Digestive System Diseases Commons^™

Correlates Of Morbidity And Mortality In Severe Necrotizing Pancreatitis, K. M. Pal, Pashtoon Murtaza Kasi, Mohammad Tayyeb, S. M. Faisal Mosharraf, Zafar Fatmi

Community Health Sciences

Acute severe pancreatitis is associated with a high morbidity and mortality and frequently is accompanied by underlying pancreatic parenchymal necrosis. Patients with pancreatic necrosis must be identified, because the morbidity and mortality rate in this subgroup is much higher. Our objective was to compare the clinical outcomes of these patients based on the degree of pancreatic necrosis. A total of 35 patients were noted to have pancreatic necrosis. These were divided into 2 groups based on extent of necrosis: group A had less than 50% necrosis and group B had more than 50% necrosis. The rate of mortality (5% versus …

Small Intestinal Bacterial Overgrowth And Lactose Intolerance Contribute To Irritable Bowel Syndrome Symptomatology In Pakistan, Javed Yakoob, Zaigham Abbas, Rustam Khan, Saeed Hamid, Safia Awan, Wasim Jafri

Department of Medicine

Background /Aim: The symptoms of irritable bowel syndrome resemble those of small intestinal bacterial overgrowth (SIBO). The aim of this study was to determine the frequency of SIBO and lactose intolerance (LI) occurrence in Patients with diarrhea-predominant irritable bowel syndrome (IBS-D) according to Rome III criteria.

PatientS and Methods: In this retrospective case-control study, Patients over 18 years of age with altered bowel habit, bloating, and Patients who had lactose Hydrogen breath test (H 2 BT) done were included. The "cases" were defined as Patients who fulfill Rome III criteria for IBS-D, while "controls" were those having chronic nonspecific diarrhea …

Mast Cell Activation And Clinical Outcome In Pediatric Cholelithiasis And Biliary Dyskinesia., Craig A. Friesen, Nancy Neilan, James F. Daniel, Kim Radford, Jennifer Verrill Schurman, Ding-You Li, Linda Andre, Shawn D. St Peter, G W. Holcomb Iii

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The current study was undertaken to determine the degree of activation of gallbladder mucosal mast cells, whether mast cell (MC) density or activation differ between patients with and without a positive clinical response to cholecystectomy, and whether either density or activation correlate with gallbladder emptying.

RESULTS: Fifteen biliary dyskinesia (BD) and 13 symptomatic cholelithiasis (CL) patients undergoing cholecystectomy were prospectively enrolled. Gallbladder wall MC density (by immunohistochemistry) and activation (by electron microscopy) were determined. Clinical response was evaluated 30 days post-cholecystectomy on a 5-point Likert-type scale. A complete or nearly complete clinical response was seen in 100% of CL …

T-Tube Management Of Late Esophageal Perforation, Irfan Qadir, Hasnain Zafar, Mubashir Zareen Khan, Hasanat Mohammad Sharif

Section of General Surgery

Esophageal perforation is a serious condition with a high mortality rate. Management strategy of such a patient depends on the extent of perforation and the time interval between perforation and diagnosis. The use of a T tube to treat delayed esophageal perforation with complete resolution and no need for future definitive surgery has been less frequently described. We adapted this principle in successful management of a 73 year old patient with four days history of fever, shortness of breath, chest pain and radiological evidence of perforation.

Helicobacter Pylori: Association With Gall Bladder Disorders In Pakistan, Javed Yakoob, M. R. Khan, Z. Abbas, W. Jafri, R. Azmi, Z. Ahmad, S. Naeem, L. Lubbad

Department of Medicine

Helicobacter species colonise the biliary tract and therefore this study explores the relationship between of Helicobacter pylori and cholecystitis. Bile and gall bladder tissue samples were obtained from 144 Patients who underwent cholecystectomy. Of these, 89 had chronic cholecystitis with cholelithiasis, 44 had gall bladder carcinoma and 11 had gall bladder polyps. Histopathology examination included special staining and immunohistochemistry (IHC), while Helicobacter species (H. pylori, H. bilis and H. hepaticus) were detected by the polymerase chain reaction (PCR). Sequencing and BLAST query of PCR products was undertaken and samples were considered to contain H. pylori if both PCR and IHC …

The Role Of Granulocyte Colony-Stimulating Factor In The Intestinal Immune System And The Response To Probiotics, Andrew J. Martins

