Clinical Focus

  • Pediatric Gastroenterology
  • Inflammatory Bowel Disease
  • fecal microbiota transplant
  • very early onset IBD
  • Dietary therapy in IBD
  • Eosinophilic disorders of the gastrointestinal tract

Administrative Appointments

  • interim Associate Chief of Clinical Affairs, Stanford Children's Health (2022 - Present)
  • Director of the Inflammatory Disease Service, Children’s Mercy Kansas City (2016 - 2020)
  • Director, Endoscopy Center, UPMC Children’s Hospital of Pittsburgh (2014 - 2016)
  • Medical Director, Infusion Center, UPMC Children’s Hospital of Pittsburgh (2013 - 2016)
  • Medical Director, Gastroenterology Inpatient Unit, UPMC Children’s Hospital of Pittsburgh (2012 - 2016)

Honors & Awards

  • Award for Commitment and Service (ACES), UPMC, Pittsburgh, PA (2010)
  • Outstanding Achievement in Patient Care, UPMC Children’s Hospital of Pittsburgh (July 2004)
  • Advanced Research Training Award, American Digestive Health Foundation (July 1996-June 1998)

Boards, Advisory Committees, Professional Organizations

  • Professional member, Crohn’s & Colitis Foundation (2006 - Present)
  • member, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (2002 - Present)
  • Member, American Gastroenterological Association (2000 - Present)
  • Life Member, Indian Academy of Pediatrics (1988 - Present)

Professional Education

  • Board Certification: American Board of Pediatrics, Pediatric Gastroenterology (1999)
  • Fellowship: Washington University Gastroenterology Fellowship (1998) MO
  • Residency: University of Connecticut Pediatric Residency (1993) CT
  • Medical Education: Lady Hardinge Medical College (1985) India

All Publications

  • Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program. Journal of clinical medicine Levitte, S., Yarani, R., Ganguly, A., Martin, L., Gubatan, J., Nadel, H. R., Franc, B., Gugig, R., Syed, A., Goyal, A., Park, K. T., Thakor, A. S. 2023; 12 (6)


    Systemic steroid exposure, while useful for the treatment of acute flares in inflammatory bowel disease (IBD), is associated with an array of side effects that are particularly significant in children. Technical advancements have enabled locoregional intraarterial steroid delivery directly into specific segments of the gastrointestinal tract, thereby maximizing tissue concentration while limiting systemic exposure. We investigated the feasibility of intraarterial steroid administration into the bowel in a cohort of nine pediatric patients who had IBD. This treatment approach provided symptom relief in all patients, with sustained relief (>2 weeks) in seven out of nine; no serious adverse effects occurred in any patient. In addition, we identified patterns of vascular morphologic changes indicative of a vasculopathy within the mesenteric circulation of inflamed segments of the bowel in pediatric patients with Crohn's disease, which correlated with disease activity. An analysis of publicly available transcriptomic studies identified vasculitis-associated molecular pathways activated in the endothelial cells of patients with active Crohn's disease, suggesting a possible shared transcriptional program between vasculitis and IBD. Intraarterial corticosteroid treatment is safe and has the potential to be widely accepted as a locoregional approach for therapy delivery directly into the bowel; however, this approach still warrants further consideration as a short-term "bridge" between therapy transitions for symptomatic IBD patients with refractory disease, as part of a broader steroid-minimizing treatment strategy.

    View details for DOI 10.3390/jcm12062386

    View details for PubMedID 36983386

  • Anemia in Children With Inflammatory Bowel Disease: A Position Paper by the IBD Committee of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition. Journal of pediatric gastroenterology and nutrition Goyal, A., Zheng, Y., Albenberg, L. G., Stoner, N. L., Hart, L., Alkhouri, R., Hampson, K., Ali, S., Cho-Dorado, M., Goyal, R. K., Grossman, A. 2020; 71 (4): 563-582


