Digestive System Diseases Commons^™

Colorectal Cancer Screening: Implementation And Evaluation Of A Screening Algorithm In A Rural Family Practice Clinic, Mollie M. Tate, Whitney Dubas

Doctor of Nursing Practice Projects: College of Nursing

Background: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the United States and disproportionately affects rural populations. Although more than 90% of cases occur in adults older than 50 years, increasing incidence among younger adults prompted an update to national guidelines recommending screening beginning at age 45. Rural residents face multiple barriers to colorectal cancer screening (CRCS), including limited access to care, transportation challenges, lack of insurance, and absence of standardized screening processes in primary care. These barriers contribute to lower screening rates, delayed diagnosis, and poorer outcomes. Evidence demonstrates that CRCS reduces CRC morbidity and …

Adaptive Leggings For Crohn’S/Colitis/Isbs Patients With A Colostomy Bag, Sarah E. Liebbe

Apparel Merchandising and Product Development Undergraduate Honors Theses

As the prevalence of inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, continues to rise in the United States, an increasing number of individuals undergo colostomy or ileostomy procedures requiring the use of an ostomy bag (Crohn’s & Colitis Foundation, 2023). While these medical devices are essential for maintaining health and quality of life, they often introduce challenges related to clothing, including discomfort, lack of support, limited concealment, and restricted self-expression (Hubbard et al., 2019). Despite growing attention to inclusive design within the fashion industry, adaptive apparel for ostomy patients remains limited in availability, style, and affordability, leaving …

Understanding The Role Of Toxs As A Bile Sensing Component Of The Toxrs Virulence Regulatory System In Vibrio Spp., Minje Kim

Dartmouth College Ph.D Dissertations

Pathogenic Vibrio bacteria, such as V. cholerae and V. parahaemolyticus, colonize in the human small intestine to cause severe gastrointestinal disease. During the infection, these bacteria encounter bile salts, antimicrobial cholesterol metabolites secreted into the intestine. Pathogenic Vibrio species have evolved to utilize bile salts as signals to regulate virulence. The signaling depends in part on ToxRS, a conserved co-component transmembrane transcription regulator. ToxRS consists of the transcription factor ToxR and its membrane-tethered binding partner ToxS. ToxS is required for ToxR stability and full transcriptional activity. Although bile salts are known to influence ToxRS-dependent virulence gene expression, the molecular …

Post-Metabolites Of Two Commensal Bacteria Suppress Dna Damage In An Experimental Model Of Acid Reflux Disease, Maanya Pradeep

Honors Undergraduate Theses

Chronic heartburn or gastroesophageal reflux disease (GERD) affects approximately 25% of the US population [1]. Repeated bile acid exposure from the regurgitation of stomach contents leads to the production of reactive oxygen species (ROS), which can cause oxidative DNA damage and promote genomic instability [2]. Barrett’s esophagus (BE), which can develop as a response to chronic bile acid exposure, increases the risk of esophageal adenocarcinoma (EAC) by 30% to 125% [1].

There are more than 18,000 new cases of esophageal cancer in the United States each year, and while its incidence is relatively low compared to other cancers, its mortality …

Investigating The Role Of Traditional Chinese Herbal Medicine For Cancer Symptom Management In Older Adults: A Rapid Review, Isabelle C. Karshner

Honors Undergraduate Theses

Background: Patients with cancer often experience symptoms related to disease, complications, and treatment. One potential method of alleviating these symptoms is traditional Chinese herbal medications (TCHM). This rapid review explores the role of traditional Chinese herbal medications in treating cancer-related symptoms in older adults.

