Erin Crawford, MD, Joins the Division of Pediatric Gastroenterology, Hepatology and Nutrition at UPMC Children’s with a Focus on Pediatric IBD

In early 2025, Erin Crawford, MD, assistant professor of Pediatrics joined the Division of Pediatric Gastroenterology, Hepatology and Nutrition at UPMC Children’s Hospital of Pittsburgh and is one of the newest members of the pediatric Inflammatory Bowel Disease (IBD) Center. In addition to her clinical work in the Division, Dr. Crawford has taken on leadership responsibilities as director of the Division’s Advanced Practice Provider (APP) Fellowship Program in pediatric gastroenterology. Dr. Crawford brings a focused interest in medical-surgical integration, translational research, and the evolving care landscape for children and adolescents living with IBD.

Getting into Medicine, Pediatrics, and Gastroenterology

Dr. Crawford’s path to medicine was shaped in part by the work of her parents, both of whom worked in service professions, her mother in special education and her father as a child and adolescent psychologist.

“They really instilled in me the importance of giving back and making a difference. That mindset stayed with me,” says Dr. Crawford.

Dr. Crawford was initially interested in veterinary medicine bu t found her interest shifting toward human health during her undergraduate education. That transition ultimately led her to enroll in a global health-focused medical school in Israel, the Ben Gurion University of the Negev, after college.

“I had already been accepted to U.S. medical schools, but the opportunity in Israel offered something different. It was a leap, but one that worked out both personally and professionally,” Dr. Crawford says.

After earning her medical degree, Dr. Crawford returned to the United States to complete her pediatric residency at University Hospitals Rainbow Babies & Children’s Hospital in Cleveland.

Training, Mentorship, and a Return to Pittsburgh

During residency, Dr. Crawford developed an interest in pediatric gastroenterology, guided by mentorship that connected her to the academic and clinical IBD community.

“One of my mentors during residency was focused on IBD, and he helped me get involved in research, conferences, and introduced me to Sandy Kim, MD, who was director of the IBD Center at UPMC Children’s at that time. That network and exposure helped shape may career path and opened the door to fellowship training in gastroenterology in Pittsburgh,” Dr. Crawford says.

Dr. Crawford completed her pediatric gastroenterology fellowship at UPMC Children’s in 2023. Following her fellowship training, Dr. Crawford spent a year and a half as an attending physician on the IBD team in Cleveland before being recruited back to UPMC Children’s.

“The IBD team here is fantastic, and the collaboration across disciplines, especially with our surgical colleagues, really strengthens our ability to deliver comprehensive and long-term patient care,” Dr. Crawford says. “It feels full circle, coming back to take care of some of the same patients I saw during fellowship. I’m excited to be part of this team again.”

Surgical Collaboration and Clinical Expansion in IBD

Dr. Crawford’s clinical focus at UPMC Children’s is focused on total IBD care, but with an emphasis on the interface between medical and surgical paradigms.

“We know that a quarter or more of patients with IBD will need surgery at some point, and being able to bring everyone together in one clinic visit can make a real difference in how clinical decisions relative to patient are made,” Dr. Crawford says.

One of the projects that Dr. Crawford and the IBD Center hope to initiate in the coming months is a joint clinic structure in which Gastroenterology and GI Surgery can see patients together, when warranted.

Translational and Experimental Research During Fellowship

During her fellowship, Dr. Crawford conducted both translational and experimental research under the mentorship of Kevin Mollen, MD, surgical director of the UPMC Children’s IBD program and Surgeon-in-Chief at UPMC Children’s. Dr. Crawford’s work included the collection and analysis of patient biopsy samples to study mitochondrial dysfunction and metabolic signatures specific to ulcerative colitis.

“We were looking for a distinct metabolic profile that could help differentiate ulcerative colitis from other diseases and point to new mechanisms at play in the pathophysiology of the condition. It is part of a larger body of work in Dr. Mollen’s lab around mitochondrial signaling and disease pathogenesis,” Dr. Crawford says.

She also contributed to developing a modified organoid model using murine-derived intestinal tissue to better emulate terminal epithelial differentiation, which is critical for studying cytokine-driven injury in ulcerative colitis.

“We created a model using a cytokine cocktail that induces the same protein patterns you see in actual patients and mouse models of colitis. That protocol has been published for other labs to replicate,” Dr. Crawford says.

A Clinical Perspective on Pediatric IBD - Complexity and Empathy

Managing IBD in children and adolescents involves a complex dynamic of treating physical, emotional, social, and the logistical factors of care associate with chronic illnesses. Many patients struggle with what Dr. Crawford refers to as the invisibility of the disease, symptoms that are difficult to deal with and disruptive to everyday life but often go unnoticed by others. The first year after an IBD diagnosis can be particularly isolating for children, adolescents, and their families, and in particular for pre-teens and teenagers navigating school, peer relationships, and emerging independence.

“Especially in that first year after diagnosis, kids are dealing with symptoms, side effects, and diet changes, but none of that is visible from the outside. It can be really isolating,” Dr. Crawford says.

“This external invisibility of IBD can make patients feel unheard, particularly when they do not know others with IBD.”

