Gastroenterology Commons^™

The Circadian Clock Gene Bmal1 Coordinates Intestinal Regeneration, Kyle Stokes, Abrial Cooke, Hanna Chang, David R. Weaver, David T. Breault, Phillip Karpowicz

Neurobiology Publications and Presentations

BACKGROUND and AIMS: The gastrointestinal syndrome is an illness of the intestine caused by high levels of radiation. It is characterized by extensive loss of epithelial tissue integrity, which initiates a regenerative response by intestinal stem and precursor cells. The intestine has 24-hour rhythms in many physiological functions that are believed to be outputs of the circadian clock: a molecular system that produces 24-hour rhythms in transcription/translation. Certain gastrointestinal illnesses are worsened when the circadian rhythms are disrupted, but the role of the circadian clock in gastrointestinal regeneration has not been studied.

METHODS: We tested the timing of regeneration ...

Patient Safety During Procedural Sedation Using Capnography Monitoring: A Systematic Review And Meta-Analysis, Rhodri Saunders, Michel M.R.F. Struys, Richard F. Pollock, Michael Mestek, Jenifer R. Lightdale

Pediatric Publications and Presentations

OBJECTIVE: To evaluate the effect of capnography monitoring on sedation-related adverse events during procedural sedation and analgesia (PSA) administered for ambulatory surgery relative to visual assessment and pulse oximetry alone.

DESIGN AND SETTING: Systematic literature review and random effects meta-analysis of randomised controlled trials (RCTs) reporting sedation-related adverse event incidence when adding capnography to visual assessment and pulse oximetry in patients undergoing PSA during ambulatory surgery in the hospital setting. Searches for eligible studies published between 1 January 1995 and 31 December 2016 (inclusive) were conducted in PubMed, the Cochrane Library and EMBASE without any language constraints. Searches were conducted ...

Complete Esophageal Obstruction After Endoscopic Variceal Band Ligation In A Patient With A Sliding Hiatal Hernia, Munthir Mansour Md, Yousef Abdel-Aziz Md, Hesham Awadh, Nihar Shah Md, Akash Ajmera

Akash Ajmera

Complete esophageal obstruction is a rare complication of endoscopic variceal banding, with only 6 cases in the English literature since the introduction of endoscopic variceal banding in 1986. We report a case of complete esophageal obstruction following esophageal banding due to entrapment of part of a sliding hiatal hernia. To our knowledge, our case is one of few with esophageal obstruction post-banding, and the first associated with a hiatal hernia. We recommend caution when performing esophageal banding on patients with a hiatal hernia.

Complete Esophageal Obstruction After Endoscopic Variceal Band Ligation In A Patient With A Sliding Hiatal Hernia, Munthir Mansour Md, Yousef Abdel-Aziz Md, Hesham Awadh, Nihar Shah Md, Akash Ajmera

Nihar Shah, MD, FACP

Complete esophageal obstruction is a rare complication of endoscopic variceal banding, with only 6 cases in the English literature since the introduction of endoscopic variceal banding in 1986. We report a case of complete esophageal obstruction following esophageal banding due to entrapment of part of a sliding hiatal hernia. To our knowledge, our case is one of few with esophageal obstruction post-banding, and the first associated with a hiatal hernia. We recommend caution when performing esophageal banding on patients with a hiatal hernia.

Enhancing Informative Frame Filtering By Water And Bubble Detection In Colonoscopy Videos, Ashok Dahal, Junghwan Oh, Wallapak Tavanapong, Johnny S. Wong, Piet C. De Groen

Johnny Wong

Colonoscopy has contributed to a marked decline in the number of colorectal cancer related deaths. However, recent data suggest that there is a significant (4-12%) miss-rate for the detection of even large polyps and cancers. To address this, we have been investigating an ‘automated feedback system’ which informs the endoscopist of possible sub-optimal inspection during colonoscopy. A fundamental step of this system is to distinguish non-informative frames from informative ones. Existing methods for this cannot classify water/bubble frames as non-informative even though they do not carry any useful visual information of the colon mucosa. In this paper, we propose ...

