Gastroenterology Commons^™

Understanding Constipation: A Cross-Sectional Study From A Developing Country Setting, Minaz Mawani, Abdul Azeem, Sakina Gheewala, Nazish Butt, Shahab Abid

Section of Gastroenterology

A cross-sectional study was conducted in the Gastroenterology Clinics of The Aga Khan Hospital and Jinnah Postgraduate Medical Centre in Karachi. All patients complaining of constipation were included. Patients with alarm features were excluded. Interviews were conducted by trained doctors using a structured Rome III based pre-tested questionnaire and Bristol Stool Form Scale. Out of 396 participants, 186 (47.0%) had FC and 209 (52.7%) had IBS-C. Based upon Bristol Stool Form Scale, only 214 (54%) reported to have slow transit constipation (BSS <2). A higher proportion of women reported severe form of constipation as compared to men (81.5%, n=150 vs. 65.1%, n=138 p<0.001). However, a higher percentage of men reported using medications to treat their symptoms (71.2%, n=151 vs. 57.1%, n=105 p=0.003). Proper understanding of patient's symptoms is essential for optimizing individual patient management.

Functional Gastrointestinal Disorders And Gut-Brain Axis: What Does The Future Hold?, Kashif Mukhtar, Hasham Nawaz, Shahab Abid

Section of Haematology/Oncology

Despite their high prevalence, lack of understanding of the exact pathophysiology of the functional gastrointestinal disorders has restricted us to symptomatic diagnostic tools and therapies. Complex mechanisms underlying the disturbances in the bidirectional communication between the gastrointestinal tract and the brain have a vital role in the pathogenesis and are key to our understanding of the disease phenomenon. Although we have come a long way in our understanding of these complex disorders with the help of studies on animals especially rodents, there need to be more studies in humans, especially to identify the therapeutic targets. This review study looks at ...

Checkpoint Inhibitors: What Gastroenterologists Need To Know., Monjur Ahmed

Division of Gastroenterology and Hepatology Faculty Papers

Checkpoint inhibitors are increasingly being used in clinical practice. They can cause various gastrointestinal, hepatic and pancreatic side effects. As these side effects can be serious, appropriate management is essential. The different checkpoint inhibitors with their mechanisms of action and indications, as well as evaluation and management of gastrointestinal, hepatic and pancreatic side effects, are discussed in this article.

Is Radiofrequency Energy A Safe And Effective Treatment For Reducing Symptoms Of Gastroesophageal Reflux Disease In Patients 18 Years Or Older?, Kristen L. Schaffer

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective evidence based medicine review is to determine whether or not “Is radiofrequency energy a safe and effective treatment for reducing symptoms of gastroesophageal reflux disease in patients 18 years or older?”

STUDY DESIGN: Review of two double-blind, randomized control trials and one double-blind, randomized cross-over study published between 2003 and 2012. All studies were published in the English language in peer reviewed journals.

DATA SOURCES: Two randomized control trials and one randomized cross-over study were found using PubMed.

OUTCOMES MEASURED: The outcomes measured include changes in GERD symptom scores for fourteen symptoms, improvement of ...

Early Oral Feeding After Bowel Resection, Jennifer Strang

Theses & Dissertations

Research Focus: The primary purpose of this project was to determine if there was an association of factors with time to first solid meal in gastrointestinal (GI) surgery patients and the impact solid diet has on length of stay (LOS) in the hospital, GI symptoms, and incidence of post-operative ileus (POI). A secondary purpose was to observe and describe when an oral diet was started and the progression of diet after GI surgery.

Research Methods: This study was a cross-sectional, retrospective chart review of a convenience sample in a multi-centered hospital system conducted in 84 GI resection patients who were ...

Impact Of Sepsis And Non-Communicable Diseases On Prognostic Models To Predict The Outcome Of Hospitalized Chronic Liver Disease Patients, Fakhar Qazi, Shahab Abid, Preet Ayoub Shaikh, Safia Awan

Section of Gastroenterology

AIM: To evaluate the impact of sepsis and non-communicable diseases (NCDs) on the outcome of decompensated chronic liver disease(CLD) patients.

Methods: In this cross-sectional study, medical records of patients with CLD admitted to the Gastroenterology unit at the Aga Khan University Hospital were reviewed. Patients older than 18 years with decompensation of CLD (i.e., jaundice, ascites, encephalopathy, and/or upper gastrointestinal bleed) as the primary reason for admission were included, while those who were admitted for reasons other than decompensation of CLD were excluded. Each patient was followed for 6 wk after index admission to assess mortality, prolonged ...

Pilot Study Of The Physiological Effects Of An Integrative Medicine Approach In Irritable Bowel Syndrome, Gigi Constable, Eleanor Lewis, Andrew B. Newberg, Md

Phase 1

Introduction: Irritable Bowel Syndrome (IBS) is the most common GI functional disease in the US, affecting 10-25% of the population and costing ~$1.6B in annual healthcare spending. Defined by varied GI symptoms, IBS is associated with gut inflammation from many factors, including diet, microbiome imbalances, and stress. However, the disease lacks a treatment algorithm, especially within integrative medicine.

