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Gastroenterology and Hepatology

Children on Pancreatic Enzymes Experience Fewer Acute Pancreatitis Episodes
 Children on Pancreatic Enzymes Experience Fewer Acute Pancreatitis Episodes 1024 429 Mary Bates, PhD
By: Mary Bates, PhD

Pancreatic enzyme therapy benefitted patients with pancreatic-sufficient acute recurrent pancreatitis and chronic pancreatitis.  A new study shows that children with both acute recurrent pancreatitis and chronic pancreatitis had significantly lower incidence of acute pancreatitis episodes per year after starting pancreatic enzyme therapy. The findings support the need for a clinical trial to determine the treatment’s…

Enhancing Intestinal Rehabilitation Workflow with Disease-Specific Documentation Tools
 Enhancing Intestinal Rehabilitation Workflow with Disease-Specific Documentation Tools 150 150 Erin Gregory
By: Erin Gregory

Structured data entry not only reduces the amount of time physicians are spending in the electronic health record but also opens the door for new research. A recent study published in JAMA Pediatrics by Nationwide Children’s Hospital’s Ethan Mezoff, MD, Jennifer Lee, MD, and team has shed light on a promising solution to improve the…

5 Keys to Managing Iron Deficiency in Children Undergoing Intestinal Rehabilitation
 5 Keys to Managing Iron Deficiency in Children Undergoing Intestinal Rehabilitation 150 150 Erin Gregory
By: Erin Gregory

A new position paper offers recommendations for the evaluation and management of iron deficiency in children undergoing intestinal rehabilitation. Iron deficiency is a prevalent concern among children with certain digestive problems, presenting various health challenges. A position paper from the NASPGHAN Intestinal Rehabilitation Special Interest Group, led by Ethan Mezoff, MD, a pediatric gastroenterologist at…

Robotic Approach to Rare Case Leads to Best Possible Outcome
 Robotic Approach to Rare Case Leads to Best Possible Outcome 1024 683 Emily Siebenmorgen
By: Emily Siebenmorgen

A rare tumor in a child from Greece is resolved by robotic spleen-sparing distal pancreatectomy. Hospital visits can feel like a foreign experience for anyone, especially so when your hospital is actually in another country. But eight-year-old Evangelia felt especially at home after traveling to Nationwide Children’s Hospital from Greece for her care. Evangelia’s first…

Reducing Surgery and Its Associated Risks Through Advanced Interventional Endoscopy
 Reducing Surgery and Its Associated Risks Through Advanced Interventional Endoscopy 150 150 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

Specially trained pediatric endoscopists can perform a range of diagnostic, interventional and therapeutic procedures for children, allowing them to avoid referral to adult endoscopists or even open surgery.   Muhammad Khan, MD, MPH, FASGE, the new director of interventional and diagnostic endoscopy at Nationwide Children’s Hospital, has big plans for the field of pediatric endoscopy.…

InSight: Total Pancreatectomy With Islet Autotranplantation: The Basics
 InSight: Total Pancreatectomy With Islet Autotranplantation: The Basics 1024 500 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES
illustrated cross section of islets from pancreas

Download a PDF version of this image.       This feature was published in the Fall/Winter 2022 print issue. Download the full issue.  Image credit: Mandy Root-Thompson for Nationwide Children’s

TPIAT: A Way Forward for Chronic Pancreatitis
 TPIAT: A Way Forward for Chronic Pancreatitis 1024 500 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES
illustrated cross section of islets from pancreas

Nationwide Children’s Hospital has assembled a veritable “dream team” of pancreatitis and pediatric transplant surgery experts to offer what they hope will become the world’s preeminent pediatric center for complex pancreatic care. Imagine your child suffering from a sudden, debilitating episode of abdominal pain. No obvious cause, no cure, just pain so severe it requires…

How One Family In Appalachia Changed the Medical Field’s Understanding of Pancreatitis
 How One Family In Appalachia Changed the Medical Field’s Understanding of Pancreatitis 150 150 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

More than 30 years ago, a teenager from Kentucky named Kevin Slone had his first attack of acute pancreatitis. Doctors at the Cleveland Clinic urged his father, Bobby Slone, to try to document whether other people in the family had similar stomach problems. Bobby Slone took the homework to heart, documenting incidences of similar symptoms…

NASPGHAN: New Guidance for Surgical Procedure Selection in Pediatric Chronic Pancreatitis
 NASPGHAN: New Guidance for Surgical Procedure Selection in Pediatric Chronic Pancreatitis 899 450 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

Informed, multispecialty decision-making is essential to give children with chronic pancreatitis the best chance for long-term pain relief and improved quality of life, according to new guidance issued by the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition.   Chronic pancreatitis has long been an underappreciated and underrecognized condition in children. Now, a NASPGHAN…

