Annual Report 2002

Division of Gastroenterology

Division Chief: Marvin Ament, M.D.

Division Highlights

The Division of Pediatric Gastroenterology, Hepatology and Nutrition during 2002 has continued to grow in its clinical care responsibilities and in its investigative productivity.

During the last academic year we have expanded our coverage in Santa Barbara County at the Cottage Hospital to the point where three of the faculty members are at that site three full days per month.

In addition to this the division has increased the coverage at the Ventura County Medical Center to 1 ½ days per month. Our Santa Clarita offsite clinic was shut down for more than 6 months because of lease problems with our clinic space which was beyond our control.

These offsite clinics have resulted in a steadily increasing number of referrals to the faculty with a similar increase in the number of procedures done. However we saw less growth than expected because of the Santa Clarita shut down.

Here at the Westwood campus the division has expanded to offer general pediatric gastroenterology, hepatology and nutritional support services every day of the week on an outpatient basis.

The division has established a routine Friday morning clinic for follow-up on liver and small bowel transplantation patients as well as a clinic where these new consultatations for small bowel transplantation may be seen. This is being done in conjunction with Dr. Douglas Farmer, Assistant Professor in the Liver and Pancreas Transplantation program.

Honors for the division include Dr. Marvin Ament being awarded the Murray Davidson Award of the subsection of pediatric gastroenterology, hepatology and nutrition in the American Academy of Pediatrics for his contributions to the development of the subspecialty. This is the third award that Dr. Ament has been given in recognition of his contributions to the development of the subspecialty. The prior awards were the Harry Schwachmann Award of the North American Society of Pediatric Gastroenterology and Hepatology in 2001 and the Janssen Award of the American Gastroenterological Association in 200.

In addition, Dr. Ament was asked to be one of the lead instructors at the first postgraduate course in 2004 given by the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition in terms of preparing individuals for the subspecialty board examination. This is quite an honor for Dr. Ament since there were only five people picked for this nationally and internationally acclaimed organization.

Both Dr. Sue McDiarmid and Dr. Martin have distinguished themselves by assuming leadership positions in national organizations related either to transplantation and in science projects sponsored by the pediatric gastroenterology, hepatology and nutrition organization.

Last, during the past academic year the division added two faculty members, Dr. Susan Pacini Edelstein, a graduate of our program who became a faculty member with the purpose of aiding in the development of our pediatric liver and small bowel transplantation program. She will be focused in working with Dr. Doug Farmer.

Dr. Steven Wu became a Clinical Instructor in July of 2003 with the purpose being to continue to develop his skills as a bench researcher working at the cell biology institute.

Faculty Profiles

AMENT, MARVIN E.

Faculty member since: 1973
Degrees: M.D., University of Minnesota Medical School
B.S., Illinois Institute of Technology
Rank: Distinguished Professor of Pediatrics
Research Interests: -Home parenteral nutrition, outcomes.
-Inflammatory bowel disease. -Gastroesophageal reflux
Teaching: -Pediatric Core Lecturer, UCLA
-Pediatric Gastroenterology elective
-Pediatric Gastroenterology research seminars
University Service: -Chairman, Pharmacy and Therapeutics Committee
-Chairman, Parenteral and Enteral Nutrition SubCommittee
-Chairman, Antiobiotic Subcommittee
Professional Committees: -United States Pharmacopeia
-Reviewer for medical journals

