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Gastroenterology

New technology eases management of liver disease

Children’s of Alabama is using FibroScan to help patients with liver disease. (Stock photo)

With obesity in children steadily rising, more young patients are coming to Children’s of Alabama with a form of fatty liver disease that can greatly imperil their health. But determining the progression of liver disease can be a thorny process. To smooth that path, Children’s recently invested in an increasingly popular technology called FibroScan, helping University of Alabama at Birmingham (UAB) pediatric physicians to deftly and comprehensively manage children’s care.

Using a technique known as transient elastography, FibroScan was the first FDA-approved device of its kind and is considered an aid to managing liver disease. Quick, noninvasive and painless, it uses an enhanced form of ultrasound to send vibrations into the liver to measure its stiffness, which typically indicates fibrosis or scarring. “The more quickly the wave passes through the liver, the more stiff the liver is,” Children’s transplant hepatologist David Willcutts, M.D., explained.

By assessing the severity of scarring—and the potential for cirrhosis—FibroScan can help diagnose or monitor the progression of various liver conditions. These range from less-common cystic fibrosis-associated liver disease to more-prevalent autoimmune liver diseases and metabolic dysfunction-associated steatotic liver disease (MASLD). The latter—which can also result from genetic predisposition—essentially makes the liver unable to process the high amounts of extra calories a person is consuming, spurring inflammation.

David Willcutts, M.D.

About one-third of the patients in Children’s Hepatology Clinic, which serves about 500 ongoing patients each year, have suspected or confirmed fatty liver disease.

“We will be using this for almost every patient with confirmed fatty liver disease, so we can measure the baseline stiffness of the liver when they first see us,” said Willcutts, who’s also an assistant professor of pediatrics at UAB. “The machine also provides a CAP (controlled attenuation parameter) score as a surrogate of fat content of the liver, which is useful for the growing numbers of adults—and unfortunately, children—in our country with fatty liver disease. It’s one of the rising conditions leading to adult liver transplants.”

FibroScan is a welcome alternative to invasive liver biopsies and other forms of elastography that require a separate radiology appointment. A FibroScan exam takes just minutes, offering little disruption for young patients and faster treatment decisions for physicians. The new equipment arrived in the summer of 2025.  

“One of the big selling points of this technology is it makes the patient experience much easier because it can be done within a clinic visit and will save them a visit with radiology, which involves a separate appointment elsewhere in the hospital or even at another Children’s facility,” Willcutts said. “It’s a one-stop kind of assessment.”

By keeping close tabs on a patient’s liver stiffness, FibroScan offers Children’s specialists the ability to understand “how much runway we have before we need to do potentially invasive assessments and other therapies,” Willcutts said.

While the goal is always to avert lasting damage to the liver, the presence of cirrhosis is generally thought to be irreversible. FibroScan can help doctors pinpoint “how close we’re getting to that and if the patient needs a biopsy—or a repeat biopsy—to evaluate scarring at the microscopic level and make sure we’re not missing something before it’s too late to act upon it,” he explained.

FibroScan results can also help physicians tailor treatments to patients’ precise stage of liver damage, including certain medications that can be tricky for the liver to process.

“Children’s is a referral center for pediatric liver disease in Alabama because we’re the only liver transplant center in the state,” Willcutts said. “Being able to offer FibroScan helps us elevate our level of care and offer smoother visits and a convenient assessment of liver disease that we didn’t have before.”

July 29, 2025 by
Gastroenterology

Children’s of Alabama Celiac Disease Clinic Growing to Meet Rising Demand

John Sands, M.D., leads the Celiac Disease Clinic at Children’s of Alabama.

Celiac disease is an autoimmune gastrointestinal disease that affects between 1% and 4% of the population. It is triggered by gluten, found in wheat, barley, rye and triticale (a mix of wheat and rye). Its incidence in children is increasing dramatically, with one study showing a 165% increase between 1994 and 2014, although recent studies suggest the incidence increase may have plateaued.[1],[2]

John Sands, M.D., who runs the Celiac Disease Clinic at Children’s of Alabama, is well aware of the increasing numbers, given the clinic’s own growth. In 2023, the clinic had 109 patient encounters. By 2024, that number had doubled to 221. Halfway through 2025, clinic staff had already had 157 patient encounters, on track for another record year. It’s gone from a monthly clinic to one that now meets three half days a month at different locations and times to make it more accessible to families.