Is 3D Anorectal Manometry Preferable to Traditional Anorectal Manometry in Children With Functional Constipation?
 Is 3D Anorectal Manometry Preferable to Traditional Anorectal Manometry in Children With Functional Constipation? 1024 680 Mary Bates, PhD
By: Mary Bates, PhD
Close up color photo of little boy holding hands on his belly

Study finds 3D-ARM is less comfortable and does not provide additional information compared to traditional ARM.   In a recent pilot study, researchers from Nationwide Children’s compared outcomes and patient experience of a new three-dimensional (3D) anorectal manometry (ARM) technique compared to regular ARM in children with functional constipation. They found that the use of…

The Importance of Body Composition in Cystic Fibrosis
 The Importance of Body Composition in Cystic Fibrosis 150 150 Mary Bates, PhD
By: Mary Bates, PhD

Lean mass deficits are common in pediatric patients with cystic fibrosis and associated with impaired lung and bone health. Now, experts are calling for increased use of body composition measurements in clinical care.  In cystic fibrosis — a multisystem disorder characterized by progressive lung disease, pancreatic insufficiency, malabsorption and malnutrition — nutrition status is correlated with…

Polyethylene Glycol 3350 Does Not Lead to Behavior Changes in Animal Model
 Polyethylene Glycol 3350 Does Not Lead to Behavior Changes in Animal Model 1024 683 Mary Bates, PhD
By: Mary Bates, PhD
Ross Maltz, MD

The laxative affected stool consistency and gut bacteria but did not alter anxiety-like behavior in mice. Polyethylene glycol 3350 (PEG3350) is a laxative commonly used to treat constipation in children. Over the years, the Food and Drug Administration has received some reports of neuropsychiatric symptoms in children administered PEG3350, including anxiety, aggression and obsessive-compulsive behaviors.…

Addition of a Radiation-Free Evaluation and Parent-Chosen Feeding Method Leads to Superior Outcomes for Infants With Swallowing Difficulties
 Addition of a Radiation-Free Evaluation and Parent-Chosen Feeding Method Leads to Superior Outcomes for Infants With Swallowing Difficulties 150 150 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

A recent NIH-NIDDK-funded study suggests that application of novel high-resolution manometry along with guided parental involvement can improve oral feeding success for infants with swallowing difficulties. The prevalence of swallowing difficulties among neonatal intensive care graduates is increasing.  Swallowing difficulties or dysphagia in infants are associated with airway and digestive consequences often presenting with signs…

Chronic Pediatric Pancreatitis and (No) Persistent Belly Pain
 Chronic Pediatric Pancreatitis and (No) Persistent Belly Pain 1024 575 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

Underlying — even silent — chronic pancreatitis can be at play in children without previous acute pancreatitis episodes, including among children with little or no reported pain. Pancreatitis in children is rare (about 3-13 per 100,000 people per year), but diagnosis is increasing, at least in part due to increased awareness among physicians. The path…

Study Highlights Relationship Between SI Gene and Chronic, Idiopathic Loose Stool in Some Children
 Study Highlights Relationship Between SI Gene and Chronic, Idiopathic Loose Stool in Some Children 1024 680 Abbie Miller
By: Abbie Miller
Close up color photo of little boy holding hands on his belly

Researchers conducted one of the largest prospective, multicenter trials in pediatrics looking at the connection between SI variants and common gastrointestinal symptoms. The SI gene codes for the sucrase-isomaltase enzyme, which is expressed in the intestinal brush border. This enzyme is important to the digestion of sucrose, and without it, maldigestion and poor absorption of…

Exploring the Link Between Cystic Fibrosis and Celiac Disease
 Exploring the Link Between Cystic Fibrosis and Celiac Disease 1024 575 Lauren Dembeck
By: Lauren Dembeck

Overlapping symptoms can cause delayed diagnosis of celiac disease in patients with cystic fibrosis. Physician scientists at Nationwide Children’s Hospital have recently identified three cases of patients with cystic fibrosis, all of whom had the same genotype, were treated with the CFTR modulator, ivacaftor, and were diagnosed with celiac disease. This adds to a novel body…

Could Restoring CD4+ T Cell Immunity Help Control Hepatitis C Infection?
 Could Restoring CD4+ T Cell Immunity Help Control Hepatitis C Infection? 1024 683 Kevin Mayhood
By: Kevin Mayhood

Following childbirth, some women with chronic infection experienced a recovery of HCV-specific CD4+ T cells and a reduction in viral replication. In chronic hepatitis C (HCV) infections, CD4+ T cells that recognize the virus have been so hard to detect, some researchers thought they may be completely depleted. But research led by investigators at Nationwide Children’s…

From Clinician Ideas to Commercially-Available Clinical Devices
 From Clinician Ideas to Commercially-Available Clinical Devices 150 150 Kevin Mayhood
By: Kevin Mayhood

Pressure wounds were a common complication following a tracheostomy, often resulting in advanced-stage wounds, national studies showed. Nationwide Children’s Hospital was no different but Kris Jatana, MD, and Charles Elmaraghy, MD, surgeons in the Department of Otolaryngology, knew they could improve these outcomes. Brendan Boyle, MD, and Alex Green, DO, were fellows in the Division…

New Ultrasound Technique for Monitoring Liver Disease
 New Ultrasound Technique for Monitoring Liver Disease 150 150 Mary Bates, PhD
By: Mary Bates, PhD

Ultrasound elastography accurately and noninvasively measures liver fibrosis in patients with short bowel syndrome.

