - MScN, NP-Peds GI Transplant 
• Stacey Lira - BScN, MN, NP-Peds 

• Ashley Cruden - BScN, RN IBD Clinic Nurse 
• Brittany Lyn - BScN, RN IBD Clinic   
• Jennifer Stunguris - RN Liver and Bowel Transplant Program 
• Jessica McDermott – RN Clinic Nurse 
• Megan Hipson- BScN RN General GI Clinic 
• Shonette Bhagwandin - RN Liver Clinic 
• Vikki Scaini - RN Clinic Nurse 

• Inez Martincevic - MSc, RD 
• Veronik Connan - MSc, RD 

Margaret Johnson 
Administrator 
Phone: 416-813-6555 
Fax: 416-813-6531 
email: margaret.johnson@sickkids.ca 

Shawana Estwick 
Administrative Assistant to: Drs. Yaron Avitzur, Vicky Ng and Peter Church  
Phone: 416-813-7654  ext. 222886
Fax: 416-813-4972 
email: shawana.estwick@sickkids.ca  

Leann Turner 
Administrative Assistant to: Drs. Simon Ling and Catharine Walsh 
Phone: 416-813-8757  
Fax: 416-813-6531 
email: leann.turner@sickkids.ca  

Clarisse Cacho 
Administrative Coordinator to: Dr. Robert Bandsma 
Phone: 416-813-5775 
Fax: 416-813-5002 
email: clarisse.cacho@sickkids.ca  

Thusiga Inderanathan 
Administrative Assistant to:  Drs. Nicola Jones, Philip Sherman and Eric Benchimol, Amanda Ricciuto 
Phone: 416-813-7733  
Fax: 416-813-6531 
thusiga.inderanathan@sickkids.ca 

Sherry Joy 
Education Administrative Coordinator to: Dr. Binita Kamath, Training Program and Residency Program, Elective and Observer Requests 
Phone: 416-813-6176 
Fax: 416-813-4972 
sherry.joy@sickkids.ca 

Suzanne Shek 
Administrative Assistant to:  Drs. Thomas Walters, Anne Griffiths  
Phone: 416-813-7734 
Fax: 416-813-6531 
email: suzanne.shek@sickkids.ca 

Sandra Layno 
Administrative Assistant to: Drs. Tanja Gonska, Peggy Marcon and Jessie Hulst  
Phone: 416-813-7735 
Fax: 416-813-6531  
email: sandra.layno@sickkids.ca

Karoline Fiedler  
Assistant to Dr. Aleixo Muise  
Phone: 416-813-6858 
Fax: 416-813-6531 
email: karoline.fiedler@sickkids.ca 

Clinic Flow Coordinators  

Mary Christofi 
Phone: 416-813-7282 
Fax: 416-813-6526 
email: mary.christofi@sickkids.ca 

Johnson Le 
Phone: 416-813-7270 ext. 1
Fax: 416-813-6526 
email: johnson.le@sickkids.ca

• Aishwarya Parmar, Clinical Research Project Coordinator 
• Aly Fawzy, Clinical Research Project Assistant    
• Claudia Quammie, Clinical Research Project Manager 
• Shannon Vandriel, Program Manager
• Deepika Sharma, Clinical Research Project Coordinator 
• Julianne Ling, Clinical Research Project Coordinator  
• Mikayla Sonnenberg, Clinical Research Project Assistant   
• Ramisha Chowdhury, Clinical Research Project Assistant
• Fatema Johara, Data Manager
• Daniel Miller, Clinical Research Project Assistant 
• Nooran Afzal, Clinical Research Project Assistant 
• Shantel Mangroo, Clinical Research Project Assistant 
• Victoria Srbely, Clinical Research Project Assistant 
• Katherine Keenan, Clinical Research Project Manager 
• Farah Khan, Clinical Research Project Coordinator 
• Joey Chan, Clinical Research Project Coordinator
• Mila Valcic, Clinical Research Project Assistant 

