2017 Annual Report Pediatric Gastroenterology · disorders, including inpatient ... Division’s physicians provide supervision to 15 Advance Practice Providers. ... “Make Friends

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Pediatric Gastroenterology 2017 Annual Report

Division Introduction

As the primary program in North Texas caring for children with gastrointestinal (GI), pancreatic and liver disorders, the Division of Pediatric Gastroenterology at UT Southwestern Medical Center, in partnership with the Children’s Health System of Texas, provides comprehensive care to an ever expanding population. The Division’s mission is to improve the lives of children through quality care, innovative clinical programs, education and training of healthcare providers, and state-of-the-art techniques in basic, translational and clinical research.

Under the leadership of interim division director Bradley Barth, M.D., M.P.H., this nationally recognized division includes distinguished faculty focusing on diverse areas of gastroenterology, including chronic viral hepatitis, recurrent and chronic pancreatitis, eosinophilic GI disease, neurogastroenterology, inflammatory bowel disease, therapeutic endoscopy, intestinal rehabilitation, non-alcoholic fatty liver disease, obesity and liver transplantation. Currently the Division is comprised of 19 faculty members who provide outstanding care to patients with gastrointestinal and liver disorders, including inpatient, outpatient and procedural services. In addition, the Division’s physicians provide supervision to 15 Advance Practice Providers. The Division has been highly ranked by U.S. News and World Report since 2009 and provides clinical services and medical leadership at three practice sites:

• Children’s Medical Center Dallas • Children’s Health™ Specialty Center Plano • Texas Health Presbyterian Hospital

Clinical activities of the Division include a high volume, high acuity service, with more than 22,000 outpatient visits, 2,000 inpatient admissions and 3,000 procedures per year.

All of these functions are organized in a programmatic fashion into 15 distinct clinical programs:

• Aerodigestive Program • Celiac Disease • Childhood Obesity • Chronic Abdominal Pain • Cystic Fibrosis Center • Eosinophilic/Allergic disorders • Feeding Disorders • General Gastroenterology • Hepatology/Liver Transplant • Inflammatory Bowel Disease • Intestinal Immunology • Intestinal Rehabilitation and Short Bowel Disease • Neuro-Gastroenterology • Pancreatic Disorders • Therapeutic Endoscopy/Gastroenterology Laboratory

Bradley Barth, M.D., M.P.H. Interim Division Chief

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Faculty One new faculty member joined the Division in 2017, Dr. Ricardo Medina-Centeno, bringing the total to 19 full-time pediatric gastroenterology faculty members. Ricardo Medina-Centeno, M.D. Assistant Professor

B.S., summa cum laude University of Puerto Rico, Rio Piedras Campus, San Juan, PR, 2007 M.D. University of Puerto Rico, Medical Sciences Campus, San Juan, PR, 2011 Postdoctoral Training Residency, Pediatrics University of Florida, UF Health, Gainesville, FL, 2011-2014 Fellowship, Pediatric Gastroenterology UT Southwestern Medical Center/Children’s Health, Dallas, TX, 2014-2017 Interests Anorectal malformations, bowel management, neurogastroenterology, motility and aerodigestive disorders, volvulus, chronic constipation, biofeedback, imperforate anus, and chronic abdominal pain

Honors / Awards Faculty Promotions

• Brad Barth, Professor of Pediatrics • Nandini Channabasappa, Associate Professor of Pediatrics • Charina Ramirez, Associate Professor of Pediatrics

Best Pediatric Specialists in Dallas, D Magazine

• John Andersen • Brad Barth • Ashish Patel • Meghana Sathe

Most Influential Woman in Neurogastroenterology 2017 – Texas, Global Health and Pharma

• Rinarani Sanghavi

Texas Super Doctor, Texas Monthly Magazine

• John Andersen • Meghana Sathe

Top Doctors in Dallas, D Magazine

• Meghana Sathe

http://www.utsouthwestern.edu/education/medical-school/departments/pediatrics/divisions/gastroenterology/faculty.html

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Invited Lectures

Michele Alkalay

• Liver Transplant Nurse Practitioners, Children’s Health, Dallas, TX, July 2017 o “Alpha-1 Antitrypsin Deficiency”

• Annual Advanced Practice Conference, Grapevine, TX, October 2017 o “Celiac Disease”

• WFAA’s local ABC affiliate, Good Morning Texas, Dallas, TX, December 2017 o The Kid’s Doctor; “Celiac Disease”

Amal Aqul

• Grand Rounds, Texas Tech University School of Medicine, Lubbock TX, February 2017 o “Neonatal Cholestasis”

Sarah Barlow

• Saint Louis University Primary Care Research Symposium, Saint Louis, MO, April 2017 o “The Texas CORD project: Community vs. Primary Healthcare Weight Management Intervention in Low-

Income, Ethnically Diverse Children” • Saint Louis University Pediatric Grand Rounds, Saint Louis, MO, April 2017

o “Severe Obesity in Childhood” • CORD (Childhood Obesity Research Demonstration) Webinar, September 2017

o “Activities in the Healthcare Setting for Primary Prevention of Childhood Obesity” • CORD (Childhood Obesity Research Demonstration) Webinar, November 2017

o “Activities in the Healthcare Setting for Secondary Prevention of Childhood Obesity” • Children’s Health LIVE: Practice to Practice, Dallas, TX, November 2017

o “Childhood Obesity Intervention and the Primary Care Office” • Children’s Medical Center 6th annual Fragile X Symposium, Dallas, TX, December 2017

o “Managing Obesity in the Special Needs Population”

Bradley Barth

• Pediatric Pancreatic Disorders Research Seminar Series, Pittsburgh, PA, January 2017 o “Endoscopic Therapy for Pediatric Pancreatic Disease: When and How?”