The rising incidence in celiac disease is thought to be due to a combination of improved disease recognition and diagnostic testing, Sands said, as well as a true rise in the disorder itself. “Theories are that the increase is driven by environmental and lifestyle factors,” he said, including dietary changes and processed foods. Disruption of the intestinal barrier from viral infections and alterations in the gut microbiome (intestinal dysbiosis) are also being investigated as potential contributors in genetically susceptible individuals.

The core of celiac disease lies with a genetic mutation. But what’s puzzling is that while about 40% of the world’s population has the gene, only between 1% and 4% develop the disease, Sands said. “And probably half of those don’t realize that they’ve got celiac disease.” Most likely, he said environmental factors activate the gene.

More Than Stomach Problems

Many people misunderstand celiac disease, thinking it only causes digestive issues. “Celiac disease is not just belly pains,” Sands said. The condition can cause serious long-term health problems if left untreated, including bone loss, increased risk of heart disease, fertility issues and certain types of lymphomas.

The disease frequently appears alongside other autoimmune conditions. “There’s a triad of autoimmune diseases that tend to cluster together,” Sands said: Type 1 diabetes (T1DM), autoimmune thyroid disease and celiac disease.

In fact, many referrals to the clinic come from endocrinologists who treat children with T1DM and routinely screen for celiac disease. “It’s not uncommon for us to see those kids without any GI symptoms at all,” Sands said. Another clue the child may have celiac is poor growth. “It’s also not unusual for this to get picked up with kids who are shorter than we would predict them to be based on their parents’ height. You do the bloodwork for celiac disease and even though they have no GI symptoms, they have it.”

The Challenge of Living Gluten Free

The only treatment for celiac disease is strict, lifelong avoidance of gluten. This goes far beyond avoiding obvious sources like bread and pasta.

“Gluten is not just in food,” Sands said. “It’s all over the place. It’s in sunscreens. It’s in lip balm, it’s in shampoo, it’s in conditioners, it’s in Play-Doh.”

Following a gluten-free diet is not only challenging but expensive. He recalled one family with a child who had celiac disease that wanted the entire family to eat gluten free since the logistics of living gluten free would be easier for all than for one. But they couldn’t afford it,” he said. “A loaf of gluten-free bread can be six dollars.”

A Team Approach

The clinic’s core is its multidisciplinary approach. “One of the beauties of a celiac clinic is I have a registered dietitian,” Sands said, something that isn’t available to general pediatricians. The clinic also provides something else many doctors can’t offer: time.

“A general pediatrician is scheduling patients every eight to 10 minutes,” he said. “I’m setting up 40-minute slots and frequently spending longer than that with the patients and family.”

The clinic also participates in research efforts, including a collaborative study with Washington University examining immune changes in celiac disease progression.

Moving forward, Sands would like to provide more education about the disease for regional primary care clinicians, as well as patients and their families.

For now, he’s thrilled to be able to provide this specialized care, particularly since he follows his patients long term. “These are kids I get to know and see over and over again, and even watch go off to college.”

[1] Absah I, Patel B, Murray J, et al. Increasing Incidence and Altered Presentation in a Population-based Study of Pediatric Celiac Disease in North America. J Ped Gastro Nutr. 2017; 65 (432–437).

[2] VanNess GH, Ismail Y, Lee AT, King KS, Murray JA, Absah I. Are we beyond the peak of celiac disease incidence in Olmsted County, Minnesota, USA?. Gastroenterology and Functional Medicine. 2024 Dec 27;2.

July 25, 2025 by
Gastroenterology

New technology improves diagnosis of esophageal conditions

The Children’s gastroenterology team began using Endoflip in the fall of 2024.

Diagnosing esophageal disorders in pediatric patients presents a number of challenges for both providers and patients. The diagnostic tools typically used in the past often caused discomfort for the patient and made diagnosis difficult. Thanks to the addition of a new technology, Children’s of Alabama is able to circumvent these issues to streamline the process for both sides.

In the fall of 2024, Children’s began using an endoluminal functional lumen imaging probe, also known as EndoFlip. It’s a device that evaluates esophageal distensibility under general anesthesia during endoscopy to provide important insights for patients with conditions like dysphagia, eosinophilic esophagitis (EoE), and post-surgical complications. Clinicians have been using this on adult patients since 2009, but it was FDA approved for children 5 and older in the last few years, and at least one study suggests it’s also safe for patients even younger. In pediatric patients, who often struggle with conventional methods, the use of anesthesia significantly reduces stress and discomfort for both children and their families.

