Ritu Verma, MD, has joined the University of Chicago Medicine Comer Children’s Hospital as section chief for pediatric gastroenterology, hepatology and nutrition, and medical director of UChicago’s Celiac Disease Center. She was most recently professor of clinical pediatrics at the University of Pennsylvania School of Medicine, where she held an endowed chair for Clinical Care of GI Motility Disorders at the Children’s Hospital of Philadelphia and led the Celiac Disease Center.
Verma is building centers of excellence for pediatric gastrointestinal diseases at Comer Children’s. She will also work with the adult gastroenterology program to provide care under one roof for teens and young adults.
“Excellent multidisciplinary clinical care, the latest therapies and easy access for families and providers are my top priorities,” Verma said. To mazimize patients' benefits from the latest research, she aims to merge University of Chicago’s robust basic science research in celiac disease, inflammatory bowel disease (IBD) and food allergies with clinical research in pediatrics. Verma also plans to collaborate with colleagues in adult gastrointestinal medicine to achieve the same goal.
When kids are diagnosed with IBD, they are often quite sick, and parents can be understandably overprotective as they step up to manage every aspect of their child’s complex care. Super-involved parents are an asset to the pediatric IBD team—until the child turns 17 with plans to attend college or move away from home. “Many older teenagers are like a deer in the headlights when it comes to their IBD,” says Ranjana Gokhale, MD, associate director of the IBD Center for Pediatrics at the University of Chicago Medicine Comer Children's Hospital. “They don’t know what medications they are taking, what foods they should avoid, or what symptoms should prompt a visit to a gastroenterologist because their parents have handled everything related to their care.” But a 19-year-old with IBD who shows up at the college health service or an emergency room with the flu must be able to name the IBD drugs he or she is taking when a clinician wants to prescribe an antiviral medication, for example.
Many older teenagers are like a deer in the headlights when it comes to their IBD.
Ranjana Gokhale, MD
Between the ages of 18 and 19, patients with IBD transition from the pediatric IBD clinic to an adult gastroenterologist at the University of Chicago Medicine. Gokhale and pediatric APN Katie Sonnenburg provide intensive support and education years earlier to help young teens eventually take that step. Gokhale points to studies showing that older teens with IBD who transition to an adult GI provider without being prepared to assume responsibility for managing their disease become noncompliant. “They feel abandoned by the pediatric gastroenterologist and overwhelmed by their adult gastroenterologist, and many of these patients slip through the cracks until they get very sick,” says Gokhale.
Gokhale and Sonnenburg work closely with teens to teach them to manage their disease independently, and with parents to wean them away from their role of being in charge of the details. Both parents and patients are given goals at each visit to move toward independence, a process that takes about a year.
Once a teen is ready to transition to adult GI, Sonnenburg accompanies him or her to appointments at the IBD Transition Clinic, the only one of its kind in the Chicago area. “I know these patients very well since I’ve seen them for years with Dr. Gokhale,” says Sonnenburg. “So the patient and the family feel comfortable that there will be a seamless transfer of care to the adult GI with me there to support them.”
Sonnenburg will continue to see the patient alone or in tandem with their adult GI specialist for about a year until the patient has mastered all aspects of their care, including medication compliance, making appointments, and calling their physician with questions or problems. And if the teen moves away from Chicago, Sonnenburg and Gokhale will help them find an adult GI specialist near school or work. “Our goal is to keep our patients healthy and educated through their transition process and beyond,” says Gokhale.
When “gluten-free” became the latest fad diet promoted by celebrities several years ago, food companies rushed to fill grocery shelves with processed gluten-free foods. Today, gluten-free foods are ubiquitous in stores and restaurants, but that’s not necessarily a good thing for teenagers with celiac disease.
“Processed gluten-free foods like pizza and baked goods are loaded with saturated fat and sugar to compensate for the lack of the pleasurable chewy texture of gluten,” says Hilary Jericho, MD, director of pediatric clinical research at the University of Chicago Medicine Celiac Disease Center. And that’s exactly the draw for teenagers with celiac disease — convenient foods that can be eaten on the go and that taste like the foods other kids eat. But these calorie-dense gluten-free foods may also be contributing to increased body mass index (BMI) and obesity in young celiac patients.
Jericho conducted a retrospective chart review of children seen at the Celiac Disease Center to determine if there was a difference in BMI over time in children diagnosed with celiac disease after 2011 — when processed gluten-free foods flooded the market — compared to children diagnosed prior to 2011. When looking at all 147 children, ages 0 to 18, the study showed no difference. However, when Jericho examined BMI in the group of patients 13 to 18 years old, she found that teens diagnosed with celiac disease post-2011 had a mean 9 percent greater rise in their BMI from baseline compared to those diagnosed before 2011. When she surveyed 10 of the teenagers — now in their 20s and 30s — those diagnosed post-2011 reported eating more processed gluten-free foods than the earlier-diagnosed patients.
The small sample size, recall bias and limited data of the retrospective study, published in the Journal of Pediatric Gastroenterology and Nutrition, make it difficult to draw conclusions about the effect of processed gluten-free foods on kids, acknowledges Jericho. But the trend she saw in her study makes sense. “Young kids with celiac disease tend to have healthier eating habits because their diets are driven by health-conscious parents,” she says. “Teenagers with celiac disease are a very vulnerable population because they often are making their own food choices.”
During the teenage years, we need to redouble our efforts to ensure patients are making ongoing healthy food choices, even after many years on a gluten-free diet.
Hilary Jericho, MD
Jericho and Joseph Runde, DO, are currently enrolling children with celiac disease in a prospective study to evaluate the validity of the BMI trend and to determine how often patients consume processed gluten-free foods over the healthy alternatives, such as lean meats and fruits and vegetables.
If the prospective study confirms that heavy consumption of processed gluten-free foods contributes to higher BMI and increased risk of obesity, Jericho says that new guidelines may be needed to more frequently assess the diets of celiac patients at risk of gaining weight to limit the rise of obesity. “The majority of celiac centers focus on making sure their patients are adhering to a gluten-free diet,” says Jericho. “We don’t necessarily monitor patients for a healthy gluten-free diet. During the teenage years, we need to redouble our efforts to ensure patients are making ongoing healthy food choices, even after many years on a gluten-free diet.”