• Brian Ngo, Clinical Research Project Assistant 
• Ashley Harvey, Clinical Research Nurse Coordinator 
• Hayley McKay, Clinical Research Project Assistant 
• Michelle Ouzounis, Clinical Research Project Manager 
• Claudia Tersigni, Clinical Research Project Coordinator  

• Ashley Wu, Clinical Research Project Assistant 
• Jeffrey Chow, Clinical Research Project Coordinator 

During the first year of training, trainees are exposed to a large variety of clinical cases and to all aspects of ambulatory and inpatient paediatric gastroenterology, hepatology & nutrition (GHN). Trainees have a unique opportunity to engage in cutting edge medicine and state of the art clinical care. Clinical care is provided in an academic environment using an evidence-based approach under ongoing staff support and supervision. 

During the first clinical year, trainees will rotate through the following services: 

• General GHN inpatient service - general GI, IBD, non-transplant liver disease, feeding disorders, motility disorders and pancreatic disorders (usual census 6-12 patients). 
• Transplant service – liver and intestine transplantation, acute liver failure and end stage liver disease (30-35 liver transplants annually; usual census 5-10 patients). 
• Consult service – consultation services to the hospital in-patient wards and to community-based practitioners 
• GIFT service – intestinal failure training (usual census 5-8 patients). 
•  Adult gastroenterology – one month of adult gastroenterology and endoscopy training. 
• Outpatient clinics – general GI and specialized clinics in IBD, hepatology, nutrition, motility disorders, celiac, intestinal failure, liver transplantation, pancreatic diseases and other. 
• Paediatric procedures – upper and lower endoscopies, variceal band ligation, polypectomy, foreign body removals. Each trainee performs 150-200 pediatric procedures during the first year of training. 

On-call service

Overnight and weekend on-call coverage for patients admitted to the GHN and transplant inpatient services is provided by core fellowship trainees during their three years of training. Trainees provide call from home and provide support for general paediatrics residents who remain in hospital overnight. Trainees may need to come to the hospital during their call. Call frequency is roughly one night each week and one weekend each month. 

Funding

Salary support is available on a competitive basis from either the Ontario Ministry of Health and Long-Term Care (for Canadian trainees) or SickKids (for international trainees for the first two years of training). Third year funding is obtained on a competitive basis through supervisor, divisional, hospital or extra-mural sources. Traditionally all of our research trainees successfully obtain salary support from these sources for their last year of research training. 

The second and third years of the Core Fellowship Program are primarily focused on research training. There are a vast number of opportunities for high caliber clinical, translational or basic science research within the division, within the SickKids Research Institute and at the University of Toronto. The Research Institute (RI) is the largest hospital-based research program in Canada, and is among the largest paediatric research programs in the world.

The multidisciplinary structure of the RI encourages collaborative research, as does its new home in the Peter Gilgen Centre for Research and Learning. Areas for research training are chosen by discussion between the trainee and potential supervisors, according to the interest of the trainee and the interests and expertise within our division and the RI. 

Specific areas of research within the division include basic science, clinical and translational science, epidemiology and education.

Trainees can undertake a postgraduate degree program (M.Sc, M.Ed, PhD) offered at the University of Toronto (e.g., programs in Institute of Health Policy, Management and Evaluation, Institute of Medical Sciences, Ontario Institute for Studies in Education, Department of Physiology or Department of Pathology Laboratory Medicine) or distance education programs offered by other Universities. A substantial number of trainees (50 per cent over the last decade) have pursued concurrent degrees during their research training. 

• University of Toronto, School of Graduate Studies 
• Institute of Health Policy, Management and Evaluation 
• Institute of Medical Science 
• Ontario Institute for Studies in Education 

The GI training program at SickKids provides opportunities for advanced clinical and research training in specific domains of paediatric gastroenterology. The advanced subspecialty fellowship training programs include inflammatory bowel disease, hepatology /liver transplantation and intestinal failure. Expand the sections below for additional details. 

