Gastroenterology Commons^™

Case Of Enterococcus Cecorum Human Bacteremia, United States, Alexander D. Lake, Ryan Fields, Francia Guerrero, Yousef Almuzaini, Koravangala Sundaresh, Joseph Staffetti

HCA Healthcare Journal of Medicine

Enterococcus cecorum rarely serves as a human pathogen, and only 6 cases of this microbe inoculating humans have been documented. We present an elderly female with a marked vascular history presenting with epigastric pain and diarrhea, followed by shaking chills. Laboratory findings revealed leukocytosis, with imaging showing diffuse colonic thickening. She had a bout of bloody diarrhea, raising the likelihood of ischemic colitis with her vascular history. To our surprise, both sets of blood cultures drawn on admission grew Enterococcus cecorum. This case is unique as it is the first documented case of E. cecorum human infection in the …

Goblet Cell Carcinoma Of The Appendix: A Case Report On Goblet Cell Carcinoid, Sheliza Kabani, Aubtin Saedi, Austin Lehr, Lina O'Brien

HCA Healthcare Journal of Medicine

Goblet cell carcinoid of the appendix is a rare neoplasm with histological features of both neuroendocrine and adenocarcinomas. The combination of its aggressive behavior, infrequent occurrence, and variable clinical presentation convolutes the management of this tumor. We report the case of a 75-year-old female presenting with acute appendicitis. A laparoscopic appendectomy was performed. The pathology report showed goblet cell carcinoid at the base of the appendix with involvement of the proximal surgical margins. At her postoperative visit, the patient’s pathology report and options for management were reviewed, and the patient agreed to proceed with a right hemicolectomy 8-10 weeks after …

Improved Tolerability And Efficaciousness Of Miralax-Gatorade When Compared To Golytely In The Outpatient Setting, Bassem Farah

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using Gu P, Lew D, Jung OS, et al. Comparing the Real-World Effectiveness of Competing Colonoscopy Preparations: Results of a Prospective Trial. Am J Gastroenterol. 2019;114(2):305-314. https://doi.org/10.14309/ajg.0000000000000057 for a patient reluctant to undergo colonoscopy screening due to concerns about GoLYTLEY's tolerability.

Translating Evidence-Based Guidelines Into Practice—Are We Getting It Right? A Multi-Centre Prospective International Audit Of Nutrition Care In Patients With Foregut Tumors (Inform), Merran Findlay, Judith D. Bauer, Rupinder Dhaliwal, Marian De Van Der Schueren, Alessandro Laviano, Adrianne Widaman, Lisa Martin, Andrew G. Day, Leah M. Gramlich

Faculty Research, Scholarly, and Creative Activity

Malnutrition is highly prevalent in patients with foregut tumors comprising head and neck (HNC) and esophageal (EC) cancers, negatively impacting outcomes. International evidence-based guidelines (EBGs) for nutrition care exist; however, translation of research evidence into practice commonly presents considerable challenges and consequently lags. This study aimed to describe and evaluate current international nutrition care practices compared with the best-available evidence for patients with foregut tumors who are at high risk of malnutrition. A multi-centre prospective cohort study enrolled 170 patients commencing treatment of curative intent for HNC (n = 119) or EC (n = 51) in 11 cancer …

Improving Colorectal Cancer Screening And Testing In A Primary Care Clinic, Leslie Michelle Dubois

Doctor of Nursing Practice

Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer-related deaths worldwide (World Health Organization, 2019a). In the United States, CRC was the fourth most common cancer in 2016 (Centers for Disease Control and Prevention, 2019a). The American Cancer Society (2020a) estimated that there will be 147,950 estimated new cases and 53,200 estimated deaths of CRC in the U.S. in 2020. The purpose of the project was to improve CRC screening completion rates and follow up referrals from 27.5% to 35% for adult patients, 50-75 years of age, within a family medicine clinic …

Liver Cancer-Specific Serine Protease Inhibitor Kazal Is A Potentially Novel Biomarker For The Early Detection Of Hepatocellular Carcinoma, Felix Lu, Pir Ahmad Shah, Abhishek Rao, Cynthia Gifford-Hollingsworth, Anne Chen, Gary Trey, Mina Soryal, Arslan Talat, Aysha Aslam, Bilal Nasir, Saad Choudhry, Rizwan Ishtiaq, Hanna Sanoff, Lanla F Conteh, Anne Noonan, Ke-Qin Hu, Carl Schmidt, Janssen Research & Development, Jesse M. Civan, Gary Xiao, Daryl T-Y Lau, Xuanyong Lu

Division of Gastroenterology and Hepatology Faculty Papers

Introduction: Liver cancer-secreted serine protease inhibitor Kazal (LC-SPIK) is a protein that is specifically elevated in cases of hepatocellular carcinoma (HCC). We assessed the performance of LC-SPIK in detecting HCC, including its early stages, in patients with cirrhosis, hepatitis B virus (HBV), and hepatitis C virus (HCV).