• 9th Annual Interventional Endoscopy Course for GI Nurses and Technicians, Las Vegas, NV, March 2017 o “Pearls of Pediatric Endoscopy”

• NASPGHAN Second Year Fellows Conference, Scottsdale, AZ, March 2017 o “How to Give a Great Talk”

• National Pancreas Foundation Fellows Symposium, Grapevine, TX, April 2017 o “Therapeutic Endoscopy for Pancreatic Disease in Children”

• NASPGHAN Annual Meeting, Las Vegas, NV, October 2017 o “Intestinal Bleeding in Children”

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Bhaskar Gurram • Allergy/Immunology Noon Conference, Children’s Health, Dallas, TX, February 2017

o “GI manifestation of primary immune deficiency” • Multidisciplinary Care Conference, Children’s Health, Dallas, TX, September 2017

o “Fecal Microbial Transplantation for Clostridium Difficile Infection” Ricardo Medina

• NASPGHAN Annual Meeting, Las Vegas, NV, October 2017 o “Gastroparesis”

Ashish Patel • ImproveCareNow Community Conference, Chicago, IL, September 2017

o “Engaging Senior Leadership” Norberto Rodriguez-Baez

• NASPGHAN-Nestlé 1st Year Fellows Conference, Orlando, FL, January 2017 o “Make Friends No Enemas – GI Quiz Show” o “Clinical Research Exercise” o “Work-Life Balance”

• 49th Annual Kenneth C. Haltalin Pediatrics for the Practitioner, Irving, TX, April 2017 o “Hepatitis C and B Infection in Children: The Tale of Two Viruses”

• Pediatric Grand Rounds, Texas Tech Health Sciences Center, Lubbock, TX, May 2017 o “Neonatal Cholestasis”

Rinarani Sanghavi

• NASPGHAN Annual Meeting, Las Vegas, NV, October 2017 o “Women in pediatric GI- breaking the Glass ceiling” o “Diagnostic testing for abdominal pain” o “Do I need to test that C.R.A.P?” post graduate course

• Annual Prune Belly Syndrome family support group convention, Dallas, TX, July 2017 o “Management of constipation in Children with Prune Belly Syndrome”

• GI Grand Rounds, Primary Children’s Hospital, Salt Lake City, UT, August 2017 o “Feeding the child with GI dysmotility”

Meghana Sathe

• NASPGHAN-Nestlé 1st Year Fellows Conference, Orlando, FL, January 2017 o “Top 10 Ways to Achieve Work-Life Balance”

• Precision Medicine in Cystic Fibrosis – Multidisciplinary Conference, Children’s Health, Dallas, TX, January 2017 o “One Gene, Multiple Manifestations”

• DIGEST, Orlando, FL February 2017 o “Meconium Ileus”

• Absolutely Practical Gastroenterology, Children’s Health, Dallas, TX, October 2017 o “The CF Clinician’s Approach to Abdominal Pain”

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• NACFC, Indianapolis, IN, November 2017 o “Evaluation of Peri-Appendiceal Abscess: An Unusual Presentation of Cystic Fibrosis Associated Liver

Disease” • NACFC, Indianapolis, IN, November 2017

o “The CF Clinician’s Approach to Abdominal Pain”

David Troendle

• NASPGHAN Annual Meeting, Las Vegas, NV, October 2017 o “EUS in Pediatrics-Sounds Cool”

• PancreasFest, Pittsburgh, PA, July 2017 o “Cases in Pediatric Pancreatitis”

Research Presentations

Digestive Disease Week, American Gastroenterological Association Meeting, Chicago, IL, May 2017

Troendle D, Barth B, et al. Oral, “Post-ERCP Pancreatitis in Children and a Report from an International Multicenter Study Group (PEDI Database)”

Nieto J, Abu-El-Haija M, Barth B, et al. Poster, “A Multi-Center Comparative Analysis of Double Pigtail Platic Stents and Lumen Apposing Metal Stents for Endoscopic Drainage of Pancreatic Walled-off Necrosis in the Pediatric Population: Evaluation of Clinical Outcomes and Success”

Uc A, LaRusch J, Zimmerman B, Wilschanski M, Werlin S, Troendle D, Shah U, Schwarzenberg S, Rhee S, Pohl J, Piccoli D, Perito E, Palermo J, Ooi C, Nathan J, Morinville V, Mascarenhas M, Maqbool A, Liu Q, Lin T, Husain S, Himes R, Heyman M, Gonska T, Giefer M, Gariepy C, Freedman S, Fishman D, Bellin M, Barth B, et al

Poster, “CTRC G60G Variant is Common in Children with Acute Recurrent and Chronic Pancreatitis and Associated with Early-onset Disease”

Liu Q, Husain S, Abu-El-Haija M, Zimmerman B, Barth B, et al Poster, “PRSS1 Mutations and Family History of Chronic Pancreatitis Predict Rapid Progression from Acute Recurrent to Chronic Pancreatitis in Childhood”

Cheng E, Zhang X, Zhang Q, Yu C, Huo X, Pham T, Dunbar KB, Wang DH, Spechler SJ, Souza RF Oral, “In Esophageal Fibroblasts, Th2 Cytokines Induce Pro-Fibrotic Periostin Expression that Can Be Blocked by JAK-STAT6 Inhibitors”

Zhang Q, Su T, Zhang X, Yu C, Huo X, Pham T, Dunbar KB, Cheng E, Wang DH, Spechler SJ, Souza RF Poster, “Epithelial-Mesenchymal Transition in Barrett’s Esophagus: The Role of HIF-1a Micro RNA-200, SP1, and MAZ”