Electronic Thesis and Dissertation Repository

Loss of immunoregulation in the intestine results in inflammation, such as is observed in the chronic, relapsing, inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis. However, our understanding of this process remains incomplete. The cytokine granulocyte-colony stimulating factor (G-CSF) is an important stimulator of granulopoiesis in steady-state and during inflammation, but has also been shown to have anti-inflammatory effects and is a potential therapeutic for IBD. In addition, certain strains of bacteria, termed probiotics, have been postulated to have anti-inflammatory effects in the intestine. The mechanisms by which these strains of bacteria elicit anti-inflammatory effects are not fully understood. …

Gastroesophageal Reflux Disease: An Overview, Mayer Eckstein

The Science Journal of the Lander College of Arts and Sciences

The following is an excerpt of the introduction of this article: There are many well-known disorders associated with the digestion process, the most common of which is gastroesophageal reflux disease, more commonly known as GERD. There are six major factors that are the primary cause for GERD: impaired esophageal motility, defective mucosal defense, lower esophageal sphincter (LES) dysfunction, reflux of gastric contents, delayed gastric emptying, and hiatal hernia (DeVault and Castell 1999). Impaired esophageal motility occurs when the esophagus has trouble moving the food down and normal peristalsis does not occur. Defective mucosal defense can cause irritation to the esophagus, …

Is The Gallbladder Really Unnecessary? An Evaluation Of Gallstone Treatment, Danielle Weinberg

The Science Journal of the Lander College of Arts and Sciences

The following is the introduction of this article: The red numbers on your alarm read two o’clock AM, but you’re wide awake. A dull ache below your ribs has tossed you from the blissful ignorance of sleep into the painful reality of another nocturnal attack. As the pale streaks of daylight appear, you grit your teeth in agony while the ambulance goes over yet another bump in its rush to get you to the emergency room. A blur of white coats, lab tests, and CT scans, and then you’re staring into the bright lights above the operating table as the …

Clinical Use Of Probiotics: A Survey Of Physicians’ Beliefs And Practice Patterns, Anastasia Ensminger

Master's Theses and Doctoral Dissertations

Background: Probiotics have the potential to be used as a preventive agent or adjuvant therapy for various medical conditions, and recent research is beginning to illuminate some of the associated benefits. Some clinicians currently prescribe probiotics in practice. Understanding physicians’ beliefs and practice patterns regarding the use of probiotics will help identify current practices, barriers preventing their acceptance, and the sources of information that impact clinical practice.

Objective: To identify and describe physicians’ beliefs and practice patterns regarding the use of probiotics.

Methods: A cross-sectional online questionnaire was administered to 130 physicians employed by or affiliated with Danville …

Does A Diet That Consists Of High Fiber Prevent The Recurrence Of Colorectal Adenomas In Patients Who Have Previously Had At Least One Adenoma Detected Via Colonoscopy?, Conor Luskin

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: To determine whether ingesting a diet high in fiber will decrease the incidence of colorectal adenoma recurrence in a person who has previously had colorectal adenomas.

Is Acupuncture An Effective Treatment For Patients With Irritable Bowel Syndrome?, Amy Leber

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this systematic review is to determine whether or not acupuncture is an effective treatment for patients with Irritable Bowel Syndrome.

Is Esomeprazole (Nexium) More Effective Than Omeprazole (Prilosec) In Reducing Heartburn And In Increasing The Rate Of Esophageal Healing In Adults With Endoscopically Diagnosed Erosive Esophagitis (Ee)?, Shawn P. Mahoney

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this systematic review is to determine whether Esomeprazole (Nexium) is more safe and effective than Omeprazole (Prilosec) in reducing Heartburn and in increasing the rate of esophageal healing in adults with endoscopically diagnosed Erosive Esophagitis (EE)

How Safe And Effective Is Infliximab In The Treatment Of Children With Moderate To Severe Crohn’S Disease?, Jackie Linh

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this systematic review is to determine whether or not “how safe and effective is infliximab in treatment of children with moderate to severe Crohn’s disease?”

Is Opt-80 A Safe And Effective Treatment For Patients With C.Difficile Infection?, Heather A. Shupp

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: Objective of this systematic review is to determine whether or not OPT-80 is a safe and effective treatment for patients with C.difficile infection.

Are Proton Pump Inhibitors A Safe And Effective Treatment For Gastroesophageal Reflux Disease In Infants Less Than Twelve Months Old?, Mariah Smith

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this systematic review is to determine whether or not proton pump inhibitors are a safe and effective treatment for gastroesophageal reflux disease in infants less than twelve months old.

