Digestive System Diseases Commons^™

The Role Of Liver Macrophages In Viral Liver Pathogenesis, Alexis Brantly, Kyle Yeakle, Michael J. Bouchard, Peter J. Gaskill, Michael R. Nonnemacher

Kimmel Cancer Center Faculty Papers

Liver macrophages play important roles in the pathophysiology of liver fibrosis and hepatocellular carcinoma. However, liver macrophages are a heterogenous population and have differing roles in maintenance of liver function and response in disease. In a healthy liver, macrophages play a critical role in antigen processing, maintaining tolerance to the high levels of gut-derived bacterial products, and regulating inflammation through cytokine response. However, macrophages also play a critical role in liver pathology, specifically in the context of viral infection. The liver is targeted by multiple viruses, including human immunodeficiency virus, hepatitis B virus, and hepatitis C virus, which dysregulate macrophage …

Efficacy Of Infliximab Versus Vedolizumab In The Management Of Immune Checkpoint Inhibitor-Induced Colitis: A Systematic Review And Meta-Analysis., Shreya Shambhavi, Harmanjeet Singh, Ganesh Ramaprasad, Murod Khikmatov, Varun Vankeshwaram, Kumar Ashish, Carlos Valladares, Tanushree Bhatt, Seth D Cohen

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Immune checkpoint inhibitors (ICIs) can cause severe gastrointestinal immune-related adverse events (irAEs), often leading to treatment interruption and increased morbidity. Immune-mediated colitis (IMC) ranges from mild diarrhea to life-threatening colitis, sometimes requiring urgent intervention. While corticosteroids are the first-line treatment, selective immunosuppressive therapy (SIT) with either infliximab or vedolizumab is used for steroid-refractory or dependent cases. However, standardized practices are lacking, and treatment decisions are largely left to provider discretion. This study compares infliximab and vedolizumab for IMC, focusing on remission rates, recurrence, SIT dosing, and systemic steroid exposure duration.

METHODS: We identified six retrospective cohort studies that compared …

The Need For Targeted Prevention And Screening In Gastrointestinal Cancer Disparities, Jason C. Lin, John C. Lin, Joy Zhao

Division of Gastroenterology and Hepatology Faculty Papers

No abstract provided.

An Integrative Genomics Approach For The Discovery Of Potential Clinically Actionable Diagnostic And Prognostic Biomarkers In Colorectal Cancer, Mark Fertel, Duaa Mohammad Alawad, Chindo Hicks

School of Graduate Studies Faculty Publications

Background: Despite remarkable progress in clinical management of patients and intensified screening, colorectal cancer remains the second most common cause of cancer-related death in the United States. The recent surge of next generation sequencing has enabled genomic analysis of colorectal cancer genomes. However, to date, there is little information about leveraging gene expression data and integrating it with somatic mutation information to discover potential biomarkers and therapeutic targets. Here, we integrated gene expression data with somatic mutation information to discover potential diagnostic and prognostic biomarkers and molecular drivers of colorectal cancer. Methods: We used publicly available gene expression and somatic …

Increasing Colorectal Cancer Screening Rates For Patients Without Insurance, Andrea F. Day

Doctor of Nursing Practice Projects

Background: Colorectal cancer is a leading cause of cancer-related death in the United States (U.S.), ranking as second most prevalent overall. Despite many initiatives, screening rates remain low, especially among clinic patients without insurance. The lack of an evidence-based screening protocol exacerbates these issues and increases the risk of advanced cancer and death. Initial data showed that 0% of patients were screened according to recommended guidelines.

Purpose: The project implemented a standard screening protocol to increase colorectal cancer screening rates in a rural Alabama free clinic for patients ages 45-64 lacking insurance.

