in the country
by US News and World Report
Gastroenterology at Texas Children’s Hospital got its start in 1964 with the arrival of Dr. Buford L. Nichols Jr., associate director of the newly established Clinical Research Center (CRC). The CRC provided space for controlled laboratory research aimed at improving children’s health. A direct application of knowledge gained from CRC research, the Gastroenterology, Hepatology and Nutrition Service at Texas Children’s today has 14 specialty programs and sees more than 27,000 patients annually.
Although officially established in 1970, the gastroenterology and nutrition service at Texas Children’s Hospital actually started in 1964, with the arrival of physiologist Dr. Buford L. Nichols Jr., as the associate director of the newly established Clinical Research Center (CRC) at Texas Children’s Hospital.
Funded under a grant from the National Institutes of Health (NIH), the CRC at Texas Children’s Hospital was one of 12 such centers in the United States. Established and financially supported by a 1959 federal mandate, the General Clinical Research Centers Program evolved to meet growing demand for highly specialized facilities and personnel to meet the needs for conducting controlled studies in a laboratory specifically designed for research.
Under the leadership of Dr. Nichols, the CRC placed an emphasis on nutritional research, and included a team of physicians, nurses, a research dietitian and diet technicians, and a unique metabolic kitchen for the preparation by dieticians of special diets and formulas. One of the special formulas created, known as the Baylor Core Formula, was found to be a significant breakthrough for curing chronic diarrhea in infants with specific or complex food intolerances. Since the inception of the core formula, many babies have gone from a hopeless condition to full recovery – not only at Texas Children’s, but also throughout the United States. For those malnourished patients with choric diarrhea who could not tolerate the modular formula, Nichols sought another solution by building off the success of the University of Pennsylvania’s Dr. Stanley Dudrick, a pioneer of Total Parenteral Nutrition (TPN). This technique enabled nutrients to be introduced intravenously by catheter. By 1971, pediatric resident Dr. William J. Klish successfully cut the mortality rate of CRC patients in half in one year’s time. He then introduced TPN to patients at Texas Children’s Hospital.
Originally created as a follow up clinic for patients seen in the CRC, the Gastroenterology and Nutrition service was formally established as a service line at Texas Children’s Hospital in 1984. Led by Dr. Klish the department led the way in significant pediatric gastrointestinal achievements.
Began a fellowship program
Performed first-of-its-kind pediatric endoscopic procedures
Created a lactation support program and the milk bank at Texas Children’s Hospital to support breastfeeding mothers of hospitalized children
Completed more than 15 liver transplants
Opened the Children’s Nutritional Research Center (CNRC) – an 11-story, 200,000-square-foot building, built with $49 million in funds appropriated by Congress, as one of the five human research centers established by the USDA dedicated to determining the needs of infants and children as well as pregnant and nursing women
Performed the first “in-situ” liver transplant in Houston by dividing a cadaver’s liver while it was still in the donor’s body; thereby doubling the number of transplant recipients
Established the liver disease center and an inflammatory bowel center
Became one of the largest pediatric gastroenterology, hepatology and nutrition services in the United States
The Gastroenterology, Hepatology and Nutrition service provides treatment for children with a broad spectrum of intestinal, liver and nutritional disorders. Each year, the department sees more than 27,000 patients in 14 specialty clinics. One program in particular, the Neurogastroenterology and Motility Program, is among the largest of its kind, and receives referrals from throughout the United States and abroad.
Bryce Singleton and the Liver Transplant Program
Except for a slight yellowing of the eyes, 9-year-old Bryce Singleton seemed perfectly fine. He was not experiencing discomfort, and he was eating, drinking and conversing normally. His mother, Bridgette Jackson, was told by an emergency room physician at a community hospital, that it was probably a virus causing the jaundice. Call it a hunch or a mother’s undeniable intuition, Jackson boldly requested a blood workup for her son.
“An hour later, our whole life changed,” Jackson said. Bryce’s lab results showed severely elevated liver enzymes. Jackson requested a transfer to Texas Children’s Hospital, where Bryce was immediately admitted. Her son’s condition deteriorated over the next several days, leading to severe acute liver failure, a historic and lifesaving treatment, and eventually a new kidney.
With Bryce’s liver failing, blood toxins increased, organs failed and he fell into a hepatic coma. “He became diabetic, had to have a Foley catheter, a feeding tube, IVs in both arms, he developed a bleed in his brain, pancreatitis and encephalopathy,” Jackson tearfully recalled. “I was scared to death, but I knew I wasn’t going to bury my son. He was going to walk out of the hospital, and I knew God was going to take care of him.”
A liver transplant was the only life-saving option for Bryce. To help him become healthy enough for a liver transplant, a multidisciplinary team of doctors and specialists created a treatment regimen that included an extracorporeal liver support therapy called Molecular Adsorbent Recirculating System or MARS®. Bryce was the first patient at Texas Children’s Hospital and in Texas to receive this groundbreaking treatment.
Similar to kidney dialysis, MARS® removes protein-bound and water soluble toxins from the blood. MARS® therapy is critical in treating patients who develop hepatic encephalopathy due to the buildup of toxins in plasma that cannot be removed by conventional dialysis machines. If instituted early, this intervention can help preserve multi-organ function and help bridge the patient to transplant.
On April 23, 2014, a medical team led by Texas Children’s Director of Liver Transplantation Dr. John Goss, performed Bryce’s liver transplant. He was healthy enough to be discharged 19 days later on May 12.
Now, Bryce has resumed a normal life. Current maintenance protocols dictate daily immuno-suppressant medications for the rest of his life. But there is a possibility that Bryce’s medicinal regimen may change. According to his physician there are active trials to determine a subset of patients who are able to come off of immuno-suppressant medications.
“I’m extremely happy and satisfied with the level of care Bryce received,” Jackson said. “I’m confident that if anything happens again, Texas Children’s will go above and beyond and give Bryce the care and treatment he needs.”