Digestive System Diseases Commons^™

Point-Of-Care Intestinal Ultrasound Is Associated With Reduced Colonoscopy Utilization And Improved Clinical Decision-Making In Ibd, Lakumi Dias, Ashlyn Mcclelland, Amy Glasofer, Charalampos Papachristou, Yecheskel Schneider, Sanket Patel

Rowan-Virtua Research Day

Background:

Point-of-care intestinal ultrasound (IUS) enables real-time assessment of bowel inflammation, and it is underutilized in the United States. IUS provides visualization of bowel wall thickness, vascularity, and complications without radiation or bowel preparation. Prior studies demonstrate that IUS changes management and reduces reliance on invasive testing. This study hypothesizes that IUS will impact downstream clinical decision-making in a U.S. outpatient IBD cohort by decreasing invasive procedures and supporting appropriate treatment decisions.

Methods:

A retrospective cohort study was performed. Logistic regression and chi-square tests assessed associations between IUS use, colonoscopy referral, hospital utilization, and treatment modification. A derived “surveillance-due” variable …

The Role Of Extracellular Vesicles As Diagnostic Tools In Gut-Brain Axis Disorders, Patricia Marçal Da Costa, Paulo Iury Gomes Nunes, Gabriella Cunha Vieira Ciurleo, José Wagner Leonel Tavares Junior, Pedro Braga Neto, Ludmila Belayev, Reinaldo Barreto Oriá

School of Graduate Studies Faculty Publications

The gut–brain axis represents a dynamic two-way signaling network whose dysregulation has been implicated in a wide range of neurogastrointestinal disorders. In this context, extracellular vesicles (EVs) have emerged as critical mediators of intercellular signaling and as promising non-invasive biomarkers. Derived from host and microbial cells, EVs carry bioactive cargo—including proteins, lipids, nucleic acids, and metabolites—that reflect the physiological or pathological state of their cells of origin. Their ability to cross biological barriers, such as the blood–brain barrier, underscores their potential for diagnosing and monitoring gut–brain axis dysfunctions. In this mini-review, we integrate microbial and brain-derived EVs within the framework …

Operative Localization Of Occult Gastrointestinal Bleeding Using Intraoperative Small Bowel Endoscopy, Shuda Xia, Furrukh Jabbar, Muhammad T. Siddique

North Texas GME Research Forum 2026

No abstract provided.

Rapid Diagnosis Of Hemorrhagic Shock Due To Upper Gi Bleeding With Point-Of-Care Ultrasound In The Emergency Department, Tamari Ronen, Derrick Huang

Gulf Coast Division GME Research Day 2026

No abstract provided.

Esophageal Squamous Cell Carcinoma Incidentally Detected On Barium Swallow: A Case Report, Muhammad Rubeel Akram, Aditya Rao, Muhammad T. Siddique

North Texas GME Research Forum 2026

Background: Esophageal cancer is an aggressive malignancy with a poor prognosis, and has high rates of recurrence despite curative-intent therapy. While endoscopy with biopsy remains the gold standard for diagnosis, non-diagnostic imaging studies are performed when evaluating for dysphagia, and may bring to light underlying pathology, warranting further workup. Surgical resection following neoadjuvant chemoradiation is often performed, but postoperative complications and disease recurrence are important concerns. This case highlights the crucial role of early detection via imaging and the clinical burden associated with esophageal squamous cell carcinoma.

Case Presentation: A 76-year-old female presented with dysphagia and underwent a barium esophagogram, …

Gross Findings With Point-Of-Care Ultrasound In Median Arcuate Ligament Syndrome: A Case Report, Justin Stanziola, Yelena Pecheny, Casey Wilson

South Atlantic Division GME Research Days 2026

No abstract provided.

A Blood-Based Test For Colorectal Cancer Screening, Joshua Cullison

HCA Healthcare Journal of Medicine

Within the United States (US), colorectal cancer (CRC) remains the fourth most common malignancy and is responsible for over 50 000 deaths annually, second only to lung cancer in cancer mortality. Despite increased public awareness and increasing screening rates, the US remains far below the 80% screening mark set by the National Colorectal Cancer Roundtable at 59%. The addition of non-invasive blood-based tests for CRC screening could potentially increase screening rates and lower CRC deaths.