Project Design: This quality improvement …

Colorectal Cancer And The Risk Of Mortality Among Individuals With Suicidal Ideation, Srikanta Banerjee, Jagdish Khubchandani, Stanley Nkemjika

Department of Psychiatry and Human Behavior Faculty Papers

Suicide is a major public health problem that has grown at alarming rates in the last two decades. Colorectal cancer (CRC) is one of the most common causes of cancer deaths in the United States in both males and females. However, the influence of suicidal ideation (SI) on the association between CRC and risk of mortality has not been well examined.

METHODS: For this study, the 2005-2018 National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of United States adults aged 20 years or older, was utilized. CRC survivorship was determined from self-reported data on CRC, and mortality …

Clinical Outcomes For Smokers With Early-Onset Colorectal Cancer: An Analysis Of The National Inpatient Sample, Matthew Ebrahim, Tony Elias, Sonika Vatsa, Yarin Trabelsi, Kyrillos Girgis, Taha Syed, Rafail Beshai

Rowan-Virtua Research Day

We sought to examine the national inpatient sample database to describe in-hospital outcomes among smokers with EOCRC. The NIS was searched for hospitalizations of adult patients with EOCRC, defined as all-cause colorectal cancer in patients 50 years old or younger. In this nationally representative population‐based retrospective cohort study, hyperlipidemia was associated with higher mortality.

Clinical Implications Of Mismatch Repair Deficiency In Pancreatic Ductal Adenocarcinoma, Zachary Kaplan, Elizabeth Prezioso, Aditi Jain, Harish Lavu, Charles Yeo, Wilbur Bowne, Avinoam Nevler

Kimmel Cancer Center Faculty Papers

BACKGROUND: Pancreatic cancer is a highly aggressive and lethal disease, characterized by a limited response to chemotherapy and overall poor prognosis. Pancreatic cancers with a distinct mismatch repair deficiency, although relatively rare, have been shown to be associated with markedly better outcomes in comparison. Furthermore, whereas pancreatic cancers are generally unresponsive to current immunotherapy, this specific group of tumors has been shown to have a notable susceptibility to immune checkpoint inhibitors.

AIMS: In this review, we aim to summarize the relevant literature regarding mismatch-repair associated pancreatic cancers, the impacted biological mechanisms, and the resulting vulnerabilities for potential opportunistic immunotherapeutic treatment …

The Association Of Physical Activity With Survival In Colon Cancer Versus A Matched General Population: Data From Cancer And Leukemia Group B 89803 And 80702 (Alliance)., Justin C. Brown, Chao Ma, Qian Shi, Leonard B. Saltz, Anthony F. Shields, Jeffrey A. Meyerhardt

School of Medicine Faculty Publications

Background: Colon cancer patients have inferior overall survival than a matched general population (MGP). It is unknown if physical activity is associated with a reduction in this survival disparity. Methods: Data were analyzed from two National Cancer Institute–sponsored postoperative treatment trials in stage III colon cancer, Cancer and Leukemia Group B (CALGB) 89803 and 80702, with 2876 patients who self-reported physical activity. Physical activity was converted to metabolic equivalents (MET-hours/week). The MGP was derived from the National Center for Health Statistics and matched on age, sex, and year. Results: In CALGB 89803, among patients who were alive at 3 years, …

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 …

Hearts Hidden Message: Right Ventricular Thrombus Reveals Esophageal Adenocarcinoma, Devika Adusumilli, Seline Haci, Jafri Imran, Arman Vaghefi, Mehdi Khalafi, Ikponmwosa Iyamu, Sarvanan Balamuthusamy

North Texas Research Forum 2025

Introduction Right ventricular thrombi are uncommon, usually found with concurrent pulmonary emboli and associated with significant mortality. They often originate from deep vein thrombi but may also be due to primary intracardiac processes . A right ventricular thrombus can be an unexpected marker for underlying malignancies, including esophageal cancer. This occurs due to the hypercoagulable state often induced by malignancy. Here we report a presentation where the identification of a right ventricular thrombus led to the diagnosis of esophageal cancer. Case Presentation Our patient is a 57-year old male with no past medical history who experienced an episode of dizziness …