MARTIN, MARTIN

Faculty Member Since: 1992
Degrees: B.A., University of California Santa Cruz
M.D., Harvard Medical School
M.P.P., Harvard University School of Government
Rank: Associate Professor of Pediatrics
Teaching: -Pediatric Gastroenterology elective
-Pediatric Gastroenterology research seminars
-Intern and resident conferences
Research Interest: -Transcriptional regulation of intestinal immunoglobulin transporters
-Glucose Galactose Malabsorption
-Inherited disorders of the gastrointestinal and hepatobiliary tracts
-The role of passive immunity in altering neonatal gut development
Acute Liver Failure
Current Grant Support: -NIH/NICHD/HD34706-RO1, PI
Molecular basis of enterocyte regulation during ontogeny
-NIH/NIDDK/DK44582-RO1, Co-PI
Familial glucose-galactose malabsorption
-NIH/NICHD/HD41034-RO3, PI
Regulation of Intestinal Nutrient Transporters
-NIH/NIDDK/DK58369-RO1, Co-PI (William M. Lee)
A Multi-Center Group to Study Acute Liver Failure
Professional Committees: -Ad Hoc Reviewer: Journal of Pediatrics; Biochemical and Molecular Medicine; Journal of Pediatric Gastroenterology and Nutrition -Grant Reviewer: NIH Special Emphasis Panel; NIAID
-Internal Committees: Department of Pediatrics Research Committee;
Coordinator of Research in Progress Seminars; Pediatric Grand Rounds Committee; Campus-Wide Ad Hoc Review Committee; DPGP-Department of Pediatrics; RAC-Chaired Basic Science/Laboratory Investigations Subcommittee;Practice Plan Review Committee
-External Committees: Working Group Infectious Causes of Acute Liver Failure (Chair); Crigler Najjar Association-Medical Advisor

MCDIARMID, SUZANNE V.

Faculty member since: 1988
Degrees: M.B, Ch.B, University of Otago (New Zealand)
Rank: Professor of Pediatrics and Surgery
Research Interests: -Pediatric liver transplantation. Clinical studies on immunosuppression in pediatric liver transplant patients.
Teaching: -Pediatric Core Lecturer, UCLA
-Pediatric Gastroenterology elective
-Pediatric Gastroenterology research seminars
University Service: -1994 – present: Director, Pediatric Liver Transplant Program, UCLA
-January 1995 - to present: Director, Pediatric Liver Transplant Program,UCLA-Cedars-Sinai Medical Center
-Medical School Admissions Committee
-Board member, Department of Pediatrics Group Practice
-Practice Plan Review Committee, Department of Pediatrics
Professional Committees: United States Pharmacopeia Convention Inc, Member of Transplant -Immunology Advisory Panel
-International Liver Transplant Society
-American Association for the Study of Liver Disease
-United Network Organ Sharing (UNOS)
-Reviewer for Transplantation
-Reviewer for Journal of Pediatric Gastroenterology and Nutrition
-Reviewer for Pediatric Research
-Reviewer for Liver Transplantation
-Reviewer for Journal of Heart and Lung Transplantation
-Reviewer for Pediatric Transplantation
-Reviewer for Journal of Pediatrics

MEHRA, MINI
Faculty Member Since: 2000
Degrees: M.D., University of Texas Health Science Center
B.S., Houston Baptist University
Rank: Assistant Professor
Research Interests: Gastroesophageal Reflux Disease, Chronic Recurrent Abdominal Pain, Inflammatory Bowel Disease, Lactose Intolerance
Teaching: Lecturer, Pediatric Gastroenterology for Medical Students, Pediatric Residents, Pediatric Dentistry Residents, and GI Fellows
University Service: Department of Pediatric Group Practice Executive Committee
Professional Committees: -Member, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
-Member, American Academy of Pediatrics

VARGAS, JORGE

Faculty member since: 1983
Degrees: MD Colegio Mayor de Nuestra Senora del Rosario School of Medicine, Bogota, Colombia
Doctor in Medicine
Rank: Professor of Pediatrics
Research Interests: Gastrointestinal motility. Pediatric liver transplantation. Nutrition in liver disease.
Teaching: -Pediatric Core Lecturer, UCLA
-Pediatric Gastroenterology elective
-Pediatric Gastroenterology research seminars
-Lecturer in Gastrointestinal and Liver disease for national and international organizations (AGA, ASGE, NASPGN, ASPEN, ESPGAN, LASPGN, APPGAN)

WU, STEVEN S.