Cheng E, Zhang X, Zhang Q, Yu C, Huo X, Pham T, Dunbar KB, Wang DH, Spechler SJ, Souza RF Poster, “In Esophageal Fibroblasts, TH2 Cytokines Induce Pro-Fibrotic Periostin Expression that can be Blocked by JAK-STAT6 Inhibitors”

Huo X, Zhang X, Yu C, Cheng E, Zhang Q, Dunbar KB, Pham T, Lynch JP, Wang DH, Bresalier RS, Spechler SJ, Souza RF Poster, “Aspirin Prevents NF-kB Activation and CDX2 Expression Induced by Acid and Bile Salts in Esophageal Squamous Cells of Patients with Barrett’s Esophagus”

Su T, Zhang X, Yu C, Huo X, Pham T, Dunbar KB, Cheng E, Baipai M, Das KM, Wang DH, Spechler SJ, Souza RF, Zhang Q Poster, “In Non-Neoplastic Barrett’s Epithelial Cells, Acid and Bile Salts Induce Epithelial Mesenchymal Transition (EMT) Through a Hif-Mediated Reduction in MicroRNA-200a and 200b Expression”

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Pediatric Academic Societies Meeting, Baltimore, MD, May 2017 Johnston R, Adamson B, Ahn C, Barlow SE, Turer CB. Poster, “Importance of Clinical Practices for Weight-Status Improvement in Overweight 2-5 Year-Olds” Zuniga L, Marton S, Schwarzwald H, Giardino A, Barlow SE

Poster, “A Characterization of Outpatient Encounters of Obese and Overweight Children”

NASPGHAN Annual Meeting, Las Vegas, NV, October 2017

Kramer R, Lerner D, Mencin A, Troendle D, et al Poster, “Multicenter Evaluation of Procedural Volume in Academic Pediatric GI Centers”

Hassan S, Umana L, Wolf M, Andersen, J, Aqul A

Poster, “Homozygous mutation of NEK 8 gene: A Novel cause of progressive neonatal cholestasis and end stage liver disease”

Carroll J, Troendle D, Josephs S, Sifuentes-Dominguez L, Cheng E, Barth B

Poster, “Clinical Characteristics in a Case-Control Study of Children with Necrotizing Pancreatitis”

Liu Q, Barth B, Troendle D, et al Oral, “Technical Approach to Infant ERCP”

Mehta M, Rojas I Poster, “9-year-old with Autoimmune Pancreatitis and Exocrine Pancreatic Insufficiency”

Mehta M, Barlow SE Poster, “Congenital Tufting Enteropathy and Protein Allergy: An Unusual Presentation”

Bonasso, Barth B., Odiase E, Lazar L, Troendle D, et al Poster, “In-hospital Pediatric ERCP is Associated with Shorter Hospitalization for Children with Choledocholithiasis” Piester T, Troendle D, Barth B Poster, “Cholangioscopy to Retrieve Migrated Biliary Stent in a Child” Uc, Barth, et al. (INSPPIRE)

Poster, “Chronic Pancreatitis is a Devastating Disease Across All Ages: Comparison of Two Large Pediatric and Adult Multicenter Cohorts”

Sara Hassan, Yuefeng (Rose) Wu, Bruce Schlomer, Bhaskar Gurram.

Poster, “Penile and Scrotal Metastatic Crohn’s Disease in a Pediatric Patient” Medina R, Peacock J, Flores E, Spain T, Harding A, Puckett S, Sanghavi R

Poster, “Use of Citalopram for Pediatric Patients with Chronic Abdominal Pain Referred to the Multidisciplinary Abdominal Pain Clinic – A Single Center Initial Experience”

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Walji-Varani, S., Semrin G Poster, “What comes first? Hepatoblastoma of Familial Adenomtous Polyposis?”

Medina R, Sanghavi R, Murpuri J

Poster, “Mucosal IgA and Microbiology Analysis in Patients with Celiac Disease “ North American Cystic Fibrosis Conference, Indianapolis, IN, November 2017

Varghese P, Sathe M, et al

Poster, “Improving Bone Health: Implementation of DEXA scan guidelines”

Arcinas RR, Varghese P, Sharma P, Sathe M

Poster, “The Challenges and Benefits of Implementation of Physical Therapist in Outpatient Pediatric CF Clinic”

Kamal D, Sharma P, Sathe M

Oral, “Raising Awareness of Clinical Research at Children’s Health”

Becker JA, Oliver BJ, Kamal D, Sathe M, Sharma P

Poster, “Challenges in Transitioning Despite Improved Communication Between Pediatric and Adult Teams”

Williams K, Sathe M, Sharma P

Poster, “The Role of a Patient and Family Educator for Cystic Fibrosis”

Education and Training

The Division continues to promote new and innovative training strategies for students, residents, fellows and junior faculty, as well as educational programs to the local community and nationally. The three-year, ACGME-accredited fellowship program, directed by Drs. Norberto Rodriguez and Meghana Sathe, provides comprehensive training for nine gastroenterology fellows (three annually). The training program is dynamic and innovative, offering individualized training tracks in quality improvement, therapeutic endoscopy, motility and clinical and basic research. In the first year of fellowship, emphasis is on acquiring knowledge and clinical skills in gastroenterology, hepatology and nutrition. Second and third year fellows will focus on a basic science or clinical project that meets the ACGME requirements for scholarly activity. Both areas emphasize acquiring skills in scientific presentation, writing abstracts and manuscripts, and grant development. The first-time passing rate for the ABP-certified Pediatric Gastroenterology board exam for graduating fellows is 100%, and the majority of graduates go on to hold faculty appointments.

