International Medicine

International Update Newsletter: Division of Gastroenterology, Hepatology and Nutrition

Ranked No. 1 in the United States for Gastroenterology in U.S.News & World Report’s 2012-13 Best Children’s Hospitals survey, the Division of Gastroenterology, Hepatology and Nutrition at The Children’s Hospital of Philadelphia is one of the largest pediatric GI programs in the world, handling more than 30,000 outpatient visits and more than 6,000 invasive procedures annually.

Led by David Piccoli, MD, the division is home to multidisciplinary programs for Alagille syndrome, biliary atresia, eosinophilic disorders, bone health, celiac disease, inflammatory bowel disease, viral hepatitis, and other conditions, and offers a full range of specialized diagnostic procedures. With 34 attending physicians, dozens of additional clinical staff, and a vibrant research program, the division is able to offer patients the most advanced treatments available anywhere in the world.

The Fred and Suzanne Biesecker Pediatric Liver Center

With a world-renowned team that includes nine pediatric hepatologists as well as surgeons, nurse practitioners, gastroenterologists, social workers, psychologists and nutritionists, the Liver Center at The Children’s Hospital of Philadelphia is the largest pediatric liver center in the United States.

The Liver Center was founded in 2001 to focus on improving treatment and outcomes for children with biliary atresia, a very rare condition that causes the bile ducts to become blocked and leads to liver damage. The center brings together experts in molecular biology, immunology, genetics, pathology, surgery and pediatric hepatology in a comprehensive program that blends clinical care with basic and translational research to improve outcomes for children with this complex disease. Surgeons at CHOP have been performing the surgery used to treat biliary atresia, called the Kasai procedure, for more than 30 years.

The Liver Center’s physicians and scientists are also internationally recognized leaders in laboratory and clinical research on pediatric liver disease. Our team includes 17 principal investigators who collaborate with experts across the institution to translate research findings into new treatments for pediatric liver disease.

Liver Transplant Program

The Children’s Hospital of Philadelphia’s Liver Transplant Program, founded in 1989, is one of the most experienced such programs in the nation. The liver transplant team, led by surgeons Kim Olthoff, MD, and Abraham Shaked, MD, and hepatologist Elizabeth Rand, MD, has performed more than 300 liver transplants in children, with graft and patient survival rates above the national average. The program is a collaboration between CHOP and our adult academic partners at the Hospital of the University of Pennsylvania (HUP), a collaboration that gives patients access to the best care enhanced by the most advanced research trials and therapies in the world.

Per CHOP policy, foreign national patients are generally not eligible for deceased donor transplants at The Children’s Hospital of Philadelphia; however, children who require a liver transplant can be treated with a transplant from a living donor. Living donor liver transplantation is accomplished by removing a small segment of liver with corresponding bile ducts and blood vessels to use as the transplant organ. The HUPCHOP team has performed 16 living-related transplants for children through its joint program, which offers state-of-the-art care for both the adult donor and the young recipient. In addition, the HUP surgeons have performed 71 adult-to-adult living donor liver transplants. The donor must be over 21 and must undergo extensive testing to ensure that a transplant is feasible. The family should contact the International Medicine team prior to coming to the United States to ensure that all necessary requirements are met.

Our team also provides second opinions for patients seeking alternatives to liver transplantation. Often this can be done through a review of a child’s medical records, and may not require a trip to CHOP.

Intestinal Rehabilitation Program

Children who have had a bowel resection, a surgical procedure in which part of the intestine is removed, are at risk for short-bowel syndrome, a complex condition that occurs when the intestine isn’t long enough to absorb nutrients properly. CHOP’s Intestinal Rehabilitation Program (IRP), led by Christina Bales, MD, works with these patients and their families to manage the condition and the complications that can accompany it, with the goal of finding an appropriate feeding plan and weaning patients off of IV nutrition, which puts patients at risk for liver disease and infections. The IRP team is currently following more than 80 children with short-bowel syndrome and/or intestinal failure on an outpatient basis, and also works to identify CHOP inpatients who could benefit from the team’s expertise.

Families whose children experience feeding difficulties, growth problems, malnutrition and pain after a bowel resection come from around the world to consult with the experts on the IRP team, which includes a gastroenterologist, a dietitian, a nurse and a social worker. The team reviews the patient’s records, performs a full range of tests and evaluations, and develops a feeding and medication plan that takes into account both the patient’s unique medical needs and the formulas and other resources available in his or her home country.

A collaborative approach is one of the hallmarks of the IRP. The IRP team works closely with clinical teams in many other top-ranked CHOP programs and subspecialties, including surgery, neonatology, GI motility and home parenteral nutrition, to provide comprehensive, well-coordinated care for every patient.

Lustgarten Center for GI Motility

The Children’s Hospital of Philadelphia’s Lustgarten Center for GI Motility, led by John T. Boyle, MD, and Kristin N. Fiorino, MD, provides the most advanced care for patients with GI motility disorders, which make eating and digesting difficult and put patients at risk of malnourishment. The Lustgarten Center is one of the very few pediatric GI motility centers in the United States and offers a full range of the most advanced diagnostic procedures, including manometric studies of the esophagus, small bowel, colon and rectum, and 24-hour pH-impedance monitoring, which helps clinicians determine how to best manage a patient’s reflux. The center’s GI Motility Lab is equipped with the technology necessary to do procedures that aren’t available at most other hospitals.

Because GI motility problems often arise in connection with another condition, such as sleep apnea, airway disorders, Trisomy 21 or scleroderma, the Lustgarten Center’s clinicians collaborate with many other CHOP subspecialists to assess patients’ needs and provide the very best care. The center’s team works especially closely with CHOP’s Pediatric Anorectal Continence Evaluation Program to provide postsurgical care for children treated for imperforate anus, myelomeningocele and Hirschsprung’s disease as well as with the aerodigestive clinic and the Dysfunctional Outpatient Voiding Education (DOVE) Center, which treats children with bladder and urinary tract dysfunction. The Lustgarten Center also has a dedicated psychologist who works with patients and families, offering ongoing support and practical strategies for improving quality of life.