GI Connect
Children's Mercy Kansas City
Division of Pediatric Gastroenterology
The Division of Pediatric Gastroenterology at Children’s Mercy is nationally recognized for pioneering groundbreaking approaches in treatment and for conducting research to improve the effectiveness of care for children.
Stay tuned to this page for updates on our clinical and research efforts, as well as leadership highlights.
We partner with medical professionals around the world to help keep children healthy and safe. Whether through training and affiliations, research collaborations, shared evidence-based practice guidelines, patient care management or other opportunities, we look forward to working with you to improve outcomes for children everywhere.
Advancing GI care through research
Working with the Genomic Medicine Center at Children’s Mercy, the GI Division is also conducting genetic testing and research to transform care for children with rare syndromes. In 2020 alone we:
Published 69 manuscripts or book chapters.
Gave 51 national or international presentations.
Find out more about the innovative developments in research and clinical care taking place.
Functional abdominal pain, IBS and auricular neurostimulation
Functional abdominal pain is very common and about 10-15% of school-age children report that they experience recurrent abdominal pain. This is typically diagnosed in otherwise healthy children who repeatedly complain of stomach pain for two months or longer.
Another common functional gastrointestinal disorder is irritable bowel syndrome (IBS) – which is altered bowel consistency combined with abdominal pain that is usually relieved with a bowel movement.
While these used to be diagnoses of exclusion, today functional abdominal pain or irritable bowel syndrome can be diagnosed much quicker through the symptom-based Rome criteria with limited diagnostic testing.
One misconception about IBS is that it’s not a big deal. However, the pain and discomfort patients experience are real, and some symptoms can create a burden on everyday life – in severe cases leading to social isolation, depression and other mental health illnesses.
Gastroenterologists often refer to the enteric nervous system as the “gut brain” since it contains the largest collection of nerve cells outside of the brain. The brain and the gut have a strong connection, sending constant signals back and forth to help the GI system function properly. Sometimes the brain and gut can become dysregulated, often due to environmental triggers or life events. When this happens, gut hypersensitivity causing abdominal pain, or abnormal movement of the gut causing constipation, or diarrhea may occur.
There is no “one size fits all” treatment for IBS. Clear communication is very important between a patient/family and the physician to discuss what is working or not working well.
Keeping track of symptoms can help identify triggers that worsen symptoms, such as lactose or foods that cause gas, stress or anxiety. Treatment may start with diet modification if symptoms are triggered by certain foods, or gut-directed hypnotherapy or cognitive behavioral therapy if stress and anxiety are major triggers. Other treatment approaches may include water-soluble fiber, antispasmodics, laxatives or antidiarrheal agents, depending on the patient’s symptoms.
For patients with symptoms that do not adequately respond to conservative measures, central neuromodulators such as low-dose antidepressants or auricular neurostimulators may be considered to help the brain-gut axis stay regulated.
Auricular neurostimulation is a novel therapy which was approved by the FDA in 2017 for use in adolescents with IBS. The device works by sending gentle electrical impulses into nerve bundles located around the ear. This stimulation targets brain areas involved in pain processing and aids in the reduction of abdominal pain from the dysregulated brain-gut axis. After being placed in clinic, the device is worn continuously for five consecutive days each week, followed by a two-day break by removal in the home setting. A typical treatment course consists of four to eight weeks of therapy based on an individual child’s needs.
While management of IBS may be long-term, most cases can be managed in the primary care setting through an individualized approach according to the patient’s needs. However, if children start to develop alarm symptoms or have an abnormal physical exam, they may require referral to a pediatric gastroenterologist for further evaluation and management.
Click below to listen to the podcast by Pang Krasaelap, MD, or read the article by Dr. Krasaelap and Gracielle Bahia, DO, MA, to learn more about this topic.
Dr. Rachel Chevalier receives grant for EoE research
Rachel Chevalier, MD, was recently awarded a two-year NASPGHAN Foundation/NASPGHAN George Ferry Young Investigator Development Award, providing her with $150,000 in funding for her project “Mucosal CYP3A4 and P-gp mediated drug metabolism of budesonide in patients with eosinophilic esophagitis (EoE).”
The award is given to support a commendable research project studying gastrointestinal conditions or nutritional disorders in children.
Eosinophilic esophagitis (EoE) is a disease of the esophagus, often triggered by a reaction to certain foods – most commonly milk and wheat products. Symptoms may include nausea, vomiting, abdominal pain, poor weight gain and difficulty swallowing.
