Division of Pediatric Gastroenterology and Hepatology

The Saint Louis University Division of Pediatric Gastroenterology and Hepatology provides patient care,  has active research programs in several diverse areas and participates regularly in medical education at the medical student and resident levels. 

Services

The division sees a large number of patients with chronic, life-altering and life-threatening diseases that involve complex diagnostic workups as well as long term management. However, many of our patients are generally healthy but burdened with gastroesophageal reflux disease, chronic abdominal pain, irritable bowel syndrome, chronic constipation or other conditions which significantly disrupt their normal developmental patterns, families and ability to function well at school.

Specifically, we follow 250 patients with Crohn's disease and ulcerative colitis, as well as many patients with chronic liver dysfunction and metabolic diseases.We also have an active service caring for infants and children with short bowel syndrome, many of whom are supported by home administration of long-term total parenteral nutrition and some of whom have had small bowel and liver transplants.

The staff of the GI division reviews on a weekly basis all inpatients at SSM Health Cardinal Glennon Children's Hospital who are supported on parenteral nutrition. Our division works weekly with a dedicated pediatric psychologist and a social worker on inpatient rounds and with continuity links to our outpatient clinics. These are key ancillary personnel who enhance our quality patient care. We also have pediatric dietitian coverage.

Our service has continued to grow and we have reached a 44 percent market share for pediatric gastroenterology in the St. Louis region, which is larger than any other area provider, while also increasing our quality and patient satisfaction. We  look forward to continued growth and quality improvement.

Research

Total Parental Nutrition

Ajay Jain, M.D., has published several basic science research papers on ameliorative strategies for Total Parenteral Nutrition (TPN) associated liver and gut injury. He has established a novel ambulatory TPN animal model system and has received several highly competitive extramural and intramural research grants as a principal investigator. His focus has been to evaluate the Gut-Liver crosstalk in the context of TPN as regulated by the enterohepatic circulation of bile acids and the gut microbiota. Dr. Jain recently received a very large National Institute of Health (NIH) grant to further clarify the mechanistic links leading to TPN associated injury. He serves as a moderator at several national meetings and has done multiple national and international plenary platform presentation relating to his work.

He serves as a grant and manuscript reviewer for several national consortia and journals and as the PI for a national NIH funded conference grant evaluating the role of gut derived signals in maintaining normal health and nutrition. He has also received funding for research involving gut adaptation post short bowel surgery and ameliorative strategies for the associated liver injury in this model. He chairs the hospital's nutrition advisory committee.

Dr. Jain also has extramural support on studies involving the orphan liver disease, Lysosomal Acid Lipase Deficiency and is a collaborator on an NIH funded multinational study evaluating technology platforms for improving international immunization practices. He is also collaborating on research involving noninvasive biomarkers for liver disease. He is the medical director for pediatric liver transplantation and our site principal investigator for Studies in Pediatric Liver Transplantation (SPLIT consortium). Dr. Jain is also part of a multi-center NIH funded research study for evaluation of fatty liver disease and serves as our site pediatric investigator (one of eight centers nationally).

Liver Injury

 Jeffrey Teckman, M.D., has an ongoing, funded basic science research program in liver injury using the genetic disease, alpha-1-antitrypsin deficiency as the primary model system. He is a recognized international authority in this condition. Dr. Teckman has had 24 years of continuous extramural research funding in this area from a combination of NIH, private and industry sources, and has been involved in basic science studies as well as human drug trials.


Dr. Teckman is also the Principal Investigator for our site of an NIH funded, multi-center study (one of 14 centers nationally) in pediatric metabolic liver disease, known as the Childhood Liver Disease Research Network. Dr. Teckman is also the Pediatric Center Private Investigator (PI), with Dr. Adrian DiBisceglie as the SLU center PI, for the NIH sponsored, multi-center study of hepatitis B infection. SSM Health Cardinal Glennon is one of seven pediatric centers nationally for this study.

Dr. Teckman participated in an industry sponsored drug trial in hepatitis C this last two years and is the National PI for a privately funded multi-center study of adult liver disease. A new grant has just been funded to expand support for these efforts. Dr. Teckman collaborates with many other investigators, which routinely results in further publications, which at present include biochemical studies of liver injury, mentoring junior investigators in studies of liver imaging liver, gene therapy projects and analysis of the hyperphagia of Prader-Willi Syndrome. Dr. Teckman also has many industry partners and is involved in drug development and drug research grants, which have led to additional publications.

Publications

Ajay Jain

1. Schwimmer JB, Lavine JE, Wilson LA, Neuschwander-Tetri BA, Xanthakos SA, Kohli R, Barlow SE, Vos MB, Karpen SJ, Molleston JP, Whitington PF, Rosenthal P, Jain AK, Murray KF, Brunt EM, Kleiner DE, Van Natta ML, Clark JM, Tonascia J, Doo E. In Children with Nonalcoholic Fatty Liver Disease, Cysteamine Bitartrate Delayed Release Improves Liver Enzymes but does not Reduce Disease Activity Scores. Gastroenterology. 2016 Aug 25. pii: S0016-5085(16)34969-1

2. Jain AK, Sharma A, Arora S, Blomenkamp KS, Jun I, Luong R, Westrich, DJ, Mittal A, Buchanan PM, Guzman MA, Long JP, Neuschwander-Tetri BA, Teckman JH. Preserved gut microbial diversity accompanies upregulation of TGR5 and hepatobiliary transporters in bile acid treated animals on Parenteral Nutrition. JPEN J Parenter Enteral Nutr. 2016 Aug 8. Premier Research Paper

3. Jain AK, McOmber M, Gilger M. Foreign bodies of the esophagus in children. UpToDate, Sep 2, 2016

4. Wooton-Kee CR, Jain AK, Michael A, Grusak MA, Finegold MJ, Lutsenko S, Moore DD. Elevated copper impairs hepatic nuclear receptor function in Wilson's disease. J Clin Invest. 2015 Sep;125 (9):3449-60.