Focused areas of research by the Division’s current fellows include: • Pathogenesis of Eosinophilic Esophagitis • Non-alcoholic fatty liver disease • Optimizing evaluation and treatment of transplant patients with fever • Chronic pancreatitis in Cystic Fibrosis patients • Epidemiology of acute pancreatitis in a pediatric population • Imaging modalities to evaluate Cystic Fibrosis liver disease

http://www.utsouthwestern.edu/education/medical-school/departments/pediatrics/divisions/gastroenterology/fellows/index.html

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Research Activities Funded research spans a wide range of important areas in both basic science and clinical investigation. The Division has many active ongoing research studies including several National Institutes of Health (NIH)-sponsored studies to understand the origins of childhood liver, esophageal and intestinal diseases. The Division is participating in more than 40 ongoing IRB-approved clinical trials, including several national, multicenter studies evaluating treatments for pancreatic disease, Cystic Fibrosis, inflammatory bowel disease, hepatitis and liver failure. Liver Research

• Dr. Norberto Rodriguez-Baez is the principle site investigator for a national, multicenter, NIH-supported study examining the causes for fulminant hepatic failure in children, as well as studies evaluating the best treatment strategies for children with hepatitis B and C.

• Dr. Charina Ramirez’s research focuses on metabolic liver disease including Niemann-Pick type C and non-alcoholic fatty liver disease (NAFLD). She is conducting a novel trial evaluating the effects of specialized diets in the treatment of childhood fatty liver disease.

Gastroenterology Research

The second general area of active research involves inflammation in the GI tract including, studies to understand the pathogenesis of eosinophilic esophagitis and inflammatory bowel disease (IBD).

• Dr. Edaire Cheng is a NIH-funded investigator unraveling the basic causes of eosinophilic esophagitis. She has developed novel cell and mouse models which are providing new insights into this disease, as well as uncovered the mechanisms of eosinophilic infiltration and tissue remodeling in the esophagus. • Dr. Luis Sifuentes is studying basic mechanisms of inflammatory bowel disease. He is supported by a departmental, NIH-sponsored, Child Health Research Career Development Award and is working closely with Dr. Ezra Burnstein in the Department of Internal Medicine’s Division of Gastroenterology at UT Southwestern to understand the molecular basis of early-onset IBD. Using cutting edge genomic and proteomic approaches, together they have identified novel genes that play a role in early-onset IBD.

• Dr. Rina Sanghavi, an expert in neurogastroenterology, is exploring new therapies for constipation, motility disorders, and aerodigestive disorders in children. Studies are underway exploring the contribution of the intestinal microbiome to GI motility.

• Dr. Ashish Patel is the site leader for the multicenter collaborative known as Improve Care Now. He has been instrumental in the development of a nutritional management algorithm and is leading treatment trials in patients with IBD. Dr. Patel is also the primary investigator on multiple grants, including funding from the NIH, CCFA and Broad Foundation. He also leads several industry-supported trials evaluating novel therapies for pediatric IBD.

• Dr. Brad Barth, Director of Therapeutic Endoscopy at Children’s, is studying therapeutic interventions for complex

childhood hepatobiliary and pancreatic disorders. His clinical and research interests include therapeutic endoscopy, ERCP, endoscopic treatment of gastrointestinal bleeding, and pancreatic disease in children.

Dr. Edaire Cheng

http://www.utsouthwestern.edu/education/medical-school/departments/pediatrics/divisions/gastroenterology/research.html

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• Dr. David Troendle’s research focuses on advanced endoscopic training and interventional endoscopic approaches for the treatment of pancreatic disease. He is also evaluating educational and training approaches in advanced therapeutic endoscopy for pediatric practitioners, as well as endoscopic treatment of complications of bariatric surgery.

• Dr. Sarah Barlow’s research interests are in childhood obesity and nonalcoholic fatty liver disease.

• Dr. Meghana Sathe is involved in several projects studying the use of DEXA scan in children with Cystic Fibrosis, optimizing weight in infants with Cystic Fibrosis, and pancreatic disease in Cystic Fibrosis patients.

Clinical Activities The nationally recognized clinical programs of the Division of Gastroenterology are housed at Children’s Medical Center Dallas with satellite activity at Children’s Plano and Texas Health Resources. In the patient-centered environment, physicians are joined by nurse practitioners, physician assistants, child psychologists, dieticians, speech therapists, child life specialists, social workers, an enterostomal therapist/educator, and a care coordinator to provide multidisciplinary, comprehensive, state-of-the-art care for children with virtually any gastrointestinal, pancreatic or liver problem.

Gastroenterology Endoscopy Lab The gastroenterology lab staff of six nurses and two endoscopy technicians supports not only routine endoscopic procedures, but also advanced and therapeutic endoscopy, including ERCP, EUS, balloon enteroscopy and capsule endoscopy and a full array of motility procedures, including anorectal, esophageal, antroduodenal, small bowel and colonic. The unit performed over 80 pediatric ERCPs and over 40 pediatric EUS cases in 2017.

Specialized Programs

The Division also supports several specialized clinical programs. Referrals are accepted for all of the following programs and a Gastroenterology physician is on call daily to take calls from physicians.

Neurogastroenterology Program

Under the direction of Dr. Rina Sanghavi, this program provides comprehensive care for children with complex motility dysfunction, including intestinal pseudo-obstruction, dysmotility following infection or surgery and neuromyopathies. It is home to one of the few ANMS-certified pediatric motility labs in the country performing esophageal, antroduodenal, colonic motility, and impedance studies. It is the only bowel management program in North Texas for children with simple and complex anorectal malformations, the only multidisciplinary abdominal pain program and the only aerodigestive disorders management program in the area. In 2017 the Biofeedback program was introduced providing effective treatment to children with disordered defecation.