The condition is managed through elimination diets or corticosteroids, including oral budesonide. However, over a quarter of patients with EoE fail to reach remission with budesonide therapy. Dr. Chevalier’s study will analyze the factors that lead to patients having this poor response.
The long-term goal of the study is to better predict therapeutic response to budesonide to optimize EoE therapy, help patients achieve remission faster, and decrease endoscopy procedures and negative long-term effects.
We are proud of Dr. Chevalier’s outstanding accomplishment and opportunity to further pediatric gastroenterology research for EoE!
Feature publications
Children’s Mercy researchers in gastroenterology analyzed 28 youth meeting Rome IV criteria for rumination syndrome who had undergone endoscopy (compared to 10 controls) to assess antral and duodenal biopsies and cell densities.
The majority of youth with chronic abdominal pain meet Rome criteria for a functional abdominal pain disorder (FAPD). FAPDs are complex and involve several contributing factors. This review gives an overview of the pathophysiology of FAPDs and a summary of existing literature.
Many studies show that a relationship exists between functional abdominal pain disorders (FAPDs) and food allergies. In this article, Craig Friesen, MD, Jennifer Colombo, MD, and Jennifer Schurman, PhD review current studies on the role of allergies in FAPDs.
This review looks at literature surrounding rumination syndrome with a focus on neurotypical youth. Authors found higher prevalence in patients with other gastrointestinal (GI) issues. However, more studies are needed to better understand prevalence and define management strategies.
Medical faculty spotlight
Nadia Ibrahimi, MD, is one of our former fellows who now specializes in pediatric gastroenterology at Children’s Mercy. Dr. Ibrahimi is the Director of our Pancreas Program and works with the Liver Care Center Team. She also has advanced training in performing endoscopies, including an endoscopic retrograde cholangiopancreatography (ERCP) – a procedure to diagnose and treat problems in the bile and pancreatic ducts.
Academically, she is also Clinical Assistant Professor of Pediatrics at the University of Missouri-Kansas City School of Medicine and Education Assistant Professor of Pediatrics at the University of Kansas School of Medicine.
In her most recent research, she worked with a few colleagues on a case series and literature review surrounding pediatric recurrent intentional foreign body ingestion, as management guidelines have yet to be outlined in pediatrics. Their paper was published in the Journal of Pediatric Gastroenterology and Nutrition.
A few years ago, Dr. Ibrahimi and pediatric gastroenterologists from around the country analyzed characteristics of nonsyndromic and syndromic juvenile polyps in a retrospective cohort analysis. They concluded that juvenile polyp recurrence is positively and significantly related to polyp burden, and that juvenile polyps can harbor adenomatous changes, independent of polyp number. Some of the data was presented at NASPGHAN 2017.
Currently, Dr. Ibrahimi is a co-investigator in a multicenter study, led by Texas Children’s Hospital, looking at the diagnostic and therapeutic benefits of pediatric enteroscopy, with the ultimate goal of creating pediatric algorithms for different indications for enteroscopy to maximize diagnostic yield and better optimize diagnostic and therapeutic benefits of pediatric enteroscopy.
Read the publication on pediatric recurrent intentional foreign body ingestion.
Clinic spotlight
Children’s Mercy Celiac Disease Program
Each year, the Celiac Disease Program diagnoses around 150 children with celiac disease – a chronic autoimmune disorder triggered by eating gluten. In children, this can have a harmful impact on growth and development if not managed properly.
The Celiac Disease Program is led by Julia Bracken, MD, Medical Director of Nutrition Services, and our care team includes medical providers, a celiac-focused dietitian and a pediatric psychologist.
Symptoms of celiac disease vary from one child to another but may include abdominal pain, bloating, vomiting, diarrhea or constipation. Some children have symptoms outside of the GI tract, like poor growth, headaches, anemia or fatigue. While celiac disease can develop at any age, it is most common for signs of celiac disease to appear during childhood.
The first step in diagnosing celiac disease is a simple blood test called a tissue transglutaminase (tTG-IgA), given while the child is still eating gluten. If the test is positive, an upper endoscopy (EGD) with biopsy of the small intestine will confirm the diagnosis.