    Anemia is one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD). It can be asymptomatic or associated with nonspecific symptoms, such as irritability, headaches, fatigue, dizziness, and anorexia. In IBD patients, the etiology of anemia is often multifactorial. Various causes include iron deficiency, anemia of inflammation and chronic disease, vitamin deficiencies, hemolysis, or myelosuppressive effect of drugs. Anemia and iron deficiency in these patients may be underestimated because of their insidious onset, lack of standardized screening practices, and possibly underappreciation that treatment of anemia is also required when treating IBD. Practitioners may hesitate to use oral preparations because of their intolerance whereas intravenous preparations are underutilized because of fear of adverse events, availability, and cost. Several publications in recent years have documented the safety and comparative efficacy of various intravenous preparations. This article reviews management of anemia in children with IBD, including diagnosis, etiopathogenesis, evaluation of a patient, protocol to screen and monitor patients for early detection and response to therapy, treatment including parenteral iron therapy, and newer approaches in management of anemia of chronic disease. This report has been compiled by a group of pediatric gastroenterologists serving on the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) IBD committee, in collaboration with a pediatric hematologist, pharmacist, and a registered dietician who specializes in pediatric IBD (IBD Anemia Working Group), after an extensive review of the current literature. The purpose of this review is to raise awareness of under-diagnosis of anemia in children with IBD and make recommendations for screening, testing, and treatment in this population.

    View details for DOI 10.1097/MPG.0000000000002885

    View details for PubMedID 32947565

  • Safety, Clinical Response, and Microbiome Findings Following Fecal Microbiota Transplant in Children With Inflammatory Bowel Disease. Inflammatory bowel diseases Goyal, A., Yeh, A., Bush, B. R., Firek, B. A., Siebold, L. M., Rogers, M. B., Kufen, A. D., Morowitz, M. J. 2018; 24 (2): 410-421


    The role of fecal microbiota transplant (FMT) in the treatment of pediatric inflammatory bowel disease (IBD) is unknown. The aims of this study were to assess safety, clinical response, and gut microbiome alterations in children with Crohn's disease (CD), ulcerative colitis (UC), or indeterminate colitis (IC).In this open-label, single-center prospective trial, patients with IBD refractory to medical therapy underwent a single FMT by upper and lower endoscopy. Adverse events, clinical response, gut microbiome, and biomarkers were assessed at baseline, 1 week, 1 month, and 6 months following FMT.Twenty-one subjects were analyzed, with a median age of 12 years, of whom 57% and 28% demonstrated clinical response at 1 and 6 months post-FMT, respectively. Two CD patients were in remission at 6 months. Adverse events attributable to FMT were mild to moderate and self-limited. Patients prior to FMT showed decreased species diversity and significant microbiome compositional differences characterized by increased Enterobacteriaceae, Enterococcus, Haemophilus, and Fusobacterium compared with donors and demonstrated increased species diversity at 30 days post-FMT. At 6 months, these changes shifted toward baseline. Clinical responders had a higher relative abundance of Fusobacterium and a lower diversity at baseline, as well as a greater shift toward donor-like microbiome after FMT compared with nonresponders.A single FMT is relatively safe and can result in a short-term response in young patients with active IBD. Responders possessed increased Fusobacterium prior to FMT and demonstrated more significant microbiome changes compared with nonresponders after FMT. Microbiome characteristics may help in predicting response.

    View details for DOI 10.1093/ibd/izx035

    View details for PubMedID 29361092

  • Clinical Decision Making in Mimickers of IBD: Practice Management From IBD Live Fiske, H. W., Ward, C., Shah, S. A., Binion, D., Wexner, S., Farraye, F. A., Goyal, A., Dueker, J. M., Hanson, J. S., Cross, R. K., Siegel, C. A., Al-Bawardy, B., Barnes, E., Brand, M., Melia, J. P., Clarke, K., Ginsburg, P. M., Herfarth, H., Forster, E., Engels, M., Qazi, T., Bohm, M., Cohen, B., Dam, A., Fine, S., Gaidos, J., Holubar, S., Hull, T. L., Kelly, C. R., Levy, L., Philpott, J., Regueiro, M. LIPPINCOTT WILLIAMS & WILKINS. 2023: S919-S920
  • SUBTYPING OF EOSINOPHILIC ESOPHAGITIS BASED ON DISEASE PRESENTATION IN A PEDIATRIC COHORT. Journal of pediatric gastroenterology and nutrition Sessions, J., Purington, N., McGhee, S., Bass, D., Wang, Y., Goyal, A., Khavari, N. 2022


