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Pediatric Gastroenterology 2018 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 a rapidly growing patient population. The Division’s mission is to promote health and a healthy society that enables achievement of every child’s full potential. We strive to fulfill this mission by providing unimpeachable care, advanced clinical programs, innovative training of future healthcare providers, and performing state-of-the-art and relevant 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 with clinical and research focus on a number of the diverse areas of pediatric digestive health. This growing and dynamic division is currently comprised of 19 faculty members offering inpatient, outpatient and procedural services. In addition, the Division’s physicians provide supervision to 15 Advance Practice Providers. The Division was ranked number 6 in the nation by US News and World Report in 2018 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 17 distinct clinical programs:
Aerodigestive Program
Anorectal Anomalies
Celiac Disease
Childhood Obesity
Chronic Abdominal Pain
Cystic Fibrosis Center
Eosinophilic/Allergic disorders
Feeding Disorders
General Gastroenterology
Hepatology/Liver Transplant
Non-alcoholic Fatty Liver Disease
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
The mission of the Division of Pediatric Gastroenterology is to promote health and a healthy society that
enables achievement of every child’s full potential. Faculty strive to fulfill this mission by providing
unimpeachable care, advanced clinical programs, innovative training of future healthcare providers, and
performing state-of-the-art and relevant basic, translational and clinical research.
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Pediatric Gastroenterology 2018 Annual Report
Faculty Currently the Division is comprised of 19 faculty members who provide care to patients with gastrointestinal, pancreas and liver disorders, including inpatient, outpatient and procedural services.
Honors / Awards Faculty Promotions
Norberto Rodriguez-Baez, Professor
Luis Sifuentes-Dominguez, Assistant Professor
Best Pediatric Specialists in Dallas, D Magazine
John Andersen
Brad Barth
Nandini Channabasappa
Aakash Goyal
Ashish Patel
Norberto Rodriguez-Baez
Meghana Sathe
Gaith Semrin
David Troendle
Texas Super Doctor, Texas Monthly Magazine
John Andersen
Meghana Sathe
Michele Alkalay
Who’s Who America
John Andersen
America’s Best Physician, National Consumer Advisory Board
Patient and Family Recognition Award - UT Southwestern Leaders in Clinical Excellence
Top Doctors
Brad Barth
Best Doctors in America
Edaire Cheng
Grand and Watkins Abstract Award, NASPGHAN 2018
APFED Outstanding EGID Abstract Award, NASPGHAN 2018
Ashish Patel
Physician of the Year, Crohn’s and Colitis Foundation
Mentoring Excellence for Developing Leaders, UT Southwestern, Dr. Keith Argenbright
Gaith Semrin
Mom-Approved Doctor, DFW Child Magazine
Dr. John Andersen received one of the inaugural
UT Southwestern Leaders in Clinical Excellence
awards - the Patient & Family Recognition
Award. This award honors clinical faculty whose
dedication to the compassionate, respectful
delivery of exceptional patient care has
garnered the highest degree of patient trust
and satisfaction. Recipients are faculty who are
routinely honored by patients and family
members through written feedback,
commendations to UT Southwestern leaders, or
other demonstrations of appreciation.