Faculty Member Since: 2001
Degrees: M.D., College of Physicians and Surgeons, Columbia University
A.B., Harvard University
Rank: Clinical Instructor
Research Interest: Signal Transduction in Intestinal Epithelia
Current Grant Support: -2 K12 HD34610-06, NIH/NICHHD: UCLA Child Health Research Career Development Award
-1 K08 DK62014-01, NIH/NIDDK: Mentored Clinical Scientist Development Award
Teaching: Attending physician, Pediatric Gastroenterology
-Lecturer, Pediatric House Staff Noon Conference.
Professional Committees: Reviewer, Molecular Genetics and Metabolism

Division Publications

Bahar, RJ, Yanni, GS, Martin, MG, McDiarmid, SV, Vargas, JH, Gershman, G, Heyman, MB, Rosenthal, P, Tipton, JR, Nanjundiah, P, Starr, A, Ament, ME. Orthotopic liver transplantation for autoimmune hepatitis and cryptogenic chronic hepatitis in children. Transplantation, 72(5):629-633, Sept. 15, 2001

Chiu,T, Wu, SS, Santiskulvong, C, Tangkijvanich, P, Yee, HF, Rozengurt, E. Vasopressin-mediated mitogenic signaling in intestinal epithelial cells. Am J Physiol Cell Physiol 282(3): C434-50, 2002

Farmer, DG, McDiarmid, SV, Yersiz, H, Cortina, G, Vargas, J, Maxfield, AJ, Vandenbogaart, B, Correa M, Kroeber, A, Geevarghese, S, Busuttil, RW. Outcomes afterintestinal transplantation: a single center experience over a decade. Transplant Proc 34(3):896-7, 2002

Farmer, DG, McDiarmid, SV, Winston, D, Yersiz, H, Cortina, G, Dry, S, Maxfield, AJ, Vandenbogaart, B, Correa, M, Krober, A, Geevarghese, S, Busuttil, RW. Effectiveness of aggressive prophylatic and preemptive therapies targeted against cytomegaloviral and Epstein-Barr viral disease after human intestinal transplantation. Transplant Proc 34(3)948-9, 2002

Farmer, DG, Amersi, F, Shen, XD, Gao, F, Anselmo, D, Ma, J, Dry, S, McDiarmid, SV, Shaw, G, Busuttil, RW, Kupiec-Weglinski, J. Improved survival through the reduction of iscemia-reperfusion injury after rat intestinal transplantation using selective P-selectin blockade with P-selectin glycoprotein ligand-Ig. Transplant Proc 34(3):985, 2002

Ghobrial, RM, Gornbein, J, Steadman, R, Danino, N, Markmann, JF, Holt, C, Anselmo, D, Amersi F, Chen, P, Farmer, DG, Han, S, Derazo, F, Saab, S, Goldstein, LI, McDiarmid, SV, Busuttil, RW. Pretransplant model to predict posttransplant survival in liver transplant patients. Ann Surg 6(3):315-22, 2002

Martín, MG, da Silveira, TR, Grand, R, Greco, L, Matsui, A., Shimizu, N, Turck, D,
Genetics of Gastrointestinal and Hepatobiliary Disorders: Working Group Report. World
Congress of Pediatric Gastroenterology, Hepatology and Nutrition, Report of the working
Works of 2000: A global plan for the future of the Digestive and Nutritional Health of
Children. Journal of Pediatric Gastroenterology and Nutrition. 35 Suppl 2:S118-
27, August 2002

Martín, MG, Infant Nutrition and the Development of Gastrointestinal Function. Pediatric Nutrition Handbook, 4th Edition, American Academy of Pediatrics, 2002

Mehra, M, Bahar, RJ, Ament, ME, Waldhausen, J, Gershman,G, George, K, Fox, V, Fishman, S, Werlin, S, Sato, T, Hill, I, Tolia, V, Atkinson, J. Laparoscopic and thoracoscopic esophagomyotomy for children with achalasia. Journal of Pediatric Gastroenterology and Nutrition 33(4):466-71, October 2001

McDiarmid, SV, Anand, R, Lindblad, AS. Development of a pediatric end-stage liver disease score to predict poor outcome in children awaiting liver transplantation. Transplantation 74(2):173-81, 2002

Miller, TL, Easley, KA, Zhang, W, Orav ,EJ, Bier, DM, Luder, E, Ting, A, Shearer, WT, Vargas, JH, Lipshultz, SE. Maternal and infant factors associated with failure to thrive in children with vertically transmitted human immunodeficiency virus-1 infection: The prospective, P2C2 human immunodeficiency virus multicenter study. Pediatrics 108(6):1287-96, December 2001