“For conditions like EoE, where esophageal inflammation and reduced distensibility are common, this tool bridges the diagnostic gap,” said Diana Montoya Melo, M.D., a pediatric gastroenterologist at Children’s. “We can now identify abnormalities that were previously undetectable, leading to timely and effective interventions.”

EndoFlip is particularly beneficial for patients with swallowing difficulties. By measuring esophageal distensibility, physicians can detect subtle functional issues that may not be evident with endoscopy or other imaging studies. For instance, patients with EoE often present with swallowing challenges despite minimal inflammation.

EndoFlip also helps physicians identify areas of reduced esophageal diameter, guiding therapeutic interventions such as esophageal dilation. This can lead to immediate symptom relief and dramatically improve a patient’s quality of life. “We can identify abnormalities we couldn’t before, like areas of decreased distensibility, and address them with esophageal dilation — fixing symptoms immediately in some cases,” Montoya Melo said.

The technology also helps evaluate post-surgical complications in patients with congenital esophageal anomalies, such as tracheoesophageal fistula. By pinpointing areas of reduced distensibility, EndoFlip helps ensure accurate diagnoses and effective management plans.

For Children’s clinicians, introducing EndoFlip into existing diagnostic workflows has streamlined the patient management process. Combining it with endoscopy has enabled physicians to save time and resources, avoiding the need for multiple procedures. “It only adds about five to seven minutes to the procedure, yet it provides critical information that can prevent unnecessary repeat evaluations,” Montoya Melo said.

Patients also benefit from reduced hospital visits, fewer diagnostic tests, and faster resolutions to their symptoms. Also, EndoFlip’s ability to guide precise interventions eliminates the trial-and-error approach, saving both time and health care resources.

“The biggest advantage for families is being able to get information similar to esophageal manometry while the patients are sedated during endoscopy,” Montoya Melo said. “This avoids the discomfort of a transnasal catheter procedure while awake.”

January 22, 2025 by
Gastroenterology

Nasogastric tube replacement at home

In April 2024, Children’s began offering training for families on how to replace nasogastric tubes at home. (File photo)

More than 100 children and adolescents are sent home from the inpatient setting at Children’s of Alabama every year with a nasogastric (NG) tube. Often, it’s a way to postpone or avoid surgically implanted tubes. The problem is that the tube can get out of place or the child pulls it out—sometimes multiple times a day. When that happens, caregivers have to return to Children’s—which can be an hours-long drive—or go a closer emergency room that may not be able to replace the tube. 

To reduce the strain on caregivers, Children’s began a one-hour training program in April 2024 to teach caregivers how to replace NG tubes at home. 

The curriculum is based on the NOVEL (New Opportunities for Verification of Enteral Tube Location) project, which established best practices for pediatric NG tube placement. The program primarily serves children of all ages.

Since it launched, nurses have trained more than 20 families through the gastrointestinal service alone, with more caregivers taught via other hospital departments. Caregivers practice on mannequins but must then demonstrate they can safely place the tube in the child before they are discharged on home NG care. “There’s no emotion involved in the model,” said pediatric gastroenterologist Rachel Kassel, M.D., Ph.D., who championed the program for years, “but there is on one’s own child.”

“They’re nervous about it, obviously,” said Kelli Anderson, RN, the GI care coordinator at Children’s, who trains nurses and other clinicians to provide the education. “But after we go through the steps on the mannequin and they do it and then they do it on their own child, they’re like, ‘Oh, that wasn’t as hard as I thought it was going to be.'”

“This offers us the ability to decrease the use of surgical tubes, and it reduces the number of trips a family has to take outside of their home,” Kassel said. “While there’s always some risk, it can be made safest by having nurses teach best practices.” Risks include putting the tube in the lungs, high in the esophagus, or in the small bowel. To date, however, there have been no complications with the families trained.

Caregivers learn techniques to keep squirming babies still during insertion, usually by swaddling or having another person gently hold the child’s arms. They’re also taught to verify proper tube placement via pH testing of stomach contents. To date, there are 13 nurses and nurse practitioners, as well as Kassel, providing training.

