Children's of Alabama Set to Launch New Pancreas Program in early 2023
Dr. Chinenye Dike will be discussing the new pancreas program at COA and UAB.
Featured Speaker:
Chinenye Dike, MD
Dr. Dike attended medical school at Abia State University Faculty of Medicine. She completed her Residency at Children’s Hospital of New Jersey at Newark Beth Israel Medical Center and her Fellowship at the University of Iowa. Dr. Dike's interests include pancreatitis, exocrine pancreatic insufficiency and nutrition. Her major research interests include nutritional deficiencies, gut dysbiosis and pain outcomes in sickle cell disease. Transcription:
Children's of Alabama Set to Launch New Pancreas Program in early 2023
Dr. Cori Cross: Welcome to Peds Cast, a podcast brought to you by Children's of Alabama I'm pediatrician, Dr. Cori Cross. Today, we'll be speaking with Dr. Dike, who is an Assistant Professor in the Division of Pediatric Gastroenterology, Hepatology and Nutrition at the University of Alabama at Birmingham. Dr. Dike, thank you for joining us today.
Dr. Chinenye Dike,: Thank you, Dr. Cross, for having me. It's a pleasure.
Dr. Cori Cross: Can you please tell us about your role at University of Alabama at Birmingham?
Dr. Chinenye Dike,: Well, I recently joined the Division of Pediatric Gastroenterology, Hepatology and Nutrition here at University of Alabama in Birmingham. Prior to that, I was at the University of Nebraska Medical Center for three years after graduating from fellowship. And my role here is to help develop a multidisciplinary pancreas program for children in Alabama who have pancreatic diseases. That's one of my major roles.
Dr. Cori Cross: So, my understanding is that UAB is set to launch a new pancreas program in 2023. Can you tell me a little about this program?
Dr. Chinenye Dike,: Yes, Dr. Cross. So, this is the first time we're going to be having this multidisciplinary pediatric pancreas program. It's going to be a multidisciplinary clinic of both physician and non-physician personnel to take the best care of children with pancreatic diseases
Dr. Cori Cross: wonderful. And so, who specifically will this program help? So, you mentioned children with pancreatic diseases. Can you elaborate? Are those children who have all types or birth anomalies or chronic pancreatitis? Who is it really geared towards?
Dr. Chinenye Dike,: So, it is specifically geared towards children who have chronic pancreatitis and acute recurrent pancreatitis. We will also see children who have had maybe one episode of acute pancreatitis in that clinic because more recent data is showing that some of them may progress to chronic pancreatitis even after one episode.
So, it's geared towards children who've had any type of pancreatitis, even if it's one attack of pancreatitis, but we'll also serve children who have pancreatic ductal anomalies that may be at increased risk of developing some form of exocrine or endocrine pancreatic insufficiency in the future. Any child who has any sort of exocrine pancreatic insufficiency.
Dr. Cori Cross: Got it. So, really you want these patients referred early, so that they can be on your radar, so that even if they don't have chronic pancreatitis at the time, if we know that the insufficiency is likely to continue, that they are already sort of benefiting from this multidisciplinary approach. Is that correct?
Dr. Chinenye Dike,: Absolutely. But of course, you know also there are children who have things like Shwachman-Diamond who may also be at risk of exocrine pancreatic insufficiency early on, but may be able to get that resolved later. We will be able to see and help those children in that clinic as well.
Dr. Cori Cross: And I'm assuming you have a lot of patients with cystic fibrosis as well.
Dr. Chinenye Dike,: Absolutely. There is a multidisciplinary cystic fibrosis clinic here and we have one of our division members who'll be going into that clinic to help in that clinic as well. So, this clinic is not particularly tailored towards those children because there is already a multidisciplinary clinic here, but for all the patients who have other forms of pancreatitis from other sources or other genetic mutations. But thank you for asking that.
Dr. Cori Cross: No, I appreciate you informing me of that. So, my question is this, it's a disciplinary approach and this new program that's going to be starting next year, how will it change or streamline patient care? Take me through it from a patient's perspective.
