Gastroenterology Commons^™

High Dose Opioid Administration For Adults Hospitalized With Acute Pancreatitis, Sharaya Hundeby, Brenda Senger, Teresa Bigand

Providence Nurse Research Conference (2022 - present)

No abstract provided.

Leveraging Single Cell Technologies For The Characterization And Treatment Of Refractory Pancreatic Cancer, Maria Monberg

The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences Dissertations and Theses (Open Access)

Heterogeneity is a hallmark of cancer, and the advent of multimodal single-cell technologies has helped uncover heterogeneity in a high-throughput manner in different cancers across varied contexts at an unprecedented resolution. In an effort to improve precision medicine approaches in pancreatic ductal adenocarcinoma (PDAC), a highly lethal malignancy with a mere 11% 5-year survival rate, this dissertation focuses on first questioning the assumptions of the most basic models used to study PDAC via multimodal single-cell characterization methods at multiple levels of biological organization (scCNVseq and snATACseq for DNA assays, scRNAseq for transcriptomics, and paired protein assays such as multiplexed immunofluorescence ...

Management Of Right Sided Carcinoid Heart Failure, Ganesh Arun, Ismat Cheema, Lorrie Pennfield, Mohammed Raza, Erik Raborn, Ami Patel, Farhan Ali

Advances in Clinical Medical Research and Healthcare Delivery

Carcinoid heart disease is a rare complication of an already rare disease. This issue is theorized to be secondary to released proinflammatory molecules that deposit on the surfaces of heart valves. These molecules are released from the carcinoid tumor itself and manifest symptoms based on liver, lung and brain function. The detection of 5-HIAA, a breakdown source of serotonin, is useful for diagnosis. These deposits occur most commonly on the endocardium of valvular cusps and cardiac chambers. This case presents a 48 year old woman with echo findings of right heart failure in the setting of a carcinoid tumor. It ...

Improving Advanced Therapeutic Endoscopy Performance At An Academic Children's Hospital, Julia Snodgrass, Thomas M. Attard, Donna Ditsch, John Colgan, Amanda Weston, Jessica Koch, Nadia Ibrahimi, Pang Krasaelap, Voytek Slowick, Laura Shroyer

Research Days

Problem Statement/Question: Advanced therapeutic endoscopy is infrequently needed but critical in the management of children with complex gastroenterology disorders. Hands-on experience in specific advanced techniques, set up of endoscopy equipment and familiarity with new ancillary equipment for use during endoscopy have been intra-departmentally identified as potential areas for improvement.

Background/Project Intent: Our aim is to improve provider scoring on an endoscopy practice test based on technical aspects of therapeutic techniques, indications and set up of standard and new endoscopic equipment by 20% over pre-practice session testing.

Methods: The Model for Improvement framework was utilized. A multidisciplinary team was ...

A Case Report Of Suspected Choledocholithiasis 20 Years After Cholecystectomy, Maleeha Memon, Dhara Rana, Chandni Patel, Christine Leroy, Bijal Sheth

Stratford Campus Research Day

Gallstones are a common prevalence in western societies where approximately 15% of Americans have gallstones. The mainstay treatment for symptomatic cholelithiasis is laparoscopic cholecystectomy. It is estimated approximately 650,000 to 700,000 cholecystectomies are performed every year. Most patients feel relief after a laparoscopic cholecystectomy, but a small number of patients experience post cholecystectomy syndrome, which presents as biliary colic pain. Although the pathophysiology of the post cholecystectomy syndrome is unclear, one theory proposes that it is due to the alteration in bile flow after the removal of the gallbladder, which serves as a reservoir for bile. This bile ...

Angiotensin Receptor Blockers Associated Enteropathy- Brief Report, Falgun Gosai, Neha Gosai

Journal of Community Hospital Internal Medicine Perspectives

The current literature has shown equivocal results regarding the association of Olmesartan and other angiotensin receptor blockers (ARBs) use and the presence of Celiac sprue-like enteropathy (CSLE). Various factors affecting the association are- patient population under study, geographic area, and duration of use of medication. Various case reports/ case series and observational studies have shown the mixed results regarding an association. We have tried to answer a question what exists in the literature regarding the angiotensin receptor blockers related sprue like enteropathy.

