Gastroenterology Commons^™

Metastatic Melanoma To The Stomach: A Rare Cause Of Upper Gastrointestinal Bleeding, Ricky Buckshaw Do, Robert V. Decker Md, Shashin Shah Md

Department of Medicine

No abstract provided.

Extracellular Vesicles In Liver Diseases: Meeting Report From The International Liver Congress 2018, Jesus M. Banales, Ariel E. Feldstein, Hanna Sanger, Veronika Lukacs-Kornek, Gyongyi Szabo, Miroslaw Kornek

Gyongyi Szabo

Extracellular vesicles (EVs) are small and heterogeneous membrane-bound structures released by cells and found in all biological fluids. They are effective intercellular communicators, acting on a number of close and/or distant target cells. EV cargo may reflect the cell of origin as well as the specific stress that induces their formation and release. They transport a variety of bioactive molecules, including messenger RNA, noncoding RNAs, proteins, lipids, and metabolites, that can be transferred among cells, regulating various cell responses. Alteration in the concentration and composition of EVs in biological fluids is a typical hallmark of pathologies in different liver diseases. …

Inhibition Of Triggering Receptor Expressed On Myeloid Cells 1 Ameliorates Inflammation And Macrophage And Neutrophil Activation In Alcoholic Liver Disease In Mice, David Tornai, Istvan Furi, Zu T. Shen, Alexander B. Sigalov, Sahin Coban, Gyongyi Szabo

Gyongyi Szabo

Alcoholic liver disease (ALD) is characterized by macrophage and neutrophil leukocyte recruitment and activation in the liver. Damage- and pathogen-associated molecular patterns contribute to a self-perpetuating proinflammatory state in ALD. Triggering receptor expressed on myeloid cells 1 (TREM-1) is a surface receptor that amplifies inflammation induced by toll-like receptors (TLRs) and is expressed on neutrophils and monocytes/macrophages. We hypothesized that TREM-1 signaling contributes to proinflammatory pathway activation in ALD. Using an in vivo ALD model in mice, we tested the effects of ligand-independent TREM-1 inhibitory peptides that were formulated into human high-density lipoprotein (HDL)-mimicking complexes GF9-HDL and GA/E31-HDL. As revealed …

The Time Is Now For Mandatory Liver-Focused Clinical Experiences In Medical School., Alexander Y. Pan, Lauren D. Feld, Jeanne M. Farnan, Steven K. Herrine, Adam E. Mikolajczyk

Division of Gastroenterology and Hepatology Faculty Papers

The national burden of chronic liver disease is steadily increasing and is only expected to worsen with the ongoing obesity and opioid epidemics fueling growth in the prevalence of nonalcoholic fatty liver disease and a resurgence of new hepatitis C infections. Our letter highlights the disparity between the rising prevalence of chronic liver disease and the proportion of medical students who receive exposure to patients with liver disease as part of their medical education. A more comprehensive survey of clerkship directors is needed to further corroborate this data, which may lead to reforms in medical school curricula to better address …

Aortoduodenal Fistula Forms From Primary Aortic Stump Graft In A Two-Time Multi-Visceral Transplant Patient With Presentation Of Gastrointestinal Bleed And Bowel Perforation: A Case Report, Brielle Corrente

Graduate Student Research Symposium

Usually not diagnosed until open laparotomy, aortoduodenalfistulas (ADF) are one of the rarest complications of intestinal transplant surgery. With an incidence rate of only 0.04% at autopsy and only 250 documented cases since the early 1800’s, aortoduodenal fistulas are the most deadly complications of intestinal transplantation with a mortality rate of 100% without surgical intervention. A 39 year old, two-time multi-visceral transplant African American female patient suffered from a primary aortoduodenal fistula formation in a primary modified multi-visceral transplant aortic stump graft site. With emergency open laparotomy repair, revascularization of the secondary multi-visceral transplant was performed, saving the life of …

A265 Lymphocytic Esophagitis: A Single Tertiary Center’S Experience With This Emerging Clinical Entity., C Shams, M Co, M Cappell

Conference Presentation Abstracts

Background: Various disorders can produce esophagitis. Lymphocytic esophagitis (LE) has emerged as another clinical entity responsible for esophagitis symptoms. Although increasingly reported pathologically, the clinical characteristics of LE have not been well characterized. Aims: The present study extends the clinicopathologic characterization of LE by comprehensive analysis of 30 affected patients and identifies specific clinical presentations significantly associated with LE. Methods: Thirty patients were identified from January 2000-December 2016 that satisfied diagnostic criteria for LE by lower esophageal biopsy; (1) high concentration of intraepithelial lymphocytes and (2) few granulocytes (ratio of lymphocytes:granulocytes >50:1). Controls, selected from patients undergoing esophagogastroduodenoscopy (EGD) during …

