At Children’s Healthcare of Atlanta, our Gastroenterology, Hepatology and Nutrition Program ranks No. 7 in the country, and is the only nationally ranked pediatric program of its kind in Georgia*.

Our team is committed to advancing care for pediatric patients across the country. Physicians in our program conduct multiple studies on a national level and are involved in collaborative efforts that further expand our understanding of liver disease and disorders of the gastrointestinal tract.

Research collaborations

Some of our research collaborations include:

ChiLDREN is a collaborative network organized to study rare childhood liver diseases, sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Children’s is among only 16 pediatric centers in the country to participate in the network.

The goals of ChiLDREN include:

  • Facilitating the discovery of causes of childhood liver disease.
  • Developing new diagnostics tests or disease markers.
  • Developing treatment options for children with liver disease and those who undergo liver transplant.
  • Training the next generation of investigators in rare pediatric liver diseases.

Diseases studied by the network include:

  • Alagille syndrome
  • Alpha 1 antitrypsin deficiency (A-1AT)
  • Bile acid synthesis and metabolic defects
  • Biliary atresia
  • Cystic fibrosis liver disease
  • Idiopathic neonatal hepatitis
  • Mitochondrial hepatopathies
  • Progressive familial intrahepatic cholestasis

Protocols that are part of ChiLDREN include:

  • Prospective Database of Infants With Cholestasis (PROBE): A study of infants up to age 6 months with jaundice from liver disease.
  • Randomized, Double-Blinded, Placebo-Controlled Trial of Corticosteroid Therapy Following Portoenterostomy in Infants With Biliary Atresia (START): A study to evaluate the usefulness of prednisone after surgery for biliary atresia.
  • Biliary Atresia Study in Infants and Children (BASIC): A study to gather information on children with biliary atresia to understand what happens after the Kasai surgery.
  • Longitudinal Studies in Children With Cholestasis (LOGIC): A study that involves children with alpha-1 antitrypsin deficiency, Alagille syndrome, progressive familial intrahepatic cholestasis and bile acid defects.
  • Longitudinal Studies of Mitochondrial Hepatopathies (MITOHEP): A study to gather information about liver problems in mitochondrial diseases and in fatty oxidation defects.

CTOT-C is a cooperative research program sponsored by the National Institute of Allergy and Infectious Diseases that conducts clinical studies that will lead to improved outcomes for children who’ve received transplants.

Learn more about CTOT-C

Children’s is the largest enroller of patients in ImproveCareNow, a national outcomes and quality registry for children with inflammatory bowel disease (IBD).

Learn more about ImproveCareNow

The Immunosuppression Withdrawal for Stable Pediatric Liver Transplant Recipients (iWith) clinical trial studies the withdrawal of immunosuppression (anti-rejection) medications in children who have received liver transplants.

Learn more about the iWith study

It’s crucial that we expand the number of living donor liver transplant recipients to improve outcomes for children who receive transplants. Consider this: 100% of living donor liver transplant recipients at Children’s are alive, based on our current calendar year survival statistics, compared with 85% of cadaver liver recipients.

Funded by the Carlos and Marguerite Mason Trust, Project LEAP seeks to:

  • Ensure minority children have access to living donor liver transplantation, which offers excellent outcomes.
  • Improve awareness and understanding of living donor transplantation among Georgia’s minorities.
  • Identify obstacles to living donor liver transplantation and eliminate those obstacles.
  • Become the national resource for children’s living donor transplantation by gathering data about living donor candidates, recipients and transplantation outcomes, including measures of survival and quality of life.

A focus on minority organ donations

A LifeLink Foundation study shows that 27% of Caucasians decide to donate organs after death, but only 10% of African Americans are willing to do so. In the last four years, only 1 in 20 children who received a living donor liver transplant at Children’s was African American. Yet the number of children receiving deceased liver donations at the hospital was proportional to the state’s ethnic makeup. Roughly 29% of Georgia’s children are African American, and of those receiving liver transplants at Children’s, 36% were African American.

Project LEAP researchers expect to discover why minority children, though undergoing liver transplants at an appropriate proportion based on the state’s population, are underrepresented in living donor transplantation.

