Pediatric gastroenterology is an expansive and ever-evolving medical field.

Common GI conditions in children can range from feeding disorders to stomach ulcers and pancreatitis – all of which can disrupt the digestive system’s ability to break down and absorb vital, life-supporting nutrients.

At Children’s Medical Center Dallas, part of Children’s Health, expert physicians and researchers know that the key to improving therapies for these conditions lies in discovery, along with advancing medical innovation across subspecialties such as hepatology and nutrition.

The hospital system’s affiliation with UT Southwestern Medical Center ensures patients access to a world-renowned medical faculty and transformative biomedical research.

“The UT Southwestern Pediatric GI faculty work clinically at Children’s Health, and these physicians and advanced practice providers are all up-to-date on cutting-edge therapies,” said Bradley Barth, M.D., who is the division director of pediatric gastroenterology at Children’s Health as well as a professor at UT Southwestern.

“Our patients benefit from the collective knowledge of 32 experts in pediatric GI who meet and talk regularly about difficult cases,” Barth continued. “The division houses leading specialists in specific disorders, as well as specialists in core pediatric GI.”

With 19 disease-specific sub-specialty programs, Children’s Health delivers world-class gastroenterology care to more than 24,000 patients in North Texas and surrounding states every year.

In addition to gastroenterologists, patients at Children’s Health also benefit from outstanding nursing and ancillary support, such as GI specific psychologists, dieticians, child life specialists, social workers and even therapy dogs.

Barth says this culture of collaborative excellence is why the gastroenterology program at Children’s Health is consistently ranked among the top pediatric specialties by U.S. News and World Report.

Shortening the Road to Diagnosis

Sindhu Pandurangi is a pediatric gastroenterologist and hepatologist at Children’s Health who specializes in biliary atresia, a condition that occurs when bile is not able to drain from the liver into the intestine.

“When bile ducts aren’t formed properly, bile backs up into the liver and can cause scarring, end-stage liver disease and cirrhosis,” she said. “Biliary atresia is currently the leading indication for pediatric liver transplant.”

If diagnosed early enough, biliary atresia can be treated with a surgery called the Kasai procedure, which removes damaged bile ducts and connects the intestine to the liver, restoring bile flow.

However, the road to diagnosis can be tricky. The typical workup to definitively diagnose biliary atresia includes common and specialized blood tests and urine analysis, ultrasound and other imaging, liver biopsy and finally an operative procedure called a cholangiogram.

“The earlier the Kasai surgery is done, the greater chance that babies are going to do well and drain the bile after the surgery,” she said. “The real hang up is when babies aren’t plugged in with the right subspecialists quick enough, to the point where children with biliary atresia are missed and now they’re several months old. At that point, we know that our chances of success with the Kasai surgery are lower.”

Pandurangi led a study on faster, less invasive ways to diagnose biliary atresia, with results presented at the 2021 meeting of the American Association of the Studies of Liver Disease. Now, she and Jorge Bezerra, M.D., a pediatric hepatologist who also serves as Pediatrician-in-Chief at Children’s Health and a professor and chair at UT Southwestern, are committed to furthering that research and spreading the message about the importance of earlier diagnosis.

“Our study quantified a biomarker called Matrix Metalloproteinase-7, or MMP-7, which can help doctors differentiate the biliary atresia from the other causes of liver disease with a high sensitivity and specificity,” she explained. “Our lingering question after that initial finding was, ‘how do we use this test in real life?’ That’s the work we brought here to Dallas.”

Children’s Health now performs MMP-7 blood tests in-house, which allows the biliary atresia team to receive the results in only a couple of days.

Even after the Kasai procedure, doctors at Children’s Health keep a close eye on patients, implementing post-operative antibiotics and corticosteroids for babies who have signs of poor bile drainage. A study by Pandurangi, Bezerra and colleagues found that this protocol led to babies being more likely to recover biliary drainage and keep their own liver within two years of the Kasai.

Providing Compassionate and Holistic Healthcare

In 2023, the American Academy of Pediatrics recognized childhood obesity to be an epidemic and updated its guidelines to recommend a range of treatments from behavior therapy and lifestyle changes to surgery and medications.

At Children’s Health, pediatric gastroenterologists approach the delicate issue of a child’s weight with comprehensive medical expertise and compassion for their patients.

An unhealthy weight is defined by a child’s body mass index (BMI). A child or teen has overweight when their BMI falls between the 85th and 95th percentile, while obesity is defined as a BMI greater than the 95th percentile.

“About 20 percent of children are at or above the cut point for obesity, and in some age, economic and racial groups, that number is substantially higher, meaning 25 percent,” said pediatric gastroenterologist Sarah Barlow, who is also a professor at UT Southwestern Medical Center.

Childhood obesity is a metabolic condition with several risk factors, including diabetes and high blood pressure, fat accumulation in the liver and sleep apnea.

“There’s also a lot of mental health issues because obesity is so stigmatized in our society,” Barlow added. “Often, our culture associates negative stereotypes with people who carry more weight. In pediatrics, parents can feel very blamed somehow, as if they’re not doing a good job when their child has higher weight, when in reality, there’s just a lot of different biology and genetics, as well as the environment, that influence the weight.”

To that end, Children’s Health offers treatment options that are holistic and personalized to a child’s age, activity level, environment and any health conditions.

Patients and their families have access to multidisciplinary experts within the hospital’s  pediatrics department, including registered dieticians and psychologists. These experts guide sustainable healthy eating and physical activity and support good mental health.

Treatment plans can include obesity treatment medications, which are approved for children 12 years and older. Providers discuss the pros and cons of this pathway and share the decision to use medication with the patient and parents. Teens with severe obesity can consult with the hospital’s Bariatric Surgical Center, which works closely with families to determine if their child is an appropriate candidate for weight loss surgery.

“We try to create an alliance with the family,” Barlow said. “I always start with the question, ‘What concerns, if any, do you have about your child’s weight?’ I want parents to feel like I am not telling them what to do or how they should feel, but really inviting them to share what is their priority for their child because they’re the expert in their child and family.”

Children’s Health also partners with YMCAs around Dallas to provide the free Get Up & Go program. For 90 minutes each week, this initiative invites children and their families to engage in fun learning and physical activities that are meant to build healthy habits that last a lifetime.

“Get Up & Go is designed to be accessible for all families,” said Barlow. “The classes are conducted in English and Spanish, and held in the early evening or weekend mornings to accommodate different family schedules. Seventy percent of the families that start also finish the 10-week program, which is really very high for this type of community programming.”

As the field of pediatric gastroenterology continues to advance, Barth is confident Children’s Health will remain on the cutting edge of world class healthcare.

“Not only do we have a number of nationally known pediatric gastroenterologists who are very active in improving clinical care, but we’re also heavily involved in training the next generation of pediatric gastroenterologists,” he said. “I’m really excited about the ways our science and research efforts will continue to develop in the future.”