A Rare Case Of Wilson Disease In A 72-Year-Old Patient., Christopher Cao, Timothy Colangelo, Raja Koteswar Dhanekula, Daniel Brandt, Indira Laothamatas, Manish Thapar, Steven K. Herrine, Jesse M. Civan

Division of Gastroenterology and Hepatology Faculty Papers

Wilson disease is an autosomal recessive disorder of abnormal copper metabolism that is prevalent in the younger population, rarely presenting in patients older than 40 years. Clinical presentation may be variable, and diagnosis is often aided by clinical and biochemical tests. We report the case of a 72-year-old woman who presented with acute liver failure initially of unclear etiology. Our patient was initially managed for presumed drug-induced liver injury but ultimately diagnosed with Wilson disease on the basis of clinical presentation, laboratory testing, liver biopsy, quantitative hepatic copper, and abnormal genetic testing.

Nonalcoholic Fatty Liver Disease And The Pnpla3 Gene, Lori Houghton-Rahrig, Debra Schutte, Jenifer I. Fenton, Jennifer Awad

Peer Reviewed Articles

Nonalcoholic fatty liver disease (NAFLD) is a rapidly emerging worldwide public health concern strongly associated with obesity, insulin resistance/diabetes type 2, and the metabolic syndrome (Younossi et al., 2011). It is the most common cause of liver disease in the world (World Gastro - enterology Organisation [WGO], 2012). Defined as a total liver weight comprised of more than 5% fat, NAFLD can progress from simple fatty liver disease to nonalcoholic steatohepatitis with or without fibrosis, liver cirrhosis, liver cancer, or liver failure resulting in premature death (Levene & Goldin, 2012). The development and progression of NAFLD is influenced by genetic …

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.

A Multicenter Evaluation Of A New Eus Core Biopsy Needle: Experience In 200 Patients., Douglas G. Adler, V. Raman Muthusamy, Dean S. Ehrlich, Gulshan Parasher, Nirav C. Thosani, Ann Chen, Jonathan M. Buscaglia, Anoop Appannagari, Eduardo Quintero, Harry Aslanian, Linda Jo Taylor, Ali Siddiqui

Division of Gastroenterology and Hepatology Faculty Papers

Background and Objectives: We present a multicenter study of a new endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) needle (Acquire, Boston Scientific, Natick, MA). The aim of the study was to analyze the needle's clinical performance when sampling solid lesions and to assess the safety of this device.

Methods: We performed a multicenter retrospective study of patients undergoing EUS-FNB during July 1-November 15, 2016.

Results: Two hundred patients (121 males and 79 females) underwent EUS-FNB of solid lesions with the Acquire needle. Lesions included solid pancreatic masses (n = 109), adenopathy (n = 45), submucosal lesions (n = 34), cholangiocarcinoma (n = …

Unusual Case Of Obstructive Jaundice., Rajesh Essrani Md, Eric Nellis Md, Patrick Hickey Do, Hiral N. Shah Md

Department of Medicine

Most malignant obstructive jaundice arises from primary periampullary tumors and rarely from metastatic cancer of the head and neck. A 60-year-old male was diagnosed with obstructive jaundice due to metastatic squamous cell carcinoma of the tonsil. Only 12 cases of small bowel metastasis from the head and neck have been reported. Most of them originate from laryngeal squamous cell carcinoma, and only one case reported tonsillar cancer metastasizing to the ileum. Our case is the first one, to the best of our knowledge, to illustrate tonsillar cancer with metastasis to the duodenum causing obstructive jaundice.

A Comparison Of The Diagnosis Of Gastroparesis In 4 H Pediatric Gastric Emptying Studies Versus 2 H Studies., Sarah T. Edwards, Jose Cocjin, Stephanie B. Theut, Douglas C. Rivard, Ashley K. Sherman, Craig A. Friesen

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: In adults, there is a consensus for standards to diagnose gastroparesis utilizing a gastric emptying study as the key diagnostic modality but there is no consensus for a standard in pediatrics. Additionally, some cost savings might be achieved if symptoms could be utilized to predict patients with gastroparesis. The aims of the current study were to confirm the sensitivity of a 4 h study in the pediatric population and to assess whether the severity of symptoms were predictive of delayed gastric emptying.