    Eosinophilic esophagitis (EoE) is an immune mediated inflammatory disease characterized by eosinophilic infiltration of esophageal tissue. Subtyping of EoE patients could be useful in predicting therapeutic response. We propose clinical subtypes, apply them to our pediatric EoE population retrospectively, and assess therapy choices and remission at one year.A retrospective chart review of pediatric patients diagnosed with EoE was conducted. Patients were grouped into proposed subtypes (severe, allergic, fibrostenotic, inflammatory, unclassified) based on presenting characteristics. The primary outcome was histologic remission, which was defined <15 eosinophils/high-powered-field (hpf) at the closest visit one year post-diagnosis.Subtyping was possible in 242/256 patients and follow-up histological data was available in 75 subjects. The majority had an overlap in phenotype with 17% severe, 77% allergic, 15% fibrostenotic, 60% inflammatory and 5% unclassified, whereas 45% of the cohort were assigned to a unique subtype. At one year, 43/75 (57%) of patients achieved histologic remission, with an overall average decrease of 33 (IQR -47, -12) eosinophils/hpf across the entire cohort. There was no difference in remission rates among subtypes. First-line therapy review revealed higher rates of proton pump inhibitor (PPI) +/- topical steroids utilization in severe patients, while topical steroids were prescribed preferentially over dietary therapy in fibrostenotic subtype.There were no observed differences in remission rates at one year among clinically defined subtypes of EoE, although this could be attributed to overlapping subtypes. Most patients responded well to medical therapy. Larger scale prospective studies designed to subtype patients and protocolize treatment may help personalize the approach to EoE management.

    View details for DOI 10.1097/MPG.0000000000003580

    View details for PubMedID 35897130

  • Sex-specific Pathways Lead to Statural Growth Impairment in Children with Crohn's Disease. The Journal of pediatrics Gupta, N., Lustig, R. H., Andrews, H., Guthery, S. L., Patel, A. S., Gokhale, R., Goyal, A., Siebold, L., Sylvester, F., Leu, C. S. 2022


    To examine the underlying mechanisms that lead growth impairment to occur more commonly in males than females with Crohn's disease (CD).Children and adolescents with CD were enrolled in a prospective multicenter longitudinal cohort study. Height Z-score difference was computed as height Z-score based on chronological age (height chronological age-Z-score) minus height Z-score based on bone age (height bone age-Z-score) using longitudinal data. Specific serum cytokines were measured, hormone Z-scores were calculated based on bone age (bone age-Z), and their longitudinal associations were examined.There were 122 children with CD (63% male) who completed 594 visits. The mean ± SD chronological age was 11.70 ± 1.79 years. The mean ± SD height chronological age-Z-score was -0.03 ± 0.99 in males and -0.49 ± 0.87 in females. The mean ± SD height bone age-Z-score was 0.23 ± 0.93 in males and 0.37 ± 0.96 in females. The magnitude of the mean height Z-score difference was greater in females (-0.87 ± 0.94) than males (-0.27 ± 0.90; P = .005), indicating growth was better in females than males. The following negative associations were identified: in females, interleukin (IL)-8 (P < .001) and IL-12p70 (P = .035) with gonadotropin-bone age-Z-scores; IL-8 (P = .010), IL-12p70 (P = .020), and interferon-γ (P = .004) with sex hormone-bone age-Z-scores, and IL-8 (P = .044) and interferon-γ (P < .001) with insulin-like growth factor 1-bone age-Z-scores; in males, IL-1 beta (P = .019) and IL-6 (P = .025) with insulin-like growth factor 1-bone age-Z-scores.Our data suggest that sex-specific molecular pathways lead to growth impairment in children with CD (primarily growth hormone/insulin-like growth factor-1 axis in males and primarily hypothalamic-pituitary-gonadal axis in females). Mapping these sex-specific molecular pathways may help in the development of sex-specific treatment approaches targeting the underlying inflammation characteristic of CD.