The NASH Clinical Research Network is a NIDDK-sponsored collaborative network that focuses on the causes of, contributing factors to, history of, complications of and therapy for NASH. NASH is caused by a buildup of fat in the liver, which results in inflammation and damage to the liver.

Learn more about the NASH network

PALF is a national collaborative study of infants, children and adolescents with acute liver failure. The purpose of the study is to develop management strategies to help improve the quality of their lives.

Join the study

Researchers will use information from your child’s hospital record, as well as blood and tissue samples (when available), to study the disease. The information they use is held in strict confidence—participation in the study is only possible with informed consent from parents or a legal guardian. No names are used in this study, so the information is confidential.

When your child participates in the study, researchers can use the information about your child’s illness to get a more complete picture of the disease and its causes. This knowledge will help them develop new treatments for this rare and very serious condition.

SPLIT is a cooperative effort among leading pediatric transplant centers in the U.S. and Canada to advance the science of liver transplants in children.

Our areas of interest for research include:

  • Acute liver failure
  • Biliary atresia
  • Crohn’s disease and ulcerative colitis
  • Chronic pancreatitis in children
  • Cystic fibrosis-associated liver disease
  • Eosinophilic esophagitis
  • Fatty liver disease
  • Hepatitis B and C therapy in children
  • Liver transplantation
    • Adolescent transplant patients’ adherence to their medication and lifestyle regimen and transitioning them from pediatric- to adult-centered care
    • Nutritional status after liver transplantation
    • Post-transplantation medical issues 
    • Transplant rejection and immunologic tolerance (acceptance by the body)
  • Neonatal alloimmune liver disease
  • Neonatal cholestatic liver disease
  • Noninvasive diagnosis of liver disease using magnetic resonance imaging (MRI)
  • Portal hypertension

Whole-genome sequencing of African Americans implicates differential genetic architecture in inflammatory bowel disease.

Our team participated in a multi-center collaborative study published in the American Journal of Human Genetics.

read the study

Whole-genome sequencing of African Americans implicates differential genetic architecture in inflammatory bowel disease. The American Journal of Human Genetics. 2021.

  • Hari K. Somineni, Sini Nagpal, Suresh Venkateswaran, David J. Cutler, David T. Okou, Talin Haritunians, Claire L. Simpson, Ferdouse Begum, Lisa W. Datta, Antonio J. Quiros, Jenifer Seminerio, Emebet Mengesha, Jonathan S. Alexander, Robert N. Baldassano, Sharon Dudley-Brown, Raymond K. Cross, Themistocles Dassopoulos, Lee A. Denson, Tanvi A. Dhere, Heba Iskandar, Gerald W. Dryden, Jason K. Hou, Sunny Z. Hussain, Jeffrey S. Hyams, Kim L. Isaacs, Howard Kader, Michael D. Kappelman, Jeffry Katz, Richard Kellermayer, JohnF .Kuemmerle, Mark Lazarev, Ellen Li, Peter Mannon, Dedrick E. Moulton, Rodney D. Newberry, Ashish S. Patel, Joel Pekow, Shehzad A. Saeed, John F. Valentine, Ming-His Wang, Jacob L. McCauley, Maria T. Abreu, Traci Jester, Zarela Molle-Rios, Sirish Palle, Ellen J. Scherl, John Kwon, John D. Rioux, Richard H. Duerr, Mark S. Silverberg, Michael E. Zwick, Christine Stevens, Mark J. Daly, Judy H. Cho, Greg Gibson, Dermot P.B. McGovern, Steven R. Brant, Subra Kugathasan
  • Whether or not populations diverge with respect to the genetic contribution to risk of specific complex diseases is relevant to understanding the evolution of susceptibility and origins of health disparities. Here, we describe a large-scale whole-genome sequencing study of inflammatory bowel disease encompassing 1,774 affected individuals and 1,644 healthy control Americans with African ancestry (African Americans).

Evolving Clinical Care in Esophageal Button Batteries: Impact of Expert-Opinion Guideline Adoption and Continued Gaps in Care. J Pediatr Gastroenterol Nutr. 2021.