Dr. Chinenye Dike,: So, patients with chronic pancreatitis or acute rerecurring pancreatitis are not only at risk of medical problems like exocrine pancreatic insufficiency and diabetes, but they're also at increased risk of having a high burden of pain, low quality of life. And so, having a clinic with, not only physician personnel, but also non-physician personnel to address some of the other complications that could be seen in this children would help decrease healthcare utilization burden, but also improve quality of life in these children in the long term.
Dr. Cori Cross: Got it. So, I'm assuming you have pain management on board and maybe nutrition?
Dr. Chinenye Dike,: So, we do have nutrition. We're going to have hopefully a pain psychologist in the clinic. And we should have an easy pathway for genetic counseling because many of these children who have chronic pancreatitis will have genetic mutations. But also easy access to pediatric endocrinologists who would be versatile with some of the nuances like type 3C diabetes that is seen in this patient population. And so, we'll have all those services within and around Children's of Alabama and UAB to be able to handle those complications that they have.
Dr. Cori Cross: I am assuming that both patients and parents will be very grateful because trying to manage and juggle all of those different appointments and the different aspects of disease that goes along with having a child who has a chronic condition like this is really challenging. How do you anticipate the new program affecting patient outcomes?
Dr. Chinenye Dike,: I think that we're going to launch it first in January of 2023. And so, we're initially going to start seeing patients in that clinic once a month. But I'm anticipating that over time, hopefully, we'll have a decreased rate of hospitalizations in those patients. We'll be able to track some of those outcomes. And also, patient-reported outcomes like quality of life measures over time to see how this clinic has helped them. And then in the long term, we'll hope to be able to become part of the National Pancreas Foundation and become a center of excellence, so that pediatric patients who have these pancreatic diseases, will be able to come to us, that we can offer this service.
Dr. Cori Cross: No, that's amazing. And it's wonderful. And you're right, it's something that's needed nationally. So to have a center, people are often willing to travel to get their best quality of care. Can you tell pediatricians anything about best practices or who you feel can benefit the most and how to go about helping patients they may see with acute pancreatitis?
Dr. Chinenye Dike,: Thank you very much. There is a national guideline from the NASPGHAN, which is the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition. I'm also in the Pancreas Committee and there is consensus guideline that was released either 2018 or 2017, I believe it was 2018, on management of acute pancreatitis.
Now, I know the general pediatricians in the community will probably be seeing patients who have one episode of pancreatitis, acute pancreatitis. Only a small subset of these patients would progress, even though there is now data showing that some people can develop chronic pancreatitis even without having first episode of pancreatitis and some people have a severe form of acute pancreatitis can progress to chronic pancreatitis after that first episode within four years.
So, I would say for community pediatricians, if they're seeing a patient with mild acute pancreatitis, most times that can easily be managed in their local community. But if it's a severe form of pancreatitis, it'll be probably best to refer to us. And now, we have our numbers, so they can always call if they have questions classifying the different types of pancreatitis because this was also recently classified by the NASPGHAN and Pancreas Committee given a classification for acute pancreatitis in the pediatric population.
So for those mild acute pancreatitis cases, most of them will probably be able to be managed in the local community with goal-directed fluid resuscitation, pain management and early nutrition. But for the severe forms of acute pancreatitis, it's probably best to refer to a center like the Children's Hospital of Alabama where we have all the resources where we can manage the complications that can arise from these episodes. And of course, if they have any patient who's had more than one episode or who developed a complication from our acute pancreatitis episode, it would be best to refer to us even from the beginning because these kids are risk of developing CP or chronic pancreatitis or complications from AP early.
Dr. Cori Cross: That was so helpful. And as a pediatrician myself, I find that just really clear and gives us a great understanding so that we can get our patients in early if they can be better helped by a referral, but also feeling uncomfortable to treat the patients that we can locally. You shared your expertise with us today and I feel like we are all better informed because of it. So, thank you very much.
Dr. Chinenye Dike,: Thank you.