Purpose: The purpose of this rapid review is to gain and provide a better understanding of the effects of TCHM on cancer-symptom management in the older adult population. This review explores the association between TCHM and effects on cancer symptoms in older adults, including interactions, toxicity, and signs/symptoms of TCHM use that may be useful information …

Establishment Of An In Vitro Dss-Induced Epithelial Injury Model To Investigate Il-6 Signaling And Microbial Metabolite Mediated Barrier Recovery, Srijal Kunwar

Graduate Studies Theses and Dissertations 2026

Dextran sodium sulphate (DSS) is widely used in vivo to induce epithelial injury; however, the molecular effects of DSS on intestinal epithelial cells, that investigate inflammatory and metabolic repair mechanisms remain unclear. Here, we establish an in vitro DSS-induced epithelial damage model using differentiated Caco-2 cell monolayer. Exposure to 2.5%(w/v) DSS for 24 hours resulted in significant upregulation of pore forming protein Claudin-2(2.677-fold) and oxidative marker, NOX-1(1.866-fold), accompanied by increased ROS production confirmed via DHE staining. Increased epithelial permeability was observed by TEER analysis, without significant cytotoxicity. Surprisingly, ELISA analysis revealed significant downregulation of IL-6 (p-value …

Effects Of Flavonoids On Reducing Colon Cancer Risk Via Macrophage Polarization, Gracien Jules

Graduate Theses and Dissertations

Colorectal cancer is one of the most fatal diseases in the United States. Chronic tissue inflammation can cause cell proliferation, which leads to tumor formation and cancer development. Macrophages are responsible for maintaining tissue homeostasis and for inflammatory responses. M1 macrophages exhibit proinflammatory responses while M2 macrophages exhibit anti-inflammatory responses. Imbalance between M1 and M2 macrophages is closely related to inflammation-associated disease development. The anti-inflammatory effects of apiaceous vegetable constituents, specifically flavonoids, have been studied for their preventative effects towards reducing disease risk. However, sufficient evidence is lacking on the mechanisms by which flavonoids impact M1/M2 macrophage polarization. RAW 264.7 …

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 …

Final Scholarly Project: Enhanced Recovery After Surgery (Eras) Guidelines For Pancreaticoduodenectomies, Rebecca Wheeler

Doctor of Nursing Practice Scholarly Projects

A pancreaticoduodenectomy, or Whipple procedure, is the only curative option for pancreatic cancer. For those eligible for tumor resection, the Whipple procedure is a difficult surgery for both the patient and provider. Complications following pancreaticoduodenectomy are numerous and include infection, delayed gastric emptying, high hospital costs, and pancreatic fistulas. Enhanced Recovery After Surgery (ERAS) protocols exist to provide evidence supporting standardization of practices that lead to the improvement of these patient outcomes. An ERAS protocol for the pancreaticoduodenectomy, first established in 2012, is inconsistently implemented in healthcare facilities. Researchers collected data involving the use of the Whipple procedure ERAS guidelines …

The Role Of Ucp2 In Pancreatic Cancer Metabolism And Its Potential As A Radiosensitizer, Emily Rieff

Dissertations and Theses (Open Access)

Uncoupling protein 2 (UCP2) is a mitochondrial protein that regulates the flow of protons down the gradient established by the electron transport chain (ETC) without generating ATP, thus uncoupling the proton gradient from ATP generation. In tumors, specifically pancreatic cancer (PDAC), the ETC is highly stimulated to generate the copious ATP needed by the tumor to grow. However, extended ETC use increases reactive oxygen species (ROS), and if left unchecked, results in cell death. To evade this, PDAC employs antioxidant strategies, including upregulating UCP2 in tumor cells. In addition to its uncoupling function, UCP2 indirectly controls ROS levels by maintaining …

The Role Of Myosin 5b In Intestinal Health And Disease: From Microvilli Assembly To Colorectal Cancer Progression, Sarah Aline Dooley

MUSC Theses and Dissertations

Background: Myosin Vb (Myo5b) is an essential molecular motor responsible for delivering diverse cargo to the apical membrane of enterocytes. Mutations in Myo5b cause congenital enteropathies, but its broader role in maintaining the integrity of the intestinal brush border under normal physiological conditions and in disease remain unclear. We hypothesize that Myo5b participates in the assembly and maintenance of the intestinal brush border by transporting members of the intermicrovillar adhesion complex (IMAC) and the xenobiotic efflux pump P-glycoprotein (P-gp) to the apical membrane of enterocytes. We further hypothesize that dysregulation of the myosin chaperone protein, UNC45A, and downregulation of Myo5b …