For many parents, the hardest part is psychological. “Just kind of getting the tube to go initially, to get it past the nasal cavity, that’s biggest thing that they have problems with,” Anderson said. “They’re afraid they’re going to hurt the child.”

Some families ultimately decide the home care option isn’t right for them. “We’ve had the experience of bringing the model in for some families and going through the training where they said, ‘I’m not comfortable doing this,'” Kassel said. “We totally respect that. We’ve also had cases where one parent is comfortable but the other is not, or grandma is comfortable but the parents are not. That’s also fine.” The team also assesses patients and their caregivers to determine if they qualify for NG tubes and/or home replacement, with strict guidelines for selecting the appropriate families.

The program provides bilingual training in Spanish and English and can accommodate non-literate caregivers. 

Early results suggest the program is achieving its goal of reducing emergency room visits and long trips for medical facilities. 

“It’s letting us provide much more family-centered care,” Kassel said. 

January 21, 2025 by
Gastroenterology

Cavender to lead new polyposis clinic

A new polyposis clinic, led by pediatric gastroenterologist Cary Cavender, M.D., is aimed at enhancing pediatric gastrointestinal care.

As the medical landscape evolves, so does the need for specialized care, particularly in areas that impact vulnerable populations. Successfully managing gastrointestinal issues in children can be extremely challenging, but a new clinic at Children’s of Alabama and the University of Alabama at Birmingham (UAB) will soon provide a hub of specialized care.

The Children’s of Alabama Polyposis Clinic was conceived to fill a crucial gap in pediatric gastroenterology. Recognizing the need to provide focused expertise and coordinated care for patients with polyposis syndromes “was the major impetus for establishing a dedicated clinic,” pediatric gastroenterologist Cary Cavender, M.D., said.

Scheduled to open in early 2024, the clinic will initially operate on a quarterly basis. To best serve patients, many of whom are at increased risk for cancer, the clinic will integrate with members of the oncology team specializing in cancer predisposition. Among their other duties, oncology team members will coordinate genetic counseling for high-risk patients at the Oncology Cancer Predisposition Clinic, ensuring families receive comprehensive support.

The new polyposis clinic will also offer advanced diagnostic and treatment procedures, including advanced endoscopy and colonoscopy techniques like pill cam endoscopy, as well as medication management. Cavender anticipates seeing approximately 15 to 20 patients at first each year, with potential growth as awareness increases. “Our patients need routine monitoring and early and more frequent colonoscopies to ensure they stay as healthy as possible. Since many of these diseases have genetic components, many families with these types of GI issues are already tuned in and aware of the need for consistent screening,” said Cavender, who’s also a professor of pediatrics at UAB. “We’ll make those services available to everyone in one convenient location.”

Polyposis syndromes, particularly familial adenomatous polyposis (FAP), present unique challenges. Cavender notes the varied penetrance of the FAP gene within families, and emphasizes the importance of early screening. The clinic’s services will extend beyond diagnostics to include treatments such as sulindac, a medication inhibiting polyp growth, administered orally for patient convenience.

The polyposis clinic stands out as a unique endeavor—one of the first of its kind in the Southeast. Cavender believes it will serve as a vital resource, offering top-tier care for children with polyposis syndromes. With a focus on early detection and a multidisciplinary approach, the clinic aims to provide families with a path forward, instilling confidence in managing these complex conditions. “Early detection makes all the difference for kids with these conditions. Our clinic will enable us to offer the most advanced procedures and genetic testing to identify problems early. Our focus means we’re on the cutting edge of delivering care,” Cavender said.

Cavender’s vision for the clinic extends beyond medical interventions to fostering awareness among health care providers and ensuring that every child in need finds a dedicated and expert team ready to guide them toward a healthier future. “Some of our health system doctors might not even know there are pediatric GI specialists that can help take care of this type of thing,” Cavender said. “Providing a path forward through the clinic will help patients and families navigate these complex GI syndromes successfully.”

January 26, 2024 by
Gastroenterology

Improving Inflammatory Bowel Disease Care

Children’s of Alabama and the Univ. of Alabama at Birmingham are embarking on five-year study with the Crohn’s and Colitis Foundation.

