Inside Pediatrics Magazine Fall/Winter 2025

GASTROENTEROLOGY

New technology eases management of liver disease

Reducing hypertension numbers in children–and adults Successfully stemming the rising rates of cardiovascular disease in adults needs to start in childhood. But with mounting numbers of children and adolescents developing high blood pressure—a trend driven largely by skyrocketing obesity rates—this objective is getting harder to achieve. The Pediatric Hypertension Program at Children’s of Alabama, with its steady growth, seeks to break the cycle. The Hypertension Clinic, which operates three half-days each week, now sees about 45 patients weekly, a tenfold increase from 14 years ago, says nephrologist Daniel Feig, M.D., Ph.D., who was recruited in 2011 to oversee the clinic’s development and expansion. With obesity in children steadily rising, more young patients are coming to Children’s of Alabama with a form of fatty liver disease that can greatly imperil their health. But determining the progression of liver disease can be a thorny process. To smooth that path, Children’s recently invested in an increasingly popular technology called FibroScan, helping UAB pediatric physicians to deftly and comprehensively manage children’s care. Using a technique known as transient elastography, FibroScan was the first FDA-approved device of its kind and is considered an aid to managing liver disease. Quick, noninvasive and painless, it uses an enhanced form of ultrasound to send vibrations into the liver to measure its stiffness, which typically indicates fibrosis or scarring. By assessing the severity of scarring—and the potential for cirrhosis—FibroScan can help diagnose or monitor the progression of various liver conditions. These range from less-common cystic fibrosis-associated liver disease to more prevalent autoimmune liver diseases and metabolic dysfunction-associated steatotic liver disease (MASLD). About one-third of the patients in the Children’s Hepatology Clinic, which serves about 500 ongoing patients each year, have NEPHROLOGY

Image courtesy of Echosens

suspected or confirmed fatty liver disease. “We will be using this for almost every patient with confirmed fatty liver disease, so we can measure the baseline stiffness of the liver when they first see us,” said David Willcutts, M.D., a transplant hepatologist at Children’s. FibroScan is an alternative to invasive liver biopsies and other forms of elastography that require a separate radiology appointment. A FibroScan exam takes just minutes, offering little disruption for young patients and faster treatment decisions for physicians. The new equipment arrived this summer.

High blood pressure—defined in adults and children 13 years and older as a reading of 130/80 mm Hg or higher— is relatively unusual in healthy young patients, affecting 2–3% of typical children and adolescents. But children with obesity—who account for nearly 20% of all Americans under 18—have a 20–30% rate of hypertension, Feig says. “There’s a fairly large number of kids with

20 - 30 % of children with

obesity have hypertension

high blood pressure, and one of the major concerns is how we can impact the long-term epidemic that results in cardiovascular disease in adults,” said Feig, who’s also the director of the Division of Pediatric Nephrology at Children’s. “The only way we can get this under control is by prevention,” he added. “If we can make an impact in children and adolescents, we can push back cardiovascular disease in adults.” Ultimately, the team is trying to prevent both short- and long-term health implications resulting from hypertension, including heart thickening, retinal damage and even impairments in cognitive function. It’s a daunting task, Feig acknowledges. “Anything we can do to reduce the numbers right now has a domino effect that reduces long-term target organ damage and long-term cardiovascular risk,” he said. “We’re not at a point where we can reverse the trajectory in 70,000 undiagnosed kids in Alabama, but we can positively impact a good number of kids, improve their health and quality of life, and gain the opportunity to gradually access more and more of them.”

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Inside Pediatrics | Children’s of Alabama