    View details for DOI 10.1016/j.jpeds.2022.05.041

    View details for PubMedID 35649448

  • Utilization of anti-tumor necrosis factor biologics in Very Early Onset Inflammatory Bowel Disease (VEOIBD): a multicenter retrospective cohort study from North America. Journal of pediatric gastroenterology and nutrition Kerur, B., Fiedler, K., Stahl, M., Hyams, J., Stephens, M., Lu, Y., Pfefferkorn, M., Alkhouri, R., Strople, J., Kelsen, J., Siebold, L., Goyal, A., Rosh, J. R., LeLeiko, N., Van Limbergen, J., Guerrerio, A. L., Maltz, R. M., Karam, L., Crowley, E., Griffiths, A. M., Heyman, M. B., Deneau, M., Benkov, K., Noe, J., Moulton, D., Pappa, H., Galanko, J., Snapper, S., Muise, A. M., Kappelman, M. D., Benchimol, E. I. 2022


    Research on the utilization and effectiveness of anti-TNF biologics in children with Very Early Onset Inflammatory Bowel (VEOIBD) is urgently needed. Here we describe anti-TNF use and durability in a multicenter cohort.We performed a retrospective cohort study of patients diagnosed with VEOIBD (<6 years) between 2008 and 2013 at 25 North American centers. We performed chart abstraction at diagnosis and 1, 3, and 5 years after diagnosis. We examined the rate of initiation and durability of infliximab and adalimumab and evaluated associations between treatment durability and the following covariates with multivariate Cox proportional hazard regression: age at diagnosis, sex, disease duration, disease classification and presence of combined immunomodulatory treatment vs. monotherapy.Of 294 children with VEOIBD, 120 initiated treatment with anti-TNF therapy and 101 had follow-up data recorded [ 50% Crohn's disease (CD), 31% ulcerative colitis (UC), and 19% IBD unclassified (IBD-U)]. The cumulative probability of anti-TNF treatment was 15% at 1 year, 30% at 3 years and 45% at 5 years from diagnosis; 56 (55%) were treated between 0-6 years old. Anti-TNF durability was 90% at 1 year, 75% at 3 years, and 55% at 5 years. The most common reason for discontinuation of anti-TNF were loss of response in 24 (57%) children. Children with UC/IBD-U had lower durability than those with CD (HR 0.17; 95% CI, 0.06-0.51; p=0.001).Utilization and durability of anti-TNF in VEOIBD is relatively high and comparable to older children. Having Crohn's disease (compared to UC/IBD-U) is associated with greater durability.An infographic is available for this article at:

    View details for DOI 10.1097/MPG.0000000000003464

    View details for PubMedID 35622080

  • Superior Mesenteric Artery Syndrome in an Adolescent With Anorexia and Suspected Pancreatitis. JPGN reports Hsu, D., Zhang, K. Y., Rubesova, E., Bruzoni, M., Khavari, N., Goyal, A. 2022; 3 (2): e194

    View details for DOI 10.1097/PG9.0000000000000194

    View details for PubMedID 37168901

    View details for PubMedCentralID PMC10158292

  • Hypersensitivity Reaction to Ustekinumab in Pediatric and Young Adult Inflammatory Bowel Disease Patients: A Case Series. JPGN reports Sunny, J., Fonseca, A. G., Crim, A. M., Goyal, A., Felipez, L. M. 2022; 3 (2): e205


    Ustekinumab (UST) is a human IgG1K monoclonal antibody that binds to the p40 receptor subunit bound by cytokines IL-12 and IL-23. It is indicated in both Crohn's disease and ulcerative colitis as a second-line agent. The safety and efficacy of UST in children and young adults has not been thoroughly studied. We report a case series of six pediatric patients and young adults who developed hypersensitivity reactions during intravenous infusion with UST. These reactions ranged from mild allergic reactions to anaphylaxis, with no detectable antibodies if tested. We hypothesize the reaction could be secondary to ethylenediaminetetraacetic acid, which is present solely in the intravenous preparation. Patients who experience hypersensitivity reactions during their UST infusion may safely receive subcutaneous preparations of UST, as demonstrated by some patients who received it based on physician discretion. Further investigation is required to establish the etiology of infusion reactions.