New Guidelines Offer Practical Tools to Treat GI Reflux
 New Guidelines Offer Practical Tools to Treat GI Reflux 150 150 Jeb Phillips
By: Jeb Phillips

An international committee’s new recommendations reflect shifting opinions about acid-suppressive medications and include an expanded diagnostic algorithm. While reflux-related complaints are heard often by pediatric gastroenterologists and primary care physicians, it can be difficult to tell when gastroesophageal reflux (GER) crosses the line into gastroesophageal reflux disease (GERD) — or how that disease should be…

A Better Non-Invasive Method To Monitor Liver Disease in Short Bowel Syndrome?
 A Better Non-Invasive Method To Monitor Liver Disease in Short Bowel Syndrome? 150 150 Jeb Phillips
By: Jeb Phillips

A pilot study suggests that acoustic radiation force impulse elastography can help monitor liver disease in children with short bowel syndrome. Patients with intestinal failure (most frequently caused by short bowel syndrome) are at risk for developing liver disease due to multiple contributing factors, including the underlying cause of their intestinal failure, need for parenteral…

New Guidelines Better Diagnose Common GI Disorders
 New Guidelines Better Diagnose Common GI Disorders 150 150 Jeb Phillips
By: Jeb Phillips

The new Rome IV criteria offer guidance to common but often misunderstood conditions. Because there are no clear causes of functional gastrointestinal disorders (FGIDs), diagnosis and treatment can be difficult. Some physicians and parents may doubt the disorders exist at all, although pediatric gastroenterologists estimate they affect 30 to 40 percent of children. However, recently…

Study Links Acute Infections With Later Functional Gastrointestinal Disorders
 Study Links Acute Infections With Later Functional Gastrointestinal Disorders 150 150 Jeb Phillips
By: Jeb Phillips

Link between acute infection in preschoolers and development of FGIDs in school-aged children could point toward interventions. Functional gastrointestinal disorders (FGIDs) are among the most common pediatric health conditions and often first appear in school-aged children. Acute diarrhea, also very common, often first manifests in preschoolers. A recently published prospective study shows that there may…

Do You Believe in Integrated Health Care?
 Do You Believe in Integrated Health Care? 150 150 Miguel Saps, MD
By: Miguel Saps, MD

Patients are more than a segregated set of organ systems. Treating them as whole beings requires the practice of integrated medicine. I believe in an integrated approach to health care. The care of patients is often envisioned as fractionated, with different specialists taking care of different organs or organ systems — a model that I…

Crohn’s Disease Not Exempt From Racial Disparities
 Crohn’s Disease Not Exempt From Racial Disparities 150 150 Gina Bericchia
By: Gina Bericchia

Disparities exist among pediatric Crohn’s patients of different races for a number of health care metrics. A study published in the journal Inflammatory Bowel Diseases found significant differences in hospital readmissions, medication usage and both medical and surgical complications of children with Crohn’s disease related to race. In the study, black children had a 1.5 times higher frequency…

Fighting Fibrosis
 Fighting Fibrosis 1024 575 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES
Colorful illustration showing how fibrosis, or a spiky lumpy mass of scar tissue, forms over healthy liver tissue when the liver attempts to repair and replace damaged cells

Fibrosis is an unmet medical challenge with no satisfactory test and insufficient therapy. Now, one naturally occurring cellular component could simultaneously diagnose and heal patients. It’s much more than a million-dollar idea. The person who invents a simple blood or urine test that can accurately measure the severity of scarring in internal organs will have…

The Continence Predictor Index
 The Continence Predictor Index 150 150 Marc Levitt, MD
By: Marc Levitt, MD

Probing for Links Between Psychotropic Drugs and Severe Liver Disease
 Probing for Links Between Psychotropic Drugs and Severe Liver Disease 150 150 Kevin Mayhood
By: Kevin Mayhood

Drugs that help minors with severe mental health disorders may put overweight and obese patients at risk for severe liver disease. In a paper that appears to be the first to suggest the connection, the authors point out that youths who suffer from psychiatric illnesses are already at greater risk for obesity and its comorbidities.…