Atypical Hemorrhoid Or Hidden Malignancy? Anal Melanoma And Palliative Strategies, Osamuyi Asemota, Kayla Brown, Megan Turley

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Pseudomyxoma Peritonei As Initial Presentation Of Mucinous Appendiceal Adenocarcinoma, Rajiv Shah, Iren Shabanova, Radhika Mohan, Sirin Khajaviyan, David Ortega, Pooja Paunikar, Dennis Besong, Mitul Patel, Valerie Sinkler

South Atlantic Division GME Research Day 2025

No abstract provided.

Prevelence Odds Of Melanoma In Patients With Inflammatory Bowel Disease: An Observational Cross-Sectional Study, Nilay Bhatt, Kumail Rizvi

Gulf Coast Division GME Research Day 2025

No abstract provided.

Large Mesenteric Cyst Casting Wide Differential Across Specialties, Jessica Harper, Katherine Kleinberg, Jose S. Saldivar

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Liver Metastasis Of Immature Teratoma And Portal Vein Embolization: A Case Report, Rohan Gupta

Gulf Coast Division GME Research Day 2025

No abstract provided.

What Newly Updated Variables Are Correlated With Colon Cancer Incidence And Death Rates In Florida?, Cody Steed, Julia Fashner

East Florida Division GME Research Day 2025

No abstract provided.

A 40 Year Journey: Adenocarcinoma In A J Pouch Post Prophylactic Surgery For Fap, Osamuyi Asemota, Kayla Brown, Megan Turley, David Fleeger

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

When Leukemia Takes A Bite: Unusual Gastric Involvement In B-All, Supritha Chintamaneni, Bilal Ashraf, Sushovan Guha

Gulf Coast Division GME Research Day 2025

No abstract provided.

Improving Colon & Rectal Cancer Screening At Medical City North Hills Clinic, Basil Nduma, Sharvani Raguthu, Gurunath Subrahmanyam, John Sturgeon

North Texas Research Forum 2025

Introduction: Colorectal cancer (CRC) is the third leading cause of cancer-related deaths globally. Despite its severity, fewer than half of eligible Americans undergo annual screening. The U.S. Preventive Services Task Force (USPSTF) recommends CRC screening from age 45 to 75, with personalized assessments for those aged 76 to 85. The current CRC screening rate at the Medical City North Hills Internal Medicine Residents’ Clinic is 9.3%, significantly below the target rate of over 66%. Objective: This project aimed to increase the CRC screening rate from 9.3% to over 66% at the Medical City North Hills Internal Medicine Residents Clinic, in …

Robotic Whipple Procedure, Chris Robert, Soomal Memon, Umar Butt, Furrukh Jabbar

North Texas Research Forum 2025

Introduction: Pancreatic cancer is an aggressive tumor with surgery being the corner stone of multidisciplinary treatment. Pancreaticoduodenectomy is a technically demanding procedure associated with significant morbidity. Case presentation: 70-year-old man with a past history of hypertension presented with jaundice, dark urine and a total bilirubin of 24. His CT scan showed biliary and pancreatic ducal dilation. An EUS revealed a 2cm pancreatic mass with an intact interface between the mass and splenoportal confluence, the biopsy was suggestive of poorly differentiated adenocarcinoma. We performed a Robotic Whipple procedure. Robotic Whipple surgery is superior in meticulous dissection of the retro pancreatic tunnel. …

Clinical Presentation And Management Of Littoral Cell Angioma: A Case Report, Rebecca Ashton Taylor, Steven Carpenter

South Atlantic Division GME Research Day 2025

No abstract provided.

A Case Of An Undocumented Immigrant With Rectal Adenocarcinoma, Rajiv Shah, Nizar Hallak, Selent Cameron

South Atlantic Division GME Research Day 2025

No abstract provided.