Perlmutter, DH, Lopez, MJ, Martín, MG, Rand, E. Research Agenda for Pediatric Gastroenterology, Hepatology and Nutrition: Molecular Basis of Gastrointestinal Diseases. Report of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition for the Children’s Digestive Health and Nutrition Foundation. Journal of Pediatric Gastroenterology and Nutrition 35(S2), S118-S128, 2002

Thakur, A, Chiu, C, Quiros-Tejeira, R, Reyen, L, Ament, M, Atkinson, JB, Fonkalsrud, EW. Morbidity and mortality of short-bowel syndrome in infants with abdominal wall defects. American Surgeon 68(1): 75-79, January 2002

Quiros-Tejeira, RE, Ament, ME, McDiarmid, SV, Gonzalez, M, Chong, R, Vargas, JH, Martin, MG. Late-onset bacteremia in uncomplicated pediatric liver-transplant recipients after a febrile episode. Transpl Int 15:502-507, 2002

Quirós-Tejeira, RE, Ament, ME, McDiarmid, SV, Gonzalez, M, Chong, R, Vargas, JH, Martín, MG. Late-Onset Bacteremia in uncomplicated Pediatric Liver Transplant recipients after a febrile episode,
Transplant International 15 (9-10):502-7, October 2002

Quiros-Tejeira, RE, Ament, ME, McDiarmid, SV, Gonzalez, M, Chong, R, Vargas, JH, Martin, MG. Late-onset bacteremia in uncomplicated pediatric liver-transplant recipients after a febrile episode. Transpl Int 15:502-507, 2002

Vargas, RSS, Wang, J, Jiang, L, Tsai, H, Ontiveros, LO, Vasir, M, Aguilera, RJ, Martín, MG. Multiple Transcription Factors in the immediate 5’-Flanking Region of the Human Polymeric IgA Receptor Control its Basal Expression. American Journal Physiology (Gastrointestinal and Liver Physiology) 283(2):G415-25, August

Wright, EM, Turk, E, Martín, MG, 2002. The molecular basis for glucose-galactose malabsorption. Symposium in Cell Biochem Biophysics 36(2-3):115-21.

Wu, SS, Chiu, T, Rozengurt, E. Ang II and LPA induce Pyk2 tyrosine phosphorylation in intestinal epithelial cells: role of Ca2+, PKC, and Rho kinase. Am J Physiol Cell Physiol 282(6): C1432-44, 2002

Division Presentations

Ament, ME, “Nutritional Dilemmas,” American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)
26th Clinical Congress/1st Annual Nutrition Week, February 27, 2002, San Diego, CA

Ament, ME, “Intricacies of Inflammatory Bowel Disease – Some new perspectives.” Children’s Hospital and Research Center at Oakland, March 26, 2002, Oakland, CA

Ament, ME, “Diagnosis and Management of Constipation in Infants and Children.” Pri-Med Conference, UCLA Medical School in collaboration with Harvard Medical School, April 4-6, 2002, Long Beach, CA

Ament, ME, ”The effect of IBD on growth and nutrition and the role of nutritional therapies,” An Update on the Diagnosis and Management of Pediatric Inflammatory Bowel Disease, Cedars-Sinai Medical Center and Crohn’s & Colitis Foundation of America, April 13, 2002, The Skirball Cultural Center, Los Angeles, CA

Ament, ME, “Enteral nutrition,” Centinela Hospital Medical Center, June 18, 2002, Inglewood, CA

Ament, ME, “Gastroenterology,” Annual Pediatric Board Review Course, UCLA Children’s Hospital, September 5, 2002, De Neve Plaza, UCLA Campus, Los Angeles, CA

Ament, ME, “Nutrition and nutritional support for the practicing gastroenterologist,” American Gastroenterological Association 2002 Symposia, Loews Philadelphia Hotel, October 5-6, 2002, Philadelphia, PA

Ament, ME, “The effect of IBD on growth and nutrition,” Physician Education Department, Kaiser Permanente, November 15, 2002, Woodland Hills, CA

Martín, MG, ”Passive Immunity,” UCLA Clinical Immunology/Allergy Training Program-Core Curriculum Lecture Series, Departments of Medicine and Pediatrics, UCLA School of Medicine, April 12, 2002, Los Angeles, California

Martín, MG, “The Art and Science of Breastfeeding: Does Maternal Milk Influence Intestinal Maturation
in the Developing Animal?” 21st Annual Ross/NASPGHAN Seminar on Pediatric Gastroenterology, Hepatology and Nutrition, April 21, 2002, Carefree, AZ.