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Pediatric Gastroenterology 2018 Annual Report
Invited Lectures
Michele Alkalay
Children’s Health School Programs, Plano, TX, August 2018 o “Celiac Disease in Children”
Sarah Barlow
HEAL (Healthy Eating Active Living of the Paso Del Norte Institute for Healthy Living) Research Symposium, El Paso, TX, April 2018
o “The Texas CORD Project: Community vs. Primary Healthcare Weight Management Intervention in Low-income, Ethnically Diverse Children”
o “Severe Obesity in Childhood” o “Childhood Obesity and the Primary Care Office”
Childhood Obesity Conference Convened by Congressman Pete Sessions, Dallas, TX, April 2018 o “Finding Solutions: Integrating Research and Reality”
Bradley Barth (Rakheja D, Megison S)
Pediatric Grand Rounds, Department of Pediatrics, Children’s Health, Dallas, TX, May 2018 o “CPC: A Boy with Chronic Intestinal Pseudo-Obstruction”
Edaire Cheng
American Academy of Allergy, Asthma, and Immunology and World Allergy Organization Joint Congress, CEGIR/TIGERS EGID Symposium, Orlando, FL, February 2018
o “Relationship between EoE and Other Forms of Esophagitis with Focus on PPI Responses”
Digestive Disease Week, Washington, DC, June 2018 o “Pediatric Eosinophilic Esophagitis: From Pathogenesis to Clinical Practice”
Aakash Goyal
Eosinophilic Family Coalition, Dallas/Fort Worth Chapter, Dallas, TX, October 2018 o “By Your Side with Comprehensive Care - Dallas Eosinophilic GI Diseases and Esophagitis Program (DEEP)”
Ashish Patel
Digestive Disease Week, Washington, DC, June 2018 o “Age-of-onset Dependent Ileal Immune Maturation and Reduced Alpha-defensin in Pediatric Crohn’s
Disease with Already Established Dysbiosis” o “The Treatment Naïve Rectal Transcriptome Identifies Pathways Mediating Clinical and Endoscopic
Severity and Response to Initial Therapy in Pediatric Ulcerative Colitis”
Academic Surgical Congress, Jacksonville, FL , February 2018 o “Does the Path to Ileo-pouch Anal Anastomoses in the Treatment of Pediatric Ulcerative Colitis Matter?” o “Does Age Affect Surgical Outcomes Following Ileo-pouch Anal Anastomosis in Children?”
University of Utah, Grand Rounds, August 2018 o “Nutritional Management and Therapy in Pediatric IBD”
IBD Great Debates and Updates, Dallas, TX, August 2018 o “Mono Therapy is Necessary If You Use Anti TNF” o “Reactive Therapeutic Drug Monitoring is Best in Pediatric IBD”
Texas Scottish Rite Hospital, Rheumatology Grand Rounds, May 2018 o “Advances in Pediatric Inflammatory Bowel Disease”
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Pediatric Gastroenterology 2018 Annual Report
Charina Ramirez
Pediatric Grand Rounds, Department of Pediatrics, Children’s Health, Dallas, TX, October 2018 o “Pediatric Nonalcoholic Fatty Liver Disease (NAFLD): A ‘Growing’ Global Epidemic”
Norberto Rodriguez-Baez
NASPGHAN 2018 Annual, Hollywood, FL, October 2018 o Training Directors Meeting - “An Update: Pediatric Gastroenterology Fellowship Training Program” o Teaching and Tomorrow Program - “Improving Your Application” o Teaching and Tomorrow Program - Panel Discussion: Program Directors and GI Fellows – “What I Look for
in an Applicant” o LASPGHAN Session – “Transición del Paciente Pediátrico Trasplantado al Cuidado del Adulto: Antes,
Durante y Después” o “The Survival Guide for the Academic Clinician: The Clinician Educator” o Association of Pediatric Gastroenterology and Nutrition Nurses Annual Meeting – “Are You Smarter Than a
5th Grader?” o Gastroenterology Jeopardy Game
Rinarani Sanghavi
Annual Advanced Practice Professional Conference, Dallas, TX, January 2018 o “Abdominal Pain in Children”
NASPGHAN 2018 Annual, Hollywood, FL, October 2018 o “Non-pharmacological therapies for functional abdominal pain/IBS”
Pediatrician Organizations of the Philippines, April 2018 o “Infant Feeding – Breast Milk is the Best Milk”
Nutrition Conference, Panama, June 2018 o “Human Milk Oligosaccharides and Motility”
2nd Annual Pediatric Urodynamics Course, Dallas, TX, October 2018 o “GI Motility Studies in the Patient with Neurogenic Bladder and Bowel”
Pediatric Airway and Dysphagia Conference, Dallas, TX, October 2018 o “Pediatric GI Considerations in the Child with Feeding Issues”
Meghana Sathe
The Galaxy Study: Multicenter Study of Patient-reported Gastrointestinal Symptoms in People with Cystic Fibrosis, Denver, CO, October 2018
o “Study Initiation Meeting at NACFC” NASPGHAN Nestlé, 1st Year Fellows Conference, Orlando, FL, January 2018
o “Top 10 Ways to Achieve Work-Live Balance” The Galaxy Study: Multicenter Study of Patient-reported Gastrointestinal Symptoms in People with Cystic Fibrosis,