Inflammatory Bowel Disease - (IBD)

A one-year advanced IBD clinical and research training fellowship is available for interested trainees and is supported through the SickKids IBD Centre. 

Canada has among the highest incidence rates for IBD worldwide.  Ontario health administrative data suggest that the incidence is continuing to increase, particularly in children. IBD care is centralized within the Gastroenterology, Hepatology and Nutrition (GHN) Division, such that three IBD specialists provide ambulatory care in six “half-day” IBD clinics weekly with over 2000 patient visits annually. IBD patients also account for the majority of inpatient days on the “GHN” ward. Ten to twelve patients are newly diagnosed each month and remain under follow-up care until the time of transfer to adult care by age 18 years. The SickKids IBD Program is hence responsible at any given time for the care of 900 children and adolescents with Crohn’s disease and ulcerative colitis, making it one of the largest paediatric IBD programs worldwide. 

The IBD ambulatory program includes three specialty clinics. Dr. Alex Muise, co-lead of the international NEOPICS consortium, which has been very successful in identifying monogenic forms of IBD, runs a very-early onset IBD clinic. There is an alternate weekly “anti-TNF” therapy clinic exclusively for patients being treated with biologics, and a periodic joint clinic with Drs. Ling and Kamath, for the care and study of patients with PSC-IBD.  

All fellows in the GI/Hepatology/Nutrition training program are given multiple opportunities for small group learning including new patient IBD rounds, challenging IBD patient rounds, IBD teaching rounds for fellows, and Magnetic Resonance Imaging rounds, all held once in every two weeks. 

The IBD program aspires always to integrate state of the art clinical care with meaningful patient-based and translational research.   The program has had remarkable opportunities to train the next generation of paediatric IBD specialists, and in networking internationally to advance IBD research and clinical care.  The Canadian Children IBD Network: a joint partnership of CIHR and the CH.I.L.D. Foundation is led by the SickKids IBD program. 

Group for Improvement of Intestinal Function and Treatment - (GIFT)

Advanced training in intestinal failure and rehabilitation is provided by the SickKids intestinal rehabilitation program (GIFT – Group for Improvement of Intestinal Function and Treatment). The GIFT program is the largest of its kind in Canada and one of the leading intestinal rehabilitation programs in the world with 20 to 25 new patients every year. The program follows a large variety of patients with intestinal failure ranging from short bowel syndrome to severe motility disorders and congenital diarrheas in an inpatient and outpatient setting. The inpatient service is an independent service with daily census of 5 to 10 patients / day. A multi-disciplinary team of paediatric gastroenterologists, paediatric surgeons, nurses, dieticians, physiotherapists, oral therapists, social workers and others provide comprehensive daily care. Clinical, translational and basic research is an integral part of the program activities and multiple opportunities exist for interested trainees under the supervision of Dr. Paul Wales, general surgery, and Dr. Yaron Avitzur, paediatric gastroenterology. 

Intestinal failure training is focused on clinical and research training in the field of intestinal failure and rehabilitation. Training is offered for a one year period for fully trained general gastroenterologists or general surgeons and is recognized by the University of Toronto. Funding is provided on a competitive basis through SickKids Transplant Centre.   

Hepatology and Liver Transplant 

Advanced training in paediatric hepatology and liver transplantation is provided by the Division of Paediatric Gastroenterology, Hepatology and Nutrition and the Liver Transplant program at SickKids*.  

Our one-year program provides flexible training to meet the needs of each individual fellow, whether their focus is advanced hepatology training, training in liver transplantation, or research training.  Our overall aim is to train the future leaders in this field across the world.  SickKids currently performs between 25 and 40 paediatric liver transplants per year, and has completed more than 500 paediatric orthotopic liver transplants, including over 150 from live donors, since the first SickKids paediatric liver transplant in 1986.  Our clinical service includes four paediatric hepatology clinics, a liver transplant clinic each week and a busy inpatient liver transplant service.  We work closely with our partners at the University of Toronto Transplant Institute and Toronto Liver Centre. 