Aerodigestive Program

Directed by Dr. Rinarani Sanghavi and Dr. Romaine Johnson (ENT), the multidisciplinary aerodigestive program combines the services of gastroenterology, pulmonology, and ear, nose and throat (ENT) specialists. Pediatric patients are referred from all over the nation for comprehensive evaluation of swallowing, breathing, and feeding disorders. This specialized program includes procedural services such as esophageal impedance, endoscopy bronchoscopy and laryngoscopy.

http://www.utsouthwestern.edu/education/medical-school/departments/pediatrics/divisions/gastroenterology/patient-care.html

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Chronic Abdominal Pain Program

Directed by Dr. Rinarani Sanghavi and Dr. Thomas Spain (Pain Specialist), the chronic abdominal pain program (CAPP) provides comprehensive evaluation and treatment of children with chronic abdominal pain. This multidisciplinary program includes a skilled team consisting of gastroenterologists, pain management specialists, psychologists, and nurses. It is the only comprehensive pain management program in North Texas for children with abdominal pain.

Hepatology & Liver Transplantation Program

Producing recognized research and clinical studies in acute liver failure, viral hepatitis and chronic liver diseases, this is an internationally recognized active Pediatric Liver Transplantation program. The transplant program performs whole and split liver transplants to treat a range of liver diseases with outcomes that are some of the best in the nation

Intestinal rehabilitation Program

Under the direction of Dr. Nandini Channabasappa, this is the only program of its type in North Texas and the surrounding states, and is one of the largest in the country. The program provides a comprehensive and integrated approach to nutritional support, including parenteral and enteral feeding programs, for children with short bowel syndrome, pseudo-obstruction and other disorders resulting in intestinal failure, as well as for those who have had intestinal transplantation.

Pediatric Inflammatory Bowel Disease (IBD) Program Directed by Dr. Ashish Patel, this program provides specialized care for children with inflammatory bowel disease, conducts research into new treatments, genetics and epidemiology, and is a founding member of the now 80+ center international collaboration, the Improve Care Now network, establishing quality improvement indicators and benchmarks in order to rapidly advance patient care and optimize outcomes. The Center is one of the largest IBD centers in the nation caring for more than 500 children with Crohn’s disease or ulcerative colitis and providing consultations to patients from throughout the U.S. and internationally. Pediatric Intestinal Immunology Clinic (PIIC) Directed by Dr. Bhaskar Gurram, the Pediatric Intestinal Immunology Clinic provides comprehensive evaluation and care to children with immunodeficiency and/or immune dysregulation with corresponding intestinal inflammation. It combines the skilled gastroenterologists, immunologists, geneticists and pathologists, and it is the only one of its kind in Texas.

Childhood Obesity Program

Directed by Dr. Sarah Barlow, the Childhood Obesity program uses a cross-disciplinary, cross-site approach to care for children. The program provides resources for primary care providers, including electronic health record clinical decision support, connections to community-based weight management programs, and nutritional education.

Therapeutic Endoscopy Program

Directed by Dr. Brad Barth, the Therapeutic Endoscopy Program is one of the few programs in the United States performing specialized, cutting-edge endoscopic procedures, including endoscopic retrograde cholangiopanereatography (ERCP) in children of all ages and leads the nation in

Drs. Aakash Goyal and Ashish Patel

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endoscopic innovation, research, and training. More than 3,000 endoscopic procedures are performed per year, including specialized procedures such as ERCP and endoscopic ultrasound. The program, which houses a state-of-the-art training program with a simulation lab, has won the North American Society of Pediatric GI endoscopy prize three times, and is the founding site for the Pediatric ERCP Database Initiative. This project was started by Dr. David Troendle and collects data from national and international centers related to ERCP indications, complications and outcomes.

Cystic Fibrosis Program

The childhood Cystic Fibrosis program is co-directed by Drs. Meg Sathe from Pediatric Gastroenterology and Preeti Sharma from Pediatric Respiratory Medicine, and provides a comprehensive team approach to this complex and chronic disease. It is actively involved in many national multicenter trials, including clinical trials of new and innovative treatments.

Eosinophilic Esophagitis and Esophageal Disorders Program

Co-directed by Drs. Edaire Cheng and Aakash Goyal, this program, known as the Dallas Eosinophilic Esophagitis Program, treats children with eosinophilic esophagitis in a multidisciplinary approach. In addition to clinical work, the program supports ongoing basic research into the basic mechanisms underlying disease pathogenesis.

Celiac Disease Program

Directed by Dr. Michele Alkalay and located at the satellite campus in Plano, this is a multidisciplinary program involving intense nutritional and family support for children with celiac disease and gluten sensitivity.

Pancreatic Disorders Program

Co-directed by Drs. Brad Barth and David Troendle, this is a comprehensive program spanning inpatient, outpatient and procedural care that brings the latest in minimally invasive surgical techniques to the treatment of children with disorders of the pancreas. Patients are referred from all over the nation, for evaluation and for advanced therapeutic techniques offered at few other Pediatric centers in the United States.

Feeding Disorders Program

Directed by Dr. Gaith Semrin, the Feeding Disorders program at Children’s Health consists of a multidisciplinary team dedicated to the care of patients with disorders of oral feeding. The mission of the program is to formulate individual therapy, foster feeding independence, and improve the quality of life for patients with feeding problems.