Assessing Influence Of Mismatch Repair Mutations On Survival In Patients After Resection Of Pancreatic Ductal And Periampullary Adenocarcinoma, Elizabeth Prezioso, Eleanor Mancheski, Kylee Shivok, Zachary Kaplan, Wilbur Bowne, Aditi Jain, Harish Lavu, Charles Yeo, Avinoam Nevler

Kimmel Cancer Center Faculty Papers

Background: Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related deaths in the United States. Previous studies have indicated that microsatellite instability and deficient mismatch repair (MMR) may be associated with improved survival in patients with pancreatic cancer. Here, we aim to investigate the impact of deficient MMR (dMMR) status on oncologic outcomes in patients after resection of PDAC and periampullary adenocarcinoma. Methods: This is a single-institution, retrospective study based on a prospectively maintained database. Pancreatic ductal adenocarcinoma (N = 342) and periampullary adenocarcinoma patients (N = 76) who underwent pancreatic resection surgery between 2016 and 2021 were …

Molecular And Clinical Features Of Pancreatic Acinar Cell Carcinoma: A Single-Institution Case Series, Ashwathy Balachandran Pillai, Mahmoud Yousef, Abdelrahman Yousef, Kristin D Alfaro-Munoz, Brandon G Smaglo, Jason Willis, Robert A Wolff, Shubham Pant, Mark W Hurd, Anirban Maitra, Huamin Wang, Matthew Harold G Katz, Laura R Prakash, Ching-Wei D Tzeng, Rebecca Snyder, Luca F Castelnovo, Anthony Chen, Andrey Kravets, Kseniia Kudriavtseva, Artem Tarasov, Kirill Kryukov, Haoqiang Ying, John Paul Shen, Dan Zhao

Faculty, Staff and Student Publications

Objectives: Acinar cell carcinoma (ACC) accounts for about 1% of pancreatic cancers. The molecular and clinical features of ACC are less characterized than those of pancreatic ductal adenocarcinoma. Methods: We retrospectively evaluated the clinical and molecular features of ACC patients who underwent germline and/or somatic molecular testing at The University of Texas MD Anderson Cancer Center from 2008 to 2022 and two cases from 2023-2024 who underwent RNA and TME analysis by Boston Gene. Patient information was extracted from our institutional database with the approval of the Institutional Review Board. Results: We identified 16 patients with available molecular testing …

Cd8Α Structural Domains Enhance Gucy2c Car-T Cell Efficacy, Trevor R. Baybutt, Ariana A. Entezari, Adi Caspi, Ross E. Staudt, Robert D. Carlson, Scott A. Waldman, Adam E. Snook

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

Despite success in treating some hematological malignancies, CAR-T cells have not yet produced similar outcomes in solid tumors due, in part, to the tumor microenvironment, poor persistence, and a paucity of suitable target antigens. Importantly, the impact of the CAR components on these challenges remains focused on the intracellular signaling and antigen-binding domains. In contrast, the flexible hinge and transmembrane domains have been commoditized and are the least studied components of the CAR. Here, we compared the hinge and transmembrane domains derived from either the CD8ɑ or CD28 molecule in identical GUCY2C-targeted third-generation designs for colorectal cancer. While these structural …

Concurrent Challenges: New-Onset Type 2 Diabetes And Invasive Pancreatic Adenocarcinoma: A Case Report, Abhishekh Pokhrel, Alexa Lissete Zarate, Sobia Hassan Memon, Everardo Cobos

Research Colloquium

Background: Pancreatic adenocarcinoma is a highly aggressive cancer with a five-year survival rate of about 10%, and is the third leading cause of cancer-related deaths in the United States. Approximately 53% of patients are diagnosed at stage IV, characterized by distant metastasis to common sites such as the liver and lungs. Liver metastases occur in 60-70% of metastatic cases, while lung metastases are seen in 10-15% of patients. The median survival for stage IV patients is typically around 3 to 6 months, with current treatments primarily focused on palliation. Advances in chemotherapy offer modest survival benefits, but early detection and …