Objective: This research explores integrative medicine approaches to IBS, including diet and supplements, to identify microbiome and symptom patterns before and after intervention.

Methods: Patients first complete surveys on diet and symptoms, the Beck depression inventory, the SF-36 questionnaire, PET-MRI imaging ...

Endoscopic Retrograde Cholangiopancreatography In Cirrhosis - A Systematic Review And Meta-Analysis Focused On Adverse Events, Harmeet Singh Mashiana, Banreet Dhindsa, Ji Won Yoo, Amaninder Singh Dhaliwal, Shailender Singh, Harlan Sayles, Qing Wu, Ali A. Siddiqui, Gordon Ohning, Mohit Girotra, Douglas A. Adler

School of Medicine Faculty Publications

AIM To investigate indications and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhotics, especially adverse events. Patients with cirrhosis undergoing ERCP are believed to have increased risk. However, there is a paucity of literature describing the indications and outcomes of ERCP procedures in patients with cirrhosis, especially focusing on adverse events. METHODS We performed a systematic appraisal of major literature databases, including PubMed and EMBASE, with a manual search of literature from their inception until April 2017. RESULTS A total of 6,505 patients from 15 studies were analyzed (male ratio 59%, mean age 59 years), 11% with alcoholic and ...

The Dynamic Roles Of Mesenchymal Stem Cells In Colon Cancer, Shan Wang, Zhiguo Miao, Qiyuan Yang, Yimin Wang, Jinzhou Zhang

Open Access Articles

Colon cancer is still one of the most common causes of cancer in human and is characterized by lymphocyte infiltrates and originates from the epithelial cells found in the lining of colon or rectum of the gastrointestinal tract. Mesenchymal stem cells (MSCs) are composed of the multipotent stem cell group of stroma and can be differentiated as various cell lineages, such as fibroblasts, osteoblasts, and adipocytes. MSCs provide mechanical and structural support and have potential functions during tumor growth and metastasis. The efficacy of MSC-based therapies is partly dependent on the migration and homing of MSCs to tumors and metastatic ...

Comparison Of Outcomes For Supine Vs. Prone Position Ercp: A Systematic Review And Meta-Analysis, Harmeet Singh Mashiana, Mahendran Jayaraj, Babu Pappu Mohan, Gordon Ohning, Douglas G. Adler

School of Medicine Faculty Publications

Background While endoscopic retrograde cholangiopancreatography (ERCP) is usually performed in the prone position, some studies have advocated for ERCP in the supine position. Studies comparing the technical success and safety outcomes have shown variable results. We performed a systematic review and meta-analysis of studies reporting the comparison between the two positions for ERCP outcomes. Methods We conducted a search of electronic databases and conference proceedings including PubMed, EMBASE, and Web of Science databases (from inception through October 2016) to identify studies that reported the comparison of technical success and safety outcomes between supine and prone ERCP. The primary outcome was ...

Video Capsule Endoscopy In The Assessment Of Portal Hypertensive Enteropathy, Yasir Al-Azzawai, Lidia Spaho, Mohammed Mahmoud, Joan Kheder, Anne Foley, David R. Cave

Open Access Articles

Background: The features of the portal hypertension enteropathy (PHE) vary from mild mucosal changes to varices with or without bleeding. The prevalence and the development are not fully understood.

Aim: Our aim is to examine the prevalence and the different manifestations of PHE using video capsule endoscopy (VCE).

Methods: It is a single center retrospective study of patients with cirrhosis, who had VCE. Based on the published literature, we divided the PHE lesions into vascular lesions and mucosal lesions.

Results: Of the 100 patients with cirrhosis that had a VCE study, the mean age was 62.82 years. Male gender ...

A Multi-Institution Consensus On How To Perform Eus-Guided Biliary Drainage For Malignant Biliary Obstruction., Jintao Guo, Marc Giovannini, Anand V. Sahai, Adrian Saftoiu, Christoph F. Dietrich, Erwin Santo, Pietro Fusaroli, Ali Siddiqui, Manoop S. Bhutani, Anthony Yuen Bun Teoh, Atsushi Irisawa, Brenda Lucia Arturo Arias, Chalapathi Rao Achanta, Christian Jenssen, Dong-Wan Seo, Douglas G. Adler, Evangelos Kalaitzakis, Everson Artifon, Fumihide Itokawa, Jan Werner Poley, Girish Mishra, Khek Yu Ho, Hsiu-Po Wang, Hussein Hassan Okasha, Jesse Lachter, Juan J. Vila, Julio Iglesias-Garcia, Kenji Yamao, Kenjiro Yasuda, Kensuke Kubota, Laurent Palazzo, Luis Carlos Sabbagh, Malay Sharma, Mitsuhiro Kida, Mohamed El-Nady, Nam Q. Nguyen, Peter Vilmann, Pramod Kumar Garg, Praveer Rai, Shuntaro Mukai, Silvia Carrara, Sreeram Parupudi, Subbaramiah Sridhar, Sundeep Lakhtakia, Surinder S Rana, Takeshi Ogura, Todd H. Baron, Vinay Dhir, Siyu Sun

Division of Gastroenterology and Hepatology Faculty Papers

Background and Objectives: EUS-guided biliary drainage (EUS-BD) was shown to be useful for malignant biliary obstruction (MBO). However, there is lack of consensus on how EUS-BD should be performed.