Dr. Cori Cross: For more information or to refer patients to Children's of Alabama, visit childrensal.org. That concludes this episode of Children's of Alabama Peds Cast. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for other topics that might interest you. Please remember to subscribe, rate, and review this podcast. Thanks for listening to this episode of Peds Cast. I'm your host, Dr. Cori Cross.
Children's of Alabama Set to Launch New Pancreas Program in early 2023
Dr. Cori Cross: Welcome to Peds Cast, a podcast brought to you by Children's of Alabama I'm pediatrician, Dr. Cori Cross. Today, we'll be speaking with Dr. Dike, who is an Assistant Professor in the Division of Pediatric Gastroenterology, Hepatology and Nutrition at the University of Alabama at Birmingham. Dr. Dike, thank you for joining us today.
Dr. Chinenye Dike,: Thank you, Dr. Cross, for having me. It's a pleasure.
Dr. Cori Cross: Can you please tell us about your role at University of Alabama at Birmingham?
Dr. Chinenye Dike,: Well, I recently joined the Division of Pediatric Gastroenterology, Hepatology and Nutrition here at University of Alabama in Birmingham. Prior to that, I was at the University of Nebraska Medical Center for three years after graduating from fellowship. And my role here is to help develop a multidisciplinary pancreas program for children in Alabama who have pancreatic diseases. That's one of my major roles.
Dr. Cori Cross: So, my understanding is that UAB is set to launch a new pancreas program in 2023. Can you tell me a little about this program?
Dr. Chinenye Dike,: Yes, Dr. Cross. So, this is the first time we're going to be having this multidisciplinary pediatric pancreas program. It's going to be a multidisciplinary clinic of both physician and non-physician personnel to take the best care of children with pancreatic diseases
Dr. Cori Cross: wonderful. And so, who specifically will this program help? So, you mentioned children with pancreatic diseases. Can you elaborate? Are those children who have all types or birth anomalies or chronic pancreatitis? Who is it really geared towards?
Dr. Chinenye Dike,: So, it is specifically geared towards children who have chronic pancreatitis and acute recurrent pancreatitis. We will also see children who have had maybe one episode of acute pancreatitis in that clinic because more recent data is showing that some of them may progress to chronic pancreatitis even after one episode.
So, it's geared towards children who've had any type of pancreatitis, even if it's one attack of pancreatitis, but we'll also serve children who have pancreatic ductal anomalies that may be at increased risk of developing some form of exocrine or endocrine pancreatic insufficiency in the future. Any child who has any sort of exocrine pancreatic insufficiency.
Dr. Cori Cross: Got it. So, really you want these patients referred early, so that they can be on your radar, so that even if they don't have chronic pancreatitis at the time, if we know that the insufficiency is likely to continue, that they are already sort of benefiting from this multidisciplinary approach. Is that correct?
Dr. Chinenye Dike,: Absolutely. But of course, you know also there are children who have things like Shwachman-Diamond who may also be at risk of exocrine pancreatic insufficiency early on, but may be able to get that resolved later. We will be able to see and help those children in that clinic as well.
Dr. Cori Cross: And I'm assuming you have a lot of patients with cystic fibrosis as well.
Dr. Chinenye Dike,: Absolutely. There is a multidisciplinary cystic fibrosis clinic here and we have one of our division members who'll be going into that clinic to help in that clinic as well. So, this clinic is not particularly tailored towards those children because there is already a multidisciplinary clinic here, but for all the patients who have other forms of pancreatitis from other sources or other genetic mutations. But thank you for asking that.
Dr. Cori Cross: No, I appreciate you informing me of that. So, my question is this, it's a disciplinary approach and this new program that's going to be starting next year, how will it change or streamline patient care? Take me through it from a patient's perspective.
Dr. Chinenye Dike,: So, patients with chronic pancreatitis or acute rerecurring pancreatitis are not only at risk of medical problems like exocrine pancreatic insufficiency and diabetes, but they're also at increased risk of having a high burden of pain, low quality of life. And so, having a clinic with, not only physician personnel, but also non-physician personnel to address some of the other complications that could be seen in this children would help decrease healthcare utilization burden, but also improve quality of life in these children in the long term.