    View details for DOI 10.1097/PG9.0000000000000205

    View details for PubMedID 37168900

    View details for PubMedCentralID PMC10158453

  • Personalized Research on Diet in Ulcerative Colitis and Crohn's Disease (PRODUCE): A Series of N-of-1 Diet Trials. The American journal of gastroenterology Kaplan, H. C., Opipari-Arrigan, L., Yang, J., Schmid, C. H., Schuler, C. L., Saeed, S. A., Braly, K. L., Chang, F., Murphy, L., Dodds, C. M., Nuding, M., Liu, H., Pilley, S., Stone, J., Woodward, G., Yokois, N., Goyal, A., Lee, D., Yeh, A. M., Lee, P., Gold, B. D., Molle-Rios, Z., Zwiener, R. J., Ali, S., Chavannes, M., Linville, T., Patel, A., Ayers, T., Bassett, M., Boyle, B., Palomo, P., Verstraete, S., Dorsey, J., Kaplan, J. L., Steiner, S. J., Nguyen, K., Burgis, J., Suskind, D. L., ImproveCareNow Pediatric IBD Learning Health System 2022


    OBJECTIVES: Evidence about Specific Carbohydrate Diet (SCD) for inflammatory bowel disease (IBD) is limited. We conducted 54 single-subject, double-crossover N-of-1 trials comparing SCD to a modified SCD (MSCD) and comparing each to the participant's baseline, usual diet (UD).METHODS: Across 19 sites, we recruited patients 7-18 years with IBD and active inflammation. Following a 2-week baseline (UD), patients were randomized to one of two sequences of four alternating 8-week SCD and MSCD periods. Outcomes included fecal calprotectin and patient-reported symptoms. We report posterior probabilities from Bayesian models comparing diets.RESULTS: Twenty-one (39%) participants completed the trial, 9 (17%) completed a single crossover, and 24 (44%) withdrew. Withdrawal or early completion occurred commonly (lack of response (n=11), adverse events (n=11) and not desiring to continue (n=6)). SCD and MSCD performed similarly for most individuals. On average, there was <1% probability of a clinically meaningful difference in IBD symptoms between SCD and MSCD. The average treatment difference was -0.3 (95% CrI -1.2, 0.75). There was no significant difference in the ratio of fecal calprotectin geometric means comparing SCD and MSCD [0.77 (95% CrI 0.51, 1.10)]. Some individuals had improvement in symptoms and fecal calprotectin compared to their UD, while others did not.CONCLUSIONS: SCD and MSCD did not consistently improve symptoms or inflammation, although some individuals may have benefited. However, there are inherent difficulties in examining dietary changes that complicate study design and ultimately conclusions regarding effectiveness.

    View details for DOI 10.14309/ajg.0000000000001800

    View details for PubMedID 35442220

  • CTLA4 haploinsufficiency presenting as celiac-like disease and treatment considerations in the setting of previous disseminated coccidioidomycosis Salgado, C., Uzel, G., Goyal, A., Khavari, N., Gernez, Y. SPRINGER/PLENUM PUBLISHERS. 2022: S38-S39
  • Pediatric eosinophilic esophagitis outcomes vary with co-morbid eczema and pollen food syndrome. Frontiers in allergy Sessions, J., Purington, N., Wang, Y., McGhee, S., Sindher, S., Goyal, A., Khavari, N. 2022; 3: 981961