Martín, MG, “The Role of Breast Feeding in the Development of the Neonatal Immune System,” Grand Rounds of the Department of Pediatrics, Oliveview Medical Center, June 12, 2002, Los Angeles, CA

Martín, MG, “Multiple Sp1 Sites in the Immediate 5’-Flanking Region of the Rat Intestinal Fc Receptor (FcRn) Promoter Controls Basal Expression in Intestinal Epithelial Cells,” Annual Meeting, American Gastroenterology Association

Martín, MG, “Intestinal Lymphocyte Differences Secondary to Absence of Passive Immunity,” Annual Meeting, Society of Pediatric Research

Martín, MG, “Hepatic and Hematological Markers as Predictors for the Development of Aplastic Anemia in Pediatric Patients with Indeterminate Fulminant Hepatic Failure,” Annual Meeting, NASPGN

Martín, MG, “Fulminant Hepatic Failure and Liver Transplantation in the Pediatric Population,” Annual Meeting, NASPGN.

McDiarmid, SV, “Issues and Controversies: Pediatric End-Stage Liver Disease Score,” “Controversies in Transplantation,” University of Colorado School of Medicine, March 9, 2002, Breckenridge, CO

McDiarmid, SV, “The Studies of Pediatric Liver Transplantation,” Pediatrics Symposium, American Society of Transplantation Annual Meeting, April 26-May 1, 2002, Washington, D.C.

McDiarmid, SV, “Prevention and Treatment of Allograft Rejection in Pediatric Liver Transplantation,”
European Society of Pediatric Gastroenterology, Hepatology and Nutrition, June 5-8, 2002, Sicily, Italy

McDiarmid, SV, “When to Refer for Liver Transplantation,” “Non-Alphabet Hepatitis,” “New Aspects of Metabolic Liver Disease,” “Immunosuppression After Pediatric Liver Transplantation,” “Recurrent Disease After Pediatric Liver Transplantation,” “Long-Term Complications after Pediatric Liver Transplantation,”
24th Annual Aspen Conference in Pediatric Gastroenterology, July 22-26, 2002, Aspen, CO

McDiarmid, SV, “Hepatic Disease in Children,” Pediatric Board Review Course at UCLA, September 4, 2002

McDiarmid, SV, “Indications Timing and Results After Pediatric Liver Transplantation,” Symposium honoring Professor Otte, October 4, 2002, Brussels, Belgium

McDiarmid, SV, “Post-Transplant Lymphoproliferative Disease After Pediatric Transplantation,” Advances in Transplantation, October 29, 2002, San Diego, CA

Pacini-Edelstein, SJ, Ament, ME, Mehra, M, “Pediatric Cholelithiasis and Cholecystitis: Predisposing Factors Among Races,” Annual Meeting of NASPGN, October 2001

Pacini-Edelstein, SJ, Bahar, RJ, McDiarmid, SV, Vargas, JH, Martin, MG, Mehra, M, Ament, ME, “Case Report: The Unique Occurrence of Hepatic Failure From Type I Autoimmune Hepatitis with Concurrent Brain Abscess,” Annual Meeting of NASPGN, October 2001

Vargas, JH, “Endoscopic Access for Placement of Feeding Tubes”, Oley Foundation, National Meeting, June 20, 2002, Anaheim, CA

Wu, SS, Chiu, T, Rozengurt, E, “Angiotensin II- and Lysophosphatidic Acid-Induced Pyk2 Tyrosine Phosphorylation in Intestinal Epithelial Cells is Mediated By Rho/ROK,” AGA/Digestive Disease Week, May 2002, San Francisco, CA

Wu, SS, Rozengurt, E, “Regulation of the Cytosolic Tyrosine Kinase Pyk2 in Intestinal Epithelial Cells,” CHRC Annual Meeting, October 2002, St. Louis, MO

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