I performed a PubMed search using the search term “blood-based colorectal cancer screening.” I was particularly interested in articles that looked at Shield, which is …

Atypical Abdominal Pain: Uncovering Malignant Peritoneal Mesothelioma In Suspected Crohn's Disease: A Case Report, Catherine Loehr, Lara Boudreaux, Ann Porter Uhlhorn, Nisha Loganantharaj

School of Medicine Faculty Publications

BACKGROUND: Malignant peritoneal mesothelioma (MPM) is a rare and aggressive cancer from the serosal membranes of the abdominal cavity. In the United States, MPM accounts for about 10-15% of all mesothelioma cases, and translates into approximately 600 new cases diagnosed annually. It is typically diagnosed in Caucasian individuals, and while asbestos exposure is a well-established risk factor for pleural mesothelioma, its association with peritoneal mesothelioma remains less clear. Clinical symptoms of MPM, such as abdominal pain, bloating, and weight loss, overlap with other gastrointestinal disorders, which often leads to delayed diagnosis. This case report presents a unique instance of MPM …

Failure To Rescue After Surgery For Pancreatic Cancer: A Systematic Review And Narrative Synthesis Of Risk Factors And Safety Strategies, Masashi Uramatsu, Yoshikazu Fujisawa, Paul Barach, Hiroaki Osakabe, Moe Matsumoto, Yuichi Nagakawa

College of Population Health Faculty Papers

Background: Failure to rescue (FTR), defined as death after major postoperative complications, is a critical quality indicator in pancreatic cancer surgery. Despite advances in surgical techniques and perioperative care, FTR rates remain high and vary across institutions. Methods: This systematic review uses a narrative synthesis followed by PRISMA 2020. A PubMed search (1992-2025) identified 83 studies; after screening, 52 studies (2010-2025) were included. Eligible designs were registry-based, multicenter, single-center, or prospective audits. Given substantial heterogeneity in study designs, FTR definitions, and outcome measures, a narrative synthesis was performed; no formal risk-of-bias assessment or meta-analysis was conducted. Results: …

A Comparative Evaluation Of Two Subharmonic-Aided Pressure Estimation (Shape) Analysis Methods, Hailee Mayer, Priscilla Machado, Trang Vu, Annalisa Berzigotti, Jaume Bosch, Elton Dajti, Antonina Antonenko, Kirk Wallace, Flemming Forsberg

Department of Radiology Faculty Papers

Pressure measurement in clinical practice is a valuable tool for diagnostic evaluation, especially in diseases such as portal hypertension. Currently, portal pressures are measured by invasive hepatic vein catheterization, posing risks to patients, and limiting how often measurements can be obtained. Subharmonic-aided pressure estimation (SHAPE) is an ultrasound-based technique that leverages ultrasound contrast agents (UCAs) to estimate changes in hydrostatic pressure. UCAs act as nonlinear oscillators when exposed to high enough acoustic pressures (typically > 200 kPa) and produce significant energy components ranging from subharmonics to higher harmonics. Tissues do not generate significant subharmonic components, thus making it the optimal component …

Redefining The Albumin-Bilirubin Score: Predictive Modeling And Multidimensional Integration In Liver And Systemic Disease, Berkay Demirors, Ramin Shekouhi, Paola Berrios Jimenez, Anjali Yadav, Guido Chiriboga, Vishal A. Mahesh, Harsheen K. Manaise, Jade Bowers, Angel Aguayo Merly, Emmanuel Gabriel

School of Medicine Faculty Publications

This editorial comment is on the article by Xu et al. It offers an in-depth analysis of liver function assessment tools and their prognostic roles in non-malignant liver diseases, with a focus on the albumin-bilirubin (ALBI) score. ALBI’s components, grading system, and clinical relevance across various liver conditions are reviewed and compared with traditional models such as the Child-Pugh and model for end-stage liver disease scores. We included recent studies evaluating ALBI’s role in estimating liver function, suggesting it may help differentiate patients who appear similar under other staging systems, and assist in guiding clinical decisions. Although ALBI is primarily …