2017 Patient Statistics

Dallas Plano THD Total Ambulatory visits 14,861 6,844 717 22,422 New 4,161 2,190 272 6,623 Follow-up 10,700 4,654 445 15,799 Procedures 3,304

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Current Grant Support

Bradley Barth

Grantor: NIH-NIDDK Title of Project: Consortium for the Study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer Role: Site PI Dates: 2017-2018

Edaire Cheng

Grantor: Children’s Medical Center Foundation CCRAC Early Career Award Title of Project: Food Antigen-Specific Innate and Adaptive Immune Responses in the Esophagus Role: Principal Investigator Dates: 2016 – 2018

Grantor: National Institutes of Diabetes and Digestive and Kidney Diseases (K08) Title of Project: The Role of Periostin and Th2 Cytokines in Eosinophilic Esophagitis Fibrogenesis Role: Principal Investigator Dates: 2013 – 2017

Grantor: American Gastroenterological Association (Research Scholar Award) Title of Project: Eosinophilic Esophagitis Fibrogenesis Role: Principal Investigator Dates: 2013 – 2017

Grantor: UTSW Center for Translational Medicine/Service Package Grant Title of Project: Registry and Biorepository for the Study of Eosinophilic Esophagitis Role: Principal Investigator Dates: 2016 – 2017

Ashish Patel

Grantor: NIH Title: PROTECT – Predicting Response to Standardized Pediatric Colitis Therapy Role: Site Principal Investigator Dates: 2012 – 2017 Grantor: NIH Title: Sex Differences in Statural Growth Impairment in Pediatric Crohn’s Disease Role: Site PI Dates: 2016-2020

Norberto Rodriguez-Baez

Grantor: NIH / Johns Hopkins University (Grant No. U01-DK082872002) Title: Hepatitis B Research Network – Effect of HBV DNA Methylation and the Mutant 1762T/1764A on Viral Load and HCC Role: Co-Investigator Dates: 2008 – 2020

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Meghana Sathe

Grantor: Cystic Fibrosis Foundation Title: Pilot Learning Network Role: Co-PI Dates: 2016-2018 Grantor: Cystic Fibrosis Foundation Title: Physical Therapy Role: Co-PI Dates: 2016-2019 Grantor: Cystic Fibrosis Therapeutics Title: SATHE14YO Therapeutic Drug Center Role: Co-PI Dates: 2015-2018 Grantor: Cystic Fibrosis Foundation Title: SATHE14GE0 Developing Innovative Gastroenterology Specialty Training Program (DIGEST) Role: Principle Investigator Dates: 2014 – 2017 Grantor: Cystic Fibrosis Foundation Title: CC034-34 TX-34/34 Children’s Medical Role: Co-PI Dates: 2013-2018 Grantor: Cystic Fibrosis Foundation Title: SIP-Newborn Screening Improvement Role: Co-PI Dates: 2016-2017

Grantor: Abbott Laboratories and Janssen Research and Development LLC Title: CFFC A Long-Term Prospective Observational Safety Study of the Incidence of and Risk Factors for Fibrosing Colonopathy in US Patients with Cystic Fibrosis Treated with Pancreatic Enzyme Replacement Therapy: A Harmonized Protocol across Sponsors Role: Principle Investigator Dates: 2012 – 2022

Grantor: Vertex Pharmaceuticals Incorporated Title: VX661-108 A Phase 3, Randomized, Double-Blind, Placebo-Controlled, Crossover Study to Evaluate the Efficacy and Safety of Ivacaftor and VX-661 in Combination with Ivacaftor in Subjects Aged 12 Years and Older with Cystic Fibrosis, Heterozygous for the F508del-CFTR Mutation, and a Second Allele with a CFTR Mutation Predicted to Have Residual Function Role: Sub-Investigator Dates: 2015 – 2017

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David Troendle

Grantor: Exalenz Bioscience, Ltd. Title: Clinical Study to Confirm Safety and Accuracy in Detection of H. pylori with 13C-Urea Breath Test Using the BreathID Hp and BreathID Hp Lab Systems in the Pediatric Population Role: Site PI Dates: 2017 Grantor: Autism Speaks (Prime Sponsor), Baylor College of Medicine (Sponsor) Title: Identifying Biomarkers of GI Morbidity in ASD: Linking Multiomics and Human Behavior Role: Site Co-I Dates: 2016-2017

Luis Sifuentes-Dominguez

Grantor: Children’s Health Foundation and Clinical Research Advisory Committee (CCRAC) Title: Role of Enteroendocrine Cells in Inflammatory Bowel Disease Pathogenesis Role: Principal Investigator Dates: 2015 – 2017 Grantor: NIH – K12 Title: Role of Enteroendocrine Cells in IBD Pathogenesis Dates: 2015 - 2017

Peer-Reviewed Publications

1. Acosta A, Streett S, Kroh MD, Cheskin LJ, Saunders KH, Kurian M, Schofield M, Barlow SE, et al. White Paper AGA: POWER - Practice Guide on Obesity and Weight Management, Education, and Resources. Clin Gastroenterol Hepatol 2017;15:631-49 e10. PMID: 28242319

2. Aqul A, Jonas MM, Harney S, et al. Correlation of Transient Elastography With Severity of Cystic Fibrosis-related Liver Disease. J Pediatr Gastroenterol Nutr 2017;64:505-11. PMID: 27782957

3. Bacha F, Tomsa A, Bartz SK, Barlow SE, Chu ZD, Krishnamurthy R, Krishnamurthy R, Smith EO. Nonalcoholic Fatty Liver Disease in Hispanic Youth With Dysglycemia: Risk for Subclinical Atherosclerosis? J Endocr Soc. 2017 Jun 27;1(8):1029-1040. PMID: 29264555 4. Barlow SE, Butte NF, Hoelscher DM, Salahuddin M, Pont SJ. Strategies to Recruit a Diverse Low-Income Population to Child Weight Management Programs From Primary Care Practices. Prev Chronic Dis. 2017 Dec 21;14:E138. PMID: 29267156 5. Barlow SE, Turer CB. Lipid Screening and Treatment Practices Conflict With Conflicting Recommendations: Where Do We Go From Here? J Pediatr 2017 Jun;185:16-18. PMID: 28284479

6. Blotte C, Styers J, Zhu H, Channabasappa N, Piper HG. A comparison of Broviac(R) and peripherally inserted central catheters in children with intestinal failure. J Pediatr Surg 2017;52:768-71. PMID: 28168988