  • Elizabeth M Sinclair, Matthew T Santore, Maneesha Agarwal, Jamie Kitzman, Cary G Sauer, Erica L Riedesel
  • Esophageal button battery impactions (BBI) in children pose a significant danger to children. With this study, we aimed to describe the care of these patients prior to and following adoption of guidelines at a single center.

Creation of a Pediatric Choledocholithiasis Prediction Model. J Pediatr Gastroenterol Nutr. 2021.

  • Reuven Zev Cohen, Hongzhen Tian, Cary G Sauer, Field F Willingham, Matthew T Santore, Yajun Mei, A Jay Freeman
  • Alanine aminotransferase (ALT), total bilirubin, alkaline phosphatase, and common bile duct diameter via ultrasound were found to be the key clinical variables to determine the likelihood of choledocholithiasis.

Early Change in Fecal Calprotectin Predicts One-Year Outcome in Children Newly Diagnosed with Ulcerative Colitis. J Pediatr Gastroenterol Nutr. 2021

  • Krishnakumar C, Ananthakrishnan AN, Boyle BM, Griffiths AM, LeLeiko NS, Mack DR, Markowitz JF, Rosh JR, Sauer CG, Walters TD, Bonkowski E, Denson LA, Hyams JS, Kugathasan S
  • While fecal calprotectin (FC) is used to assess disease activity in ulcerative colitis (UC) there are little data concerning the role of serial FC levels at diagnosis in predicting clinical course. We sought to determine whether FC at diagnosis or early change following therapy predicts clinical outcome in pediatric UC.methods.

Clinical and Host Biological Factors Predict Colectomy Risk in Children Newly Diagnosed With Ulcerative Colitis. Inflamm Bowel Dis. 2021.

  • Hyams JS, Brimacombe M, Haberman Y, Walters T, Gibson G, Mo A, Mack D, Griffiths A, Boyle B, LeLeiko N, Markowitz J, Rosh J, Patel A, Shah S, Baldassano R, Pfefferkorn M, Sauer C, Dailey J, Venkateswaran S, Kugathasan S, Denson LA.
  • This was a multicenter inception cohort study of children (ages 4-17 years) newly diagnosed with UC treated with standardized initial regimens of mesalamine or corticosteroids (CS) depending upon initial disease severity.

Quality Improvement Methodology Optimizes Infliximab Levels in Pediatric Patients with Inflammatory Bowel Disease. Pediatr Qual Saf. 2021.

  • Jennifer Hellmann, Renee K Etter, Lee A Denson, Phillip Minar, Denise Hill, Dana Dykes, Michael J Rosen
  • Quality improvement methodology was effective in improving provider adherence to infliximab therapeutic drug monitoring guidelines. Improvement in adherence to guidelines directly improved the percentage of patients achieving target infliximab levels at any time during infliximab therapy.

Gastrointestinal Factors Associated With Hospitalization in Infants With Cystic Fibrosis: Results From the Baby Observational and Nutrition Study. J Pediatr Gastroenterol Nutr. 2021.

  • Sathe M, Huang R, Heltshe S, Eng A, Borenstein E, Miller SI, Hoffman L, Gelfond D, Leung DH, Borowitz D, Ramsey B, Freeman AJ
  • Factors associated with a higher risk for GI-related admission during the first 12 months include high PERT dosing, exposure to acid suppressive medications, higher fCP levels, and/or relative abundance of fecal K pneumoniae early in life.

Designing the GALAXY Study: Partnering with the Cystic Fibrosis Community to Optimize Assessment of Gastrointestinal Symptoms. J Cyst Fibros. 2021.

  • Freeman AJ, Sathe M, Aliaj E, Borowitz D, Fogarty B, Goss CH, Freedman S, Heltshe SL, Khan U, Riva D, Roman C, Romasco M, Schwarzenberg SJ, Ufret-Vincenty CA, Moshiree B
  • GI involvement among persons with CF is highly prevalent, representing a significant source of morbidity. Persons with CF have identified GI concerns as a top research priority, yet universal clinical outcome measures capturing many of the GI symptoms experienced in CF are lacking. The GALAXY study was envisioned to address this unmet need.

Serial MRI Findings After Endoscopic Removal of Button Battery From the Esophagus. AJR Am J Roentgenol. 2020.