The psychosocial burden of living with IBD is significant and well-documented in the literature. Children and teens with the disease have higher rates of anxiety and depression, which requires clinicians to be vigilant in supporting mental and emotional health, as well as disease control of the underlying IBD.

Dietary therapy is another area where empathy and nuance are essential. While there is growing evidence for the role of diet and the microbiome in disease modulation, implementing these strategies in real life along with the pressures of modern schedules, food access, and cultural norms can be profoundly challenging for patients and their families.

“We live in a world of fast food and food deserts. It is not enough to say, ‘Just change your diet.’ There are real barriers families face to this all the time, even when they're motivated,” Dr. Crawford says.

Exclusive enteral nutrition (EEN), though clinically effective, requires complete reliance on nutritional shakes for long periods of time, a strategy that can be especially difficult for adolescents. Dr. Crawford personally tried the regimen for six weeks during fellowship to gain insight into its complexity and burdens. The experience gave her a firsthand understanding of the social and emotional strain involved in long-term EEN use.

“We talk about EEN as a great alternative to steroids, but it is incredibly hard to do. I tried it myself to better understand it, and even with all the motivation in the world, it was tough,” Dr. Crawford says. “I had to carry an entire suitcase of shakes to a national GI conference. Even surrounded by supportive colleagues who treat IBD patients every single day, it still felt a bit awkward and isolating.”

Compounding the challenge of nutritional therapies are its costs, inconsistent insurance coverage, and other factors.

“Access to something like EEN shouldn’t depend on socioeconomic status or what kind of insurance plan you have. We have been fortunate to work with manufacturer reps and vendors to bridge some of those gaps for our patients, but that’s not a long-term or scalable solution for the entire population of IBD patients out there in the community,” Dr. Crawford says.

Despite the challenges of living with IBD, every difficulty encountered is an opportunity to improve patient care. Regular check-ins, validation of the patient experience, and tailoring therapies to the realities of everyday life are central to how the UPMC Children’s IBD center approaches patient care.

“These are hard things we’re asking kids and families to do, but with the right support, they can succeed. That is what makes this work so meaningful,” Dr. Crawford says.

Early Intervention and Long-Term Care Planning

Advances in pediatric IBD therapeutics have reshaped the clinical outlook for many patients. The past few decades have seen a rapid acceleration in treatment development, shifting the standard of care from steroids and immunomodulators to increasingly targeted biologics. At the same time, the IBD research community has gained a better understanding of the influence of the gut microbiome and dietary triggers, while immune modulation approaches have opened new investigative and clinical pathways.

“It is an exciting time to be working in IBD space. Thirty years ago, we had steroids and Imuran. Then came Remicade. Now there are new biologics coming out almost every year, and we understand so much more about how to help kids grow, live well, and if possible, avoid surgery,” Dr. Crawford says. “We are learning more all the time about how nutrition and environmental factors influence outcomes. There is still a lot to figure out, but we are in a place where real progress is happening.”

A hallmark of pediatric IBD care is the opportunity for early intervention that can alter long-term trajectories. For Dr. Crawford, this includes the adoption of top-down therapy using biologics and the strategic framing of surgery as part of the overall care continuum.

“We know that starting with top-down therapy with early use of biologics can help prevent complications and support growth during a critical window,” Dr. Crawford says. “Once puberty ends, we lose the opportunity to impact growth in the same way.”

She is also working to shift perceptions around surgery in IBD.

“Needing surgery is not a failure in care. For some patients, it is the right part of the treatment plan at the right time, Dr. Crawford says. “We are trying to frame care in terms of lifelong management, not short-term fixes because our patients will be living with IBD for a very long time and achieving optimal outcomes over the lifespan begins at the time of diagnosis.”

Further Reading

Below is a selection of research for further reading coauthored by Dr. Crawford.

• Hadjiyannis Y, Ali S, Wang Q, Crawford EC, Scholz S, Waltz PK, Alissa F, Ayers MH, Reyes-Múgica M, Salgado CM. The Spectrum of Sarcina Colonization in the Gastrointestinal Tract of Pediatric and Adolescent Patients. Int J Surg Pathol. 2025 Feb; 33(1): 65-75.
• Novak EA, Crawford EC, Mentrup HL, Griffith BD, Fletcher DM, Flanagan MR, Schneider C, Firek B, Rogers MB, Morowitz MJ, Piganelli JD, Wang Q, Mollen KP. Epithelial NAD+ depletion drives mitochondrial dysfunction and contributes to intestinal inflammation. Front Immunol. 2023 Sep 7; 14: 1231700.
• Crawford E, Mentrup HL, Novak EA, Mollen KP. Studying the Epithelial Effects of Intestinal Inflammation In Vitro on Established Murine Colonoids. J Vis Exp. 2023 Jun 2; (196): 10.3791/64804.
• Maltz RM, McClinchie MG, Boyle BM, McNicol M, Morris GA, Crawford EC, Moses J, Kim SC. Biosimilars for Pediatric Patients With Inflammatory Bowel Disease: Pediatric Gastroenterology Clinical Practice Survey. J Pediatr Gastroenterol Nutr. 2023 May 1; 76(5): 616-621.