7. Boyle B, Collins MH, Wang Z, Mack D, Griffiths A, Sauer C, Markowitz J, LeLeiko N, Keljo D, Rosh J, Baker SS, Pfefferkorn M, Heyman M, Patel A, et al. Histologic Correlates of Clinical and Endoscopic Severity in Children Newly Diagnosed With Ulcerative Colitis. Am J Surg Pathol 2017 Nov;41(11):1491-1498. PMID: 28863076

http://www.ncbi.nlm.nih.gov/pubmed/28242319




https://www.ncbi.nlm.nih.gov/pubmed/29264555










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8. Brant SR, Okou DT, Simpson CL, Cutler DJ, Haritunians T, Bradfield JP, Chopra P, Prince J, Begum F, Kumar A, Venkateswaran S, Datta LW, Wei Z, Thomas K, Herrinton LJ, Klapproth JA, Quiros AJ, Seminerio J, Liu Z, Alexander JS, Baldassano RN, Dudley-Brown S, Cross RK, Dassopoulos T, Denson LA, Dhere TA, Dryden GW, Hanson JS, Hou JK, Hussain SZ, Hyams JS, Isaacs KL, Kader H, Kappelman MD, Katz J, Kellermayer R, Kirschner BS, Kuemmerle JF, Kwon JH, Lazarev M, Li E, Mack D, Mannon P, Moulton DE, Newberry RD, Osuntokun BO, Patel AS, et al. Genome-Wide Association Study Identifies African-Specific Susceptibility Loci in African Americans With Inflammatory Bowel Disease. Gastroenterology 2017;152:206-17 e2. PMID: 27693347

9. Butte NF, Hoelscher DM, Barlow SE, et al. Efficacy of a Community- Versus Primary Care-Centered Program for Childhood Obesity: TX CORD RCT. Obesity (Silver Spring) 2017;25:1584-93. PMID: 28703504

10. Drews B, Macaluso M, Piper H, Channabasappa N. Caregiver Education Reduces the Incidence of Community-Acquired CLABSIs in the Pediatric Patient With Intestinal Failure. Gastroenterol Nurs. 2017 Nov/Dec;40(6):458-462. PMID: 29210814 11. Fishman DS, Giefer MJ, Barth B, Troendle DM. Digital Evaluation of the Biliopancreatic Tree: Cases From the Pediatric ERCP Database Initiative Consortium. J Pediatr Gastroenterol Nutr 2017;64:e125. PMID: 28151768

12. Friedlander JA, Liu QY, Sahn B, Kooros K, Walsh CM, Kramer RE, Lightdale JR, Khlevner J, McOmber M, Kurowski J, Giefer MJ, Pall H, Troendle DM, et al. NASPGHAN Capsule Endoscopy Clinical Report. J Pediatr Gastroenterol Nutr 2017;64:485-94. PMID: 27642781

13. Gariepy CE, Heyman MB, Lowe ME, Pohl JF, Werlin SL, Wilschanski M, Barth B, Fishman DS, Freedman SD, Giefer MJ, Gonska T, Himes R, Husain SZ, Morinville VD, Ooi CY, Schwarzenberg SJ, Troendle DM, et al. Causal Evaluation of Acute Recurrent and Chronic Pancreatitis in Children: Consensus From the INSPPIRE Group. J Pediatr Gastroenterol Nutr 2017 Jan;64:95-103. PMID: 27782962

14. Giefer MJ, Lowe ME, Werlin SL, Zimmerman B, Wilschanski M, Troendle D, Schwarzenberg SJ, Pohl JF, Palermo J, Ooi CY, Morinville VD, Lin TK, Husain SZ, Himes R, Heyman MB, Gonska T, Gariepy CE, Freedman SD, Fishman DS, Bellin MD, Barth B, et al. Early-Onset Acute Recurrent and Chronic Pancreatitis Is Associated with PRSS1 or CTRC Gene Mutations. J Pediatr 2017 Jul;186:95-100.PMID: 28502372

15. Gonzalez-Hernandez J, Prajapati P, Ogola G, Channabasappa N, Drews B, Piper HG. Predicting time to full enteral nutrition in children after significant bowel resection. J Pediatr Surg 2017;52:764-7. PMID: 28168985

16. Haber B, Alonso E, Pedreira A, Rodriguez-Baez N, et al. Long-Term Follow-Up of Children Treated With Peginterferon and Ribavirin for Hepatitis C Virus Infection. J Pediatr Gastroenterol Nutr 2017;64:89-94. PMID: 27111344

17. Huo X, Agoston AT, Dunbar KB, Cipher DJ, Zhang Z, Yu C, Cheng E, et al. Hypoxia-inducible factor-2alpha plays a role in mediating oesophagitis in GORD. Gut 2017;66:1542-54. PMID: 27694141

18. Klages KL, Berlin KS, Silverman AH, Mugie S, Di Lorenzo C, Nurko S, Ponnambalam A, Sanghavi R, et al. Empirically Derived Patterns of Pain, Stooling, and Incontinence and Their Relations to Health-Related Quality of Life Among Youth With Chronic Constipation. J Pediatr Psychol 2017;42:325-34. PMID: 27474732

19. Kugathasan S, Denson LA, Walters TD, Kim MO, Marigorta UM, Schirmer M, Mondal K, Liu C, Griffiths A, Noe JD, Crandall WV, Snapper S, Rabizadeh S, Rosh JR, Shapiro JM, Guthery S, Mack DR, Kellermayer R, Kappelman MD, Steiner S, Moulton DE, Keljo D, Cohen S, Oliva-Hemker M, Heyman MB, Otley AR, Baker SS, Evans JS, Kirschner BS, Patel AS, et al. Prediction of complicated disease course for children newly diagnosed with Crohn's disease: a multicentre inception cohort study. Lancet 2017;389:1710-8. PMID: 28259484