Therapeutic Roles For Alkaline Phosphatases To Target Intestinal Dysfunction In Mouse Models Of Experimental Sepsis And Ischemic Stroke, Rhiannon V. Macom

Graduate Theses, Dissertations, and Problem Reports (ETD)

Abstract

Therapeutic Roles for Alkaline Phosphatases to Target Intestinal Dysfunction in Mouse Models of Experimental Sepsis and Ischemic Stroke

Rhiannon V. Macom

Stroke is a disease that primarily affects the brain; however, ongoing research continues to show that stroke has far reaching systemic effects that can affect both short- and long-term recovery. The gastrointestinal tract has been shown to be affected post-stroke, and these effects are likely due to the bidirectional communication between the gut and the brain via the gut-brain-axis. Alkaline phosphatases (APs) are common membrane bound enzymes that are known to have a role in mitigating inflammation. The …

Opioid Tolerance And Withdrawal In The Mouse Colon, James Fune

Theses and Dissertations

Constipation is a major clinical obstacle associated with opioids, prompting patients to discontinue treatment due to pain, discomfort, and psychosocial stressors. Moreover, chronic users become tolerant to the analgesic effects of opioids, but not to their constipating effects. Upon cessation of long-term treatment, serious diarrhea–among other somatic signs of withdrawal–may ensue. These symptoms become a driving factor for relapse, causing patients to restart opioid treatment. In this study, we aim to understand mechanisms that contribute to opioid tolerance and withdrawal in the colon. Previous findings suggest that constipation occurs partly due to the colon’s lack of tolerance to opioids’ inhibitory …

Pancreatic Cancer In Appalachia: An Examination Of Detection, Associated Factors, And Provider Experiences With A Focus On West Virginia, Melissa Mae Elder

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Pancreatic Cancer in Appalachia: An Examination of Detection, Associated Factors, and Provider Experiences with a Focus on West Virginia

Melissa M. Elder

Introduction: The Appalachian population accounts for a substantial proportion of the United States and are uniquely susceptible to health care disparities. The Appalachian Regional Commission has reported on the inequities found within the Appalachian region as part of its formal establishment in 1965. When compared to the Non-Appalachian U.S., Appalachia experiences a higher incidence of chronic disease such as diabetes, cancer, lung, and liver disease; mortality from diseases of despair constituting prescription drug, alcohol, illegal drug use, …

Best Practice Toolkit For Increasing Colorectal Cancer Screenings In At-Risk Adults, Zoe Windfelder

Student Scholarly Projects

Adult individuals at risk for colorectal cancer (CRC) do not have a direct, accessible best-practice toolkit to follow for screening measures. Research showed that at least three guidelines (i.e., American Cancer Society [ACS], American College of Gastroenterology [ACG], and U.S. Preventive Services Task Forces [USPSTF]) are used interchangeably daily by interprofessional staff for individuals with average to high-risk variables. The project was guided by the following PICOT question: For interprofessional staff supporting the at-risk adult population for colorectal cancer (P), how does the development of a best practice for coordination of care toolkit (I) compared to no structured program strategy …

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 …

Red Raspberries Attenuate Blood Glucose Spike Of A High Glycemic Load Breakfast Cereal, Dante J. Martin

Master's Theses

Blood glucose (BG) spikes increase chronic disease risk in those with and without diabetes. The fiber and phytonutrient content of fruit, such as raspberries has the potential to attenuate the BG spike of a high glycemic load (HGL) meal. We examined the effect of red raspberries (RRs) on the BG spike when added to a HGL meal. In this randomized cross-over trial, 16 university students were given breakfast cereal and almond milk (control), the control breakfast with 140g added RRs, and the control breakfast with sugar equivalent to the sugar content of the RRs (50% sugar increase from control). Meals …