In an effort to confront the challenges faced by patients with inflammatory bowel disease (IBD), the Crohn’s and Colitis Foundation recently received a transformative grant from the Centers for Disease Control and Prevention (CDC). This comprehensive five-year project marks a pivotal collaboration with Children’s of Alabama and the University of Alabama at Birmingham (UAB), targeting the identification and resolution of barriers hindering the diagnosis and care of individuals affected by IBD.

Traci Jester, M.D., associate professor of Pediatric Gastroenterology, Hepatology and Nutrition at UAB, is a project co-investigator. The project holds promise in transforming the approach to IBD management. The grant encompasses a three-part strategy; the first phase involves patient recruitment at both the Pediatric Inflammatory Bowel Disease Clinic at Children’s and the UAB Gastroenterology Inflammatory Bowel Disease Clinic.

The study aims to comprehensively address barriers to timely diagnosis and care through data collection initiatives. The initial phase involves survey-based assessments covering a variety of factors such as psychological resilience, socio-economic status and healthcare access. Then, patient-centric focus groups comprised of a cohort of patients from the initial phase of the study will delve deeper into the challenges faced and identify potential solutions.

As the study unfolds over its five-year span, the final phase will focus on developing and testing strategic interventions. These interventions aim to bridge the gaps in disease awareness among the public and specific demographics while also focusing on educating primary care providers to ensure timely referrals to specialists.

The choice of UAB as the collaboration site for this groundbreaking study stems from its robust research infrastructure, diverse patient population and track record of successfully investigating health disparities across various medical fields. This partnership builds on previous collaborations, signifying a shared commitment to improving patient care and advancing IBD research.

IBD encompasses chronic inflammatory conditions affecting various sections of the gastrointestinal tract. Both Crohn’s disease and ulcerative colitis, two well-known inflammatory bowel conditions, affect large numbers of children throughout the country. Jester highlighted that while Crohn’s disease can impact any part of the gastrointestinal tract, ulcerative colitis typically involves inflammation in the colon.

“Both adults and children can be diagnosed with inflammatory bowel disease, but the incidence in diagnosis is actually rising in the pediatric population,” Jester said. “We’re seeing younger and younger patients being diagnosed—roughly 25% of all patients with inflammatory bowel disease are identified before the age of 18.”

One of the primary barriers to prompt diagnosis and treatment revolves around a lack of awareness among both patients and health care providers regarding the prevalence and symptoms of IBD. Jester explained how this can lead to delayed referrals and inadequate support for patients, compounded by socioeconomic factors like transportation issues and limited resources.

Jester expressed enthusiasm for this pivotal project and its potential to enhance care for all patients affected by IBD. The collaboration between UAB, Children’s and the Crohn’s and Colitis Foundation reflects a concerted effort to create tangible improvements in disease management and patient outcomes.

“We’re very excited about this project here at UAB and partnering with such a national organization as the Crohn’s and Colitis Foundation,” Jester said. “We’re very much looking forward to improving care for all of our patients.”

January 26, 2024 by
Gastroenterology

New Device Makes Esophageal Endoscopy Faster and Safer for Patients with EoE

Dr. Nicholas CaJacob performs a transnasal endoscopy on a patient using a new endoscope manufactured by EvoEndo.

Children’s of Alabama is among the first 10 pediatric medical centers in the nation to use a new endoscope that can make transnasal endoscopy (TNE) faster and easier for some patients with eosinophilic esophagitis (EoE). The device, manufactured by EvoEndo, was approved by the U.S. Food and Drug Administration last year. Children’s began using it in June 2023.

EoE is a chronic immune-mediated inflammatory disease of the esophagus resulting in symptoms and signs of esophageal dysfunction. Physicians use endoscopy every two to three months to biopsy tissue to evaluate treatment success. The new endoscope, which is inserted through the nose into the esophagus, requires no general anesthesia, just an anesthetic spray to numb the nasal passages. Patients remain awake during the procedure and need to fast only for two hours prior. Virtual reality goggles keep patient’s focus off the procedure, while a family member can be in the room observing and getting updates in real time. Children’s pediatric gastroenterologist Diana Montoya Melo, M.D., says it’s a potential game changer for patients and their families.

Montoya Melo and Nicholas CaJacob, M.D., also a pediatric gastroenterologist at Children’s, each perform about 10 EoE endoscopic procedures a week.Previously, the standard endoscopic procedure involved inserting the endoscope through the mouth into the esophagus. That method requires general anesthesia and intubation, fasting for at least six hours, a very early arrival at the hospital, IV insertion and about an hour in the recovery room after the 10-minute procedure—all of which puts a tremendous burden on the family and increases costs and the risk of potentially serious side effects.