5. Jain AK, Teckman JH. Wilson Disease: Hepatic Manifestations. Clinical Decision Support, Feb 2016

6. Mavers M, Blaufuss T, Friedman H, Becker BA, Jain AK. Eosinophilic esophagitis in a pediatric patient with Herpes simplex virus esophagitis. A cause or a consequence?. OJCMR, Vol 1, Issue 6: Oct 2015

7. Jain AK, Teckman JH. Controversies in the mechanism of Total Parenteral Nutrition induced pathology. Children, Jul 2015, 2, 358-370.

8. Jain AK, Wen JX, Blomenkamp KS, Arora S, Blaufuss TA, Rodrigues J, Long JP, Neuschwander-Tetri BA, Teckman, JH. Oleanolic Acid improves gut atrophy induced by Total Parenteral Nutrition (TPN). JPEN J Parenter Enteral Nutr. 2015 Apr 28: 2015 Premier Research Paper

Jeffrey Teckman

1. Kamath BM, Chen Z, Romero R, Fredericks EM, Alonso EM, Arnon R, Heubi J, Hertel PM, Karpen SJ, Loomes KM, Murray KF, Rosenthal P, Schwarz KB, Subbarao G, Teckman JH, Turmelle YP,Wang KS, Sherker AH, Sokol RJ, Magee JC; Childhood Liver Disease Research Network (ChilDReN). Quality of life and Its Determinants in a Multicenter Cohort of Children with Alagille Syndrome. J Pediatr 2015. Aug;167(2):390-396.e3. doi:10.1016/j.jpeds.2015.04.077PMID:26059338

2. Schwarz K, Rosenthal P, Teckman JH, lingS, Rodriquez R, Murray K, for the Hepatitis B Research Network (HBRN). Children in the US and Canada with Chronic Hepatitis B. J Pediatr. 2015 Dec;167(6):1287-1294.e2. doi: 10.1016/j.jpeds.2015.08.021. Epub 2015 Sep 10. PMID: 26364985

3. Gaczynska M, Karpowicz P, Stuart CE, Norton MG, Teckman JH, Marszal E, Osmulski PA. AFM Imaging Reveals Topographic Diversity of Wild Type and Z Variant Polymers of Human atProteinase Inhibitor. PloS One. 2016 Mar 23;11(3):e0151902.

4. Baseline Analysis of a Young a-t-Antitrypsin Deficiency liver Disease Cohort Reveals Frequent Portal Hypertension. Teckman JH, Rosenthal P, Abel R, Sass LM, Michail S, Murray KF, Rudnick DA, Thomas OW, Spino C, Arnon R, Hertel PM, Heubl J, Kamath BM, Karnsakul W, loomes KM, Magee JC, Molleston JP, Romero R, Shneider Bl, Sherker AH, Sokol RJ; Childhood liver Disease Research Network (ChilDReN). J Pediatr Gastroenterol Nutr. 2015 Jul;61{1):94·101.

5. Oleanolic Acid Improves Gut Atrophy Induced by Parenteral Nutrition. Jain AK, Wen JX, Blomenkamp KS, Arora S, Blaufuss TA, Rodrigues J, Long JP, Neuschwander-Tetri BA, Teckman JH. JPEN J Parenter Enteral Nutr. 2016 Jan;40(1):67-72.

6. Teckman JH, Blomenkamp K. Pathophysiology of Alpha·l·antitrypsin Deficiency Liver Disease. In Alpha-1-Antitrypsin Deficiency: Methods and Protocols. Florie Borel, Christian Mueller, eds. Springer Protocols Publishing.

7. Blomenkamp K, Teckman JH. AAT Monomer/Polymer Separation. In Alpha-1-Antitrypsin Deficiency: Methods and Protocols. Florie Borel, Christian Mueller, eds. Springer Protocols Publishing.

8. Teckman JH. Chapter 9. liver Disease: Pathology, Treatment and Clinical Trials. In Alpha-1-antitrypsin Deficiency: Biology, Diagnosis, Clinical Significance and Emerging Therapies. Noor Kalsheker, Robert Stockley, eds. Elsevier Publishing.

9. Jain AK, Teckman JH. Wilson's Disease; in Decision Support in Medicine: Pediatrics. Barrett OJ, McMillan J, Jones 0, Boney C. eds. (Textbook on-line app).

10. Teckman JH, Mangalat N. Alpha-1 antitrypsin and liver disease: mechanism of injury and novel Interventions. Expert Review of Gastroenterology & Hepatology. 2015 9{2): 261-268. ISSN 1747-4124. PMID: 25066184.

11. Jain AK, Teckman JH. Controversies in the Mechanism of Total Parenteral Nutrition Induced Pathology. Controversies in Pediatric Digestive Diseases. Children, 2, 358-370; doi:l0.3390/children2030358) 2015, Aug.ISSN 2227-9067.