Pediatric Gastroenterology Clinic of South Texas

07/13/2026

For families managing pediatric celiac disease, the gluten-free diet isn't just a treatment — it's a constant, everyday responsibility. One cross-contamination event, one mislabeled ingredient, and symptoms can return. It's effective, but it's demanding, and strict adherence is genuinely difficult to sustain long-term.

That's part of why emerging research is worth watching. Investigators are studying non-dietary candidates aimed at supporting — not replacing — dietary management. These include gluten-degrading enzymes such as latiglutenase and Kuma030, which aim to break down gluten before it triggers an immune response, and zonulin inhibitors like larazotide acetate, which target the intestinal permeability that gluten exposure can cause.

It's important to be direct about where this stands: none of these therapies are approved or standard of care yet. What's new is the direction of the research, not a change in today's treatment plan. For families who ask about "a pill instead of the diet," the honest answer right now is that the diet remains essential — these are potential future adjuncts, not current alternatives.

For referring providers, this is useful context for setting expectations with families who've read about these developments online and want to know what's real. Managing that expectation well now builds trust for later.

Have a patient or child who might benefit from a consultation?
Pediatric Gastroenterology Clinic of South Texas

Source: New Therapeutic Challenges in Pediatric Gastroenterology: A Narrative Review, 2026

07/13/2026

For a long time, managing pediatric inflammatory bowel disease came down to a fairly straightforward question: which biologic should we start? That question is still important — but it's no longer the whole picture.

In 2026, we're seeing durable long-term outcome data on established IL-23 therapies, and newer mechanisms — including anti-TL1A agents — entering the pediatric IBD conversation. At the same time, small molecules like etrasimod and upadacitinib are moving through adolescent and pediatric trials, giving us more tools than we've had before.

What's actually new isn't just the expanding drug list. It's that treatment sequencing — the order in which therapies are tried, and when to move to the next one — is now a central clinical decision in its own right. A child who doesn't respond well to a first-line biologic isn't necessarily a treatment failure; they may simply need a different sequencing strategy.

For families and referring providers, the practical takeaway is this: if a child with IBD has plateaued, is cycling through therapies without durable remission, or isn't responding the way you'd expect, that's a signal to reassess the overall treatment sequence — not just increase the current dose.

Have a patient or child who might benefit from a consultation?
Pediatric Gastroenterology Clinic of South Texas

Source: New Therapeutic Challenges in Pediatric Gastroenterology: A Narrative Review, 2026

07/13/2026

Functional constipation is one of the most common reasons families are referred to pediatric GI — and the way we approach it just got an update worth knowing about.

For a long time, treatment followed a fairly standard step-up path: dietary changes, then osmotic laxatives, then escalation if things didn't improve. That approach helps many children, but it doesn't fit every child equally well — particularly neurodiverse kids, for whom toileting challenges often involve sensory and behavioral factors that a purely medical approach doesn't address.

This May, the American Gastroenterological Association and NASPGHAN jointly released a new Pediatric Functional Constipation Clinical Care Pathway. It lays out a standardized but individualized framework for diagnosis and management, with specific guidance for neurodiverse children and a push to bring in behavioral health support earlier rather than as a last resort.

For referring providers and families, the practical implication is this: if a child's constipation isn't improving on a standard protocol, that's a signal to individualize the plan sooner — not simply escalate the same approach. Early behavioral health involvement, where indicated, is now part of best practice, not an afterthought.

Have a patient or child who might benefit from a consultation?
Pediatric Gastroenterology Clinic of South Texas

Source: AGA/NASPGHAN Pediatric Functional Constipation Care Pathway, May 2026

06/28/2026

A first in pediatric GI: there's now an FDA-approved option for children with IBS and constipation.

If you care for children, you know the pattern — a school-age child with months of abdominal pain, hard and infrequent stools, missed school, and a worried family. For years, care meant fiber, hydration, osmotic laxatives, and dietary changes, with only partial relief for many.

That changed in November 2025, when the FDA approved an option for children 7 years and older with IBS-C — the first approved treatment for this condition in children. As with any therapy, it isn't right for every child and depends on an accurate diagnosis and careful patient selection.

Why it matters: a common, disruptive condition that long had no approved pediatric option now has one — a meaningful step for the children and families who live with it.

Educational information only — not medical advice.