Methods: We enrolled 488 patients, including 164 HCC patients (81 early HCC) and 324 controls in a blinded, prospective, case-control study. Serum LC-SPIK levels were determined by an enzyme-linked immunosorbent assay-based assay. The performance of serum LC-SPIK and α-fetoprotein (AFP), including area under the curve (AUC), sensitivity, and specificity, are compared. The performance …

Gastrointestinal Endoscopy In The Era Of Covid-19, Abhilash Perisetti, Hemant Goyal, Neil Sharma Md

PCI Publications and Projects

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which led to a worldwide pandemic that started in early 2020. Healthcare systems across the world encountered an unprecedented surge of COVID-19 patients resulting in more than half a million deaths globally. COVID-19 has affected multiple sub-specialties and procedure-related fields, including gastroenterology. Gastrointestinal (GI) endoscopy centers are specialized units where thousands of endoscopies are performed annually. A significant proportion of these procedures are affected due to the national and regional lockdowns across the globe. To adapt to this rapidly evolving situation, endoscopy centers have undergone significant changes …

Patient Factors Influencing Acute Gluten Reactions And Cytokine Release In Treated Coeliac Disease., Jason A Tye-Din, A James M Daveson, Kaela E Goldstein, Holly L Hand, Kristin M Neff, Gautam Goel, Leslie J Williams, Kenneth E Truitt, Robert P Anderson, Anthony Dimariono (Reset Ced Study Group)

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Patients with coeliac disease (CD) commonly report a variety of adverse symptoms to gluten, but descriptions of the symptomatic response in the literature may have been confounded by the presence of food components such as fermentable carbohydrates (FODMAPs) causing symptoms of irritable bowel syndrome independent of gluten. In recent unmasked and masked low FODMAP gluten challenge studies in small groups of treated CD patients, nausea and vomiting were shown to be the key symptoms associated with serum interleukin (IL)-2 release. Our objective was to utilise a large and diverse cohort of people with CD undertaking a standardised gluten food …

Exploring Peer Mentoring In Pediatric Transition: Perspectives Of Different Stakeholders About Accompanying Patients In Gastroenterology, Guillaume Dumais-Lévesque, Marie-Pascale Pomey

Patient Experience Journal

The literature identifies several issues in the pediatric transition, such as the lack of coordination between pediatric and adult settings and young patients who are not exercising independence in the self-management of their disease. The objective of this study is to explore the potential for a pediatric transition program in gastroenterology, introducing an accompanying patient program to support the transition. A qualitative case study was conducted, including semi-structured focus groups and individual interviews with each group involved in the pediatric transition between two centres in Quebec. A thematic analysis of the collected data was performed using QDA Miner v5.1. In …

Associations Between Household-Level Exposures And All-Cause Diarrhea And Pathogen-Specific Enteric Infections In Children Enrolled In Five Sentinel Surveillance Studies, Josh M. Colston, Abu S G. Faruque, M Jahangir Hossain, Debasish Saha, Suman Kanungo, Inácio Mandomando, Muhammad Imran Nisar, Anita K. M. Zaidi, Richard Omore, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Diarrheal disease remains a major cause of childhood mortality and morbidity causing poor health and economic outcomes. In low-resource settings, young children are exposed to numerous risk factors for enteric pathogen transmission within their dwellings, though the relative importance of different transmission pathways varies by pathogen species. The objective of this analysis was to model associations between five household-level risk factors-water, sanitation, flooring, caregiver education, and crowding-and infection status for endemic enteric pathogens in children in five surveillance studies. Data were combined from 22 sites in which a total of 58,000 stool samples were tested for 16 specific enteropathogens using …

Semiautomated Glasgow-Blatchford Bleeding Score Helps Direct Bed Placement For Patients With Upper Gastrointestinal Bleeding., Drew B Schembre, Robson E Ely, Janice M Connolly, Kunjali T Padhya, Rohit Sharda, John J Brandabur

Articles, Abstracts, and Reports

OBJECTIVE: The Glasgow-Blatchford Bleeding Score (GBS) was designed to identify patients with upper gastrointestinal bleeding (UGIB) who do not require hospitalisation. It may also help stratify patients unlikely to benefit from intensive care.

DESIGN: We reviewed patients assigned a GBS in the emergency room (ER) via a semiautomated calculator. Patients with a score ≤7 (low risk) were directed to an unmonitored bed (UMB), while those with a score of ≥8 (high risk) were considered for MB placement. Conformity with guidelines and subsequent transfers to MB were reviewed, along with transfusion requirement, rebleeding, length of stay, need for intervention and death. …

An Atypical Case Of Necrotizing Fasciitis Secondary To Perforated Cecal Cancer., Laura S Heidelberg, Erica Pettke, Teresa E Wagner, Lauren Angotti

Articles, Abstracts, and Reports

Necrotizing fasciitis is an aggressive, life threatening soft tissue infection that requires high index of suspicion for diagnosis. Diagnosis is clinical with management including broad spectrum antibiotics and emergent operative debridement. The majority of cases are secondary to underlying medical processes, local tissue damage, abscess, or inciting procedure, with a paucity of data correlating causation with colon cancer. We describe the case of an 84-year-old man presenting with sepsis of unknown origin who was diagnosed with an atypical presentation of necrotizing fasciitis secondary to a perforated cecal malignancy. His case is unique in that a less virulent polymicrobial infection was …