Artificial Intelligence-Based Segmentation Of Residual Pancreatic Cancer In Resection Specimens Following Neoadjuvant Treatment (Isgpp-2): International Improvement And Validation Study, Boris V Janssen, Bart Oteman, Mahsoem Ali, Pieter A Valkema, Volkan Adsay, Olca Basturk, Deyali Chatterjee, Angela Chou, Stijn Crobach, Michael Doukas, Paul Drillenburg, Irene Esposito, Anthony J Gill, Seung-Mo Hong, Casper Jansen, Mike Kliffen, Anubhav Mittal, Jas Samra, Marie-Louise F Van Velthuysen, Aslihan Yavas, Geert Kazemier, Joanne Verheij, Ewout Steyerberg, Marc G Besselink, Huamin Wang, Caroline Verbeke, Arantza Fariña, Onno J De Boer, Pancreatobiliary And Hepatic Artificial Intelligence Research (Phair) Consortium, International Study Group Of Pancreatic Pathologists (Isgpp);

Faculty, Staff and Student Publications

Neoadjuvant therapy (NAT) has become routine in patients with borderline resectable pancreatic cancer. Pathologists examine pancreatic cancer resection specimens to evaluate the effect of NAT. However, an automated scoring system to objectively quantify residual pancreatic cancer (RPC) is currently lacking. Herein, we developed and validated the first automated segmentation model using artificial intelligence techniques to objectively quantify RPC. Digitized histopathological tissue slides were included from resected pancreatic cancer specimens from 14 centers in 7 countries in Europe, North America, Australia, and Asia. Four different scanner types were used: Philips (56%), Hamamatsu (27%), 3DHistech (10%), and Leica (7%). Regions of interest …

Understanding The Role Of Mastl In Colon Homeostasis And Colitis-Associated Cancer Development, Kristina Pravoverov

Theses & Dissertations

Colitis-associated cancer (CAC) is the most devastating complication of longstanding inflammatory bowel disease (IBD). Understanding the mechanisms underlying the switch from damage-repair to dysplasia in IBD is critical for identifying novel therapies to facilitate mucosal healing while mitigating CAC risk. Microtubule-associated serine-threonine kinase-like (MASTL), though crucial in cell growth and repair, is upregulated in sporadic colorectal cancer and CAC. This study sought to delineate the role of MASTL in colitis and CAC development.

First, we examined whether MASTL is associated with colitis and recovery. Review of publicly available data found significant elevation of MASTL and interleukin (IL)-22 in biopsies from …

Global Prevalence Of Metabolic Dysfunction-Associated Fatty Liver Disease-Related Hepatocellular Carcinoma: A Systematic Review And Meta-Analysis, Harry Crane, Guy D Eslick, Cameron Gofton, Anjiya Shaikh, George Cholankeril, Mark Cheah, Jian-Hong Zhong, Gianluca Svegliati-Baroni, Alessandro Vitale, Beom Kyung Kim, Sang Hoon Ahn, Mi Na Kim, Simone I Strasser, Jacob George

Faculty, Staff and Students Publications

BACKGROUND/AIMS: The global proportion of hepatocellular carcinoma (HCC) attributable to metabolic dysfunction-associated fatty liver disease (MAFLD) is unclear. The MAFLD diagnostic criteria allows objective diagnosis in the presence of steatosis plus defined markers of metabolic dysfunction, irrespective of concurrent liver disease. We aimed to determine the total global prevalence of MAFLD in HCC cohorts (total-MAFLD), including the proportion with MAFLD as their sole liver disease (single-MAFLD), and the proportion of those with concurrent liver disease where MAFLD was a contributary factor (mixed-MAFLD).

METHODS: This systematic review and meta-analysis included studies systematically ascertaining MAFLD in HCC cohorts, defined using international expert …