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Zhu A.,Greater Los Angeles Veterans Affairs Healthcare System | Kaneshiro M.,Greater Los Angeles Veterans Affairs Healthcare System | Kaunitz J.D.,Greater Los Angeles Veterans Affairs Healthcare System | Kaunitz J.D.,University of California at Los Angeles | And 2 more authors.
Digestive Diseases and Sciences | Year: 2010

A substantial volume of the consultations requested of gastroenterologists are directed towards the evaluation of anemia. Since iron deficiency anemia often arises from bleeding gastrointestinal lesions, many of which are malignant, establishment of a firm diagnosis usually obligates an endoscopic evaluation. Although the laboratory tests used to make the diagnosis have not changed in many decades, their interpretation has, and this is possibly due to the availability of extensive testing in key populations. We provide data supporting the use of the serum ferritin as the sole useful measure of iron stores, setting the lower limit at 100 μg/l for some populations in order to increase the sensitivity of the test. Trends of the commonly obtained red cell indices, mean corpuscular volume, and the red cell distribution width can provide valuable diagnostic information. Once the diagnosis is established, upper and lower gastrointestinal endoscopy is usually indicated. Nevertheless, in many cases a gastrointestinal source is not found after routine evaluation. Additional studies, including repeat upper and lower endoscopy and often investigation of the small intestine may thus be required. Although oral iron is inexpensive and usually effective, there are many gastrointestinal conditions that warrant treatment of iron deficiency with intravenous iron. © 2009 Springer Science+Business Media, LLC. Source


Kemmerly T.,Cedars Sinai Medical Center | Kaunitz J.D.,Medical Center | Kaunitz J.D.,University of California at Los Angeles | Kaunitz J.D.,Digestive Diseases Research Center | Kaunitz J.D.,Brentwood Biomedical Research Institute
Current Opinion in Gastroenterology | Year: 2013

Purpose of Review: To review recent developments in the field of gastroduodenal mucosal defense. Recent Findings: Research in the field of gastroduodenal mucosal defense has focused on continued elucidation of molecular mechanisms that protect the mucosa and influence healing at the cellular level. Review of literature over the past year reveals focus on familiar processes such as superoxide dismutase, nitric oxide, heme oxygenase-1, neutrophil infiltration, cysteamine, mucin, hydrogen sulfide, ghrelin, adiponectin and the influence of Helicobacter pylori, but also brings into light new processes such as the balance between apoptosis and cellular proliferation, as well as the influence of other organ systems such as the bone marrow and central nervous system on the gastrointestinal tract. Summary: These new published findings contribute to our overall understanding of gastroduodenal defense and suggest innovative avenues of future research and possible novel therapeutic targets. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source


Kemmerly T.,Cedars Sinai Medical Residency Program | Vuong C.,Medical Center | Kaunitz J.D.,University of California at Los Angeles | Kaunitz J.D.,Brentwood Biomedical Research Institute
Nutrition in Clinical Practice | Year: 2014

We describe a case in which a patient receiving parenteral nutrition (PN) developed hypophosphatemia. Due to lack of availability of parenteral phosphate supplements, we chose to restore phosphate using diluted hypertonic sodium phosphate enemas. Due to the recent shortages of parenteral minerals and vitamins, such an alternate means of repletion is of increasing importance. Diluted hypertonic sodium phosphate enemas are inexpensive, easy to administer, and effective since phosphate is readily absorbed across the rectal mucosa. We hope that through this type of repletion, life-threatening hypophosphatemia among patients receiving PN can be avoided. © 2014 American Society for Parenteral and Enteral Nutrition. Source


Soldavini J.,Medical Center | Kaunitz J.D.,Medical Center | Kaunitz J.D.,University of California at Los Angeles | Kaunitz J.D.,Digestive Diseases Research Center | Kaunitz J.D.,Brentwood Biomedical Research Institute
Digestive Diseases and Sciences | Year: 2013

Background: The lumen of the gastrointestinal tract contains many substances produced from the breakdown of foodstuffs, from salivary, esophageal, intestinal, hepatic, and pancreatic secretions, and from sloughed cells present in the gastrointestinal lumen. Although these substances were traditionally regarded as waste products, there is increasing realization that many can be biologically active, either as signalling compounds or as nutrients. For example, proteins are broken down into amino acids, which are then sensed by nutrient receptors. The gut microbiome, which is at highest abundance in the ileocecum, has powerful metabolic activity, digesting and breaking down unabsorbed carbohydrates, proteins, and other ingested nutrients into phenols, amines, volatile organic compounds, methane, carbon dioxide, hydrogen, and hydrogen sulfide into volatile fatty acids, also called short-chain fatty acids (SCFAs). Conclusion: These latter substances are the topic of this review. In this review, we will briefly discuss recent advances in the understanding SCFA production, signalling, and absorption, followed by a detailed description and discussion of trials of SCFAs, probiotics, and prebiotics in the treatment of gastrointestinal disease, in particular ulcerative colitis (UC), pouchitis, short bowel syndrome, and obesity. © 2013 Springer Science+Business Media New York (Outside the USA). Source


Kemmerly T.,Cedars SinaiMedical Residency Program | Kaunitz J.D.,Medical Center | Kaunitz J.D.,University of California at Los Angeles | Kaunitz J.D.,Digestive Diseases Research Center | Kaunitz J.D.,Brentwood Biomedical Research Institute
Current Opinion in Gastroenterology | Year: 2014

Purpose of review: To review recent developments in the field of gastroduodenal mucosal defense. Recent findings: Research in the field of gastroduodenal mucosal defense has focused on continued elucidation of molecular mechanisms that protect the mucosa and influence healing at the cellular level. Review of literature over the past year reveals that familiar proteins and mediators, such as nitric oxide, toll-like receptors, nucleotidebinding oligomerization domain-containing proteins (NOD2), β-defensins, macrophages, dendritic cells, mucins, autophagy, and the influence of aging and diet, are still subjects of study, but also brings into light new processes and mediators, such as dual oxidases, defense against radiation injuries, and novel proteins such as ZBP-89. Summary: These new published findings contribute to our overall understanding of gastroduodenal defense and suggest innovative avenues of future research and possible novel therapeutic targets. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

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