Seattle, WA, November 2018 o “Therapeutic Drug Network for Clinical Research Scholars Award” o “Research Talk at Seattle Children’s for Clinical Research Scholars Award”
David Troendle
Children’s Health 12th Annual Advanced Practice Professional Conference, Dallas, TX, January 2018 o “The Pediatric Acute Abdomen”
Texas Academy of Physician Assistants Annual CME Conference, Dallas, TX, January 2018 o “Pediatric Pancreatitis”
NASPGHAN 2018 Annual, Hollywood, FL, October 2018 o Meet the Professor Breakfast – “ERCP for Congenital Pancreatic Anomalies” o Instructor at Colonoscopy Hands-on Course o Instructor at Hands-on Endoscopy Session – Circulating Endoscopy Expert
Digestive Disease Week, Washington, DC, June 2018 o Endoscopy Oral Presentation Session – Moderator
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Pediatric Gastroenterology 2018 Annual Report
PancreasFest, Pittsburgh, PA, July 2018 o “EUS for Pediatric Pancreatitis”
Conference Presentations
Amal Aqul
NASPGHAN Annual Meeting, Hollywood, FL, October 2018 o Poster, “Role of Contrast-Enhanced Ultrasound in evaluating focal Liver lesions in a Teenage”
Sarah Barlow
Obesity Week, Nashville, TN, November 2018 o Oral, “For Whom Does the Intervention Work? Correlates of successful BMI reduction in the TX CORD
project”
Brad Barth
NASPGHAN Annual Meeting, Hollywood, FL, October 2018 o Oral, “What it Means to be a Pediatric Endoscopist” o Instructor, Hands-on Endoscopy Session on How to Use Heater Probe and Bipolar Current in the Treatment
of GI Bleeding o Moderator, Pediatric Endoscopy Research Session
Edaire Cheng
NASPGHAN Annual Meeting, Hollywood, FL, October 2018
o Oral, “JAK/STAT6 are Potential Therapeutic Targets for Esophageal Remodeling in EoE”
Norberto Rodriguez-Baez
NASPGHAN Nestlé 1st Year Fellows Conference, Orlando, FL, January 2018 o GI Quiz Show, “Make Friends No Enemas” o Clinical Research Exercise o Oral, “Work-Life Balance”
NASPGHAN Nestlé 2nd Year Fellows Conference, Scottsdale, AZ, March 2018 o Oral, “How to Write a Curriculum Vitae”
51st European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Annual Meeting, Geneva, Switzerland, May 2018
o Poster, “Entecavir Monotherapy Results in Complete Remission of Hepatitis B Virus-Related Membranous Nephropathy in a Paediatric Patient”
Simposio de Gastroenterología y Hepatología Pediátrica: 40 años de Pediatría. Hospital Italiano de Buenos Aires – Buenos Aires, Argentina, August 2018
o Oral, “Casos Difíciles en Hepatología Pediátrica” o Oral, “Hepatitis C: Situación Actual y Nuevos Desafíos” o Oral, “Entrenamiento en Gastroenterología y Hepatología Pediátrica: Sugerencias para un Futuro Mejor” o Oral, “Casos Clínicos en Gastroenterología y Hepatología Pediátrica”
NASPGHAN Mead Johnson 3rd Year Fellows Conference, Phoenix, AZ, September 2018 o Oral, “Teaching How to Teach”
Meghana Sathe
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Pediatric Gastroenterology 2018 Annual Report
NASPGHAN Nestlé 1st Year Fellows Conference, Orlando, FL, January 2018 o Oral, “Top 10 Ways to Achieve Work-Live Balance”
PancreasFest, Pittsburgh, PA, July 2018 Poster, “Severe Pancreatitis is Rare in Pediatric Patients: Results From a Retrospective Review”
NACFC, Denver, CO, October 2018 o Poster & Oral, “Improving Nutritional Outcomes for Infants with CF” o Poster, “Biliary Atresia versus Hepatobiliary Manifestations of Cystic Fibrosis: Diagnostic Conundrum” o Poster, “Creation of A Treatment Algorithm for Pulmonary Exacerbations in Pediatric Cystic Fibrosis
Patients at Children’s Medical Center” o Poster & Oral, “Putting the Pieces Together: Comprehensive Application of PT interventions in CF”
NASPGHAN 2018 Annual, Hollywood, FL October 2018 o Poster, “From Pancreatitis to Puestow: The Winding Path of Cystic Fibrosis” o Poster, “Severe pancreatitis is rare in pediatric patients: Results from a retrospective review”
Ricardo Medina
NASPGHAN 2018 Annual, Hollywood, FL October 2018 o Poster, “Limitations of multichannel intraluminal impedance- pH monitoring for pediatric patients- a single
center initial experience” o Instructor, Hands on Endoscopy Session on How to Place Endoscopic Hemostasis Clips
Rinarani Sanghavi
NASPGHAN 2018 Annual, Hollywood, FL October 2018 o Poster, “Limitations of multichannel intraluminal impedance- pH monitoring for pediatric patients- a single
center initial experience” o Poster, “Effects of a Constipation Educational Video: A Randomized Controlled Trial”
David Troendle