20. Lin TK, Troendle DM, Wallihan DB, Barth B, et al. Specialized Imaging and Procedures in Pediatric Pancreatology: A North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Clinical Report. J Pediatr Gastroenterol Nutr 2017;64:472-84. PMID: 28230608


























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21. McCandless SE, Yanovski JA, Miller J, Fu C, Bird LM, Salehi P, Chan CL, Stafford D, Abuzzahab MJ, Viskochil D, Barlow SE, et al. Effects of MetAP2 inhibition on hyperphagia and body weight in Prader-Willi syndrome: a randomized, double-blind, placebo-controlled trial. Diabetes Obes Metab 2017 Dec;19(12):1751-1761. PMID: 28556449

22. Newton KP, Feldman HS, Chambers CD, et al, Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) (Barlow S). Low and High Birth Weights Are Risk Factors for Nonalcoholic Fatty Liver Disease in Children. J Pediatr 2017 Aug;187:141-146.e1. PMID: 28366357

23. Piper HG, Fan D, Coughlin LA, Ho EX, McDaniel MM, Channabasappa N, Kim J, Kim M, Zhan X, Xie Y, Koh AY. Severe Gut Microbiota Dysbiosis Is Associated With Poor Growth in Patients With Short Bowel Syndrome. JPEN J Parenter Enteral Nutr. 2017 Sep;41(7):1202-1212. PMID: 27406942 24. Salahuddin M, Pérez A, Ranjit N, Kelder SH, Barlow SE, Pont SJ, Butte NF, Hoelscher DM. Predictors of Severe Obesity in Low-Income, Predominantly Hispanic/Latino Children: The Texas Childhood Obesity Research Demonstration Study. Prev Chronic Dis. 2017 Dec 28;14:E141. PMID: 29283881 25. Sathe M, Houwen R. Meconium ileus in Cystic Fibrosis. J Cyst Fibros. 2017 Nov;16 Suppl 2:S32-S39. PMID: 28986020 26. Scheers I, Palermo JJ, Freedman S, Wilschanski M, Shah U, Abu-El-Haija M, Barth B, Fishman DS, Gariepy C, Giefer MJ, Heyman MB, Himes RW, Husain SZ, Lin TK, Liu Q, Lowe M, Mascarenhas M, Morinville V, Ooi CY, Perito ER, Piccoli DA, Pohl JF, Schwarzenberg SJ, Troendle D, et al. Autoimmune Pancreatitis in Children: Characteristic Features, Diagnosis, and Management. Am J Gastroenterol 2017 Oct;112(10):1604-1611. PMID: 28374818

27. Schwarzenberg SJ, Ling SC, Cloonan YK, Lin HS, Evon DM, Murray KF, Rodriguez-Baez N, et al. Health-related Quality of Life in Pediatric Patients With Chronic Hepatitis B Living in the United States and Canada. J Pediatr Gastroenterol Nutr 2017;64:760-9. PMID: 28169971

28. Starokadomskyy P, Sifuentes-Dominguez L, Gemelli T, et al. Evolution of the skin manifestations of X-linked Pigmentary Reticulate Disorder. Br J Dermatol 2017 Nov;177(5):e200-e201. PMID: 28407217

29. Troendle DM, Fishman DS, Barth BA, et al. Therapeutic Endoscopic Retrograde Cholangiopancreatography in Pediatric Patients With Acute Recurrent and Chronic Pancreatitis: Data From the INSPPIRE (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) Study. Pancreas 2017;46:764-9. PMID: 28609364

30. Troendle DM, Qureshi F. Endoscopic Closure of Gastric Leak Following Sleeve Gastrectomy in a Pediatric Patient. J Pediatr Gastroenterol Nutr 2017 Sep;65(3):e68. PMID: 28267074

31. Turer CB, Barlow SE, Montano S, Flores G. Discrepancies in Communication Versus Documentation of Weight-Management Benchmarks: Analysis of Recorded Visits With Latino Children and Associated Health-Record Documentation. Glob Pediatr Health 2017;4:2333794X16685190. PMID: 28239625

32. Varni JW, Shulman RJ, Self MM, Nurko S, Saps M, Saeed SA, Patel AS, et al. Gastrointestinal symptoms predictors of health-related quality of life in pediatric patients with functional gastrointestinal disorders. Qual Life Res 2017;26:1015-25. PMID: 27743332

33. Varni JW, Shulman RJ, Self MM, Saeed SA, Patel AS, et al. Patient Health Communication Mediating Effects Between Gastrointestinal Symptoms and Gastrointestinal Worry in Pediatric Inflammatory Bowel Disease. Inflamm Bowel Dis 2017;23:704-11. PMID: 28394807

34. Vos MB, Abrams SH, Barlow SE, et al. NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children: Recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr 2017;64:319-34. PMID: 28107283





























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35. Vos MB, Abrams SH, Barlow SE, et al. Response to the Letters Regarding the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition NAFLD Guidelines. J Pediatr Gastroenterol Nutr. 2017 Nov;65(5):e115-e116. PMID: 29059122 36. Vos MB, Abrams SH, Barlow SE, et al. Response to Letters Regarding the NASPGHAN NAFLD Guidelines. J Pediatr Gastroenterol Nutr 2017 Nov;65(5):e115-e116. PMID: 28872475

Book Sections

1. Medina-Centeno R, Sanghavi R. State of the Art of the Diagnosis and Management of Gastroesophageal Reflux Disease. In: Ulualp S, ed. Synopsis of Current General Pediatrics Practice. Bentham Science; 217-230. 2017.




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