For information about COVID-19, including symptoms and prevention, please read our COVID-19 patient guide. Please also consider supporting Weill Cornell Medicine’s efforts against the pandemic.

Tall Order

Body: 

An ambitious study aims to understand how Crohn's disease stunts kids' growth

When Alex Bancroft was 5, it was clear that something was awry with his digestive system. During kindergarten, his mom says, he was spending a lot of time in the bathroom. Doctors first thought he had a virus, but the symptoms persisted. Then a pediatric gastroenterologist diagnosed Alex with irritable bowel syndrome and put him on medication for it. But he didn't get any better — and on top of enduring diarrhea and fatigue, he wasn't growing. "He wouldn't eat, because he was afraid that he wouldn't make it to the bathroom in school," says his mother, Caroline Bancroft. "At age 7, he dropped down to about 40 pounds."

Eventually, Alex's parents brought him to NewYork-Presbyterian/Weill Cornell Medical Center, where he saw Dr. Thomas Ciecierega, an assistant professor of pediatrics. Dr. Ciecierega made the correct diagnosis — Crohn's disease, a type of inflammatory bowel disease (IBD) that is characterized by intestinal inflammation — and put the boy on the proper course of medication. "He started gaining weight and was more active," Caroline says. "You could see the life coming back." Today, Alex is still a little short for his age, but the Long Islander is an active 9-year- old and avid lacrosse player. He'll have to stay on medication indefinitely, and the disease has other potential complications, like eye problems and arthritis. But for now, he's doing well. Says his mom: "This is the healthiest I've ever seen him in his life."

Someday, kids like Alex could benefit from research now under way at Weill Cornell Medicine. Dr. Neera Gupta, director of research and a specialist at the Weill Cornell Medicine Pediatric Inflammatory Bowel Disease Center and an associate professor of pediatrics, recently launched a study to uncover why kids with Crohn's — especially boys — are often shorter than their peers. Growth is a dynamic marker of a child's health status, she notes, and it's an issue of central importance to patients, families, and providers.

Dr. Gupta, who is also a physician-scientist at the Jill Roberts Institute for Research in Inflammatory Bowel Disease at Weill Cornell Medicine, notes that roughly 25 percent of patients with IBD are diagnosed during childhood and adolescence. In the United States, there are about 5,000 new pediatric IBD cases each year — and they present unique challenges. Not only is growth impairment a major complication of pediatric-onset Crohn's disease that distinguishes it from the adult-onset version, she explains, but diffuse disease is more common in children at the time of diagnosis, and progression occurs more frequently in kids than in adults.

There are also sex differences in the presentation and course of Crohn's disease. In Dr. Gupta's previous studies, she found that girls tend to have a more severe course of disease and are more likely to need surgery, but boys are more likely to have growth problems. Her current work, funded by an NIH award of more than $3 million, aims to figure out why.

The study will follow children and adolescent boys and girls for two years. After an initial screening to make sure they qualify, participants will come in every six months for a total of five visits, either at Weill Cornell Medicine or one of the other collaborating institutions. Procedures will include height and weight measurements, assessment of pubertal status, medical history, blood draw, hand x-rays (for bone age) and nutrient intake assessments.

Dr. Gupta's team will utilize the data to develop predictive models to identify which children are most likely to have persistent growth problems caused by Crohn's disease, ultimately helping clinicians to better determine a course of treatment. "One of the debates in our field is when to introduce the most aggressive therapies for Crohn's disease," Dr. Gupta says. "Some believe we should do it at the time of diagnosis, and some believe we should start with other therapies first. Most agree there are high-risk children who would benefit from early intervention with aggressive therapy — but we need to figure out who these high-risk children are. Because there is a very narrow therapeutic window in which we can intervene to improve growth, children who are at highest risk for persistent growth impairment may be candidates for early intervention with aggressive therapy."

After data collection is completed, doctors will be able to look at a combination of variables — including sex, race/ethnicity, disease location, bone age, inflammatory markers, hormone levels and genetic markers — to determine whether a child is at high risk for growth impairment. The next step will be an interventional clinical trial assessing aggressive therapies in children who are at highest risk for remaining growth-impaired. Importantly, Dr. Gupta says, the study will improve understanding of the underlying mechanisms of growth impairment in Crohn's disease. It's known that impairment may result from inflammation, malnutrition, or the side effects of medications; despite this knowledge, it continues to occur frequently in children and adolescents. "We need to advance our understanding of the underlying mechanisms of growth impairment in Crohn's disease," Dr. Gupta says. "We hope that findings from our research will lead to improved treatments not only for the children identified as high-risk for persistent growth impairment, but for all children with IBD."

