I am a pediatric gastroenterologist at GI Care for Kids (previously called CCDHC) in Atlanta, Georgia. The goal of my blog is to share some of my reading in my field more broadly. In addition, I wanted to provide my voice to a wide range of topics that often have inaccurate or incomplete information.
Before starting this blog in 2011, I would tear out articles from journals and/or keep notes in a palm pilot. This blog helps provide an updated source of information that is easy to access and search, along with links to useful multimedia sources.
I was born and raised in Chattanooga. After graduating from the University of Virginia, I attended Baylor College of Medicine. I completed residency and fellowship training at the University of Cincinnati at the Children’s Hospital Medical Center. I received funding from the National Institutes of Health for molecular biology research of the gastrointestinal tract.
During my fellowship, I had the opportunity to work with some of the most amazing pediatric gastroenterologists and mentors. Some of these individuals included Mitchell Cohen, William Balistreri, James Heubi, Jorge Bezerra, Colin Rudolph, John Bucuvalas, and Michael Farrell. I am grateful for their teaching and their friendship. During my training with their help, I received a nationwide award for the best research by a GI fellow.
I have authored numerous publications/presentations including original research, case reports, review articles, and textbook chapters on various pediatric gastrointestinal problems. In addition, I have been recognized by Atlanta Magazine as a "Top Doctor" in my field multiple times.
Currently, I am the vice chair of the section of nutrition for the Georgia Chapter of the American Academy of Pediatrics. In addition, I am an adjunct Associate Clinical Professor of Pediatrics at Emory University School of Medicine. Other society memberships have included the North American Society for Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN), American Academy of Pediatrics, the Food Allergy Network, the American Gastroenterology Association, the American Association for the Study of Liver Diseases, and the Crohn’s and Colitis Foundation.
As part of a national pediatric GI organization called NASPGHAN (and its affiliated website GIKids), I have helped develop educational materials on a wide-range of gastrointestinal and liver diseases which are used across the country. Also, I have been an invited speaker for national campaigns to improve the evaluation and treatment of gastroesophageal reflux disease, celiac disease, eosinophilic esophagitis, hepatitis C, and inflammatory bowel disease (IBD). Some information on these topics has been posted at my work website, www.gicareforkids.com, which has links to multiple other useful resources.
I am fortunate to work at GI Care For Kids. Our group has 17 terrific physicians with a wide range of subspecialization, including liver diseases, feeding disorders, eosinophilic diseases, inflammatory bowel disease, cystic fibrosis, DiGeorge/22q, celiac disease, and motility disorders. Many of our physicians are recognized nationally for their achievements. Our group of physicians have worked closely together for many years. None of the physicians in our group have ever left to join other groups. I have also worked with the same nurse (Bernadette) since I moved to Atlanta in 1997.
For many families, more practical matters about our office include the following:
– 14 office/satellite locations
– physicians who speak Spanish
– cutting edge research
– on-site nutritionists
– on-site psychology support for abdominal pain and feeding disorders
– participation in ImproveCareNow to better the outcomes for children with inflammatory bowel disease
– office endoscopy suite (lower costs and easier scheduling)
– office infusion center (lower costs and easier for families)
– easy access to nursing advice (each physician has at least one nurse)
I am married and have two sons (both adults). I like to read, walk/hike, bike, swim, and play tennis with my free time.
I do not have any financial relationships with pharmaceutical companies or other financial relationships to disclose. I have helped enroll patients in industry-sponsored research studies.
This year was the 2nd year that I had the opportunity to give a lecture to our group that reviewed much of the important advances that happened in 2025. All of the slides are based on studies or lectures that were reviewed on my blog, gutsandgrowth. Here are some of the slides:
This year was the 2nd year that I had the opportunity to give a lecture to our group that reviewed much of the important advances that happened in 2025. All of the slides are based on studies or lectures that were reviewed on my blog, gutsandgrowth. Here are some of the slides:
It turns out that there has been a DBPC study for parachute use
Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.
This year was the 2nd year that I had the opportunity to give a lecture to our group that reviewed much of the important advances that happened in 2025. All of the slides are based on studies or lectures that were reviewed on my blog, gutsandgrowth. Here are some of the slides:
Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.
This year was the 2nd year that I had the opportunity to give a lecture to our group that reviewed much of the important advances that happened in 2025. All of the slides are based on studies or lectures that were reviewed on my blog, gutsandgrowth. Here are some of the slides:
“Pediatric MASLD is still perceived as an indolent condition by many patients, families, and clinicians. In this Call to Action, we aim to raise awareness of pediatric MASLD as a public health crisis. Herein, we describe insufficient screening and disease staging practices, and a lack of accurate non-invasive tests and effective pharmacotherapy, both stemming from a paucity of multicenter clinical trials in pediatric MASLD.”
“GLP-1 RAs have not been formally investigated in pediatric MASLD.”
This was a retrospective study with 5 Latino adolescents obesity and MASLD who received semaglutide for at least 3 months. The range of BMI at the start of treatment was between 51 and 68.