Cable Footprint History: Spatio-Temporal Technique For Instrument Detection In Gastrointestinal Endoscopic Procedures, Chuanhai Zhang, Wallapak Tavanapong, Johnny S. Wong, Piet C. De Groen, Junghwan Oh

Johnny Wong

We propose a new fast spatio-temporal technique that detects an operation scene---a video segment corresponding to a single purpose diagnosis action or a single purpose therapeutic action. The technique utilizes (1) color contrast of the cable region and the background, (2) the new area-based coordinate system to compute spatial features, and (3) the history of locations of detected cables of the instrument in a video to discard false regions. The proposed technique and software are useful for (1) automatic documentation of diagnostic or therapeutic operations at the end of the procedure, (2) a second review for causes of complications due ...

Prevalence Of Non Helicobacter Pylori Species In Patients Presenting With Dyspepsia, Javed Yakoob, Zaigham Abbas, Rustam Khan, Shagufta Naz, Zubair Ahmad, Muhammad Islam, Safia Awan, Fatima Jafri, Wasim Jafri

Zubair Ahmad

Background: Helicobacter species associated with human infection include Helicobacter pylori, Helicobacter heilmannii and Helicobacter felis among others. In this study we determined the prevalence of H. pylori and non-Helicobacter pylori organisms H. felis and H. heilmannii and analyzed the association between coinfection with these organisms and gastric pathology in Patients presenting with dyspepsia. Biopsy specimens were obtained from Patients with dyspepsia on esophagogastroduodenoscopy (EGD) for rapid urease test, histology and PCR examination for Helicobacter genus specific 16S rDNA, H. pylori phosphoglucosamine mutase (glmM) and urease B (ureB) gene of H. heilmannii and H. felis. Sequencing of PCR products of H ...

Size Or The Number Of Portal Tracts: Which Matters In A Liver Biopsy Core In Chronic Hepatitis C?, Om Parkash, Khalid Mumtaz, Zubair Ahmad, Saeed Hamid, Fatima Jafri, Wasim Jafri

Zubair Ahmad

Liver biopsy has an important role in staging of fibrosis (SoF) and grading of inflammation (GoI) in chronic hepatitis C (CHC) patients. The effect of size and number of portal tracts (NoP) on grading and staging of liver biopsy was evaluated. A total of 150 consecutive liver biopsy core (LBC) of patients with CHC were obtained. There were 98 (65.3%) males. Mean length of LBC was 1.45 ± 0.48 cm. Mean number of portal tracts (NoP) was 11±4.6. Mean length of LBC was greater (1.60±0.45 cm) in stage 4 (n=41; 27.3 ...

The Clinical, Endoscopic And Histological Spectrum Of The Solitary Rectal Ulcer Syndrome: A Single-Center Experience Of 116 Cases, Shahab Abid, Ali Khawaja, Salima Ahmed Bhimani, Zubair Ahmad, Saeed Hamid, Wasim Jafri

Zubair Ahmad

Background Solitary rectal ulcer syndrome (SRUS) is an uncommon although benign defecation disorder. The aim of this study was to evaluate the variable endoscopic manifestations of SRUS and its association with other diseases. Methods All the patients diagnosed with SRUS histologically from January 1990 to February 2011 at The Aga Khan University, Karachi were included in the study. The medical records were reviewed retrospectively to evaluate the clinical spectrum of the patients along with the endoscopic and histological findings. Results A total of 116 patients were evaluated. The mean age was 37.4 ± 16.6 (range: 13–80) years, 61 ...

Gastric Juice For The Diagnosis Of H Pylori Infection In Patients On Proton Pump Inhibitors, Javed Yakoob, Shahid Rasool, Z Abbas, Wasim Jafri, Shahab Abid, Muhammad Islam, Zubair Ahmad

Zubair Ahmad

Aim:To determine the efficacy of gastric juice polymerase chain reaction (PCR) for the detection of H pylori infection in comparison with histology and gastric antral biopsy PCR in Patients on a proton pump inhibitor (PPI). Methods: Eighty-five consecutive Patients with dyspeptic symptoms were enrolled. Gastric biopsies for histology, PCR and gastric juice were collected at endoscopy for PCR of the H pylori urease C gene (ure C). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, positive and negative likelihood ratio for PCR of gastric juice for the H pylori ure C gene was compared to histology ...

