Gastroenterology, Hepatology and Nutrition

Significant Accomplishments

Digestive Health Center One of 17 Core Research Centers Nationwide

The Digestive Health Center (DHC) directed by Jorge Bezerra, MD, and managed by Cynthia Wetzel, PhD, is one of only 17 Silvio O. Conte Digestive Diseases Research Core Centers in the U.S., and the only one dedicated to pediatric diseases. The center seeks to improve diagnosis, treatments and outcomes for chronic liver disease, inflammatory and diarrheal diseases and obesity. Our center engages 102 investigators from 21 divisions within the Department of Pediatrics and eight other departments within the University of Cincinnati College of Medicine. This year, we added nine investigators from Gastroenterology, Hepatology and Nutrition, Allergy and Immunology, Oncology, Endocrinology, Infectious Diseases, and Experimental Hematology and Cancer Biology. Alexander Miethke, MD, a member of our Division, was among those joining the center after receiving NIH funding to study the role of regulatory T cells in biliary atresia. Noah Shroyer, PhD, a DHC member from our Division, was elected  Vice Chair of the Growth, Development and Child Health Section of the American Gastroenterological Association. Also in 2013, the DHC started the Pluripotent Stem Cell and Organoid Core, under the leadership of  James Wells, PhD,  and Chris Mayhew, PhD, which uses state-of-the-art technology to advance translational research in digestive diseases. Collectively, DHC investigators have received $32.5 million in extramural research funds and have published more than 140 peer-reviewed articles during the past 12 months. Our successful Pilot and Feasibility Program also distributed $1.15 million among 29 junior investigators since 2007. These investigators have since attracted $20.1 million in extramural grant funding.

Liver Transplant Program Reducing Immunosuppression Dose Levels

Immunosuppression is a critical component of the care of children following liver transplantation. The goal is to administer the lowest possible dosage to prevent rejection, both in the short- and long-term phases of life of after transplant. John Bucuvalas, MD, is our site principal investigator for the IWITH trial, a multi-center study of immunosuppression withdrawal in children with stable graft function. The trial addresses key conclusions of the NIH-sponsored 2007 consensus conference on long-term outcomes in pediatric liver transplantation, which states that long-term immunosuppression can lead to  substantial complications and that identifying biomarkers to predict therapy tolerance could lessen the risk. The overriding goal of the IWITH trial is to guide clinical decision-making to achieve safe withdrawal of immunosuppression. The 12-center study is jointly funded by NIDDK and NIAID. Sandy Feng MD, PhD, from the University of California San Francisco is the trial principal investigator. In addition to his local role, Bucuvalas serves as the study’s protocol chair.

Inflammatory Bowel Disease Services Continue to Grow

More than 700 children with inflammatory bowel disease (IBD) from 25 states visited Cincinnati Children’s in the past year to receive primary IBD care and second opinions. Many families are seeking  our state-of-the art services, which include diagnostic imaging without radiation exposure and targeted psychology interventions for non-adherence. Many others are seeking expert advice. Our volume of second opinion patients has quadrupled in the past three years. In February, more than 300 families attended our annual Family Education and Support day, which continues to grow in collaboration with the local Crohn’s and Colitis Foundation of America chapter. Our research efforts this year included contributing to international genome-wide association studies to identify susceptibility genes for pediatric-onset disease, and prospective cohort studies to develop personalized models of disease behavior and response to therapy. In collaboration with the Broad Institute, MIT, we have characterized the gut microbial community and host response in 1,600 children with IBD  and have used this information to define novel pathogenic mechanisms and patient sub-groups. Our investigators are deeply involved in launching the PROTECT study, the first NIH-funded multi-center clinical trial to test a model for predicting therapeutic responses and clinical outcomes among newly diagnosed children with ulcerative colitis. The project will incorporate clinical, genomic, microbial and immune biomarkers that we have developed. At Cincinnati Children’s, this study includes Bruce Trapnell, MD, Pulmonary Biology;  Mi-Ok Kim, PhD, Epidemiology and Biostatistics; and Bruce Aronow, PhD, Biomedical Informatics. Meanwhile, Kevin Hommel, PhD, is leading the first randomized controlled multi-center trial of a telemedicine intervention to improve medication adherence in children with IBD. Knowledge gained from these studies will be rapidly translated into practice through our collaborations with Peter Margolis, MD, PhD, in Clinical Effectiveness, via his leadership of the ImproveCareNow (ICN) pediatric IBD quality improvement network. The IBD Center has played a leading role in ICN, which has achieved significant improvement in patient remission rates by implementing consensus patient care guidelines and practices. At Cincinnati Children’s, we have reached a sustained 67 percent remission rate among our IBD patients, up 20 percent over the past two years.