Digestive Disease Week, Washington, DC, June 2018 o Poster, “Pediatric Chronic Pancreatitis without Prior Acute or Acute Recurrent Pancreatitis: Report from
the INSPPIRE Consortium” o Poster, “Multicenter Evaluation of Procedural Volume in Academic Pediatric Gastroenterology Centers”
NASPGHAN 2018 Annual, Hollywood, FL October 2018 o Poster, “IV Ibuprofen for the Prevention of Post-ERCP Pancreatitis in Pediatric Patients: A Prospective
Randomized Double-Blind Placebo-Controlled Pilot Study” o Poster, “Regional Variations in Clinical Characteristics and Management of Pediatric Acute Recurrent and
Chronic Pancreatitis: Report from the INSPPIRE Study” o Poster, “Factors Associated with Frequent Opioid Use in Children with Acute Recurrent or Chronic
Pancreatitis” o Poster, “Severe Pancreatitis is Rare in Pediatric Patients: Results from a Retrospective Review o Oral, “Endoscopic Management of Duodenal Web”
Education and Training
The Division continuously promotes new and innovative training strategies for students, residents, fellows and junior faculty, as well as educational programs to the local and national community.
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Pediatric Gastroenterology 2018 Annual Report
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, inflammatory bowel disease 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 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:
Classification of severity of acute pancreatitis
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
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.
Dr. Meghana Sathe, 2018 graduating fellow, Dr. Diana Montoya, and Dr. Norberto Rodriguez-Baez
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Pediatric Gastroenterology 2018 Annual Report
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 unraveling the basic causes of eosinophilic esophagitis. She has developed novel cell and mouse models, which are providing new insights into this disease and elucidating the mechanisms of eosinophilic infiltration and tissue remodeling in the esophagus. Recently she has begun work on a biorepository that will house tissue from patients suffering from food allergic disease for use in further trials.
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. Furthermore, she is exploring more efficient methods of catheter placement to study colonic 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 studies 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. David Troendle’s research focuses on interventional endoscopic approaches for the treatment of GI bleeding and pancreatic disease, as well as the prevention of post-ERCP pancreatitis. He is also investigating the epidemiology and severity of acute, recurrent and chronic pancreatitis in children.
Dr. Sarah Barlow is actively involved in the study childhood obesity and nonalcoholic fatty liver disease, working toward effective interventions.
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.
Dr. Aakash Goyal is the primary investigator on a study to evaluate the pharmacokinetics of IV proton pump inhibitors in children. He is also involved as a co-investigator on projects working to establish a biorepository for samples of patients with suspected EoE, and to evaluate esophageal biopsy techniques in children. Lastly, Dr. Goyal is involved in a project evaluating efficacy and safety of dose escalation in children with IBD on infliximab.
Drs. Edaire Cheng and Dongmei Lu
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Pediatric Gastroenterology 2018 Annual Report
Dr. Michele Alkalay focuses on the quality of life in children with celiac disease, and collaborates on research examining the microbiome in various celiac populations.
Dr. Bhaskar Gurram is involved in several projects examining the use of biologic agents such as infliximab and ustekinumab in children with IBD. He is also investigating the prevalence and etiologies of esophagitis dessicans in pediatric 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, cholangioscopy, EUS, balloon enteroscopy and capsule endoscopy and a full array of motility procedures, including anorectal, esophageal, antroduodenal, small bowel and colonic. The unit performed approximately 100 pediatric ERCPs and over 40 pediatric EUS cases in 2018.
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 GI dysmotility, 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 manometry, antroduodenal and colonic motility, and esophageal 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 directed by Dr. Ricardo-Medina was introduced providing life changing treatment to children with disordered defecation.