Key findings:
There were clinically significant reductions in liver enzymes and APRI, a noninvasive marker of fibrosis. Specifically, mean ALT decreased by 38.4 IU/L (p < 0.01), mean AST decreased by 21.0 IU/L (p < 0.01), and mean APRI decreased by 0.128 (p = 0.01)
All 5 patients experienced weight loss with drop in BMI% from 2.3% to 14.2%
My take: This small study is consistent with others that show GLP1 RAs are likely to be an important tool for patients with MASLD. Current recommendations support use mainly in patients with comorbidities including obesity and T2DM.
Methods: “Faecal calprotectin was measured in asymptomatic FDRs aged 6–38 years; those with persistent elevation, defined as >70 µg/g in at least two separate tests, were offered panenteric video capsule endoscopy or ileocolonoscopy”
Population: 331 (35%) first-degree relatives (FDRs) (from a group of 950) agreed to be screened: 63 (19%) had persistently elevated calprotectin, of whom 42 underwent further evaluation
Key findings:
From the initial screened cohort of 331 patients, nine (2.7%) had endoscopic appearance compatible with presymptomatic CD, and 22 (6.6%) had non-specific macroscopic mucosal changes
Median calprotectin was significantly higher in those with presymptomatic CD (772µg/g (IQR 279–1685)) compared with others (31µg/g (IQR 30–61), p<0.0001)
Calprotectin >225 µg/g predicted presymptomatic CD (area under the receiver operating characteristic curve 0.97 (95% CI 0.94 to 1.0; p<0.001; sensitivity 89%, specificity 94%)
Discussion Points:
“There is no universally accepted definition for preclinical stages of CD, and the distinction between these stages remains partly subjective.”
“The lack of longitudinal follow-up is also a limitation, but this will be completed as part of the PIONIR trial.”
My take (borrowed in part from the authors):
Identification of pre-symptomatic CD “can facilitate designing targeted interventions and defining inclusion criteria for prevention trials.” The disease may be more modifiable in the early stages of disease.
This trial suggests the calprotectin threshold of >70 is too low to target screening. For specificity, the study showed that persistent elevation above 225 merits investigation; though, it has been our practice to use a threshold of >150 for children older than 5 years.
Approximately 5% of asymptomatic FDRs of CD patients have evidence of pre-symptomatic CD and approximately 10% more have non-specific mucosal changes when evaluated
Methods: Prospective European registry with 36,699 treatments were recorded, where 8,233 (22%) were prescribed with probiotics. The analysis of the effectiveness of probiotics was restricted to those receiving first-line therapy.
Key findings:
Overall, the eradication rate was 90.6% with probiotics and 86.1% without probiotics.
With quadruple therapy, the eradication rate was 93.1% with probiotics and 89.3% without probiotics
Discussion Points:
“The prevalence of H pylori infection remains close to 45% in the European population”
The population receiving probiotics may have been expected to have a higher risk of eradication failure (eg. antibiotic resistance and more prior treatments) and/or higher expectations of adverse effects
This was NOT a randomized study which limits a more definitive conclusion on the effectiveness of adding a probiotic
My take: In highly-motivated families, probiotics may be worthwhile as part of an H pylori eradication regimen. This could, of course, necessitate changes in nomenclature. Would quadruple therapy with probiotics be called 5-drug (quintuple) treatment?
This article summarizes the recent changes in the treatment options for Clostridioides difficile (C diff).
Key points:
Fidaxomicin targets C diff with limited collateral microbiome disruption. This leads to significantly lower recurrence rates compared to vancomycin. Thus, it is preferred 1st line therapy for initial and recurrent C diff. In “the coming years, fidaxomicin is expected to come off patents” which will improve access and affordability.
Bexlotoxumab which lowered recurrence rate is no longer being produced
FMT via Openbiome is no longer available. In those in which FMT was used, options include the following:
live-jslm (REBYOTA), a broad consortium enema-based formulation
live-brpk (VOWST), a narrow consortium of Firmicutes in an encapsulated form. This treatment in adults: four capsules daily for three days
Both treatments are not recommended for patients who are severely immunocompromised. In these patients, prolonged vancomycin course with taper or using every other day therapy with fidaxomicin for days 7-25 could be considered
My take: I have been seeing less C diff cases recently. This may be due to better antibiotic stewardship, changes in C diff strains, or improved testing approaches.. My observation is supported by recent reports:
Annual number of hospitalized community-onset and hospital-onset CDI events reported to the National Healthcare Safety Network, 2015 to 2023. (From CDC’s Antibiotic Resistance & Patient Safety Portal (Available at https://arpsp.cdc.gov/profile/nhsn/cdi).)
Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.
Methods: The RE-WATCH study was an observational, multicenter, retrospective study performed in four IBD referral centers. Inclusion criteria meant that only patients receiving on label SC-IFX at a dosage of 120 mg every other week were included in the study. The initiation of IFX therapy as the baseline timepoint.
