Alka Goyal, MD

Clinical Professor

“I strive to offer personalized and comprehensive care to each patient by a process of shared decision-making.”

I am a pediatric gastroenterologist with over 20 years of experience in taking care of children with a variety of GI problems. My clinical and research focus has been in childhood inflammatory bowel disorders (IBD). I aim to incorporate the latest innovations in medical therapeutics with dietary and other lifestyle interventions to achieve complete healing. I am especially interested in taking care of children with very early onset IBD, some of whom might have an underlying genetic condition that requires specialized testing and treatment. My other area of interest is managing children with hard-to-treat or refractory IBD.

My research interests include optimizing medical and dietary therapies and restoring a healthy gut microbiome by interventions such as fecal microbiota transplant in the treatment of IBD. In collaboration with the genomics department and adult gastroenterologists, I am studying the effects of environmental and dietary exposures on the clinical course of Crohn’s disease.

As a participating site for ImproveCareNow and the PROKIIDS network, we collaborate with national and international IBD centers in quality initiatives, with multicenter research studies, and most importantly with families who are affected by IBD.

I am thankful to be a part of Stanford University for not just its scientific excellence but also its focus on addressing important issues of health care disparities. At Stanford Children’s Health, I am excited to be a part of the growth and expansion of the pediatric gastroenterology and IBD centers with the goal of healing children with digestive diseases through innovation.

Especialidades médicas y/o especialidades quirúrgicas

Gastroenterology

Trabajo y educación

Educación

Lady Hardinge Medical College, New Delhi, India, 3/24/1985

Últimos años de residencia

University of Connecticut Pediatric Residency, Hartford, CT, 06/30/1993

Subespecialidad

Washington University Gastroenterology Fellowship, St Louis, MO, 06/30/1998

Certificado(s) de especialidad

Pediatric Gastroenterology, American Board of Pediatrics

Mi perfil médico académico en Stanford

Servicios

Centro de la IBD

Todo Publicaciones

Anemia in Children With Inflammatory Bowel Disease: A Position Paper by the IBD Committee of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition. Journal of pediatric gastroenterology and nutrition Goyal, A. n., Zheng, Y. n., Albenberg, L. G., Stoner, N. L., Hart, L. n., Alkhouri, R. n., Hampson, K. n., Ali, S. n., Cho-Dorado, M. n., Goyal, R. K., Grossman, A. n. 2020; 71 (4): 56382

Abstract

Anemia is one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD). It can be asymptomatic or associated with nonspecific symptoms, such as irritability, headaches, fatigue, dizziness, and anorexia. In IBD patients, the etiology of anemia is often multifactorial. Various causes include iron deficiency, anemia of inflammation and chronic disease, vitamin deficiencies, hemolysis, or myelosuppressive effect of drugs. Anemia and iron deficiency in these patients may be underestimated because of their insidious onset, lack of standardized screening practices, and possibly underappreciation that treatment of anemia is also required when treating IBD. Practitioners may hesitate to use oral preparations because of their intolerance whereas intravenous preparations are underutilized because of fear of adverse events, availability, and cost. Several publications in recent years have documented the safety and comparative efficacy of various intravenous preparations. This article reviews management of anemia in children with IBD, including diagnosis, etiopathogenesis, evaluation of a patient, protocol to screen and monitor patients for early detection and response to therapy, treatment including parenteral iron therapy, and newer approaches in management of anemia of chronic disease. This report has been compiled by a group of pediatric gastroenterologists serving on the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) IBD committee, in collaboration with a pediatric hematologist, pharmacist, and a registered dietician who specializes in pediatric IBD (IBD Anemia Working Group), after an extensive review of the current literature. The purpose of this review is to raise awareness of under-diagnosis of anemia in children with IBD and make recommendations for screening, testing, and treatment in this population.

View details for DOI 10.1097/MPG.0000000000002885

View details for PubMedID 32947565

Safety, Clinical Response, and Microbiome Findings Following Fecal Microbiota Transplant in Children With Inflammatory Bowel Disease. Inflammatory bowel diseases Goyal, A. n., Yeh, A. n., Bush, B. R., Firek, B. A., Siebold, L. M., Rogers, M. B., Kufen, A. D., Morowitz, M. J. 2018; 24 (2): 41021

Abstract

The role of fecal microbiota transplant (FMT) in the treatment of pediatric inflammatory bowel disease (IBD) is unknown. The aims of this study were to assess safety, clinical response, and gut microbiome alterations in children with Crohn's disease (CD), ulcerative colitis (UC), or indeterminate colitis (IC).In this open-label, single-center prospective trial, patients with IBD refractory to medical therapy underwent a single FMT by upper and lower endoscopy. Adverse events, clinical response, gut microbiome, and biomarkers were assessed at baseline, 1 week, 1 month, and 6 months following FMT.Twenty-one subjects were analyzed, with a median age of 12 years, of whom 57% and 28% demonstrated clinical response at 1 and 6 months post-FMT, respectively. Two CD patients were in remission at 6 months. Adverse events attributable to FMT were mild to moderate and self-limited. Patients prior to FMT showed decreased species diversity and significant microbiome compositional differences characterized by increased Enterobacteriaceae, Enterococcus, Haemophilus, and Fusobacterium compared with donors and demonstrated increased species diversity at 30 days post-FMT. At 6 months, these changes shifted toward baseline. Clinical responders had a higher relative abundance of Fusobacterium and a lower diversity at baseline, as well as a greater shift toward donor-like microbiome after FMT compared with nonresponders.A single FMT is relatively safe and can result in a short-term response in young patients with active IBD. Responders possessed increased Fusobacterium prior to FMT and demonstrated more significant microbiome changes compared with nonresponders after FMT. Microbiome characteristics may help in predicting response.