Aerodigestive Program
Directed by Dr. Rinarani Sanghavi and Dr. Yalonda Rivera-Sanchez (Pulmonology) 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, BRAVO pH monitoring, endoscopy, bronchoscopy and laryngoscopy.
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.
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Pediatric Gastroenterology 2018 Annual Report
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 with some of the best outcomes in the nation. Led by Dr. Amal Aqul (Transplant Hepatology) and Dr. Dev Desai (Transplant Surgery), the liver transplant program performs whole and split liver transplants in a multidisciplinary setting.
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. Located in a geographic region with a rapidly growing pediatric population, the program provides a much-needed comprehensive 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 undergone 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 skills of gastroenterologists, immunologists, geneticists and pathologists, and it is the only one of its kind in North 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. David Troendle, 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 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. 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
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Pediatric Gastroenterology 2018 Annual Report
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 mechanisms underlying disease pathogenesis. In 2018 we became the first program to offer unsedated transnasal endoscopy for children with EoE allowing us to histologically monitor response to therapy without the need for sedation or anesthesia.
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. It is the only program of its kind in the DFW area.
Pancreatic Disorders Program
Dr. David Troendle directs this 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.
Fecal Microbial Transplant Program
In 2018, Dr. Bhaskar Gurram and Dr. Paul Sue co-founded this program, which is the first of its kind in North Texas, aimed at treating children with recurrent or refractory C difficile infection.
Patient Statistics
Dallas 2017 2018
Ambulatory Visits New Follow-up
14,861 4,161
10,700
15,110 4,077
11,033
Plano 2017 2018 Ambulatory Visits New Follow-up
6,844 2,190 4,654
6,652 1,980 4,672
THD 2017 2018 Ambulatory Visits New Follow-up
717 272 445
711 264 447
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Pediatric Gastroenterology 2018 Annual Report
Totals 2017 2018 Ambulatory Visits New Follow-up
22,422 6,623
15,799
22,473 6,321
16,152
Procedures 3,304 3,663
Current Grant Support
Sarah Barlow
Grantor: AHRQ, Pilot Funding Title of Project: Needs Assessment of Parents and Healthcare Practices to Improve Childhood Obesity Management Role: Site Principal Investigator Dates: 2018 Grantor: NIDDK Title of Project: Building Evidence for High-quality Pediatric Primary Care Weight and Comorbidity Management Role: Co- Principal Investigator Dates: 2018-2020
Grantor: NHLBI Title of Project: Development of Single-screen Clinical Decision Support to Increase Guideline-based Weight Management and Co-Morbidity Care Role: Co- Principal Investigator
Dates: 2018-2020 Bradley Barth
Grantor: NIH-NIDDK Title of Project: Consortium for the Study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer Role: Site Principal Investigator 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
Ashish Patel
Grantor: NIH Title: Sex Differences in Statural Growth Impairment in Pediatric Crohn’s Disease Role: Site Principal Investigator 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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Pediatric Gastroenterology 2018 Annual Report
Meghana Sathe Grantor: Cystic Fibrosis Foundation Title: STRC Role: Co-Principal Investigator Dates: 2018-2020 Grantor: Cystic Fibrosis Therapeutics Title: ARC “Additional Research Coordinator” Role: Principal Investigator Dates: 2015-2019 Grantor: Cystic Fibrosis Foundation Title: MHC “Mental Health Coordinator” Role: Sub-Investigator Dates: 2016-2018 Grantor: Cystic Fibrosis Foundation Title: LAZA17BO 1st and 2nd Year Fellowship Grant Role: Principal Investigator Dates: 2017-2019
Grantor: Cystic Fibrosis Foundation Title: PHEN18BO 1st and 2nd Year Fellowship Grant Role: Principal Investigator Dates: 2018-2020
Grantor: Cystic Fibrosis Foundation Title: STIGMA Role: Principal Investigator Dates: 2018
Grantor: Cystic Fibrosis Foundation Title: CRSP (Clinical Research Scholars Program) Role: Principal Investigator Dates: 2018 - 2021
Grantor: Cystic Fibrosis Foundation Title: CNCF3 – Pilot Learning Network Role: Co-Principal Investigator Dates: 2016-2019