Case Report: Sarcina Ventriculi, A Masquerade Of Motility, Katherine Westbrook Cates, Catherine Hudson

School of Medicine Faculty Publications

Sarcina ventriculi is a rare bacterium that has the potential to cause severe disease in the gastric mucosa. According to our search, there are less than 100 prior published case reports. This case discusses a 69-year-old man who presented to the hospital with severe gastric distention noted on CT of the abdomen with intractable nausea and emesis, for which endoscopy was performed and ruled out gastric outlet obstruction, with biopsies resulting as S. ventriculi. This bacterium has previously been reported to cause gastric dysmotility, as well as severe side effects including gastric perforation.

Plane Xanthoma, Connor A. Sheehan, Theresa N. Tran, Jason B. Lee, Jeffrey Y. Liu, Sylvia Hsu

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

Childhood Gastroesophageal Reflux Disease: A Comprehensive Review Of Disease, Diagnosis, And Therapeutic Management, Daniyal Raza, Farhan Mohiuddin, Muhammad Haris Khan, Maheen Fawad, Syed Musa Raza

School of Medicine Faculty Publications

Gastroesophageal reflux disease (GERD) affects both adults and children, although the symptoms differ significantly between these groups. While adults typically experience heartburn and regurgitation, children may present with more subtle signs, such as failure to thrive, chronic cough, wheezing, and Sandifer syndrome. Diagnosing GERD in children necessitates a multifaceted approach due to the diverse symptomatology and challenges in communication. Clinical assessment serves as the cornerstone of diagnosis, supported by tools like pH monitoring, esophageal impedance testing, and upper gastrointestinal endoscopy. Imaging studies, such as barium swallow, can also provide valuable insights into anatomical abnormalities and the extent of reflux. Treatment …

Igg4-Related Autoimmune Pancreatitis In Patients With Prior Occupational Exposure: A Case Report And Review Of Risks Concerning Blue-Collared Workers, Zachary A. Coren, Justin Le, Jason Tran, Nicholas Moscardelli, Krish Patel, Joshua Coren

Rowan-Virtua Research Day

Autoimmune pancreatitis (AIP), a manifestation of IgG4-related disease (IgG4-RD), is a rare, often misdiagnosed condition that can closely mimic pancreatic cancer, particularly in its clinical and radiographic presentation. We report the case of a 76-year-old retired plumber who presented with painless jaundice and was initially suspected to have pancreatic cancer based on imaging findings. Subsequent endoscopic evaluation, biopsy, and markedly elevated serum IgG4 levels led to a diagnosis of type 1 AIP. Treatment with corticosteroids resulted in rapid clinical improvement and reduction in IgG4 levels, confirming the diagnosis.

This case highlights the diagnostic challenges of AIP, especially among blue-collar workers …

A Case Of Choledocholithiasis In A Patient With A Recent History Of Hellp Syndrome And Pre-Eclampsia, Akhil Tumpudi

Rowan-Virtua Research Day

Jaundice in a patient presenting to the emergency department (ED) can be indicative of a range of conditions, and it's important to determine the underlying cause for proper management. Here we describe a case of an unusual presentation of choledocholithiasis in a 25-year-old female with a recent history of HELLP and preeclampsia.

The First International Experience With Histotripsy: A Safety Analysis Of 230 Cases, Chase J. Wehrle, Kevin Burns, Evan Ong, Allison Couillard, Neehar D. Parikh, Elaine Caoili, Jaekeun Kim, Federico Aucejo, Andrea Schlegel, Emily Knott, Paul Laeseke, J Philip Boudreaux, Philipp Von Breitenbuch, Mikhail Silk, Mohamed Alassas, Andrew Guzowski, Brian Fuller, Erica Knavel Koepsel, Brock Hewitt, Mishal Mendiratta-Lala, David C. Kwon