    Background: Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disease characterized by eosinophil inflammation of the esophagus. It has been described as a component of the Allergic March and is often seen with other atopic diseases. Some atopic diseases, including asthma, are known to be heterogenous with endotypes that guide treatment. Similarly, we propose that EoE is a heterogenous disease with varying phenotypes and endotypes that might impact response to therapy.Methods: A single-center retrospective review of pediatric patients ≤18 years of age diagnosed with EoE was conducted. All gastrointestinal clinic visits and esophagogastroduodenoscopies (EGD) from disease presentation through the first three years after diagnosis were reviewed. Histologic remission rate and therapies utilized [proton pump inhibitor (PPI), topical steroid, dietary elimination] were assessed.Results: One hundred and thirty-seven patients were included, 80% of whom had at least one concurrent atopic condition at diagnosis, with food allergies being the most common (57%) followed by eczema (34%), and asthma (29%). The remission rate of the overall cohort was 65%, and by concurrent allergy, comorbid pollen food syndrome and eczema had the highest remission rates at 100% and 81%, respectively followed by asthma (62%), food allergies (62%), seasonal allergic rhinitis (60%), and history of anaphylaxis (56%). Kaplan-Meier curves for each atopic condition show that patients with eczema and pollen food syndrome achieve histologic remission faster than those without. All treatment modalities were more successful in patients with eczema than those without, and PPI was most effective treatment at inducing remission.Conclusions: In a real-world pediatric cohort, 80% of patients with EoE had an underlying atopic condition. Patients with eczema and pollen food syndrome had a swifter response and were more likely to achieve histologic remission than patients with other atopic conditions. This study suggests that EoE, like other allergic diseases, may have heterogenous phenotypes that could affect response to treatment. There is currently a knowledge gap in classifying EoE based on endotypes and phenotypes at diagnosis and correlating responses to various treatment modalities.

    View details for DOI 10.3389/falgy.2022.981961

    View details for PubMedID 36118171

  • When It Is Not Inflammatory Bowel Disease: IBD Mimics Presented at IBD Live Ward, C., Shah, S. A., Farraye, F. A., Goyal, A., Watson, A. R., Lazarev, M., Hanson, J., Brand, M. H., Wexner, S. D., Cross, R. K., Kelly, C. R., Fine, S., Siegel, C., Dueker, J. M., Rosh, J., Clarke, K., Hashash, J., Al Bawardy, B. F., Rupawala, A., Gaidos, J., Cohen, B., Forster, E. M., Bruckel, T., Herfarth, H., Levy, L., Regueiro, M. LIPPINCOTT WILLIAMS & WILKINS. 2021: S1377
  • Current Challenges in Fecal Microbiota Transplantation for Clostridioides difficile Infection in Children. The American journal of gastroenterology Nicholson, M. R., Hourigan, S. K., Conrad, M., Goyal, A., Jensen, K., Kelsen, J., Kennedy, M., Weatherly, M., Kahn, S. A. 2021


    INTRODUCTION: The impact of the 2019 US Food and Drug Administration safety alert involving transmission of multidrug resistant organisms through fecal microbiota transplantation (FMT), and the COVID-19 pandemic on the use of FMT in children, is unknown.METHODS: A survey of pediatric gastroenterologists performing FMT for Clostridioides difficile infection was conducted.RESULTS: Of 36 respondents, 17 (47%) and 30 (83%) changed their FMT practices related to the US Food and Drug Administration safety alert and COVID-19 pandemic, respectively, with 22 (61%) of programs halted.DISCUSSION: The US Food and Drug Administration safety alert and COVID-19 pandemic have substantially influenced the availability and access of FMT for children.

    View details for DOI 10.14309/ajg.0000000000001350

    View details for PubMedID 34140459

  • A Case of Epinephrin-associated Refractory Hypotension Secondary to Lactic Acidosis. Inflammatory bowel diseases Joseph, M., Kochanski, J., Goyal, A. 2021

    View details for DOI 10.1093/ibd/izab268

    View details for PubMedID 34718560

  • Natural History of  Very Early Onset Inflammatory Bowel Disease in North America: A Retrospective Cohort Study. Inflammatory bowel diseases Kerur, B., Benchimol, E. I., Fiedler, K., Stahl, M., Hyams, J., Stephens, M., Lu, Y., Pfefferkorn, M., Alkhouri, R., Strople, J., Kelsen, J., Siebold, L., Goyal, A., Rosh, J. R., LeLeiko, N., Van Limbergen, J., Guerrerio, A. L., Maltz, R., Karam, L., Crowley, E., Griffiths, A., Heyman, M. B., Deneau, M., Benkov, K., Noe, J., Mouton, D., Pappa, H., Galanko, J. A., Snapper, S., Muise, A. M., Kappelman, M. D. 2020