With the new device, transnasal endoscopies takes about 15 minutes, and Montoya Melo expects the endoscopy team to be able to complete them even faster as they gain more experience. Patients also are able to leave right after the procedure. “We don’t have to monitor anything,” she said. “We’re getting the same results but in a safer, more convenient way for families and patients.”

An added bonus, Montoya Melo says, is that the endoscope is disposable. “Families like to know that it hasn’t been used on anybody before.” This also expedites the procedure because doctors don’t have to process or reprocess the equipment. “We just take it out of the box and use it,” she said. The device is approved for children 5 and older, although most centers limit its use to those 10 and older, she says.

TNE isn’t for everyone. “There are some children who are more anxious, or they will not tolerate the endoscope going through the nose,” Montoya Melo said. “This is mostly for patients and families who are interested in a different approach.” One way to know if a child is a good candidate? “We ask how they tolerated their COVID test,” she said. “And we tell them it won’t feel any worse than that.”

August 24, 2023 by
Gastroenterology

Gupta Aims to Make Children’s a “Destination of Choice” for Gastroenterology

Dr. Sandeep Gupta joined Children’s of Alabama as chief of Pediatric Gastroenterology, Hepatology and Nutrition in April 2023.

Ask Sandeep Gupta, M.D., Children’s of Alabama’s new chief of the Division of Pediatric Gastroenterology, Hepatology and Nutrition, about his goals, and he answers immediately: “To drive positive change and empower people to rise. At the end of the day, their success is our collective success.”

To that end, he said, he wants to bring “positive energy and collaborative change so as to make everyone a winner.” Without that, he said, the department can’t do its most important job: serving patients.

Gupta came to Children’s of Alabama in April after nearly 30 years at Indiana University School of Medicine and Riley Hospital for Children in Indianapolis. He brings leadership experience to Children’s, including roles as the editor-in-chief of the Journal of Pediatric Gastroenterology and Nutrition and the vice-chair of the Pediatric Growth and Development Biology Section of the American Gastroenterological Association Institute. He’s also the co-director of the training core and chair of the publications committee of the Consortium of Eosinophilic Gastrointestinal Diseases Researchers (CEGIR). Since his arrival, he’s been impressed by the team at Children’s.

“The beauty of GI at Children’s of Alabama/the University of Alabama at Birmingham (UAB) is the fantastic people in the division,” he said. “People are our most valuable resource. Our people are here for the right reason, they have their heart in the right place, and they want to do the right thing.”

He wants to make their jobs easier and more efficient with stronger infrastructure and support systems, so, as he said, “We are working at the top of our license and being effective, rather than just busy.” That means ensuring goals and synergies are aligned. He also wants to drive the academic mission in addition to patient care. “We want to take care of all patients—from simple to complex—and serve the missions of Children’s and of UAB,” he said.

Gupta wants to make Children’s a destination of choice, not just of need, by patients. He envisions Children’s as a preeminent center of excellence, not only in Alabama, but also in surrounding areas regionally and nationally. His vision encompasses four As: access for patients, ambitions and aspirations for GI personnel and academic work.

Gupta’s special areas of focus are in eosinophilic GI diseases, nutrition, pediatric obesity and pediatric endoscopy. “What I love about this field is there is so much innovation happening, plus a strong national and international community,” he said. “Yes, we do procedures, but we also use our analytical skills because we are seeing patients in clinic and in the hospital and delivering exemplary care. GI provides an enviable mix of critical thinking and procedural skills.”

August 23, 2023 by
Gastroenterology

New Clinic Offers Care for Children with Pancreatitis

Children with chronic pancreatitis are at increased risk for multiple issues.

While pancreatitis is not as prevalent in children as in adults, it can be an aggressive disease resulting in significant morbidity and even death. Now, children with this condition have access to a multidisciplinary clinic at Children’s of Alabama designed to manage their medical, physical and emotional health needs.