School of Medicine Faculty Publications

BACKGROUND: Histotripsy is a novel, noninvasive, nonionizing, and nonthermal approach that uses focused ultrasound waves to treat liver tumors. This technology received a de novo Food and Drug Administration grant in late 2023. This study aimed to provide the first report on post-trial real-world clinical safety data. METHODS: Safety outcomes within 30 days of histotripsy were collected after obtaining Food and Drug Administration clearance (December 22, 2023 to July 26, 2024). All centers that performed histotripsy were invited to participate in this study. Complications requiring treatment were graded using the Clavien-Dindo classification and Comprehensive Complication Index (CCI). RESULTS: A total …

The Gut Feeling: Diagnosing The Unexpected Ogilvie’S Syndrome, Sakina Haider, Jenny Cherenfant, Supritha Chintamaneni, Rama Laxman

Gulf Coast Division GME Research Day 2025

No abstract provided.

Diverticulitis—New Evidence To Share With Patients, Nicholas B. D'Alessandro, Tarun Vippa, Edward C. Oldfield Iv, David A. Johnson

Department of Medicine Faculty Publications

Diverticulitis is one of the most common gastrointestinal causes of hospitalization in Western society. While previously characterized as a disease of older patients, new literature highlights an increasing incidence among the younger population. Over the past few decades, the understanding of etiology and management of diverticulitis has changed drastically. New data refute past beliefs while promoting other novel recommendations to mitigate incidence and subsequent complications. Data now confirms the safety and possible protective benefit of particulate food, while highlighting evidence-based approaches for the use of diagnostic imaging and antibiotics. We recognize modifiable and non-modifiable risk factors that are commonly seen …

Case Report: Diverticulitis Involving A Meckel’S Diverticulum, Samuel M. Thalathoti, Russell A. Mordecai

Rowan-Virtua Research Day

We report a case of a 65-year-old female who presented with abdominal pain and was diagnosed with diverticulitis involving a Meckel‘s Diverticulum. The differential diagnosis of abdominal pain is vast, in this age group includes, but is not limited to appendicitis, diverticulitis, cholecystitis, and small bowel obstruction. In the absence of complicated features, conservative management with oral antibiotics and close outpatient follow is advised. However, in the case of complicated diverticulitis and a rare manifestation such as a Meckel’s Diverticulum, careful management is indicated.

Ultrasound Versus Radiography For Evaluating Surgical Necrotizing Enterocolitis, Sayed H. Aftab, Santiago Martinez-Correa, Minh-Huy Huynh, Wondwossen T. Lerebo, Jorge Delgado, Rebecca Denis, Misun Hwang

Rowan-Virtua Research Day

Purpose:

Necrotizing enterocolitis (NEC) is an abdominal inflammatory condition that is common in premature neonates. Although abdominal radiograph (AR) remains the imaging standard for NEC, it may miss up to 50% of early signs of NEC and has been described to have a sensitivity as low as 15.4% for detecting pneumoperitoneum. Abdominal ultrasound (US) is portable, non-invasive, and allows real-time bowel integrity, movement, and perfusion assessment. We aim to evaluate the concordance between US and AR in detecting NEC features and the diagnostic performance of both modalities in detecting pneumoperitoneum.

Methods and materials:

We conducted an IRB-approved retrospective, cross-sectional, single-center …

A Case Of Esophagogastric Junction Outflow Obstruction Resulting To Megaesophagus In A 37-Year-Old Male, Dean Esma, Robin Lahr, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Esophagogastric junction outflow obstruction (EGJOO) is a major motility disorder characterized by an increase of > 15 mmHg in the integrated relaxation pressure (IRP) with or without problems in esophageal motility. This presents as dysphagia, chest pain, regurgitation, heartburn, cough, and a globus sensation, with dysphagia. Severe cases may lead to a megaesophagus causing compression of mediastinal structures.6 Its similarity to other esophageal disorders urge an investigation to improve its identification and treatment. This report presents a case of EGJOO in a 37-year-old cachectic male patient with dysphagia and vomiting, eventually determined to be EGJOO with diagnostic manometry.