Dr. Gupta aims to complete data collection by 2019, but for now her team is still in the process of recruiting participants. The goal is 125 — but that's challenging, in part because not every Crohn's patient in the specified age range will qualify for the study. Alex, for example, hasn't qualified so far, because his bone age hasn't met the eligibility criteria. But his parents hope that work like Dr. Gupta's will someday ensure that other kids don't have to go through the ordeal that he has. "Ultimately," says his dad, Bob Bancroft, "what we're hoping for is a cure."

Keri Blakinger

logo

This story first appeared in Weill Cornell Medicine, Vol. 15, No.2.

Featured Image: 
Alex Family
Type of News: 
News from WCM
Highlight this Story: 
No

Alex: Hope for Tomorrow

Body: 

At the end of a neighborhood street, Alex, 9, plays basketball with his family and friends. Catching his opponent off guard, he makes a back-door cut to the basket and calls for the ball. The pass, the right-hand lay-up, the sweetness of the two-point play – these are moments of normalcy for the little boy, who has been plagued by a debilitating, incurable disease for the past four years.

Alex Bancroft’s journey began at the age of 5, when his health began to spiral out of control: vomiting, persistent and sometimes uncontrollable diarrhea, and worst of all, alarming weight loss. After visits with two pediatricians and a gastroenterologist, his parents thought they had a diagnosis and a treatment plan, but Alex’s illness persisted. Watching his son suffer from this unknown illness, Alex’s father knew the family needed another opinion.

"It was hard," said Alex's father, Bob Bancroft, who narrates the boy's story in the opening episode of the second season of Weill Cornell Medicine's Inside Medicine video series. "There's nothing you can say that makes him feel better. Nothing you can do to make it go away."

After some investigating, Alex’s parents finally found an answer, and it came from Weill Cornell Medicine pediatric gastroenterologist Dr. Thomas Ciecierega. Alex has Crohn’s disease, a chronic inflammatory bowel disease that in children can lead to a variety of symptoms, such as severe weight loss, growth failure, decreased bone density and eye problems.

Bob Bancroft gives his son Alex a shot of methotrexate to treat his Crohn's disease, while Alex's brother Christian looks on.

With help from one of Dr. Ciecierega's colleagues, Dr. Neera Gupta, the team discovered that Alex actually had delayed bone age — a common complication of pediatric IBD. Although he was 9-years-old, Alex’s bone age was of a 7-year-old. Dr. Gupta, an associate professor of pediatrics, director of research at the Weill Cornell Medicine Pediatric Inflammatory Bowel Disease Center, and an associate member of the Jill Roberts Institute for Research in Inflammatory Bowel Disease at Weill Cornell Medicine, is investigating the underlying mechanisms of differences in growth impairment between boys and girls with Crohn’s disease – research that Alex hopes to one day participate in.

"If there’s something he can do as a patient to potentially help that next child, at the age of 4 or 5 that’s being diagnosed, not have to go through the same things he had to, then he wants to do it," Bancroft said.

Along with wanting to help other children with Crohn’s disease, Bancroft said his son has learned to manage his disease. On the first day of treatment, Dr. Ciecierega, an associate professor of pediatrics, shared with Alex an important tip: "This is your disease," Bancroft recalled him saying. "You need to learn it; you need to understand it."

"I think that is what's really made such a difference for us as parents,” Bancroft said. “Dr. Ciecierega is teaching Alex how to live his life with Crohn's disease. He’s teaching him that you can live a normal, fulfilling, happy life with a disease that has no cure at this point."

In the last 18 months of treatment, Alex has had no flare-ups, signs or symptoms of the disease, giving his parents a reason to hope.

"It’s difficult to not know what tomorrow brings for your son,” Bancroft said. “My hope is that he can grow old and be happy — that he can live his life and just grow old."

 Using the social media hashtag, #WeAreWCM, read more stories to discover the faces behind the medicine and how they are paving the future for innovative healthcare.

Featured Image: 
Bob Bancroft and sons Alex and Christian
Type of News: 
We Are Weill Cornell Medicine
Highlight this Story: 
No

Awards and Honors Across Weill Cornell Medical College - Week of Sept. 11 - Sept. 18

Body: 

Dr. Costantino Iadecola Wins Excellence Award in Hypertension Research

Dr. Costantino Iadecola, director of the Feil Family Brain and Mind Research Institute and the Anne Parrish Titzell Professor of Neurology, has won the 2015 Excellence Award for Hypertension Research from the American Heart Association's Council on Hypertension.