— Dr. Nelson Spinetti, MD | Pediatric Gastroenterology

Source: U.S. FDA approval, November 2025

06/04/2026

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06/03/2026

A landmark moment for pediatric GI: there is now a first FDA-approved medication for IBS with constipation in children.

IBS-C is one of the most common functional GI conditions in school-age children. For families dealing with it — chronic abdominal pain, disrupted daily life, and years of being told to "try more fiber" with no pharmacologic option.

In November 2025, the FDA approved linaclotide (Linzess) for children aged 7 and older with IBS-C. A 12-week randomized trial and 52-week NASPGHAN 2025 safety data support it.

If your child has IBS-C and conservative measures haven't been enough, a specialist consultation is the right next step.

📍 Pediatric Gastroenterology Clinic of South Texas

Source: FDA Drug Approval / NASPGHAN 2025

06/03/2026

Is your pediatric IBD patient still on their first biologic — and how long has it been working?

One in four IBD diagnoses happens before age 20, and pediatric-onset disease is often more extensive and aggressive than adult IBD. Active inflammation during childhood doesn't just cause symptoms — it interferes with growth, bone density, puberty, and long-term quality of life in ways that can't be reversed.

A 2026 review in Pharmaceuticals documents the expanding role of newer agents: JAK inhibitors (upadacitinib, tofacitinib) and S1P modulators like etrasimod offer oral, rapidly-acting alternatives for refractory disease.

These patients benefit from subspecialty co-management — ideally before first-line therapy fails.

📍 Pediatric Gastroenterology Clinic of South Texas

Source: Advances in Pediatric IBD Management, Pharmaceuticals 2026

05/17/2026

🚨 Is your child's diarrhea "just stress" — or something more serious?

Here's a story I see too often in my clinic:

A teenager comes in with bloody diarrhea that's been going on for months. They've been told it's probably IBS. Or anxiety. Or something they ate. Meanwhile, they're losing weight, missing school, and too exhausted to function normally.

The real diagnosis? Ulcerative colitis.

What is UC?
Ulcerative colitis is a chronic inflammatory bowel disease that causes inflammation and ulcers in the lining of the large intestine. It's NOT the same as Crohn's disease — and that distinction matters for treatment.

The symptoms most parents don't recognize:
✅ Bloody or mucus-filled diarrhea
✅ Urgent, unpredictable bathroom trips (6–10 times a day)
✅ Lower abdominal cramping
✅ Profound fatigue
✅ Unintentional weight loss
✅ Diarrhea that wakes your child at night

The 2026 news that gives me hope:
A major new clinical trial — the KEPLER study — just confirmed that vedolizumab (Entyvio) works in children with moderate-to-severe UC, with nearly 47% achieving remission at one year. This trial enrolled kids as young as 2 years old. We finally have real pediatric data.

🎙️ This week's episode of Gut Whisperers covers everything — from diagnosis to the full treatment ladder to when surgery is needed.

If your child has had bloody diarrhea for more than 2 weeks, is losing weight, or seems exhausted — please don't wait. Ask your pediatrician for a GI referral.

You know your child. Trust your instincts. 💙

🎙️ New episode live now — link in comments.
📍 Pediatric Gastroenterology Clinic of South Texas | Edinburg, TX

05/12/2026

If your teenager keeps having sudden, intense vomiting attacks — hours of retching, nothing helping, then completely fine the next day — and every ER visit comes back with no clear answer, there's a name for what you're describing. It's called Cyclic Vomiting Syndrome, and it's one of the most underdiagnosed conditions in adolescents, with an average delay of 2 to 3 years to a correct diagnosis.

Episode 5 of Gut Whisperers breaks down what CVS is, why it keeps getting missed, and what treatment actually looks like — including the preventive approach that helps most adolescents see a dramatic reduction in episode frequency. Listen at gutwhisperers.com or search "Gut Whisperers" wherever you get your podcasts.

Share this with a parent who needs to hear it. 🎙

09/21/2025

🤔 Do you wonder if you might have IBS?
Irritable Bowel Syndrome (IBS) is one of the most common digestive conditions, but it’s often misunderstood. In this short video, Dr. Nelson Spinetti explains the most common IBS symptoms, how to recognize them, and when it’s time to talk to a doctor.
📋 Want more clarity? Take our free IBS Symptom Quiz here ➡️ www.drnelsonspinetti.com/blog
postcast Spotify or amazon only typing Nelson Spinetti podcast