Methods: This was a worldwide multi-institutional survey among members of the International Society of EUS conducted in February 2018. The survey consisted of 10 questions related to the practice of EUS-BD.

Results: Forty-six endoscopists of them completed the survey. The majority of endoscopists felt that EUS-BD could replace percutaneous transhepatic biliary drainage after failure of ERCP. Among all EUS-BD methods, the rendezvous stenting technique should be the first choice. Self-expandable metal ...

Reduced Gut Microbiome Protects From Alcohol-Induced Neuroinflammation And Alters Intestinal And Brain Inflammasome Expression, Patrick P. Lowe, Benedek Gyongyosi, Abhishek Satishchandran, Arvin Iracheta-Vellve, Yeonhee Cho, Aditya Ambade, Gyongyi Szabo

Open Access Articles

BACKGROUND: The end-organ effects of alcohol span throughout the entire body, from the gastrointestinal tract to the central nervous system (CNS). In the intestine, alcohol use changes the microbiome composition and increases gut permeability allowing translocation of microbial components into the circulation. Gut-derived pathogen-associated signals initiate inflammatory responses in the liver and possibly elsewhere in the body. Because previous studies showed that the gut microbiome contributes to alcohol-induced liver disease, we hypothesized that antibiotic administration to reduce the gut microbiome would attenuate alcohol-induced inflammation in the brain and small intestine (SI).

METHODS: Six- to 8-week-old C57BL/6J female mice were ...

Economical Effect Of Lumen Apposing Metal Stents For Treating Benign Foregut Strictures., Alexander Hallac, Wichit Srikureja, Eashen Liu, Parag Dhumal, Ashish Thatte, Nishant Puri

Articles, Abstracts, and Reports

AIM: To evaluate the clinical and economical efficacy of lumen apposing metal stent (LAMS) in the treatment of benign foregut strictures.

METHODS: A single center retrospective database of patients who underwent endoscopic treatment of benign foregut strictures between January 2014 and May 2017 was analyzed. A control group of non-stented patients who underwent three endoscopic dilations was compared to patients who underwent LAMS placement. Statistical tests performed included independent

RESULTS: Nine hundred and ninety-eight foregut endoscopic dilations were performed between January 2014 and May 2017. 15 patients underwent endoscopic LAMS placement for treatment of benign foregut stricture. Thirty-six patients with ...

Fxr And Tgr5 Agonists Ameliorate Liver Injury, Steatosis, And Inflammation After Binge Or Prolonged Alcohol Feeding In Mice, Arvin Iracheta-Vellve, Charles D. Calenda, Jan Petrasek, Aditya Ambade, Karen Kodys, Luciano Adorini, Gyongyi Szabo

Open Access Articles

Bile acids (BAs) activate various dedicated receptors, including the farnesoid X receptor (FXR) and the Takeda G protein-coupled receptor 5 (TGR5). The FXR agonist obeticholic acid (OCA) is licensed for the treatment of primary biliary cholangitis and has shown promising results in NASH patients, whereas TGR5 agonists target inflammation and metabolism. We hypothesized that FXR and/or TGR5 agonists may be therapeutic in early alcoholic liver disease (ALD) in mice, in which hepatic inflammation plays a major role. OCA, INT-777, and INT-767 are BA derivatives with selective agonist properties for FXR, TGR5, or both, respectively. These compounds were tested in ...

Over-The-Scope Clip Defect Closure Following Endoscopic Mucosal Resection Throughout The Gastrointestinal Tract: A Case Series, Kyle Kreitman Do, Patrick Hickey Do, Shashin Shah Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

The Sensitivity Of Cross-Sectional Imaging For Identifying Periampullary Diverticula, Austin Chiang, Md, Mph, Jetmir Vojnika, Md, Alexander Schlachterman, Md, David E. Loren, Md, Thomas E. Kowalski

Division of Gastroenterology and Hepatology Posters

Our aim was to determine the sensitivity of imaging in identifying duodenal diverticula as seen during ERCP.

The Incidental Discovery Of Strongyloidiasis Colitis, Elizabeth Gold Do, Travis Magdaleno Md, Cheryl A. Bloomfield Md

Department of Medicine

No abstract provided.

Real World Experience With Obeticholic Acid For Primary Biliary Cholangitis: A Case Series, Eric Nellis Md, Adam Peyton Do, She-Yan Wong Md

Department of Medicine

No abstract provided.

Benign Colonic Schwann Cell Hamartoma In A Pediatric Patient With Pten Hamartoma Tumor Syndrome (Phts), Naser Tolaymat Md, Adam R. Paul Do

Department of Medicine

No abstract provided.