Dr. Costantino Iadecola

The accolade, sponsored by Novartis, is the council's most prestigious award and carries a $10,000 honorarium. It recognizes researchers' contributions to the field of hypertension that have led to improved treatment and a greater understanding of high blood pressure.

A neurobiologist and neurologist, Dr. Iadecola was honored for his research into the connection between hypertension and stroke and Alzheimer's disease. He discovered that blood vessels in the brain are uniquely and highly susceptible to the effects of hypertension. The resulting damage to the vessels may lead not only to stroke and vascular dementia, but also to an increased risk of developing Alzheimer's disease. Dr. Iadecola received the award at a reception on Sept. 18 during the American Heart Association's 2015 Hypertension Scientific Sessions in Washington, D.C. Dr. Iadecola also gave a lecture during the four-day conference.

"I am honored and humbled to have been selected for this award, which I am delighted to accept on behalf of my associates in the Feil Family Brain and Mind Research Institute who made the research possible," Dr. Iadecola said.

"This recognition has been typically bestowed on scientists working on the heart and blood vessels," he added. "Giving this award for research on the link between high blood pressure and Alzheimer's disease highlights the fact that the hypertension community worldwide acknowledges that the brain is a critical target of hypertension. This realization strengthens my resolve to continue this work, with the ultimate goal of developing new therapies to shield the brain from the devastating impact of hypertension."

Additional Awards and Honors

Dr. Wallace Carter, an associate professor of emergency medicine in clinical medicine and an adjunct associate professor of clinical medicine, received the Council of Emergency Medicine Residency Directors CORD Impact Award at its annual academic assembly on April 15 in Phoenix. The council is a scientific and educational organization focused on improving the quality of emergency medical care, enhancing the quality of emergency medicine instruction and encouraging communication between the faculty of various emergency medicine training programs. The Impact Award is given annually to faculty members who have made significant contributions toward those goals.

Dr. Marisa Censani, an assistant professor of pediatrics, was appointed to the Pediatric Endocrine Society's Obesity Committee for a three-year term, effective May 1. The society's mission is to advance the care of children and adolescents with endocrine disorders. The committee focuses on the problem of childhood and adolescent obesity caused, at least in part, by endocrine disorders.

Dr. Nikolaos Skubas, a professor of clinical anesthesiology and of anesthesiology in clinical cardiothoracic surgery, was elected into the Society of Cardiovascular Anesthesiologists Nominating Committee in May for a two-year term. The society is an international organization of anesthesiologists that promotes excellence in clinical care, education and research in the subspecialty.

Featured Image: 
Awards and Honors
Type of News: 
Awards & Honors
Highlight this Story: 
No

Awards and Honors Across Weill Cornell Medical College - Week of May 29 - June 5

Body: 

Dr. Owen K. Davis, a professor of obstetrics and gynecology and of reproductive medicine, received the Path2Parenthood Joyce M. Vargyas, M.D., Visionary Award in October at its annual gala in New York City. The award honors individuals who have made extraordinary contributions to the fertility field. Path2Parenthood, formerly the American Fertility Association, is an inclusive organization committed to helping people create their families of choice by providing leading-edge outreach programs and timely educational information.

Dr. Shari Lipner, an assistant professor of dermatology, was appointed in March to the audio lecture series Dialogues in Dermatology's Editorial Board. The subscription-based audio program, produced by the American Academy of Dermatology, is offered monthly to dermatologists and other healthcare professionals to enhance and update their knowledge of dermatology. The academy is the largest, most influential and most representative dermatology group in the United States. With a membership of more than 17,000, it represents virtually all practicing dermatologists in the United States, as well as a growing number of international dermatologists.

Dr. Rahul Sharma, an assistant professor of medicine, has been appointed chair of the American College of Emergency Physicians' Emergency Medicine Practice Subcommittee on Triage. In his role, Dr. Sharma is spearheading the committee's efforts to identify best practice triage processes across the nation. The college is the leading advocate for emergency physicians, their patients and the public.

Dr. Neera Gupta, an assistant professor of pediatrics, was selected to serve a second three-year term as co-chair of the Crohn's & Colitis Foundation's America Pediatric Affairs Committee. The Crohn's & Colitis Foundation of America is a non-profit, volunteer-driven organization dedicated to finding cures for Crohn's disease and ulcerative colitis. The committee focuses on the foundation's larger goals as they relate specifically to the care of children.

Featured Image: 
Awards and Honors
Type of News: 
Awards & Honors
Highlight this Story: 
No