Dr. Cori Cross: Got it. So, I'm assuming you have pain management on board and maybe nutrition?
Dr. Chinenye Dike,: So, we do have nutrition. We're going to have hopefully a pain psychologist in the clinic. And we should have an easy pathway for genetic counseling because many of these children who have chronic pancreatitis will have genetic mutations. But also easy access to pediatric endocrinologists who would be versatile with some of the nuances like type 3C diabetes that is seen in this patient population. And so, we'll have all those services within and around Children's of Alabama and UAB to be able to handle those complications that they have.
Dr. Cori Cross: I am assuming that both patients and parents will be very grateful because trying to manage and juggle all of those different appointments and the different aspects of disease that goes along with having a child who has a chronic condition like this is really challenging. How do you anticipate the new program affecting patient outcomes?
Dr. Chinenye Dike,: I think that we're going to launch it first in January of 2023. And so, we're initially going to start seeing patients in that clinic once a month. But I'm anticipating that over time, hopefully, we'll have a decreased rate of hospitalizations in those patients. We'll be able to track some of those outcomes. And also, patient-reported outcomes like quality of life measures over time to see how this clinic has helped them. And then in the long term, we'll hope to be able to become part of the National Pancreas Foundation and become a center of excellence, so that pediatric patients who have these pancreatic diseases, will be able to come to us, that we can offer this service.
Dr. Cori Cross: No, that's amazing. And it's wonderful. And you're right, it's something that's needed nationally. So to have a center, people are often willing to travel to get their best quality of care. Can you tell pediatricians anything about best practices or who you feel can benefit the most and how to go about helping patients they may see with acute pancreatitis?
Dr. Chinenye Dike,: Thank you very much. There is a national guideline from the NASPGHAN, which is the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition. I'm also in the Pancreas Committee and there is consensus guideline that was released either 2018 or 2017, I believe it was 2018, on management of acute pancreatitis.
Now, I know the general pediatricians in the community will probably be seeing patients who have one episode of pancreatitis, acute pancreatitis. Only a small subset of these patients would progress, even though there is now data showing that some people can develop chronic pancreatitis even without having first episode of pancreatitis and some people have a severe form of acute pancreatitis can progress to chronic pancreatitis after that first episode within four years.
So, I would say for community pediatricians, if they're seeing a patient with mild acute pancreatitis, most times that can easily be managed in their local community. But if it's a severe form of pancreatitis, it'll be probably best to refer to us. And now, we have our numbers, so they can always call if they have questions classifying the different types of pancreatitis because this was also recently classified by the NASPGHAN and Pancreas Committee given a classification for acute pancreatitis in the pediatric population.
So for those mild acute pancreatitis cases, most of them will probably be able to be managed in the local community with goal-directed fluid resuscitation, pain management and early nutrition. But for the severe forms of acute pancreatitis, it's probably best to refer to a center like the Children's Hospital of Alabama where we have all the resources where we can manage the complications that can arise from these episodes. And of course, if they have any patient who's had more than one episode or who developed a complication from our acute pancreatitis episode, it would be best to refer to us even from the beginning because these kids are risk of developing CP or chronic pancreatitis or complications from AP early.
Dr. Cori Cross: That was so helpful. And as a pediatrician myself, I find that just really clear and gives us a great understanding so that we can get our patients in early if they can be better helped by a referral, but also feeling uncomfortable to treat the patients that we can locally. You shared your expertise with us today and I feel like we are all better informed because of it. So, thank you very much.
Dr. Chinenye Dike,: Thank you.
Dr. Cori Cross: For more information or to refer patients to Children's of Alabama, visit childrensal.org. That concludes this episode of Children's of Alabama Peds Cast. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for other topics that might interest you. Please remember to subscribe, rate, and review this podcast. Thanks for listening to this episode of Peds Cast. I'm your host, Dr. Cori Cross.