Clinical Focus


  • Pediatric Gastroenterology

Academic Appointments


Professional Education


  • Board Certification: American Board of Pediatrics, Pediatric Gastroenterology (2013)
  • Fellowship: Cleveland Clinic Children's Pediatric Gastroenterology Dept (2012) OH
  • Residency: Nationwide Children's Hospital Pediatric Residency (2008) OH
  • Medical Education: The Ohio State University College of Medicine (2005) OH

All Publications


  • Standardizing steroid protocols for newly diagnosed inflammatory bowel disease patients: A quality improvement initiative. Journal of pediatric gastroenterology and nutrition Lendner, N., Perry, S., Sferra, T. J., Moses, J., Young, D. D. 2024

    Abstract

    Systemic steroids can be used for induction of inflammatory bowel disease (IBD), but are not recommended as long-term therapy. Steroid weaning requires rigorous monitoring of symptoms, which may be cumbersome and lead to missed opportunities. We aim to describe our local quality improvement (QI) initiative to improve and standardize the steroid weaning process.After identifying drivers of steroid weaning, a protocol was developed and implemented for newly diagnosed IBD patients started on steroids and subsequently initiated on anti-TNF-╬▒ therapy. Interventions included development of a tapering schedule, and standardizing communication with patients and evaluation of symptoms. The primary aim was to increase the percent of patients called on a weekly basis by 20%; secondary aims were to decrease the median steroid days by 25% and to increase the number of our patients weaned off steroids at 8 weeks from 35% to 75% by 1 year after the initiative.The median percent of patients called on a weekly basis to assess clinical symptoms and to wean steroids increased to 80% after 1 year. The median number of systemic corticosteroid days decreased from 67.5 to 50.5 days post-protocol implementation with 61.1% patients weaned off by 8 weeks from discharge. Zero patients were admitted for flares with the protocol implementation.Our experience illustrates that QI methodology can be used successfully to improve and standardize the steroid weaning process, leading to shortened steroid duration and without increased flares and hospitalizations.

    View details for DOI 10.1002/jpn3.12246

    View details for PubMedID 38769760

  • Invited commentary┬áto immunotherapy withdrawal by step-down to mesalamine in pediatrics patients with ulcerative colitis. JPGN reports O'Connell, D. M., Moses, J. 2024; 5 (2): 95-96

    View details for DOI 10.1002/jpr3.12047

    View details for PubMedID 38756131

    View details for PubMedCentralID PMC11093890

  • High Body Mass Index and Response to Anti-TNF Therapy in Pediatric Crohn Disease. The American journal of gastroenterology Ebach, D. R., Jester, T. W., Galanko, J. A., Firestine, A. M., Ammoury, R., Cabrera, J., Bass, J., Minar, P., Olano, K., Margolis, P., Sandberg, K., Linnville, T. M., Kaplan, J., Pitch, L., Steiner, S. J., Bass, D., Moses, J., Adler, J., Gulati, A. S., Wali, P., Pashankar, D., Ivanova, A., Herfarth, H., Wohl, D. A., Benkov, K. J., Strople, J., Sullivan, J., Tung, J., Molle-Rios, Z., Saeed, S. A., Bousvaros, A., Kappelman, M. D. 2024

    Abstract

    BACKGROUND: Obesity is common among patients with pediatric Crohn's disease (PCD). Some adult studies suggest obese patients respond less well to anti-TNF treatment. This study sought compares anti-TNF response and anti-TNF levels between pediatric patients with normal and high body mass index (BMI).METHODS: The COMBINE trial compared anti-TNF monotherapy to combination therapy with methotrexate in patients with PCD. In this secondary analysis, a comparison of time-to-treatment failure among patients with normal BMI versus BMI Z score > 1, adjusting for prescribed anti-TNF (infliximab or adalimumab), trial treatment assignment (combination versus monotherapy), and relevant covariates. Median anti-TNF levels across BMI category was also examined.RESULTS: Of 224 participants (162 infliximab initiators and 62 adalimumab initiators), 111 (81%) had a normal BMI and 43 (19%) had a high BMI. High BMI was associated with treatment failure among adalimumab initiators [7/10 (70%) vs 12/52 (23%), HR 0.29, p=.007] but not infliximab initiators. Additionally, adalimumab-treated patients with a high BMI had lower adalimumab levels compared to those with normal BMI (median 5.8 ug/mL vs 12.8 ug/mL, p=0.02). Infliximab trough levels did not differ between BMI groups.CONCLUSIONS: Overweight and obese patients with PCD are more likely to experience adalimumab treatment failure than those with normal BMI. Higher BMI was associated with lower drug trough levels. Standard adalimumab dosing may be insufficient for overweight children with PCD. Among infliximab initiators, there was no observed difference in clinical outcomes or drug levels, perhaps due to weight-based dosing and/or greater use of proactive drug monitoring.