Device-Assisted Enteroscopy In The Surveillance Of Intestinal Hamartomas In Peutz-Jeghers Syndrome, Omar Wahid Mohamed Elfeky, Suraj Panjwani, David Cave, Daniel Wild, Daniel Raines

School of Medicine Faculty Publications

Background: PJS is an autosomal dominant, genetic disorder characterized by the formation of hamartomatous polyps in the gastrointestinal tract. These polyps result in significant morbidity due to adverse events including intestinal obstruction, bleeding, and malignancy. The aim of this study was to describe the role of DAE in monitoring and prophylactic polypectomy within the small bowel. Methods: Electronic medical records were surveyed to identify all DAE procedures performed in patients with PJS within three U.S. referral centers between Jan 1st 2007 and January 1st 2020. Individual charts were reviewed to collect and analyze specific data points. Primary end points included …

Classification Of Colorectal Cancer Using Resnet And Efficientnet Models, Abhishek Ranjan, Priyanshu Srivastva, B Prabadevi, R Sivakumar, Rahul Soangra, Shamala K. Subramaniam

Physical Therapy Faculty Articles and Research

Introduction:

Cancer is one of the most prevalent diseases from children to elderly adults. This will be deadly if not detected at an earlier stage of the cancerous cell formation, thereby increasing the mortality rate. One such cancer is colorectal cancer, caused due to abnormal growth in the rectum or colon. Early screening of colorectal cancer helps to identify these abnormal growth and can exterminate them before they turn into cancerous cells.

Aim:

Therefore, this study aims to develop a robust and efficient classification system for colorectal cancer through Convolutional Neural Networks (CNNs) on histological images.

Methods:

Despite challenges in …

Colon Adenocarcinoma Mimicking Acute Appendicitis In A 28-Year-Old, Bridget Kowalczyk, Edward Pingenot, Vivek Bansal

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

Case Report: Proximal Large Bowel Obstruction Due To Constipation Requiring Subtotal Colectomy And Ileostomy, Brian Lim, Russell Mordecai, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Large bowel obstructions are an abdominal emergency with morbidity and mortality dependent on early diagnosis . This case is of a 58-year-old male who presented with large bowel obstruction due to constipation. Differential diagnosis of large bowel obstruction ranges from benign to emergent should include conditions such as Ogilvie’s syndrome, paralytic ileus, small bowel obstruction to toxic megacolon. This male with only a risk factor of opioid use after spinal surgery. Attempts at medical management were made but the patient ultimately needed definitive management through exploratory laparostomy.

Barriers To Colorectal Cancer Screening For Low-Income Hispanic Men In Urban Areas Between 50-75, Alex Vega

Rowan-Virtua Research Day

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Although CRC screening rates have improved in non-Hispanic whites (NHW), Hispanic adult males (HAM) aged 50-75 in urban areas continue to experience low screening rates and higher CRC morbidity and mortality. This review aims to identify the barriers to CRC screening among HAM and propose targeted interventions to increase screening rates. A comprehensive literature review was conducted using databases such as PubMed, Scopus, and Google Scholar. Key search terms included "colorectal cancer", "screening", "Hispanic adult males", "urban", "barriers", and "interventions". Factors identified include poverty, language …

Small Intestinal Bacterial Overgrowth Testing Strategies, Carla Bonczak

Doctor of Nursing Practice Scholarly Projects

Small Intestinal Bacterial Overgrowth (SIBO) is an overgrowth of bacteria in the small intestine. Symptoms such as bloating, abdominal pain and discomfort, malabsorption, nausea, constipation, or diarrhea overlap with several common GI complaints. SIBO affects millions of people worldwide. Many providers are not aware of SIBO or the guidelines that standardize testing and diagnosing.

The Final Scholarly Project (FSP) was based on a literature review that discovered evidence-based literature on SIBO testing strategies such as gut aspirate and culture, clinical symptom presentation, breath testing, nutrient challenge test, and scintigraphy with either lactulose or hydrogen breath testing. To implement the project, …

Midgut Volvulus A Rare Cause Of Acute Abdomen In The Adult Patient, Mason S. Deinema, Saptarshi Biswas

South Atlantic Division GME Research Day 2023

No abstract provided.

Stone-Containing Meckel’S Diverticulitis As A Mimic Of Acute Appendicitis, Justin Denny, David Pardue

South Atlantic Division GME Research Day 2023

No abstract provided.