Adenoma Detection Rate As A Quality Indicator For Colonoscopy: A Descriptive Cross-Sectional Study From A Tertiary Care Hospital In Pakistan, Mian Shah Yousaf, Shameel Shafqat, Roger Christopher Gill, Asfia Arham Khursheed, Om Parkash

Section of Gastroenterology

Background and study aims: Adenoma detection rate (ADR) is validated for measuring quality of colonoscopy, however there is lack of colorectal cancer (CRC) screening program in South Asia. The purpose of this study is to analyze and review the polyp detection rate (PDR) and ADR and provide insight into the factors that influence them in Pakistan.
Patients and methods: This retrospective, cross-sectional study was performed at the Aga Khan University Hospital, Karachi, Pakistan, on patients ≥ 18 years, who underwent colonoscopy between January 1, 2017 and June 30, 2018.
Results: Of 1985 patients, 59 % were male and 41 % …

Prevalence, Mechanisms, And Implications Of Gastrointestinal Symptoms In Covid-19, Abhilash Perisetti, Hemant Goyal, Mahesh Gajendran, Umesha Boregowda, Rupinder Mann, Neil Sharma Md

PCI Publications and Projects

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The infection started as an outbreak of pneumonia-like symptoms in Wuhan, China. Within a few weeks, it spread across the entire globe resulting in millions of cases and thousands of deaths. While respiratory symptoms and complications are well-defined and can be severe, non-respiratory symptoms of COVID-19 are increasingly being recognized. Gastrointestinal manifestations such as nausea, vomiting, diarrhea, and abdominal pain have been added to the list of common COVID-19 symptoms. Their prevalence has been increasing, probably due to increased recognition and experience with the pandemic. Furthermore, …

Successful Treatment Of Splenic Vein Thrombosis Induced Gastric Varices During Pregnancy, Travis Magdaleno Md, Anam Malik Md, She-Yan Wong Md

Department of Medicine

No abstract provided.

A Young Male With Cholestatic Jaundice Induced By Dymethazine Present In Nutritional Supplement “Xtreme Dmz”, Michal Kloska Md, Reema M. Vaze Md, Travis Magdaleno Md, She-Yan Wong Md

Department of Medicine

No abstract provided.

Transoral Incisionless Fundoplication In A Treatment Of Refractory Gerd: A Retrospective Experience At A Large Quaternary Care Center, Michal Kloska Md, Abdul Aleem Md, Valery Hrad Md, Hiral N. Shah Md, Scott Beman Md, Shashin Shah Md

Department of Medicine

No abstract provided.

Brucella Melitensis-Induced Transaminitis, Rajesh Essrani Md

Department of Medicine

No abstract provided.

Idiopathic Isolated Thrombosis Of The Superior Mesenteric Vein, Rajesh Essrani Md

Department of Medicine

No abstract provided.

Geographic And Intra-Racial Disparities In Early-Onset Colorectal Cancer In The Seer 18 Registries Of The United States, Wesal H. Abualkhair, Meijiao Zhou, Carolina O. Ochoa, Leonel Lacayo, Caitlin Murphy, Xiao Cheng Wu, Jordan J. Karlitz

School of Medicine Faculty Publications

Background: Although early-onset colorectal cancer (EOCRC) incidence rates (IRs) are increasing, geographic and intra-racial IR disparities are not well defined. Methods: 2000-2015 Surveillance, Epidemiology, and End Results (SEER) program CRC IR Analysis (170,434 cases) was performed from ages 30 to 60 in four US regions, 18 individual registries, metropolitan and nonmetropolitan locations and stratified by race. Analyses were conducted in 1-year and 5-year age increments. Results: Wide US regional EOCRC IR variations exist: For example, age 45 IRs in the south are 26.8/100,000, 36.0% higher than the West, 19.7/100,000 (p < 0.0001). Disparities magnify between individual registries: EOCRC IRs in highest risk registries were 177-348% (Alaska Natives), 75-200% (Hawaii), 76-128% (Louisiana), and 61-125% (Kentucky) higher than lowest risk registries depending on age. EOCRC IRs are 18.2%-25.6% higher in nonmetropolitan versus metropolitan settings. Wide geographic intra-racial disparities exist. Within the White population, the greatest IR difference (78.8%) was between Kentucky (5.9/100,000) and Los Angeles (3.3/100,000) in 30- to 34-year-olds (p <.0001). Within the Black population, the greatest difference (136.2%) was between rural Georgia (30.7/100,000) and California excluding San Francisco-Oakland/San Jose-Monterey/Los Angeles (13/100,000) in 40- to 44-year-olds (p = 0003). Conclusion: Marked geographic EOCRC disparities exist with disproportionately high IRs in Alaska Natives, Hawaii, and southern registries. Geographic intra-racial disparities are present within White and Black populations. In Blacks, there are disproportionately high EOCRC IRs in rural Georgia. Although vigilance is required in all populations, attention must be paid to these higher risk populations. Potential interventions include assuring early investigation of symptoms, targeting modifiable risk factors and utilizing earlier age 45 screening options supported by some guidelines.