We highly value the significance of conducting medical research at the Children's Gastroenterology and Nutrition Institute at Shaare Zedek Medical Center. We believe that medical units engaged in research often provide better care for patients. Research not only grants access to innovative treatments and technologies not yet available in routine practice but also offers patients leading-edge treatment without cost and waiting times.
The Children's Gastroenterology and Nutrition Institute at Shaare Zedek Medical Center leads international research initiatives involving millions of dollars across four continents and dozens of medical centers worldwide. In addition to the specialized medical staff, the research framework of the institute consists of a team of nine researchers, including project managers, research coordinators, statisticians, and laboratory personnel. The research infrastructure comprises a laboratory equipped with all necessary facilities to support various studies that require sample analysis.
The research at the institute encompasses all aspects of chronic inflammatory bowel diseases (Crohn's disease and ulcerative colitis). This includes understanding the triggers of disease outbreaks in children, evaluating disease management and improvement strategies, developing measurement tools and mechanisms to assess disease progression in children, as well as clinical trials involving existing and novel devices for treating these diseases.
The Genetic Environmental Microbial (GEM) study is a comprehensive international research effort aiming to uncover the causes of inflammatory bowel diseases. In this pioneering study, we follow 5,000 healthy family members (siblings or children) of Crohn's disease patients for six years to identify factors that may lead some of them to develop the disease while others do not. This study is led by the Children's Gastroenterology and Nutrition Institute at Shaare Zedek Medical Center and involves 13 leading medical centers in Israel, along with several in Canada and the United States.
Another significant project initiated by the institute is the ImageKids study, led by Prof. Dan Turner (Director of the Children's Gastroenterology and Nutrition Institute at Shaare Zedek Medical Center). The study's aim is to develop metrics for assessing gut damage and disease activity in children with Crohn's disease using MRI, a non-radiation method. This approach aims to minimize the need for invasive endoscopic procedures and provide precise measurements of inflammation and damage in the gut. This ongoing study, which started recruiting participants in 2013, is conducted in collaboration with 28 leading gastroenterology centers in North America, Europe, Australia, and Israel.
Furthermore, a significant ongoing project involves collaboration with four major health funds and other large medical centers in Israel. This research, utilizing electronic health records, aims to assess the scope of IBD patients in Israel and various factors related to disease development, medication usage, procedures, and more. This project is expected to provide a valuable and unique tool for studying IBD in Israel and globally across different population groups.
In addition to the above, the institute is concurrently conducting genetic, clinical, experimental, and epidemiological studies.
Notable completed studies in 2014, published in leading journals, include:
1. Identification of clinical and endoscopic predictors for severe course of ulcerative colitis in children. A clinical measure calculated three months after treatment initiation was found to be a strong predictor of disease activity and the need for hospitalization and surgery 1-3 years after diagnosis. The high accuracy allowed for the establishment of a treatment protocol based on these findings, ensuring that stronger and more expensive medications are reserved only for the population that requires them.
2. In the largest study to date regarding infliximab therapy in pediatric Crohn's disease, data were collected from 330 children treated with this therapy across seven centers in Israel, Europe, Canada, and the United States. This study aimed to assess whether subcutaneous administration of the medication is as effective as intravenous administration. Advanced statistical methods, in collaboration with the Biostatistics Department at the Technion, revealed that subcutaneous administration effectively controlled the disease over time without excessive side effects. This study was the first to address this question in Crohn's disease, suggesting that subcutaneous administration is a viable option for children with stable disease, with careful monitoring of disease activity and growth.
3. The optimal dosage of steroids for hospitalized children experiencing a severe flare-up of ulcerative colitis remained uncertain. A medical center in England used higher dosages than the conventional practice. This variation was utilized in a study that collected data from 265 children admitted for steroid treatment due to ulcerative colitis in Israel, England, and Canada. The research, part of a medical student's thesis at the Hebrew University, found no difference in hospital outcomes between those who received high dosages and those who received low dosages. This indicates that low dosages of steroids can be utilized to minimize the risk of side effects.