Our multidisciplinary team works with each family to provide comprehensive care for kids diagnosed with celiac disease who need to be on a gluten-free diet. As this is a lifelong diagnosis, our team continues to care for kids and teens with celiac disease as they grow until they are ready to transition to adult care. We also treat kids with non-celiac gluten sensitivity.
Access to nutritious, gluten-free food is an important aspect of caring for children with celiac disease regardless of their economic status. Therefore, the Celiac Disease Program has a partnership with the Food Equality Initiative (FEI), a local gluten-free assistance program.
Fellow spotlight
Moises Alatorre Jimenez, MD, PhD, is a first-year pediatric gastroenterology fellow who started his fellowship in July 2021. He came to Children’s Mercy after completing his residency in pediatrics at SUNY Downstate Medical Center in Brooklyn, N.Y. He received his medical degree at Universidad Autónoma De Guadalajara Facultad De Medicina in Guadalajara, Mexico.
His research interests combine basic sciences and clinical research, including studies surrounding the potential benefits of melatonin as an antioxidant for conditions such as IBD. As a fellow, he hopes to expand his involvement in clinical research even further.
While he was completing his PhD, Dr. Alatorre Jimenez was involved in the leadership of multiple nongovernmental organizations to help children with rare diseases receive treatments needed to manage their conditions. As a resident, he also became Editor-in-Chief for the Iberoamerican Journal of Medicine – an international medical journal which publishes research in all fields of medicine.
Read the publication on melatonin as an antioxidant.
Read the publication on melatonin’s role as a co-adjuvant treatment in colonic diseases.
COVID-19 news and resources
Thomas Attard, MD, FAAP, FACG, Pediatric Gastroenterologist and Medical Director of Endoscopy and the Polyposis Center at Children’s Mercy, led the development and implementation of a strategy to triage pediatric gastrointestinal endoscopy procedures that are either new or cancelled (non-urgent) due to the COVID-19 pandemic. This strategy was developed in collaboration with a multidisciplinary team, including physician, nursing, and psychology providers, to provide a rational, conceptual framework for triaging elective endoscopies. As a result of successful prioritization of patients and application of the tool, the GI team is close to pre-COVID-19 scheduling volume.
- View the webinar for the American College of Gastroenterology.
- View the presentation slides.
- View the publication in Gastroenterology Nursing authored by Children’s Mercy GI providers Panamdeep Kaur, MD, Thomas Attard, MD, Fernando Zapata, MD, Donna Ditsch, BSN, RN, CPN, Jennifer V. Schurman, PhD.
Clinical psychologists in clinics across the GI Division have partnered with the social work team to conduct a “COVID Impact” survey with parents of children who receive care at Children’s Mercy. The goal of the survey, conducted either via phone or through REDCAP depending on the clinic, is to identify barriers to care during the COVID-19 pandemic and use that information to tailor care approaches to the family’s needs.
The survey measures the impact of COVID-19 on their parenting (e.g., made it better or worse) and has respondents rate on a scale of 1-10 certain factors such as the ability to care for their child with GI needs, care for their other children, care for aging parents, and to seek out self-care (e.g., therapy). The survey includes questions about the status of their basic needs, interpersonal relationships and financial situations to assess how things such as being furloughed or losing their job may impact them and their family.
The screener was developed and provided by The Center for Pediatric Traumatic Stress at Nemours /A.I. duPont Hospital for Children. Anonymous results from the survey will be aggregated across institutions to better understand the impact of the pandemic on children, youth and families across the US.
In the meantime, the Children’s Mercy GI psychosocial team, including Jennifer V. Schurman, PhD, Michele H. Maddux, PhD, Amanda D. Deacy, PhD, Jamie L. Ryan, PhD, Laura E. Slosky, PhD, and Christina Low Kapalu, PhD, is using the data to guide whole-family-based care that is sensitive to the individual support needs of families. Families that have participated report positive feedback and appreciate the opportunity to express the impact of COVID-19.
The COVID-19 pandemic has drastically changed health care systems and training around the world. The Training Committee of NASPGHAN sought to understand how COVID-19 has affected pediatric gastroenterology fellowship training. John Rosen, MD, et al., authored a paper on a survey conducted among pediatric gastroenterology fellowship program directors. Important changes include rapid adoption of telehealth and reduced clinical and research experiences. Survey information may spur communication and innovation to help educators adapt.
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Among the top pediatric gastroenterology programs in the nation, according to U.S. News & World Report.