Chinenye Dike, M.D. M.S, a pediatric gastroenterologist at Children’s, started the Pancreatic Disorders Center of Excellence clinic in January 2023. It serves children with any type of pancreatitis, whether it be a single episode or recurrent attacks and chronic pancreatitis. It also serves children with pancreatic ductal anomalies and exocrine pancreatic insufficiency from other causes such as Shwachman-Diamond syndrome. The clinic is the only National Pancreas Foundation Pediatric Center of Excellence in Alabama.

“A major advantage of the multidisciplinary format is the ability to address the diverse medical and psychosocial effects of chronic pancreatic diseases all in one place,” Dike said. “Children with chronic pancreatitis are at increased risk for multiple issues including constant pain, missed school, diabetes, poor nutrition and reduced quality of life.” By bringing together physicians, nutritionists, pain specialists, psychologists and other providers to evaluate and create integrated treatment plans for these patients, Dike says the clinic aims to improve long-term outcomes and reduce repeat hospitalizations.

The multidisciplinary team also includes a genetic counselor—because many children with chronic pancreatitis have genetic mutations—and a pediatric endocrinologist to address endocrine complications from chronic pancreatitis, such as Type 3c diabetes, which develops when the pancreas experiences damage, such as from chronic pancreatitis or cystic fibrosis.

The clinic sees patients once a month. “We have the potential to grow,” Dike said, “given the increasing need for specialized pediatric pancreatic care in Alabama and surrounding states.” Data shows that some children can develop chronic pancreatitis even without a first episode of acute pancreatitis, she says, while some children with a severe first episode of acute pancreatitis can progress to chronic pancreatitis within four years. Additionally, a child’s quality of life can be impaired, and complications can develop after just a single episode of acute pancreatitis.

Dike and her team also track outcomes, including patient-reported outcomes such as quality of life.

August 23, 2023 by
Gastroenterology

New Surgical Liver Transplant Director Hopes to Build on Transplant Center’s Success

Dr. Marcos Pozo Jatem joined Children’s of Alabama as the surgical liver transplant director in September 2022.

In March 2023, the Children’s of Alabama Transplant Center will celebrate its 10th anniversary. It’s a decade that’s been marked by growth, and leaders believe more is ahead.

One reason for that belief is the arrival of a new surgical liver transplant director. Marcos Pozo Jatem, M.D., arrived in September after completing a fellowship in pediatric transplant and hepato-pancreato-biliary (HPB) surgery at Lurie Children’s Hospital of Chicago. He’s also completed fellowships in abdominal transplant surgery and clinical bioethics at Northwestern and was a resident at Johns Hopkins. He’s a member of 10 professional societies related to surgery and transplant, holds nine board certifications and has won several surgery and teaching awards.

Pozo Jatem was drawn to the Children’s Transplant Center because of its history of success and potential for growth. The program currently serves three to five patients per year; he believes it can serve at least eight to ten. He hopes to build a referral pattern, especially for children in Alabama. A transplant hospitalization, he says, can last a couple months, depending on how complicated the transplant is. He doesn’t want a transplant family to have the additional burden of traveling outside the state to get the services they need.

“It is a significant investment for the family, not just economically, but also for rearranging other children that they may have, their school, the parents’ work commitments, and it’s sometimes very, very difficult for a parent, for a whole family to be uprooted like that to another state,” he said.

He also hopes to begin offering partial liver transplants, which are often ideal for smaller babies. For these patients, finding a donor match with a perfectly sized liver can be rare, even when the donor is similar in size to the recipient. Giving that child a portion of a larger liver can reduce the amount of time the child is on the transplant waiting list.

“Being on the waiting list and needing a liver is still a risky position to be in sometimes,” he said.

So far, Pozo Jatem has been impressed with the center’s culture. He says he’s humbled to join the transplant team, led by Jayme Locke, M.D., director of the Division of Transplantation; and Mike Chen, M.D., chief of the Division of Pediatric Surgery. The team also includes two hepatologists, Helena Gutierrez, M.D., and Henry Shiau, M.D., who have a partnership in patient care. “We share medical decisions; we constantly communicate and discuss evaluations, assessments and plans,” Gutierrez, the medical director of the liver transplant program, said. “We have a great partnership that has been built on open communication, respect and support.”

Pozo Jatem recognizes the team’s past efforts and the resulting growth and says he looks forward to helping the center grow more.

“I think the arc of progress has led us to this point that we can now expand on the services we can provide,” he said. “So that’s the thing that I’m most proud of—being part of a team that is interested in providing the best for children.”

January 16, 2023 by