  • Erica L Riedesel, Edward J Richer, Elizabeth M Sinclair, Cary G Sauer, Matthew T Santore, Stephen F Simoneaux, Adina L Alazraki
  • The purpose of this study was to evaluate findings at serial MRI after endoscopic removal of a button battery from the esophagus in a series of pediatric patients. 

Dietary sugar restriction reduces hepatic de novo lipogenesis in adolescent boys with fatty liver disease

  • Catherine C Cohen, Kelvin W Li, Adina L Alazraki, Carine Beysen, Carissa A Carrier, Rebecca L Cleeton, Mohamad Dandan, Janet Figueroa, Jack Knight-Scott, Cynthia J Knott, Kimberly P Newton, Edna M Nyangau, Claude B Sirlin, Patricia A Ugalde-Nicalo, Jean A Welsh, Marc K Hellerstein, Jeffrey B Schwimmer, Miriam B Vos
  • Hepatic de novo lipogenesis (DNL) is elevated in nonalcoholic fatty liver disease (NAFLD). Improvements in hepatic fat by dietary sugar reduction may be mediated by reduced DNL, but data are limited, especially in children. We examined the effects of 8 weeks of dietary sugar restriction on hepatic DNL in adolescents with NAFLD and correlations between DNL and other metabolic outcomes.

PRO-C3, a Serological Marker of Fibrosis, During Childhood and Correlations With Fibrosis in Pediatric NAFLD. Hepatol Commun. 2021.

  • Cohen CC, Castillo-Leon E, Farris AB, Caltharp SA, Cleeton RL, Sinclair EM, Shevell DE, Karsdal MA, Nielsen MJF, Leeming DJ, Vos MB
  • The objectives of this study were to examine PRO-C3 (a neo-epitope pro-peptide of type III collagen formation) levels across childhood/adolescence and associations with advanced fibrosis in pediatric NAFLD. 

Patient Determinants for Histologic Diagnosis of NAFLD in the Real World: A TARGET-NASH Study. Hepatol Commun. 2021.

  • Barritt AS, Watkins S, Gitlin N, Klein S, Lok AS, Loomba R, Schoen C, Reddy KR, Trinh HN, Mospan AR, Vos MB, et al.
  • The aim of this study was to determine patient factors predictive of histologic versus empiric clinical diagnosis of NAFLD in real-world practice.

Neurodevelopmental Outcomes in Children with Inherited Liver Disease and Native Liver. J Pediatr Gastroenterol Nutr. 2021.

  • Leung DH, Sorensen LG, Ye W, Hawthorne K, Ng VL, Loomes KM, Fredericks EM, Alonso EM, Heubi JE, Horslen SP, Karpen SJ, et al.
  • To evaluate neurodevelopmental status among children with inherited cholestatic liver diseases with native liver and variables predictive of impairment.

Heterogeneous Liver on Research Ultrasound Identifies Children with Cystic Fibrosis at High Risk of Advanced Liver Disease: Interim Results of a Prospective Observational Case-Controlled Study. J Pediatr. 2020. 

  • Siegel MJ, Freeman AJ, et al.
  • To assess if a heterogeneous pattern on research liver ultrasound examination can identify children at risk for advanced cystic fibrosis (CF) liver disease.

NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children: Recommendations from the Expert Committee on NAFLD (ECON) and NASPGHAN. J Pediatr Gastroenterol Nutr. 2017.

  • Miriam B Vos, et al.
  • In this guideline, the expert committee on NAFLD reviewed and summarized the available literature, formulating recommendations to guide screening and clinical care of children with NAFLD

Medical Management of Chronic Pancreatitis in Children: A Position Paper by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pancreas Committee. Journal of Pediatric Gastroenterology and Nutrition.

  • Freeman, A. Jay, et al.
  • This position paper summarizes the current understanding of the medical management of chronic pancreatitis (CP) in children in light of the existing medical literature, incorporating recent advances in understanding of nutrition, pain, lifestyle considerations, and sequelae of CP.

Pancreatitis in Children. Pediatr Clin North Am. 2021.

  • Reuven Zev Cohen, A Jay Freeman
  • Pediatric pancreatitis describes a spectrum covering acute pancreatitis, acute recurrent pancreatitis, and chronic pancreatitis, each with varying clinical manifestations and risk factors requiring a tailored diagnostic approach. 