Grantor: Cystic Fibrosis Foundation Title: Physical Therapy Role: Co-Principal Investigator Dates: 2016-2019
Grantor: Cystic Fibrosis Therapeutics Title: SATHE14YO Therapeutic Drug Center Role: Co-Principal Investigator Dates: 2015-2019
Grantor: Cystic Fibrosis Foundation Title: CC034-34 TX-34/34 Children’s Medical Role: Co-Principal Investigator Dates: 2013-2019
David Troendle
Grantor: NIH-NIDDK U01 DK108328-02S1 Title: Consortium for the Study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer: Coordinating and Data Management Center (CSCPDPC-CDMC) Role: Principal Investigator Dates: 2015-2018
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 – 2019
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Pediatric Gastroenterology 2018 Annual Report
Peer-Reviewed Publications
1. Abu-El-Haija M, Kumar S, Quiros JA, Balakrishnan K, Barth B, et al. Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr. 2018 Jan;66(1):159-176. PMID: 29280782
2. Arsik I, Frediani JK, Frezza D, Chen W, Ayer T, Keskinocak P, Jin R, Konomi JV, Barlow SE, et al. Alanine Aminotransferase
as a Monitoring Biomarker in Children with Nonalcoholic Fatty Liver Disease: A Secondary Analysis Using TONIC Trial Data. Children (Basel). 2018 May 25;5(6). PMID: 29799476
3. Barlow SE, Salahuddin M, Butte NF, Hoelscher DM, Pont SJ. Improvement in Primary Care Provider Self-Efficacy and
Use of Patient-Centered Counseling To Address Child Overweight and Obesity after Practice-Based Changes: Texas Childhood Obesity Research Demonstration Study. Child Obes. 2018 Nov/Dec;14(8):518-527. PMID: 30153036
4. Barth BA. Challenges in pediatric gastroenterology, 2018. Curr Opin Pediatr. 2018 Oct;30(5):645. PMID: 30045084 5. Dellon ES, Liacouras CA, Molina-Infante J, Furuta GT, Spergel JM, Zevit N, Spechler SJ, Attwood SE, Straumann A, Aceves
SS, Alexander JA, Atkins D, Arva NC, Blanchard C, Bonis PA, Book WM, Capocelli KE, Chehade M, Cheng E, et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology. 2018 Oct;155(4):1022-1033.e10. PMID: 30009819
6. Fisher WE, Cruz-Monserrate Z, McElhany AL, Lesinski GB, Hart PA, Ghosh R, Van Buren G, Fishman DS, Rinaudo JAS,
Serrano J, Srivastava S, Mace T, Topazian M, Feng Z, Yadav D, Pandol SJ, Hughes SJ, Liu RY, Lu E, Orr R, Whitcomb DC, Abouhamze AS, Steen H, Sellers ZM, Troendle DM, et al; Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC). Standard Operating Procedures for Biospecimen Collection, Processing, and Storage: From the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer. Pancreas. 2018 Nov/Dec;47(10):1213-1221. PMID: 30325860
7. Goyal A. Eosinophilic esophagitis: short and long-term considerations. Curr Opin Pediatr. 2018 Oct;30(5):646-652.
PMID: 30015687 8. Haberman Y, BenShoshan M, Di Segni A, Dexheimer PJ, Braun T, Weiss B, Walters TD, Baldassano RN, Noe JD,
Markowitz J, Rosh J, Heyman MB, Griffiths AM, Crandall WV, Mack DR, Baker SS, Kellermayer R, Patel A, et al. Long ncRNA Landscape in the Ileum of Treatment-Naive Early-Onset Crohn Disease. Inflamm Bowel Dis. 2018 Jan 18;24(2):346-360. PMID: 29361088
9. Harlow KE, Africa JA, Wells A, Belt PH, Behling CA, Jain AK, Molleston JP, Newton KP, Rosenthal P, Vos MB, Xanthakos
SA, Lavine JE, Schwimmer JB; Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) (Barlow SE). Clinically Actionable Hypercholesterolemia and Hypertriglyceridemia in Children with Nonalcoholic Fatty Liver Disease. J Pediatr. 2018 Jul;198:76-83.e2. PMID: 29661561
10. Lindoso L, Mondal K, Venkateswaran S, Somineni HK, Ballengee C, Walters TD, Griffiths A, Noe JD, Crandall W, Snapper
S, Rabizadeh S, Rosh JR, LeLeiko N, Guthery S, Mack D, Kellermayer R, Gulati AS, Pfefferkorn MD, Moulton DE, Keljo D, Cohen S, Oliva-Hemker M, Heyman MB, Otley A, Baker SS, Evans JS, Kirschner BS, Patel AS, et al. The Effect of Early-Life Environmental Exposures on Disease Phenotype and Clinical Course of Crohn's Disease in Children. Am J Gastroenterol. 2018 Oct;113(10):1524-1529. PMID: 30267029
11. McLaughlin CM, Bennett M, Channabasappa N, Journeycake J, Piper HG. Anticoagulation results in increased line
salvage for children with intestinal failure and central venous thrombosis. J Pediatr Surg. 2018 May;53(5):1052-1055. PMID: 29499845
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Pediatric Gastroenterology 2018 Annual Report
12. Miyata N, Morris LL, Chen Q, Thorne C, Singla A, Zhu W, Winter M, Melton SD, Li H, Sifuentes-Dominguez L, et al. Microbial Sensing by Intestinal Myeloid Cells Controls Carcinogenesis and Epithelial Differentiation. Cell Rep. 2018 Aug 28;24(9):2342-2355. PMID: 30157428
13. Narkewicz MR, Horslen S, Hardison RM, Shneider BL, Rodriguez-Baez N, et al; Pediatric Acute Liver Failure Study Group.