Distribution Of Helicobacter Pylori Virulence Markers In Patients With Gastroduodenal Diseases In Pakistan, Javed Yakoob, Shahab Abid, Zaigham Abbas, Wasim Jafri, Zubair Ahmad, Rashida Ahmed, Muhammad Islam

Zubair Ahmad

Background: Helicobacter pylori (H. pylori) infection is known to be associated with a spectrum of gastroduodenal diseases. We studied the association of H. pylori virulence markers cytotoxin-associated gene (cagA) and vacuolating associated cytotoxin gene (vacA) alleles in Patients with non ulcer dyspepsia (NUD), gastric ulcer (GU), gastric carcinoma (GC) and duodenal ulcer (DU). Methods: H. pylori infection established by both rapid urease test and histology were studied. The cagA and vacA allelic status was determined by polymerase chain reaction (PCR). Sequencing of vacA i1 and i2 PCR product was carried out. Results: Two hundred and twenty-four Patients were included, 141 ...

Gastric Corpus Polyps Associated With Proton Pump Inhibitors Therapy, Javed Yakoob, Zaigham Abbas, Wasim Jafri, Zubair Ahmad

Zubair Ahmad

The prevalence of Gastroesophageal Reflux Disease (GERD) is rapidly rising in Asia. We describe here a case of 51 years old man who had surgery for esophageal leiomyoma and received long-term therapy with Proton Pump Inhibitors (PPIs) for persisting reflux symptoms. On Esophago-Gastroduodenoscopy (EGD) several sessile polyps were seen in the gastric corpus. Earlier EGD done 15 years back had not demonstrated those polyps. Sections revealed polypoid fragments of glandular epithelium with dilated glands and negative histology for H. pylori. Polymerase chain reaction for 16S ribosomal RNA gene (16S rRNA PCR) of H. pylori was also negative. This is the ...

Cytokine Changes In Colonic Mucosa Associated With Blastocystis Spp. Subtypes 1 And 3 In Diarrhoea-Predominant Irritable Bowel Syndrome, Javed Yakoob, Zaigham Abbas, Muhammad Waqas Usman, Aisha Sultana, Muhammad Islam, Safia Awan, Zubair Ahmad, Saeed Hamid, Wasim Jafri

Zubair Ahmad

We determined cytokines (e.g. interleukin-8, 10, 12 and TNF-α) expression by peripheral blood mononuclear cells (PBMCs) and in rectal mucosa in diarrhoea-predominant irritable bowel syndrome (D-IBS) with Blastocystis spp. Eighty patients with D-IBS and Blastocystis spp. infection were classified as 'cases' and 80 with D-IBS without Blastocystis spp. infection were classified as 'control'. Cases were subdivided into D-IBS and Blastocystis sp. defined type 1 (subtype-specific primer SB83) and type 3 (SB227). Stool microscopy and culture were performed. Rectal biopsies were obtained for histology and cytokines by real-time PCR for mRNA expression of cytokines. PBMCs IL-8 was similar in different ...

Colorectal Carcinoma, Extent And Spread In Our Population. Resection Specimens Give Valuable Information, Zubair Ahmad, Rooma Idrees, Rashid Ahmed, Naila Kayani, Shahid Pervez, Sheema Habibul Hasan

Zubair Ahmad

Objective: To acquire information about the extent and spread of colorectal carcinomas in our population by examining colon and colorectum resection specimens received.

Methods: All colon and colorectum resection specimens received in the section of Histopathology, Aga Khan University Hospital, Karachi from January 1, 2003 to July 31, 2003 were included in the study.

Results: Eighty five resection specimens were received during the study period, 69.41% patients were males, and 30.59% were females. The mean age for males was 49 years and for females 48 years. Tumor location was in left colon (58.82%), and in right colon ...

Hepatitis C Virus-Induced Monocyte Differentiation Into Polarized M2 Macrophages Promotes Stellate Cell Activation Via Tgf-Beta, Banishree Saha, Karen Kodys, Gyongyi Szabo

Gyongyi Szabo

BACKGROUND and AIMS: Monocyte and macrophage (MPhi) activation contributes to the pathogenesis of chronic hepatitis C virus (HCV) infection. Disease pathogenesis is regulated by both liver-resident MPhis and monocytes recruited as precursors of MPhis into the damaged liver. Monocytes differentiate into M1 (classic/proinflammatory) or M2 (alternative/anti-inflammatory) polarized MPhis in response to tissue microenvironment. We hypothesized that HCV-infected hepatoma cells (infected with Japanese fulminant hepatitis-1 [Huh7.5/JFH-1]) induce monocyte differentiation into polarized MPhis. METHODS: Healthy human monocytes were co-cultured with Huh7.5/JFH-1 cells or cell-free virus for 7 days and analyzed for MPhi markers and cytokine levels ...