Pegylated Interferon Α-2b Up-Regulates Specific Cd8+ T Cells In Patients With Chronic Hepatitis B, Ji Chen, Yan Wang, Jun Li, Feng-Qin Hou, Gui-Qiang Wang

Pharmacology and Toxicology Faculty Publications

AIM: To investigate the effect of pegylated interferon (IFN) α-2b on specific CD8+ T lymphocytes in patients with chronic hepatitis B (CHB). METHODS: Twenty-one patients with CHB were treated with pegylated IFN α-2b. Periphery blood mononuclear cells were isolated from fresh heparinized blood by Ficoll-Hypaque density gradient centrifugation (density: 1.077 g/L, Pharmingen) at weeks 0, 4, 8, 12, and 24, respectively. Frequency of circulating hepatitis B virus (HBV) epitope-specific CD8 T cells was detected by flow cytometry. Cytokines were detected by cytometric bead assay. RESULTS: The frequency of circulating HBV core or env-specific CD8 T cells was higher (P …

Antibiotic Susceptibility Patterns Of Helicobacter Pylori And Triple Therapy In A High-Prevalence Area, Javed Yakoob, Shahab Abid, Z. Abbas, S. N. W. Jafri

Department of Medicine

This study aims to determine primary Helicobacter pylori resistance and its effect on eradication of the organism. Ninety-two Patients with dyspeptic symptoms were enrolled. H. pylori was cultured and antibiotic sensitivity was determined by the Epsilometer test (Etest) for clarithromycin (CLR), amoxicillin (AMX) and metronidazole (MTR). 23S ribosomal RNA (rRNA) point mutations associated with clarithromycin resistance were also detected. Patients were treated with omeprazole (40 mg daily), CLR (500 mg) and AMX (1g twice a day) for 14 days. A (14)C-urea breath test ((14)C-UBT) was repeated four weeks after completion of treatment to confirm eradication. Triple therapy failure was seen …

Prevalences Of Giardia Lamblia And Cryptosporidium Parvum Infection In Adults Presenting With Chronic Diarrhoea, Javed Yakoob, Zaigham Abbas, M. Asim Beg, Shagufta Naz, Rustam Khan, Muhammad Islam, Wasim Jafri

Section of Gastroenterology

iardia lamblia and Cryptosporidium parvum are both waterborne pathogens associated with diarrhoea in developing countries. In a recent study based at the Aga Khan University in Karachi, 334 adults aged 16–83 years (178 patients with chronic diarrhoea and 156 diarrhoea-free volunteers who acted as controls) were checked for infection with these parasites, using stool microscopy and/or PCR. Overall, 21 (6.3%) and 29 (8.7%) of the subjects were found positive for G. lamblia by microscopy and PCR, respectively, while the corresponding values for C. parvum were 13 (3.9%) and 14 (4.2%). Although, compared with the diarrhoea-free controls, the patients with diarrhoea …

Precipitating Factors And The Outcome Of Hepatic Encephalopathy In Liver Cirrhosis, Khalid Mumtaz, Umair Syed Ahmed, Shahab Abid, Noshaba Baig, Saeed Hamid, Wasim Jafri

Section of Gastroenterology

Objective: To determine precipitants of hepatic encephalopathy (HE) and their impact on hospital stay and mortality.

Study Design: Cross-sectional, analytical study. Place and Duration of Study: The Aga Khan University Hospital, from January 2005 to December 2007.

Methodology: Consecutive patients admitted with different grades of HE were evaluated between January 2005 and December 2007. The precipitants of HE were correlated with the different grades of HE, and length of hospital stay and mortality. Chi-square test was used to compare the proportion of precipitating factors versus hospital stay and grade with significance at p < 0.05.

Results: Of the 404 patients 252 (62%) …

Is There An Association Of Giardiasis With Beta-Thalassemia Minor?, Javed Yakoob, Wasim Jafri, Hizbullah Shaikh

Section of Gastroenterology

Beta–thalassemia minor is a symptomless carrier state of a hemoglobinopathy which predisposes to bacterial infections. We report three cases presenting with giardiasis, a parasitic infection of gastrointestinal tract caused by Giardia lamblia. Patients presented with recurrent diarrhea and abdominal pain for over a year. An esophagogastroduodenoscopy finding varied from normal to acute duodenitis. Duodenal biopsy demonstrated changes consistent with mild chronic non-specific inflammation with G. lamblia trophozoites. All three patients were diagnosed as β -thalassemia minor hemoglobin electrophoresis. They were treated with Diloxanide furoate 500 mg and Metronidazole 400mg three times daily for five days. Their symptoms resolved and a …