    View details for DOI 10.14309/ajg.0000000000002741

    View details for PubMedID 38445644

  • Comparative Effectiveness of Anti-TNF in Combination with Low Dose Methotrexate vs Anti-TNF Monotherapy in Pediatric Crohn's Disease: a Pragmatic Randomized Trial. Gastroenterology Kappelman, M. D., Wohl, D. A., Herfarth, H. H., Firestine, A. M., Adler, J., Ammoury, R. F., Aronow, J. E., Bass, D. M., Bass, J. A., Benkov, K., Berenblum Tobi, C., Boccieri, M. E., Boyle, B. M., Brinkman, W. B., Cabera, J. M., Chun, K., Colletti, R. B., Dodds, C. M., Dorsey, J. M., Ebach, D. R., Entrena, E., Forrest, C. B., Galanko, J. A., Grunow, J. E., Gulati, A. S., Ivanova, A., Jester, T. W., Kaplan, J. L., Kugathasan, S., Kusek, M. E., Leibowitz, I. H., Linville, T. M., Lipstein, E. A., Margolis, P. A., Minar, P., Molle Rios, Z., Moses, J., Olano, K. K., Osaba, L., Palomo, P. J., Pappa, H., Park, K. T., Pashankar, D. S., Pitch, L., Robinson, M., Samson, C. M., Sandberg, K. C., Schuchard, J. R., Seid, M., Shelly, K. A., Steiner, S. J., Strople, J. A., Sullivan, J. S., Tung, J., Wali, P., Zikry, M., Weinberger, M., Saeed, S. A., Bousvaros, A. 2023

    Abstract

    BACKGROUND AND AIMS: Tumor Necrosis Factor inhibitors (TNFi), including infliximab and adalimumab, are a mainstay of pediatric Crohn's disease (PCD) therapy; however, non-response and loss of response is common. As combination therapy with methotrexate may improve response, we performed a multi-center, randomized, double-blind, placebo-controlled pragmatic trial to compare TNFi with oral methotrexate to TNFi monotherapy.METHODS: PCD patients initiating infliximab or adalimumab were randomized in 1:1 allocation to methotrexate or placebo and followed for 12-36 months. The primary outcome was a composite indicator of treatment failure. Secondary outcomes included anti-drug antibodies (ADA) and patient reported outcomes (PROs) of pain interference and fatigue. Adverse events (AEs) and Serious AEs (SAEs) were collected.RESULTS: Of 297 participants (mean age 13.9 years, 35% female), 156 were assigned to methotrexate (110 infliximab initiators and 46 adalimumab initiators) and 141 to placebo (102 infliximab initiators and 39 adalimumab initiators). In the overall population, time to treatment failure did not differ by study arm (HR 0.69, 95% CI 0.45-1.05). Among infliximab initiators, there were no differences between combination and monotherapy (HR 0.93, 95% CI 0.55-1.56). Among adalimumab initiators, combination therapy was associated with longer time to treatment failure (HR 0.40, 95% CI 0.19-0.81). A trend towards lower ADA development in the combination therapy arm was not significant. [(infliximab OR 0.72 (0.49-1.07); adalimumab OR 0.71 (0.24-2.07)]. No differences in PROs were observed. Combination therapy resulted in more AEs but fewer SAEs.CONCLUSIONS: Among adalimumab but not infliximab initiators, PCD patients treated with methotrexate combination therapy experienced a 2-fold reduction in treatment failure with a tolerable safety profile.

    View details for DOI 10.1053/j.gastro.2023.03.224

    View details for PubMedID 37004887

  • Clinical Practice Survey of Repeat Endoscopy in Pediatric Inflammatory Bowel Disease in North America. Journal of pediatric gastroenterology and nutrition Moses, J., Sandberg, K., Winberry, G., Riera, D., DeLozier, S., Gupta, S. K., Reilly, N., Park, K. T., Picoraro, J. 2021