During this year of training, the Hepatology and Liver Transplant Fellow will gain clinical mastery in a wide range of general acute and chronic liver conditions, including care of patients with neonatal cholestasis, abnormal liver tests, end-stage liver failure, fulminant liver failure, hepatic neoplasms, metabolic liver conditions, portal hypertension, viral hepatitis, biliary diseases, vascular malformations of the liver; diagnosis of immune-mediated liver diseases and cholestasis syndromes; assessment of the candidacy of patients for liver transplantation;  management of paediatric patients pre- and post-liver transplantation; and long-term post-liver transplantation care. Fellows will interact closely with subspecialists in other divisions, including critical care medicine, interventional radiology, pathology, metabolic genetics, and transplant surgery. Fellows will develop diagnostic and therapeutic expertise in areas of hepatology and nutritional disorders and develop proficiency in the performance of diagnostic and therapeutic procedures (ie. endoscopic variceal band ligation); observation of procedures (including liver transplantation, percutaneous cholangiography), and non-transplant hepatobiliary surgeries (including Kasai portoenterostomy, partial external biliary diversion, shunt surgery); interpretation of liver histopathology; organizational structure and administration of a liver transplant program.  

Clinical, translational and basic research is an integral part of the program activities and multiple opportunities exist for interested trainees under the supervision of faculty hepatologists within the Division of Paediatric Gastroenterology, Hepatology, Nutrition and Liver Transplantation to complete a mentored concise clinical or translational research project. 

Note to US Citizens:  This one-year training program is not yet RCPSC or ACGME-accredited and training therefore may not be accepted towards the Certificate of Added Qualification (CAQ) from the American Board of Pediatrics.

Interested applicants should send an updated CV to Mrs. Sherry Joy, Education Administrative Coordinator, for pre-application screening starting March 2 in the year before the intended start date. CVs will be screened on a rolling basis between March 2 and July 1 only. Selected candidates will be invited to complete a full application.  The deadline to submit completed applications is July 15. Earlier submission of your application is recommended. If your application is successful you will be invited for interviews with faculty and trainees.  Interviews are projected to occur during the month of September. Decisions are made approximately six to eight months prior to the start of training which is on July 1 in any given year.

International applicants interested in applying for the three year training program or the one year clinical training program should be certified pediatricians in their home country.    

Applicants interested in advanced subspecialty fellowship training program should be either a certified Paediatric Gastroenterologist, completed successfully paediatric gastroenterology training in accredited training program or are considered Paediatric Gastroenterologist in countries with no formal accreditation or certification process. 

Applicants who have applied to the U.S match through the National Residency Matching Program (NRMP), please be advised that the University of Toronto is a participating institution and adheres to the match policy. The policy states that "Applicants who have matched to a program or have accepted a position during the Supplemental Offer and Acceptance Program (SOAP), shall not apply for, discuss, interview for, or accept a concurrent year position in another program prior to the NRMP granting the requested waiver." More information is available on NRMP.org.

Canadian residents are requested to submit their application through the CaRMS website. 

Information for international applicants seeking to apply can be found via the University of Toronto. 

For further details please contact: 

Binita Kamath, MD, MBBChir, MRCP 
Training Program Director 
Division of Gastroenterology, Hepatology and Nutrition 
The Hospital for Sick Children 
555 University Avenue 
Toronto, Ontario M5G 1X8 
Canada 

Phone: 416-813-6176 
Fax: 416-813-4972 
Email address: binita.kamath@sickkids.ca 

Sherry Joy, CMEA 
Education Administrative Coordinator 
Division of Gastroenterology, Hepatology and Nutrition 
The Hospital for Sick Children 
555 University Avenue 
Toronto, 
Ontario M5G 1X8 
Canada 

Phone: 416-813-6176 
Fax: 416-813-4972 
Email: sherry.joy@sickkids.ca