Tag Archive for: Vahe Badalyan

USA line art map with a wheat plant icon

State of Celiac Disease in the United States

USA line art map with a wheat plant iconVahe Badalyan, M.D., director of the Children’s National Celiac Disease Program, discusses the current state of celiac disease in the United States, including diagnosis and care among pediatric populations.

Q: In your opinion, how would you classify the state of Celiac Disease among children in the United States as it compares to 10 years ago?

A: Celiac disease in the United States is increasingly recognized as a common disorder of childhood. While this can partly be attributed to improved recognition and more testing by primary care providers, “true incidence” of this immune-mediated disease is also said to be rising, independent of the screening practices.

While there is a larger variety of gluten-free food options available today, these options are often more costly than their gluten-counterparts. Additionally, gluten-free food options are not covered by insurance companies. With inflation and rising food prices, there is a real concern for increased economic burden and food insecurity for the families of children with celiac.

Q: Are there any misnomers about Celiac Disease that you think are important to address?

A: Classic symptoms of celiac disease, including diarrhea and malnutrition, now occur in a minority of celiac patients. There is a rising proportion of milder or asymptomatic presentation at the time of diagnosis. Paired with the fact that most celiac patients identified through mass-screening did not have a family history of celiac disease (~90%) or gastrointestinal symptoms (70%), one may need to have a high index of suspicion for children with atypical presentation, such as neurologic symptoms, iron and vitamin D deficiency.

Q: What excites you about the future of treatment for Celiac Disease?

A: I am encouraged that researchers across the globe are testing new, pharmacologic therapies for celiac disease. Some of the tested compounds, such as latiglutenase or TAK-062 , involve breaking down gluten-using enzymes, while others, such as TAK-101 aim to induce immune tolerance. These compounds are still at the early stages of the long and arduous process of drug development and approval. Current randomized trials typically include adults, although some recently opened enrollment to adolescents. While there are no guarantees, I am cautiously optimistic that in the future we will have pharmacologic, non-dietary treatment options for celiac disease.

Q: How is Children’s National a leader in the field of pediatric Celiac Disease?

A: Concerns about gluten exposure can be quite stressful for our patients and families, which can lead to hypervigilance, anxiety and even depression. We are fortunate to have a full-time psychologist, Shayna Coburn, Ph.D., as part of our Multidisciplinary Celiac Disease Program team. This allows us to treat not only physiological symptoms and concerns associated with celiac disease, but to also evaluate the psychological problems that may arise as a result of the condition.

Human Digestive System Anatomy

Intestinal rehabilitation program demonstrates high survival rates

Human Digestive System AnatomyIn a new study, researchers at Children’s National Hospital analyzed outcomes in children with short-bowel syndrome (SBS), parenteral nutrition dependence (PND) and intestinal failure-associated liver disease (IFALD) who were treated in the Children’s National Intestinal Rehabilitation Program (IRP) from 2007 to 2018.

The study, led by Clarivet Torres, M.D., director of the IRP at Children’s National, reviewed charts of 135 patients with SBS-PND at the time of their enrollment in the IRP. Of these, 89 patients had IFALD, defined as sustained (>2 months) conjugated bilirubin (CB) of ≥2 mg/dl at enrollment and/or abnormal liver biopsy, showing stage two through four fibrosis.

Historically, IFALD was a major cause of mortality among patients with intestinal failure and accounted for the high percentage of pediatric small-bowel transplants. Over the last two decades, outcomes of patients with SBS, PND and IFALD have been improving with creation of intestinal rehabilitation programs.

Recent data from the International Intestinal Failure Registry Pilot Phase showed improved outcomes, with 8% mortality. However, IFALD was the cause of death in 7% and almost 50% of patients were still PN dependent at 12 months of follow-up.

The study at Children’s National reveals normalization of the conjugate hyperbilirubinemia in 99% of the patients with IFALD, over a median time of 9.5 weeks after enrollment, with nontransplant treatment. It also demonstrates a transplant-free survival in 97% of these patients. Although the median percentage of expected bowel length in the study population was only 23% and over half had no ileocecal valve, 81% of patients were successfully weaned from PN over a median time of 5 months of being enrolled in the IRP.

Dr. Torres and her team demonstrate high rates of transplant-free survival and enteral autonomy among SBS children with IFALD who do not have underlying primary motility/genetic disorders.

Despite a high acuity of symptoms and pathology (for example, ultrashort bowel, initially high PND, initial CB >4 mg/dl, significant fibrosis/cirrhosis), they reduced their PN needs relatively quickly and improved IFALD. As one of the larger IRPs in the United States, Children’s National demonstrates high survival rates of patients without the need for liver or intestinal transplantation.

Other Children’s National authors include Vahe Badalyan, M.D., and Parvathi Mohan, M.D.

Torres C, Badalyan V, Mohan P. Twelve-year outcomes of intestinal failure associated liver disease in children with short bowel syndrome: 97% transplant -free survival and 81% enteral autonomy.  Journal of Parenteral and Enteral Nutrition. 2021;1–10. https://doi.org/10.1002/jpen.2112

Vahe Badalyan

Q & A with Celiac Disease Program Director Vahe Badalyan, M.D.

Vahe Badalyan

Vahe Badalyan, M.D., Celiac Disease Program Director

Children’s National Hospital is helping to improve the way pediatric celiac disease is diagnosed and treated. We are proud to announce that Vahe Badalyan, M.D., is the new director of our Celiac Disease Program. Here, Dr. Badalyan tells us more about his work and what makes the Children’s National Celiac Disease Program unique.

Why did you decide to work in this field?

I developed my interest in gastroenterology (GI) from the first months of being a pediatric intern at Inova Fairfax Children’s Hospital. As a resident, I was fortunate to work with and learn from the pediatric GI group led by Ian Leibowitz, M.D., whose mentorship and example inspired me to choose a career in pediatric GI. This field is ripe with so many opportunities to improve the lives of children with very diverse medical conditions, such as celiac disease, inflammatory bowel disease, liver disease and short bowel syndrome, while achieving professional fulfillment and satisfaction. Later, as a pediatric GI fellow at Children’s National, I was fortunate to work with the late John Snyder, M.D., who was in the foundation of developing our celiac program and was so passionate about helping children and families cope with celiac disease. Part of the reason I joined the celiac program is to continue Dr. Snyder’s legacy and to build on his vision to provide excellent care, education and advocacy for our celiac patients.

What is the importance of the multidisciplinary clinic approach for celiac care?

The advantage of the multidisciplinary clinic approach is that patients receive comprehensive care that is tailored to their specific needs. In this setting, medical, nutrition and mental health professionals come together to share the care priorities from their unique perspectives and build a roadmap for the patient that incorporates details of care that may otherwise have been missed. Patient questions pertaining to multiple specialties can be discussed and answered right then and there.

What are some of the most valuable changes or advancements for the program you hope to see in the next couple of years?

We hope to expand the screening and diagnosis of celiac disease in our communities, as many patients with celiac have minimal or no symptoms and go undiagnosed for years. Early detection will allow us to get involved sooner in patients’ lives and make a bigger difference for them. We also hope to be a part of clinical research on celiac disease, including drug therapy trials.

What makes the Celiac Program at Children’s National unique from other programs in the country?

We place a big emphasis on mental health and have a dedicated psychologist working with the children and their families. We also have an excellent celiac educator, dietician, coordinator and nurse practitioner who empower our patients to cope with celiac, lead normal lives and achieve their dreams and aspirations.