Conversation with…Dr. Jeffrey Hyams
Top pediatric G.I. sees research as key
By Judie Jacobson
WEST HARTFORD-For Dr. Jeffrey S. Hyams, the task of helping children overcome the pain and suffering that are a byproduct of inflammatory bowel disorders such as Crohn’s disease and ulcerative colitis is more than a job n it is his life’s mission.
And he has pursued that all-consuming mission relentlessly for the past 26 years, as Director of Digestive Diseases and Nutrition at Connecticut Children’s Medical Center (CCMC) in Hartford.
In October 2006, Dr. Hyams also became the first director of CCMC’s newly opened Center for Pediatric Inflammatory Bowel Disease. One of the largest such programs in the northeast, the new Center serves as a resource for clinical care, for research, and philanthropic funding to help find a cure.
A New Jersey native who lives in West Hartford, Dr. Hyams is also founder and primary investigator of the Pediatric IBD Collaborative Research Group, a consortium of 20 clinical research centers in North America compiling detailed data on newly diagnosed children with IBD.
The 55-year-old Hyams is a graduate of Brandeis University, where he was awarded the Rishon M. Bialer Memorial Prize in biology, and the University of Pennsylvania School of Medicine.
Recently, Dr. Hyams spoke with the Ledger about the new Center and his work as a pediatric gastroenterologist.
Q: When you chose the specialty of pediatric gastroenterology it was a very small field. What prompted you to choose that field?
A: When I was an intern at Children’s Hospital in Boston I cared for a young boy with Crohn’s disease (incidentally named Jeffrey). I was struck by how little we knew of his disease, how inadequate the therapies were then, and how the disease had profoundly affected his life and that of his family. I had previously wanted to be a pediatric hematologist but found this more appealing and had a “career moment”. I finished my three years of residency and then did my fellowship at Harvard Medical School and Children’s with a particular interest in inflammatory bowel disease (IBD). The fact that there were only a limited number of pediatric gastroenterologists was also appealing, and I wanted to start my own program one day. An opportunity arose to come to Connecticut in 1980 and as they say, the rest is history. My first year I saw about 600 patient visits. This year our group saw over 12,000 patients from the region. We have developed a wonderful team of doctors, nurses, nutritionists, and support staff who are incredibly dedicated to our patients. We care for children with IBD as well as a whole range of acute and chronic gastrointestinal, hepatic, and nutritional disorders.
Q: In recent years the number of cases of Crohn’s disease and ulcerative colitis is reported to have increased dramatically. To what do you attribute this rise?
A: I think this increase is real and does not represent increased recognition. The most common theory rests upon what is called the hygiene hypothesis. It has been suggested that exposure to intestinal pathogens n bacteria and other microorganisms n early in life may induce a degree of tolerance of the intestinal immune system to normal intestinal bacteria later in life. In developed countries we have become too clean, constantly washing our children’s hands and in so doing do not expose them to mild diseases that may induce this tolerance. In undeveloped countries where children frequently are infected with parasites early in life there is no IBD. If you take the same parents and move them to developed countries and they have children their children now get IBD. Same genetics, different environment.
Q: Is it true that Crohn’s and colitis are more prevalent among Jews? If so, why is that?
A: Maybe. It has been suggested that Jews of Eastern European ancestry are at greatest risk. However, as the diseases have become more prevalent throughout society the differences between Jews and non-Jews have been decreasing. As noted above, it is likely that IBD represents the culmination of multiple factors including genetics and the environment.
Q: Tell us about the new Center for Pediatric Inflammatory Bowel Disease at CCMC.
A: The Center for Pediatric IBD at CCMC represents a platform for delivering coordinated care by a highly trained team of pediatric gastroenterologists, specially trained nurses, nutritionists, and a program coordinator. It is the culmination of years of planning and thought as to how best to deliver care. The treatment of children is not limited to medication but also includes nutritional counseling, psychological support, and education. Research is also a key part of our mission. Without research we will never improve the understanding of these diseases or the care of these children. We have been very fortunate to be leaders in these efforts. I have had the pleasure of being the primary investigator for the two largest pediatric clinical trials of new medications involving Remicade (infliximab) and Tysabri (natalizumab). Dr. Francisco Sylvester, one of my associates, is a leader in the field trying to elucidate the relationship between intestinal inflammation and abnormalities in bone metabolism that may result in osteoporosis and growth abnormalities.
Q: Have there been significant advances in IBD in recent years? How close are we to a cure?
A: The fundamental breakthrough has not happened. We continue to get closer to understanding the fundamental abnormalities that result in these diseases but the defining discovery awaits us. However, our treatment is vastly better than 20 years ago. The use of immunomodulators, such as azathioprine and biological therapy with Remicade have dramatically improved outcomes. Having said that, these treatments are not cures, and kids still get sick at times. Their use is also associated with serious potential side-effects, some of which may not become apparent during clinical trials. Remember, clinical trials often involve hundreds of patients. Only after widespread use of medications for thousands of patients do some rare complications become evident. It is imperative that patients, families, and physicians fully discuss risk versus benefit, but that information can only be based on what we know now, not what we will know next year.
We are currently initiating a major prospective project involving 50 pediatric IBD centers in the country to look at the relationship of genetic markers to complications of disease. Knowing that someone is bound to have more aggressive disease allows us to target them for more aggressive therapy up-front.
Q: What’s next?
A: Research is the key and support for research is vital. We need to partner with our patients and the community through philanthropy to help us complete our mission. We all have a stake in this and the Center is a wonderful resource for the state of Connecticut and the region.
Comments? Email judiejacobson@jewishledger.com