Natural Killer Cells In Liver Transplantation: Can We Harness The Power Of The Immune Checkpoint To Promote Tolerance?, Jennifer Halma, Stephen Pierce, Rebecca Mclennan, Todd Bradley, Ryan T. Fischer

Manuscripts, Articles, Book Chapters and Other Papers

The roles that natural killer (NK) cells play in liver disease and transplantation remain ill-defined. Reports on the matter are often contradictory, and the mechanisms elucidated are complex and dependent on the context of the model tested. Moreover, NK cell attributes, such as receptor protein expression and function differ among species, make study of primate or rodent transplant models challenging. Recent insights into NK function and NK-mediated therapy in the context of cancer therapy may prove applicable to transplantation. Of specific interest are immune checkpoint molecules and the mechanisms by which they modulate NK cells in the tumor micro-environment. In ...

Necrotizing Enterocolitis Rates In Preterm Infants, Alexis Howard

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Breast milk and donor human milk is used in the prevention of necrotizing enterocolitis (NEC) in preterm infants born prior to 37 weeks gestation and those with very low birth weight. This process occurs through direct breast feeding and tube feeding. The aim of this study was to compare the use of breast milk and donor milk to the use of formula feed in preterm infants. A systematic review was conducted using articles collected from CINAHL and PubMed and was guided by PRISMA guidelines. A total of 15 studies that met criteria were analyzed by purpose, variables, study design, population ...

Intestinal Tuberculosis Presenting With Gastrointestinal Bleeding In Patient On Warfarin Therapy, Pascal Kuka, Joe Rakiro, Joseph Gatheru, Felix Riunga

Internal Medicine, East Africa

Background: Intestinal tuberculosis (ITB) constitutes less than 5% of overall cases of extrapulmonary disease and mostly affects the ileocecal region. The presentation and radiologic findings in enteric tuberculosis can mimic Crohn’s disease (CD).

Case Pre- sentation: We present a case report of an African woman who presented to a Kenyan hospital with lower gastrointestinal bleeding while on anticoagulation for valvular atrial fibrillation, and was diagnosed with intestinal tuberculosis after colonoscopy, biopsy, and positive staining for tuberculous bacilli.

Conclusion: Intestinal tuberculosis causing gastrointestinal bleeding is rare but should be suspected in patients living in TB endemic regions.

Acute Esophageal Necrosis Following Acetaminophen Overdose: An Unreported Cause Of Black Esophagus, Karolina N. Dziadkowiec, Renuka Reddy, Akiva J. Marcus

HCA Healthcare Journal of Medicine

Acute esophageal necrosis (AEN), also known as “black esophagus” or Gurvits syndrome, is an uncommon finding with an unclear etiology and pathogenesis. This condition often presents as an upper gastrointestinal bleed in older men with multiple comorbidities. AEN is characterized by circumferential black, necrotic mucosa in the esophagus. We present a case of AEN following acetaminophen overdose. The patient was ultimately discharged from the hospital with oral omeprazole twice daily, a clear liquid diet, and a recommendation for follow-up in the outpatient setting for repeat EGD in 4 to 6 weeks. Acetaminophen overdose, although a rare cause, must be considered ...

Indications For Esophagogastroduodenoscopy In Anemic Patients Without Overt Signs Of Upper Gastrointestinal Bleeding, Geoffrey M. Ginter

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Majid S, Salih M, Wasaya R, Jafri W. Predictors of gastrointestinal lesions on endoscopy in iron deficiency anemia without gastrointestinal symptoms. BMC Gastroenterol. 2008;8:52. https://doi.org/10.1186/1471-230X-8-52

for a patient with a complicated presentation of severe anemia

The Surgical Management Of Pancreatic Pseudocysts – Outcomes On A Group Of Seven Patients, Mihai Faur, Andrei Moisin, Alexandru Dan Sabau, Dan Sabau

Journal of Mind and Medical Sciences

The pancreatic pseudocyst represents the main complication that occurred 3 to 6 weeks after an outbreak of acute or chronic pancreatitis represented by a collection containing pancreatic enzymes without their own epithelial wall. In the present paper, we present a study performed on 7 patients admitted to the Surgical Department of Sibiu County Emergency Clinical Hospital who were diagnosed with pancreatic pseudocyst between 2016 and 2020, and the drainage of the mini-invasive pancreatic pseudocyst by an incision in the right lumbar area, in the case of a 53-year-old patient known to have a history of multiple cardiac defects, the pancreatic ...