Low Rate Of Recurrence Of Helicobacter Pylori Infection In Spite Of High Clarithromycin Resistance In Pakistan, Javed Yakoob, Shahab Abid, Wasim Jafri, Zaigham Abbas, Khalid Mumtaz, Saeed Hamid, Rashida Ahmed

Rashida Ahmed

Background The aim was to investigate the reinfection rate of H. pylori during a follow-up period of 12 months in adults who had undergone eradication therapy. Methods One hundred-twenty patients; 116 with gastritis, 3 with duodenal ulcer and 1 gastric ulcer, were studied. Their mean age was 41 ± 13 years (range 18–77) and male: female ratio of 2:1. H. pylori were cultured and antibiotic sensitivity was determined by Epsilometer test (E-test) for clarithromycin (CLR) and amoxicillin (AMX). Primers of urease C gene of H. pylori and Sau-3 and Hha I restriction enzymes were used for polymerase chain reaction-restriction ...

Distribution Of Helicobacter Pylori Virulence Markers In Patients With Gastroduodenal Diseases In Pakistan, Javed Yakoob, Shahab Abid, Zaigham Abbas, Wasim Jafri, Zubair Ahmad, Rashida Ahmed, Muhammad Islam

Rashida Ahmed

Background: Helicobacter pylori (H. pylori) infection is known to be associated with a spectrum of gastroduodenal diseases. We studied the association of H. pylori virulence markers cytotoxin-associated gene (cagA) and vacuolating associated cytotoxin gene (vacA) alleles in Patients with non ulcer dyspepsia (NUD), gastric ulcer (GU), gastric carcinoma (GC) and duodenal ulcer (DU). Methods: H. pylori infection established by both rapid urease test and histology were studied. The cagA and vacA allelic status was determined by polymerase chain reaction (PCR). Sequencing of vacA i1 and i2 PCR product was carried out. Results: Two hundred and twenty-four Patients were included, 141 ...

The Utilization Of Video Capsule Endoscopy In Patients With Peutz-Jeghers Syndrome, Yasir Al-Azzawai, Erik Holzwanger, David R. Cave

UMass Center for Clinical and Translational Science Research Retreat

AIM: Our aim is to demonstrate the utilization of VCE in the patients with Peutz–Jeghers syndrome (PJS) and evaluate the distribution of the polyps in each part of the small intestine and the percentage of patients with PJS who developed complications.

METHODS: Single center, retrospective chart review study of outpatients with PJS who underwent a video capsule endoscopy study between January 2006 and January2016.

RESULTS: A total of 16 patients were identified with PJS; mean age was 40 years. Female gender was predominant with 9 patients. Polyps were found in the duodenum, jejunum and ileum in 33%, 80% and ...

Video Capsule Endoscopy In Patients With Muir-Torre Syndrome, Erik Holzwanger, Yasir Al-Azzawi, David R. Cave

UMass Center for Clinical and Translational Science Research Retreat

Introduction: Muir-Torre Syndrome (MTS) is a rare, primarily autosomal dominant disorder that is distinguished by having sebaceous skin malignancies in addition to visceral malignancies. The most common form of MTS is a variant of HNPCC. Our aim is to demonstrate the utilization of VCE in patients with MTS as the first line screening method.

Methods: Single center, retrospective chart review study of outpatients with MTS who underwent a video capsule endoscopy study between January 2006 and January 2016.

Results: Four patients, all women and mean age of 57 years old, with MTS underwent a video capsule endoscopy at our institution ...

Pleural Sepsis Associated With High Mortality In Orthotopic Liver Transplantation Recipients, Erik Holzwanger, Soumil Patwardhan, Sunkaru Touray, Daniel B. Knox

UMass Center for Clinical and Translational Science Research Retreat

Background: Orthotopic liver transplantation (OLT) is currently the only definitive treatment for patients with acute liver failure and end-stage liver cirrhosis. Pulmonary complications are a leading cause of post-operative morbidity and mortality. Post-transplant pleural effusions have been reported in the immediate post-operative period reported in about 32 – 47 % of effusion.

Methods: From a database of 1517 patients who presented at our medical center with pleural effusions from 2010 – 2015, we identified 21 patients who had liver transplants using ICD code 50.59. We performed chart reviews to assess the occurrence of the pleural effusion in relation to their liver transplant ...