The Role Of B Cell Activation State And Sex In Aryl Hydrocarbon Receptor Mediated Induction Of Chemokine Receptor 9 And Alpha4beta7 Expression In Vitro, Logan Bauerle

Master's Theses

Defense of mucosal tissues from microbial infection and allergy is reliant on continual production of antibodies. The aryl hydrocarbon receptor (AhR) is known to regulate B cell development and is associated with suppression of systemic humoral immunity. Recent attention has been paid to the role of the AhR in altering expression of cell adhesion molecules (CAMs). B cells express CAMs and chemokine receptors to migrate around the body for localized secretion of antibodies. AhR agonists promote B cell migration to the small intestine through upregulation of chemokine receptor 9 (CCR9) and integrin α₄β₇. Both the AhR …

Interrogating Therapeutic Resistance To Oncogenic Krasg12c-Based Therapies In Colorectal Cancer, Oluwadara Coker

Dissertations and Theses (Open Access)

Colorectal cancer is the second leading cause of cancer-related deaths and the third most common cancer in the United States. Although KRAS is mutated in 50% of patients with metastatic CRC (mCRC), it has historically been a challenging therapeutic target. The recent approval of novel covalent inhibitors selective for KRASG12C mutation have entered the clinic, which has not only marked a major milestone in cancer drug discovery but has also intensified efforts to directly target other KRAS mutations that have also successfully entered the clinic. However, treatment-associated resistance mechanisms have long threatened to attenuate clinical benefit through either adaptive or …

Advancing School Nursing Practice: A Novel Approach To Screening For Gastrointestinal Disorders In Children, Ashley Bunting, Isabella Cavlan

Nursing | Senior Theses

Background: Currently, mandated health screenings in California schools are limited to vision, hearing, and scoliosis; this leaves several other body systems unmonitored during the crucial years of childhood development. One such system is the gastrointestinal (GI) system, which plays a vital role in the normal growth, nutrition status, development, and overall health of children. Objective: By developing and implementing a GI-specific screening tool in the outpatient school setting, this research aims to increase the detection of GI disorders in children. Not only that, but school nurses can use this novel screening tool to promote early diagnosis, intervention, and …

Associations Among Psychosocial Factors, Health-Related Quality Of Life, And Adherence In Pediatric Inflammatory Bowel Disease, Cecelia I. Nelson

Graduate Theses, Dissertations, and Problem Reports (ETD)

Inflammatory Bowel Disease (IBD) is a prevalent disorder among youth in the United States. IBD is one of the leading causes of chronic pain in adolescence and symptoms can lead to reduced quality of life, social embarrassment, and lower self-esteem. Adherence to medical regimens for IBD is incredibly important to prevent morbidity, mortality, and impaired health-related quality of life (HRQOL). However, adolescents struggle generally with adherence and the regimen for IBD can be complicated and include aversive side effects. Psychological factors, such as depressive symptoms, are key factors associated with non-adherence. Nevertheless, gut-specific anxiety (GSA) is a psychological factor that …

Clostridioides Difficile: Identification Of Rival Organisms & Evaluation Of Non-Antibiotic Treatment Implementation, Justin Davis

Honors Undergraduate Theses

Clostrioides difficile is a common cause of nosocomial (hospital-acquired) infections. Patients receiving antibiotic treatment experience dysbiosis of gut microbiota, and C. difficile, normally held in check by the various other organisms, takes this opportunity to propagate. Symptoms of infection generally include diarrhea, colitis, dehydration, and fever. Understanding that C. difficile generally only causes illness when it is the dominant bacterium (i.e. when growth is relatively unchecked by other microbes), it is appropriate to investigate potential competitive organisms that may be introduced after antibiotic courses or during active C. difficile infection to effectively displace it. Fecal samples from the University …

A Comprehensive Program Evaluation Of Colorectal Rescreening Initiatives In Rural Virginia, Sarah E. Stowell

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Background: Despite low-cost and effective screening tools, colorectal cancer (CRC) mortality remains high in the U.S., particularly in rural areas like Virginia’s Northern Shenandoah Valley, where screening rates are low. While literature highlights barriers to CRC screening in these communities and suggests improvement strategies, few studies focus on long-term adherence to screening in rural health clinics (RHCs).