Colonic Diverticulosis - Diagnostic And Therapeutic Difficulties, Cristian Meșină, Theodor Viorel Dumitrescu, Mihai Calin Ciorbagiu, Cosmin Vasile Obleaga, Ionica Daniel Vilcea, Mihaela Iustina Mesina-Botoran

Journal of Mind and Medical Sciences

Objectives. The objectives of this study are to highlight the diagnostic and therapeutic difficulties in patients with complicated acute colonic diverticulosis. Methods. The study group comprised 40 patients hospitalized to the Second Surgical Clinic of the Emergency County Hospital in Craiova, Romania, through the emergency service between 2015 and 2021. Regarding the sex distribution of the patients with colonic diverticular disease studied, there was a predominance of males. The distribution of patients was as follows: 22 patients with acute colonic diverticulitis, out of whom 21 patients suffered from left acute colonic diverticulitis and 1 patient suffered from right acute colonic ...

Diet And Food Chemicals Increasing The Risk Of Colorectal Cancer – Literature Review, Mihail Silviu Tudosie, Andreea Pauna, Cristian Stefani, Iulia Madalina Staicu

Journal of Mind and Medical Sciences

Colorectal cancer is a common form of cancer nowadays. There are many risk factors in the pathogenesis of colorectal cancer. The malignant proliferation is caused by one or more genetic mutations, which activate oncogenes and deactivate tumor suppressor genes. Some factors cannot be changed, such as a person's age or family history. An essential aspect in the pathogenesis of colorectal cancer is the choice of lifestyles, such as a high-fat diet, smoking, and excess alcohol. Carcinogens can be either natural or chemical. The mechanisms by which carcinogens initiate tumor formation are genetic or non-genotoxic. The most common form of ...

Inflammatory Bowel Disease: Pathogenesis, Diagnosis And Current Therapeutic Approach, Adrian Silaghi, Vlad Denis Constantin, Bogdan Socea, Petrișor Banu, Vladimir Sandu, Liliana Florina Andronache, Anca Silvia Dumitriu, Stana Paunica

Journal of Mind and Medical Sciences

Inflammatory bowel disease is a group of conditions of unknown etiology, represented by Crohn’s disease and ulcerative colitis and characterized by the presence of intestinal wall inflammation. From the first cases described to date, several studies have been performed to elucidate the cause of inflammatory bowel disease. Generally, the genetic factors predispose to their occurrence while epigenetic and environmental factors trigger them. Genetic factors are mutations of the genes involved in the response and recognition of immune cells to different pathogens. The most studied epigenetic and environmental factors are smoking (which predisposes to Crohn’s disease and can be ...

Alpha-Fetoprotein (Afp) And Afp-L3 Is Most Useful In Detection Of Recurrence Of Hepatocellular Carcinoma In Patients After Tumor Ablation And With Low Afp Level, Madison Force, Grace Park, Divya Chalikonda, Christopher G. Roth, Micah Cohen, Dina Halegoua-De Marzio, Hie-Won Hann

Department of Medicine Faculty Papers

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and is a leading cause of mortality worldwide. While there are many risk factors for HCC including alcohol, obesity, and diabetes, hepatitis B virus (HBV) and hepatitis C virus (HCV) infection still account for the majority of HCC worldwide. Globally, HBV is the leading risk factor for HCC. Patients with chronic hepatitis B (CHB) and advanced liver disease are at high risk for HCC. Screening for HCC is done routinely with ultrasound with or without alpha-fetoprotein (AFP) at six-month intervals. The combination of ultrasound and AFP has been ...