    Abstract

    OBJECTIVES: Endoscopic remission has become a standard treatment target in inflammatory bowel disease (IBD). It is unclear how widely this practice has been adopted amongst pediatric gastroenterology providers. This study determines the frequency of repeat endoscopy in pediatric IBD and evaluates for predictive baseline characteristics of providers.METHODS: We developed a cross-sectional survey which was distributed via three national email listservs to pediatric gastroenterology providers. We obtained baseline characteristics of respondents and assessed motivations and barriers for the practice of repeat endoscopy compared to none.RESULTS: 238 unique respondents completed the online survey. Response rate was 11% (238 of 2300 possible participants). The majority practice in an academic setting (77%) and reported participation in ImproveCareNow (63%). Overall, 65% of respondents perform repeat endoscopy to assess for endoscopic remission in pediatric IBD as part of routine clinical practice. 56% reported repeat endoscopy as individuals in the absence of a departmental protocol. "Symptoms are not sufficient to follow IBD patients" was reported by 82% of those who repeat endoscopy; conversely, "I perform endoscopy based on clinical, biomarker, and/or imaging trends" was reported by 81% of those who do not repeat endoscopy. The establishment of a pediatric-specific guideline was most commonly reported to change current practice, based on rank-order scoring.CONCLUSION: A majority of representative providers repeat endoscopy to assess for endoscopic remission in pediatric IBD. Fewer years in practice favored repeating endoscopy. The need for North American pediatric guidelines with pediatric-specific evidence to support the long term benefits of endoscopic remission are highlighted in this study.

    View details for DOI 10.1097/MPG.0000000000003100

    View details for PubMedID 33633082

  • Assuring Quality for Non-Hospital Based Biologic Infusions in Pediatric Inflammatory Bowel Disease: A Clinical Report from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Journal of pediatric gastroenterology and nutrition Barfield, E. n., Sockolow, R. n., Hoffenberg, E. n., Saeed, S. n., Kim, S. n., Siebold, L. n., Picoraro, J. n., Moses, J. n., Dykes, D. n., Grossman, A. n., Wahbeh, G. n., Park, K. T. 2018

    Abstract

    The primary aim of this Clinical Report by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition is to provide formal guidance to pediatric gastroenterologists and clinicians, health systems, and insurance payers regarding home- and office-based infusions for biologic therapies in pediatric inflammatory bowel disease (IBD). Patients in North America are increasingly denied coverage by payers based on "place of service" codes at hospital-based infusion units where the treating clinicians primarily provide care. A task force with topic expertise generated 8 best practice recommendations to ensure quality of care for pediatric patients with IBD receiving non-hospital based biologic infusions. Pragmatic considerations discussed in this report include patient safety, pediatric-trained nurse availability, care coordination, patient-centeredness, shared liability, administrative support, clinical governance, and costs of care.

    View details for PubMedID 29324477

  • Premedication Use Before Infliximab Administration: A Cross-sectional Analysis INFLAMMATORY BOWEL DISEASES Picoraro, J., Winberry, G., Siegel, C. A., El-Matary, W., Moses, J., Grossman, A., Park, K. T. 2017; 23 (1): 174-180

    Abstract

    Premedications are commonly given to patients with inflammatory bowel disease before intravenous infliximab administration. We aimed to (1) describe practice variability; and (2) determine clinician rationale for premedicating patients with inflammatory bowel disease before infliximab administration.We developed a cross-sectional electronic survey after comprehensive literature review to assess practice variability and clinician rationale for premedication use before infliximab. An optional postsurvey quiz assessed clinicians' understanding of the available literature. The survey was distributed through members-only NASPGHAN and Crohn's and Colitis Foundation of America (CCFA) listservs and American Gastroenterological Association (AGA) and American College of Gastroenterology (ACG) web-based discussion boards.Three hundred seventy-nine unique respondents with a 93.3% survey completion rate comprised 331 (87%) and 45 (12%) pediatric and adult gastroenterologists. Among numerous options for premedications, acetaminophen (66%) and diphenhydramine (64%) were most often given before each infliximab infusion. Only 20% did not routinely use premedications. There was heterogeneity of premedication use between gastroenterologists within the same clinical practice. Of 328 (87%) respondents who completed the knowledge assessment quiz, only 18% identified the association of diphenhydramine use with increased reaction.There is high interpractice and intrapractice variability for premedication use before infliximab administration. Clinician rationale for premedicating patients seems to be driven by individual preference or group practice habit. Improved knowledge of the evidence may assist in decreasing overuse of premedications, particularly diphenhydramine.

    View details for DOI 10.1097/MIB.0000000000001002

    View details for Web of Science ID 000393897100027

    View details for PubMedID 28002131

    View details for PubMedCentralID PMC5180444