    The incidence of very early onset inflammatory bowel disease (VEOIBD) is increasing, yet the phenotype and natural history of VEOIBD are not well described.We performed a retrospective cohort study of patients diagnosed with VEOIBD (6 years of age and younger) between 2008 and 2013 at 25 North American centers. Eligible patients at each center were randomly selected for chart review. We abstracted data at diagnosis and at 1, 3, and 5 years after diagnosis. We compared the clinical features and outcomes with VEOIBD diagnosed younger than 3 years of age with children diagnosed with VEOIBD at age 3 to 6 years.The study population included 269 children (105 [39%] Crohn's disease, 106 [39%] ulcerative colitis, and 58 [22%] IBD unclassified). The median age of diagnosis was 4.2 years (interquartile range 2.9-5.2). Most (94%) Crohn's disease patients had inflammatory disease behavior (B1). Isolated colitis (L2) was the most common disease location (70% of children diagnosed younger than 3 years vs 43% of children diagnosed 3 years and older; P = 0.10). By the end of follow-up, stricturing/penetrating occurred in 7 (6.6%) children. The risk of any bowel surgery in Crohn's disease was 3% by 1 year, 12% by 3 years, and 15% by 5 years and did not differ by age at diagnosis. Most ulcerative colitis patients had pancolitis (57% of children diagnosed younger than 3 years vs 45% of children diagnosed 3 years and older; P = 0.18). The risk of colectomy in ulcerative colitis/IBD unclassified was 0% by 1 year, 3% by 3 years, and 14% by 5 years and did not differ by age of diagnosis.Very early onset inflammatory bowel disease has a distinct phenotype with predominantly colonic involvement and infrequent stricturing/penetrating disease. The cumulative risk of bowel surgery in children with VEOIBD was approximately 14%-15% by 5 years. These data can be used to provide anticipatory guidance in this emerging patient population.

    View details for DOI 10.1093/ibd/izaa080

    View details for PubMedID 32386060

  • Liver Enzyme Elevations Within 3 Months of Diagnosis of Inflammatory Bowel Disease and Likelihood of Liver Disease JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION Goyal, A., Hyams, J. S., Lerer, T., Leleiko, N. S., Otley, A. R., Griffiths, A. M., Rosh, J. R., Cabrera, J. M., Oliva-hemker, M. M., Mack, D. R., Rick, J. N., Pfefferkorn, M. D., Carvalho, R., Grossman, A. B., Hitch, M. C., Sudel, B., Kappelman, M. D., Saeed, S. A., Faubion, W. A., Schaefer, M. E., Markowitz, J. F., Keljo, D. J. 2014; 59 (3): 321-323


    Inflammatory bowel disease-associated liver diseases (IBD-LDs) include autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and an overlap syndrome. Prospective unbiased multicenter data regarding the frequency of IBD-LD in patients with pediatric inflammatory bowel disease (IBD) are lacking. We examined early alanine aminotransferase (ALT) and γ-glutamyl transpeptidase (GGT) elevations in children diagnosed as having IBD and assessed the likelihood of IBD-LD.Data collected from the prospective observational Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry enrolling children of age <16 years within 30 days of diagnosis. AIH, PSC, and overlap syndrome were diagnosed using local institutional criteria.A total of 1569 subjects had liver enzymes available. Of the total, 757 had both ALT and GGT, 800 had ALT only (no GGT), and 12 had GGT only (no ALT). Overall, 29 of 1569 patients (1.8%) had IBD-LD. IBD-LD was diagnosed in 1 of 661 (0.15%) of patients with both ALT and GGT ≤ 50 IU/L compared with 21 of 42 (50%) of patients with both ALT and GGT > 50 (odds ratio 660, P < 0.0001). Of the 29 patients with IBD-LD, 21 had PSC, 2 had AIH, and 6 had overlap syndrome. IBD-LD was more common in patients with ulcerative colitis and IBD-unclassified (indeterminate colitis) than in those with Crohn disease (4% vs 0.8%, respectively, P < 0.001).Elevation of both ALT and GGT within 90 days after the diagnosis of IBD is associated with a markedly increased likelihood of IBD-LD. Both ALT and GGT levels should be measured in all of the pediatric patients newly diagnosed as having IBD.

    View details for DOI 10.1097/MPG.0000000000000409

    View details for Web of Science ID 000341080700012

    View details for PubMedID 24796799