Hur Plays A Role In Double-Strand Break Repair In Pancreatic Cancer Cells And Regulates Functional Brca1-Associated-Ring-Domain-1(Bard1) Isoforms, Aditi Jain, Matthew Mccoy, Carolyn Coats, Samantha Z Brown, Sankar Addya, Carl Pelz, Rosalie C Sears, Charles Yeo, Jonathan R Brody

Department of Surgery Faculty Papers

Human Antigen R (HuR/ELAVL1) is known to regulate stability of mRNAs involved in pancreatic ductal adenocarcinoma (PDAC) cell survival. Although several HuR targets are established, it is likely that many remain currently unknown. Here, we identified BARD1 mRNA as a novel target of HuR. Silencing HuR caused a >70% decrease in homologous recombination repair (HRR) efficiency as measured by the double-strand break repair (pDR-GFP reporter) assay. HuR-bound mRNAs extracted from RNP-immunoprecipitation and probed on a microarray, revealed a subset of HRR genes as putative HuR targets, including the BRCA1-Associated-Ring-Domain-1 (BARD1) (p < 0.005). BARD1 genetic alterations are infrequent in PDAC, and its context-dependent upregulation is poorly understood. Genetic silencing (siRNA and CRISPR knock-out) and pharmacological targeting of HuR inhibited both full length (FL) BARD1 and its functional isoforms (α, δ, Φ). Silencing BARD1 sensitized cells to olaparib and oxaliplatin; caused G2-M cell cycle arrest; and increased DNA-damage while decreasing HRR efficiency in cells. Exogenous overexpression of BARD1 in HuR-deficient cells partially rescued the HRR dysfunction, independent of an HuR pro-oncogenic function. Collectively, our findings demonstrate for the first time that BARD1 is a bona fide HuR target, which serves as an important regulatory point of the transient DNA-repair response in PDAC cells.

Hepatitis B Virus-Associated Hepatocellular Carcinoma And Chronic Stress, Nicholas Noverati, Rukaiya Bashir, Dina Halegoua-De Marzio, Hie-Won Hann

Department of Medicine Faculty Papers

The Hepatitis B virus is one of the most significant hepatocarcinogens globally. The carcinogenic mechanisms of this virus are complex, and may include interactions with the host's immune system. Certain factors, such as stress on the body, can also potentiate these mechanisms. Stress, although adaptive in an acute form, is deleterious to health when chronic and can both suppress and activate the host's defense system. In hepatocellular carcinoma, this can lead to tumor initiation and progression. Those that are more prone to stress, or exposed to situations that incite stress, may be at higher risk of developing cancer ...

Longitudinal Analysis Of The Impact Of Oral Contraceptive Use On The Gut Microbiome, Xinwei Hua, Yueming Cao, David M Morgan, Kaia Miller, Samantha M Chin, Danielle Bellavance, Hamed Khalili

Department of Medicine Faculty Papers

Introduction. Evidence has linked exogenous and endogenous sex hormones with the human microbiome.Hypothesis/Gap statement. The longitudinal effects of oral contraceptives (OC) on the human gut microbiome have not previously been studied.Aim. We sought to examine the longitudinal impact of OC use on the taxonomic composition and metabolic functions of the gut microbiota and endogenous sex steroid hormones after initiation of OC use.Methodology. We recruited ten healthy women who provided blood and stool samples prior to OC use, 1 month and 6 months after starting OC. We measured serum levels of sex hormones, including estradiol, progesterone, sex ...

Pediatric Growth Patterns In Youth-Onset Type 2 Diabetes Mellitus: Implications For Physiologically-Based Pharmacokinetic Models., Chelsea M. Hosey, Kelsee Halpin, Valentina Shakhnovich, Chengpeng Bi, Brooke Sweeney, Yun Yan, J Steven Leeder

Manuscripts, Articles, Book Chapters and Other Papers

An accurate understanding of the changes in height and weight of children with age is critical to the development of models predicting drug concentrations in children (i.e., physiologically-based pharmacokinetic models). However, curves describing the growth of a typical population of children may not accurately characterize growth of children with various conditions, such as obesity. Therefore, to develop height and weight versus age growth curves for youth who were diagnosed with type 2 diabetes, we extracted data from electronic medical records. Robust nonlinear models were parameterized to the equations describing height and weight versus age as defined by the Centers ...