Order Set Use and Education Association With Pediatric Acute Pancreatitis Outcomes. Hosp Pediatr. 2021.

  • Shah M, Leong T, Freeman AJ.
  • Pediatric-specific recommendations for treatment of AP were recently developed by North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, but their impact on clinical outcomes has yet to be evaluated. We developed an AP order set on the basis of these recommendations to assess impact on clinical outcomes.

COVID-19-associated Multisystem Inflammatory Syndrome in Children Presenting as Acute Pancreatitis. J Pediatr Gastroenterol Nutr. 2020.

  • Stevens JP, Brownell JN, Freeman AJ, Bashaw H
  • We describe a patient who presented with acute pancreatitis before rapidly progressing to multisystem organ dysfunction consistent with multisystem inflammatory syndrome in children due to COVID-19.

SARS-CoV2 Infection in Children with Liver Transplant and Native Liver Disease. J Pediatr Gastroenterol Nutr. 2021

  • Mohit Kehar, Noelle H Ebel, Vicky L Ng, Jairo Eduardo Rivera Baquero, Daniel H Leung, Voytek Slowik, Nadia Ovchinsky, Amit A Shah, Ronen Arnon, Tamir Miloh, Nitika Gupta, Saeed Mohammad, Debora Kogan-Liberman, James E Squires, Maria Camila Sanchez, Amber Hildreth, Linda Book, Christopher Chu, Leina Alrabadi, Ruba Azzam, Bhavika Chepuri, Scott Elisofon, Rachel Falik, Lisa Gallagher, Howard Kader, Douglas Mogul, Quais Mujawar, Shweta S Namjoshi, Pamela L Valentino, Bernadette Vitola, Nadia Waheed, Ming-Hua Zheng, Steven Lobritto, Mercedes Martinez
  • Increased mortality risk because of severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) infection in adults with native liver disease (LD) and liver transplant (LT) is associated with advanced age and comorbid conditions. We aim to report outcomes for children with LD and LT enrolled in the NASPGHAN/SPLIT SARS-CoV2 registry.

North American biliary stricture management strategies in children post liver transplant: multicenter analysis from the SPLIT Registry. Liver Transpl. 2021.

  • Valentino PL, Wang T, Shabanova V, Ng VL, Bucuvalas JC, Feldman AG, Gonzalez-Peralta RP, Gupta NA, et al.
  • Study objectives included analyses of outcomes associated with biliary stricture management strategies via PTC, ERCP or surgery.

Presentation and Outcomes of Infants With Idiopathic Cholestasis: A Multicenter Prospective Study. J Pediatr Gastroenterol Nutr. 2021.

  • Hertel PM, Hawthorne K, Kim S, Finegold MJ, Shneider BL, Squires JE, Gupta NA, et al.
  • The aim of the study was to determine the frequency and natural history of infantile idiopathic cholestasis (IC) in a large, prospective, multicenter cohort of infants.

Resolution of recurrent pediatric acute liver failure with liver transplantation in a patient with NBAS mutation. Pediatr Transplant. 2021.

  • Duke Geem, Wenxiao Jiang, Heather B Rytting, Shanmuganathan Chandrakasan, Anand Salem, James P Stevens, Saul J Karpen, Joseph F Magliocca, Rene Romero, Dellys Soler Rodriguez
  • A growing body of research has identified mutations in the NBAS gene to be associated with recurrent acute liver failure and multi-systemic disease including short stature, skeletal dysplasia, facial dysmorphism, immunologic abnormalities, and Pelger-Huët anomaly.

Pretransplantation and Post-Transplantation Liver Disease Assessment in Adolescents Undergoing Isolated Heart Transplantation for Fontan Failure. J Pediatr. 2021.

  • Rodriguez DS, Mao C, Mahle WT, Kanter KR, Alazraki A, Braithwaite K, Rytting H, Caltharp S Magliocca JF, Romero R
  • To describe the assessment of Fontan-associated liver disease and determine the clinical and imaging measures that may identify hepatic morbidity risk in isolated heart transplantation candidates and trend those measures post-isolated heart transplantation.