A Learning Collaborative Approach Increases Specificity of Diagnosis of Acute Liver Failure in Pediatric Patients. Clin Gastroenterol Hepatol. 2018 Nov;16(11):1801-1810.e3. PMID: 29723692
14. Ruan W, Shamoun M, Schindel D, Patel AS. Hypercoagulation and Pediatric Inflammatory Bowel Disease: A Case
Report. J Pediatr Gastroenterol Nutr. 2018 Apr;66(4):e112-e114. PMID: 29287018 15. Salahuddin M, Barlow SE, Pont SJ, Butte NF, Hoelscher DM. Development and use of an index for measuring
implementation of a weight management program in children in primary care clinics in Texas. BMC Fam Pract. 2018 Dec 5;19(1):191. PMID: 30518321
16. Sanghavi RM, Centeno RM, Barth B. Single Balloon-assisted Colonoscopy for Placement of Colonic Manometry Catheters: Initial Experience in Children. J Pediatr Gastroenterol Nutr. 2018 Aug;67(2):194-197.PMID: 29570555
17. 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. Recommendations for Diagnosis and Management of Autoimmune Pancreatitis in Childhood: Consensus From INSPPIRE. J Pediatr Gastroenterol Nutr. 2018 Aug;67(2):232-236. PMID: 29746340
18. Schirmer M, Denson L, Vlamakis H, Franzosa EA, Thomas S, Gotman NM, Rufo P, Baker SS, Sauer C, Markowitz J, Pfefferkorn M, Oliva-Hemker M, Rosh J, Otley A, Boyle B, Mack D, Baldassano R, Keljo D, LeLeiko N, Heyman M, Griffiths A, Patel AS, et al. Compositional and Temporal Changes in the Gut Microbiome of Pediatric Ulcerative Colitis Patients Are Linked to Disease Course. Cell Host Microbe. 2018 Oct 10;24(4):600-610.e4. PMID: 30308161
19. Sorensen LG, Neighbors K, Hardison RM, Loomes KM, Varni JW, Ng VL, Squires RH, Alonso EM; Pediatric Acute Liver
Failure Study Group (Rodriguez-Baez N). Health Related Quality of Life and Neurocognitive Outcomes in the First Year after Pediatric Acute Liver Failure. J Pediatr. 2018 May;196:129-138.e3. PMID: 29551316
20. Spencer EA, Davis SM, Mack DR, Boyle BM, Griffiths AM, LeLeiko NS, Sauer CG, Keljo DJ, Markowitz JF, Baker SS, Rosh
JR, Baldassano RN, Oliva-Hemker M, Pfefferkorn MD, Otley AR, Heyman MB, Noe JD, Patel AS, et al. Serologic Reactivity Reflects Clinical Expression of Ulcerative Colitis in Children. Inflamm Bowel Dis. 2018 May 18;24(6):1335-1343. PMID: 29718391
21. Spergel JM, Aceves SS, Kliewer K, Gonsalves N, Chehade M, Wechsler JB, Groetch M, Friedlander J, Dellon ES, Book W,
Hirano I, Muir AB, Cianferoni A, Spencer L, Liacouras CA, Cheng E, et al. New developments in patients with eosinophilic gastrointestinal diseases presented at the CEGIR/TIGERS Symposium at the 2018 American Academy of Allergy, Asthma & Immunology Meeting. J Allergy Clin Immunol. 2018 Jul;142(1):48-53. PMID: 29803797
22. Tran P, Carroll J, Barth BA, Channabasappa N, Troendle DM. Over the Scope Clips for Treatment of Acute Nonvariceal Gastrointestinal Bleeding in Children Are Safe and Effective. J Pediatr Gastroenterol Nutr. 2018 Oct;67(4):458-463. PMID: 29927862