Key findings:
There were no statistical differences between the two groups, early vs. late switch, after one year in terms of the respective endoscopic response (71.4% vs 70.8%, P = .95), steroid-free clinical remission (62.5% vs 68.7%, P = .51), or IFX retention rate (75.0% vs 66.7%, P = .35).
There was higher endoscopic remission rates in early switch patients as compared to late switch patients; however, this trend was not significant (69.6% vs 52.1%, P = .07).
A return to IV-IFX was required in 1 of 43 early switch patients and in 3 of 44 late switch patients (2.3% vs 6.8%, P = .31)
While the early switch group appears to fare a little better, there is likely a selection bias. For example, the early group had a much lower rate of severe endoscopic score at baseline (20% vs. 54%) and lower rate of Crohn’s fistulizing disease (8% vs 33%).
partial Mayo score (pMS)Harvey–Bradshaw index (HBI)
My take: These results indicate that outcomes are similar between patients switching from to IFX SC at both early (after induction) and late (after 6 months).
It is worth noting that prior studies have shown that home-based therapies (eg. home infusion), compared to office-based therapies, have been “associated with suboptimal outcomes including higher rates of nonadherence and discontinuation of infliximab.” This is a concern for SC biologics as well.
Last week, the following article explained why the newest changes, announced yesterday (see link below), to the vaccine schedule recommendations are not a good idea:
“Proponents of the push to align U.S. recommendations with those of so-called peer nations such as Denmark, Japan and Germany — all of which recommend fewer shots than the United States — have billed it as a common-sense corrective. But, as innumerable doctorsandscientists have explained, when it comes to public health, countries with fewer shots on their must-have list are not actually our peers.
In Denmark, to take the administration’s favorite example, prenatal care is free and universal. More than 95 percent of pregnant women are screened for hepatitis B, and those who test positive are promptly treated and duly monitored…
None of this is true in the United States.
Here, nearly a quarter of pregnant women lack adequate prenatal care, and those who face the highest risk of contracting and spreading vaccine-preventable diseases are often the least likely to have access to doctors or pharmacies. When U.S. health officials tried to stamp out hepatitis B through vaccination programs aimed at high-risk groups, they failed miserably. It was not until they carried out a universal, at-birth vaccination policy in 1991 that hepatitis B infections finally plummeted — by about 99 percent.
In fact, if the U.S. public health system has one thing going for it relative to other nations, it’s probably vaccines. As the C.D.C.’s own data indicates, routine childhood vaccination has prevented hundreds of millions of illnesses and tens of millions of hospitalizations here. It has also saved half a trillion dollars in medical costs, a figure that jumps into the multitrillions once you factor in indirect, societal costs like lost productivity and lost wages.
The United States tends to have higher rates of measles vaccination than Europe, and fewer measles cases as a result. Compared with Denmark, we also tend to have lower hospitalization rates for rotavirus (which causes diarrhea and can be fatal in infants and children) and respiratory syncytial virus, or R.S.V. (which is a leading cause of hospitalization among children). The reason for those disparities is not in dispute: We vaccinate routinely against both viruses. Denmark does not…
In the meantime, the Food and Drug Administration is angling to make an even bigger and more enduring impact on Americans’ access to vaccines…top officials at the agency have proposed a roster of new requirements for the shots, including several that critics say would be logistically impossible and could leave us with no F.D.A.-approved Covid or flu vaccines…
We don’t have to wonder what that future will look like. We can glimpse it already in communities across the country where measles and whooping cough are resurgent and where infants and young children have already died from both. We can also see it foretold in the current flu season: This year’s flu vaccine has proved an imperfect match to the currently circulating strains. New shots, based on mRNA technology, would have one day enabled us to avoid this kind of misfire. But the nation’s leaders have imperiled that future with the decisions they made this year…
Mr. Kennedy has brought us to this precipice by aggressively subverting nearly every process and protocol that previously governed our public health institutions. He has granted political appointees enormous sway over agency scientists. He has excluded people with meaningful expertise from his planning and deliberations. And he has fired dissenters all the way up to the C.D.C. director and replaced them with lackeys, sycophants and wellness grifters.”
My take: RFK Jr and this administration has already done great damage to our health care and the toll will be evident for a long time. But, they are not done yet.
Link to yesterday’s announcement: NY Times 1/05/25: Kennedy Scales Back the Number of Vaccines Recommended for Children“Public health experts expressed outrage at the sweeping revisions, saying federal officials did not present evidence to support the changes or incorporate input from vaccine experts…and will endanger the health of children in the United States…The C.D.C.’s new schedule continues to recommend vaccines against some diseases, including measles, polio and whooping cough, for all children. Immunization against six other illnesses — hepatitis A, hepatitis B, meningococcal disease, rotavirus, influenza and respiratory syncytial virus, the leading cause of hospitalization in American infants — will be recommended for only some high-risk groups or after consultation with a health care provider.”