View details for DOI 10.1093/ibd/izx035

View details for PubMedID 29361092

Natural History of Very Early Onset Inflammatory Bowel Disease in North America: A Retrospective Cohort Study. Inflammatory bowel diseases Kerur, B. n., Benchimol, E. I., Fiedler, K. n., Stahl, M. n., Hyams, J. n., Stephens, M. n., Lu, Y. n., Pfefferkorn, M. n., Alkhouri, R. n., Strople, J. n., Kelsen, J. n., Siebold, L. n., Goyal, A. n., Rosh, J. R., LeLeiko, N. n., Van Limbergen, J. n., Guerrerio, A. L., Maltz, R. n., Karam, L. n., Crowley, E. n., Griffiths, A. n., Heyman, M. B., Deneau, M. n., Benkov, K. n., Noe, J. n., Mouton, D. n., Pappa, H. n., Galanko, J. A., Snapper, S. n., Muise, A. M., Kappelman, M. D. 2020

Abstract

The incidence of very early onset inflammatory bowel disease (VEOIBD) is increasing, yet the phenotype and natural history of VEOIBD are not well described.We performed a retrospective cohort study of patients diagnosed with VEOIBD (6 years of age and younger) between 2008 and 2013 at 25 North American centers. Eligible patients at each center were randomly selected for chart review. We abstracted data at diagnosis and at 1, 3, and 5 years after diagnosis. We compared the clinical features and outcomes with VEOIBD diagnosed younger than 3 years of age with children diagnosed with VEOIBD at age 3 to 6 years.The study population included 269 children (105 [39%] Crohn's disease, 106 [39%] ulcerative colitis, and 58 [22%] IBD unclassified). The median age of diagnosis was 4.2 years (interquartile range 2.9-5.2). Most (94%) Crohn's disease patients had inflammatory disease behavior (B1). Isolated colitis (L2) was the most common disease location (70% of children diagnosed younger than 3 years vs 43% of children diagnosed 3 years and older; P = 0.10). By the end of follow-up, stricturing/penetrating occurred in 7 (6.6%) children. The risk of any bowel surgery in Crohn's disease was 3% by 1 year, 12% by 3 years, and 15% by 5 years and did not differ by age at diagnosis. Most ulcerative colitis patients had pancolitis (57% of children diagnosed younger than 3 years vs 45% of children diagnosed 3 years and older; P = 0.18). The risk of colectomy in ulcerative colitis/IBD unclassified was 0% by 1 year, 3% by 3 years, and 14% by 5 years and did not differ by age of diagnosis.Very early onset inflammatory bowel disease has a distinct phenotype with predominantly colonic involvement and infrequent stricturing/penetrating disease. The cumulative risk of bowel surgery in children with VEOIBD was approximately 14%-15% by 5 years. These data can be used to provide anticipatory guidance in this emerging patient population.

View details for DOI 10.1093/ibd/izaa080

View details for PubMedID 32386060

Liver Enzyme Elevations Within 3 Months of Diagnosis of Inflammatory Bowel Disease and Likelihood of Liver Disease JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION Goyal, A., Hyams, J. S., Lerer, T., Leleiko, N. S., Otley, A. R., Griffiths, A. M., Rosh, J. R., Cabrera, J. M., Oliva-hemker, M. M., Mack, D. R., Rick, J. N., Pfefferkorn, M. D., Carvalho, R., Grossman, A. B., Hitch, M. C., Sudel, B., Kappelman, M. D., Saeed, S. A., Faubion, W. A., Schaefer, M. E., Markowitz, J. F., Keljo, D. J. 2014; 59 (3): 321-323

Abstract

Inflammatory bowel disease-associated liver diseases (IBD-LDs) include autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and an overlap syndrome. Prospective unbiased multicenter data regarding the frequency of IBD-LD in patients with pediatric inflammatory bowel disease (IBD) are lacking. We examined early alanine aminotransferase (ALT) and -glutamyl transpeptidase (GGT) elevations in children diagnosed as having IBD and assessed the likelihood of IBD-LD.Data collected from the prospective observational Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry enrolling children of age <16 years within 30 days of diagnosis. AIH, PSC, and overlap syndrome were diagnosed using local institutional criteria.A total of 1569 subjects had liver enzymes available. Of the total, 757 had both ALT and GGT, 800 had ALT only (no GGT), and 12 had GGT only (no ALT). Overall, 29 of 1569 patients (1.8%) had IBD-LD. IBD-LD was diagnosed in 1 of 661 (0.15%) of patients with both ALT and GGT50 IU/L compared with 21 of 42 (50%) of patients with both ALT and GGT>50 (odds ratio 660, P<0.0001). Of the 29 patients with IBD-LD, 21 had PSC, 2 had AIH, and 6 had overlap syndrome. IBD-LD was more common in patients with ulcerative colitis and IBD-unclassified (indeterminate colitis) than in those with Crohn disease (4% vs 0.8%, respectively, P<0.001).Elevation of both ALT and GGT within 90 days after the diagnosis of IBD is associated with a markedly increased likelihood of IBD-LD. Both ALT and GGT levels should be measured in all of the pediatric patients newly diagnosed as having IBD.

View details for DOI 10.1097/MPG.0000000000000409

View details for Web of Science ID 000341080700012

View details for PubMedID 24796799

Alka Goyal, MD