23. Uc A, Perito ER, Pohl JF, Shah U, Abu-El-Haija M, Barth B, Bellin MD, Ellery KM, Fishman DS, Gariepy CE, Giefer MJ,
Gonska T, Heyman MB, Himes RW, Husain SZ, Maqbool A, Mascarenhas MR, McFerron BA, Morinville VD, Lin TK, Liu QY, Nathan JD, Rhee SJ, Ooi CY, Sellers ZM, Schwarzenberg SJ, Serrano J, Troendle DM, et al; Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC). INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE Cohort Study: Design and Rationale for INSPPIRE 2 From the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer. Pancreas. 2018 Nov/Dec;47(10):1222-1228. PMID: 30325861
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Pediatric Gastroenterology 2018 Annual Report
24. Uc A, Zimmerman MB, Wilschanski M, Werlin SL, Troendle D, Shah U, Schwarzenberg SJ, Rhee S, Pohl JF, Perito ER,
Palermo JJ, Ooi CY, Liu Q, Lin TK, Morinville VD, McFerron BA, Husain SZ, Himes R, Heyman MB, Gonska T, Giefer MJ, Gariepy CE, Freedman SD, Fishman DS, Bellin MD, Barth B, Abu-El-Haija M, Lowe ME. Impact of Obesity on Pediatric Acute Recurrent and Chronic Pancreatitis. Pancreas. 2018 Sep;47(8):967-973. PMID: 30059474
25. Varni JW, Shulman RJ, Self MM, Saeed SA, Zacur GM, Patel AS, et al. Perceived medication adherence barriers
mediating effects between gastrointestinal symptoms and health-related quality of life in pediatric inflammatory bowel disease. Qual Life Res. 2018 Jan;27(1):195-204. PMID: 28887749
26. Venkateswaran S, Prince J, Cutler DJ, Marigorta UM, Okou DT, Prahalad S, Mack D, Boyle B, Walters T, Griffiths A, Sauer
CG, LeLeiko N, Keljo D, Markowitz J, Baker SS, Rosh J, Pfefferkorn M, Heyman MB, Patel A, et al. Enhanced Contribution of HLA in Pediatric Onset Ulcerative Colitis. Inflamm Bowel Dis. 2018 Mar 19;24(4):829-838. PMID: 29562276
27. Walls T, Cavuoti D, Channabasappa N, Yang M, Southern P, Gill MA, Park JY. Abdominal Angiostrongyliasis: A
Presentation of Eosinophilic Granulomatous Colitis. Int J Surg Pathol. 2018 Aug;26(5):475-478. PMID: 29278974
28. Wang J, Park JY, Huang R, Souza RF, Specher SJ, Cheng E. Obtaining Adequate Lamina Propria for Subepithelial Fibrosis Evaluation in Pediatric Eosinophilic Esophagitis. Gastrointest Endosc. 2018 May;87(5):1207-1214.e3. PMID: 29309779
29. Zhu W, Winter MG, Byndloss MX, Spiga L, Duerkop BA, Hughes ER, Büttner L, de Lima Romão E, Behrendt CL, Lopez CA,
Sifuentes-Dominguez L, et al. Precision editing of the gut microbiota ameliorates colitis. Nature. 2018 Jan 11; 553(7687):208-211. PMID: 29323293
Book Sections
1. Gurram B. Diarrhea. In: Kliegman RM, Lye PS, Bordini BJ, Toth H, Basel D, eds. Nelson Pediatric-Symptom Based Diagnosis. Elsevier; 182-203. 2018.
2. Sanghavi R, Rosen R. Esophageal Dysphagia. In: Ongkasuwan J, Chiou EH, eds. Pediatric Dysphagia; Challenges and
Controversies. Springer International Publishing; 215-238. 2018.
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Pediatric Gastroenterology 2018 Annual Report