STUDY: This was a single site, two part study. In the first part, results were reviewed for …

Identification Of Novel Regulatory Genes In Apap Induced Hepatocyte Toxicity By A Genome-Wide Crispr-Cas9 Screen., Katherine Shortt, Daniel P. Heruth, Nini Zhang, Weibin Wu, Shipra Singh, Ding-You Li, Li Qin Zhang, Gerald J. Wyckoff, Lei S Qi, Craig A. Friesen, Shui Qing Ye

Manuscripts, Articles, Book Chapters and Other Papers

Acetaminophen (APAP) is a commonly used analgesic responsible for more than half of acute liver failure cases. Identification of previously unknown genetic risk factors would provide mechanistic insights and novel therapeutic targets for APAP-induced liver injury. This study used a genome-wide CRISPR-Cas9 screen to evaluate genes that are protective against, or cause susceptibility to, APAP-induced liver injury. HuH7 human hepatocellular carcinoma cells containing CRISPR-Cas9 gene knockouts were treated with 15 mM APAP for 30 minutes to 4 days. A gene expression profile was developed based on the 1) top screening hits, 2) overlap of expression data from APAP overdose studies, …

A Rare Non-Oncological Pancreatic Mass: Eosinophilic Pancreatitis Diagnosis Through Eus-Fna, Andres Gelrud

All Publications

No abstract provided.

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 …

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

Section of Gastroenterology

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 …

Persistent Risk For New, Subsequent New And Recurrent Hepatocellular Carcinoma Despite Successful Anti-Hepatitis B Virus Therapy And Tumor Ablation: The Need For Hepatitis B Virus Cure., Brianna J. Shinn, Aaron Martin, Robert M. Coben, Mitchell I. Conn, Jorge Prieto, Howard Kroop, Anthony J. Dimarino, Hie-Won Hann

Division of Gastroenterology and Hepatology Faculty Papers

Hepatitis B virus (HBV) is one of the most significant hepatocarcinogens. The ultimate goal of anti-HBV treatment is to prevent the development of hepatocellular carcinoma (HCC). During the last two decades, with the use of currently available anti-HBV therapies (lamivudine, entecavir and tenofovir disoproxil fumatate), there has been a decrease in the incidence of HBV-associated HCC (HBV-HCC). Furthermore, several studies have demonstrated a reduction in recurrent or new HCC development after initial HCC tumor ablation. However, during an observation period spanning 10 to 20 years, several case reports have demonstrated the development of new, subsequent new and recurrent HCC even …

Denture Misadventure: The Tooth About Your Colon., Rajesh Essrani Md, Patrick Hickey Do, Hiral N. Shah Md

Department of Medicine

Foreign body ingestion occurs mainly in a mentally impaired person, but rarely in healthy adults. A 48-year-old male was admitted with a recurrence of previously diagnosed right knee septic arthritis and accidentally ingested his dental bridge which was removed from a proximal ascending colon with a colonoscopy.

Volumetric Laser Endomicroscopy And Its Application To Barrett's Esophagus: Results From A 1,000 Patient Registry., M. S. Smith, B. Cash, V. Konda, A. J. Trindade, S. Gordon, S. Demeester, V. Joshi, C. Lee, D. V. Sejpal, K. Chang, +38 Additional Authors

Journal Articles

Volumetric laser endomicroscopy (VLE) uses optical coherence tomography (OCT) for real-time, microscopic cross-sectional imaging. A US-based multi-center registry was constructed to prospectively collect data on patients undergoing upper endoscopy during which a VLE scan was performed. The objective of this registry was to determine usage patterns of VLE in clinical practice and to estimate quantitative and qualitative performance metrics as they are applied to Barrett's esophagus (BE) management. All procedures utilized the NvisionVLE Imaging System (NinePoint Medical, Bedford, MA) which was used by investigators to identify the tissue types present, along with focal areas of concern. Following the VLE procedure, …

Lumen Apposing Metal Stents Are Superior To Plastic Stents In Pancreatic Walled-Off Necrosis: A Large International Multicenter Study., Y. Chen, J. Yang, S. Friedland, I. Holmes, R. Law, A. Hosmer, D. V. Sejpal, S. Inamdar, A. J. Trindade, M. A. Khashab, +30 Additional Authors

Journal Articles

Background and study aims  The use of lumen apposing metal stents (LAMS) during EUS-guided transmural drainage (EUS-TD) of pancreatic walled-off necrosis (WON) has gained popularity. Data supporting their use in WON over plastic stents (PS), however, remain scarce. The aim of this study was to compare the clinical efficacy of LAMS (Axios, Boston Scientific) with PS in WON. Patients and methods  This was a multicenter, retrospective study involving 14 centers. Consecutive patients who underwent EUS-TD of WON (2012 - 2016) were included. The primary end point was clinical success defined as WON size ≤ 3 cm within a 6-month period …