Purpose: This program evaluation assessed the impact and effectiveness of the Rural Colorectal Cancer Rescreening Initiative (RCRI), a pilot program to increase colorectal cancer rescreening rates in a local RHC. It also offers recommendations for optimizing future RCRI efforts. Methods: The program evaluation …

Intestinal Microbiome, Fecal Fermentation Profile, And Health Indices In Hiv Infected Men Versus Non-Infected Controls, Mary Andreae, Mary C. Andreae Mrs

Electronic Theses and Dissertations

Many HIV-positive (HIV+) males on Highly Active Anti-Retroviral Therapy (HAART) experience metabolic abnormalities, including Non-Alcoholic Fatty Liver Disease (NAFLD) and lipodystrophy. The intestinal microbiota and short chain fatty acids (SCFA), participate in bidirectional communication with their host. Dysbiosis in HIV+ males on HAART demonstrate a Prevotella-rich enterotype shaped by multiple factors including, medications, adiposity, diet, intestinal permeability, and lifestyle; our objective was to investigate these factors. 19 HIV+ and 21 HIV- males were enrolled. BMI and hip-to-waist ratio (H:W) were obtained, and FibroScan for liver health. Intestinal permeability markers Claudin-21, flagellin, and intestinal fatty acid binding protein (IFABP) in …

Cystic Duct Morphology And Heister Valves: A Cadaveric Study, Cierra R. Goerish

Theses & Dissertations

Continued occurrence of cholelithiasis, gallstones, commonly results in cholecystectomy, removal of the gallbladder. Having a comprehensive anatomical, histological, and physiological knowledge of the biliary apparatus is imperative in clinical medicine today. Additionally, the functionality of cystic duct (CD) Heister valves (HV) has been speculatory since being reported in 1732. This study summarizes the morphology, orientation, and variability of the gross biliary system and provides data to help justify HV functionality.

Cadaveric dissection was utilized for gross observation and analysis of the biliary system. The angulation of the CD was found primarily as an acute angle; however, obtuse angulation could be …

Mechanisms Of Mutated Myosin Vb Mediated Cholestasis In Microvillus Inclusion Disease, Melissa S. Holzapfel

Theses & Dissertations

Microvillus inclusion disease (MVID) is a constitutive intestinal epithelial disease which causes definitive intestinal failure and cholestatic liver disease primarily caused by mutations in the Myosin Vb gene. Genotype-clinical phenotype associations suggest that the progression of liver disease can be predicted through a correlation between myosin Vb residual function and variable retention of bile salt transport machinery in intestinal enterocytes and liver hepatocytes. We proposed that aberrant distribution of bile salt transport proteins disrupts enterohepatic regulation of bile acids and contributes to the progression of cholestatic liver disease. To investigate the genotype-phenotype correlation, samples from MVID patients were evaluated for …

Short Term Medical Mission Gerd And Ulcer Treatment Guideline, Robin Risky

Doctor of Nursing Practice Projects

The United States conducts over 6,000 international medical mission trips each year. The short-term nature of these trips, unfamiliarity with the patient population, language barriers, limited resources, and inadequate staff training are just some of the factors that make it challenging to provide quality care. One way to avoid doing harm is to follow evidence-based guidelines when treating common conditions. This quality improvement project sought to provide an evidence-based protocol for short-term medical missions (STMMs), guiding providers and pharmacy staff on the treatment of GERD and peptic ulcer. This project was implemented in a rural health clinic at the Land …

Inhibiting Survival Of Salmonella During Desiccation Through The Use Of Naturally Occurring Signals, Joseph Headrick

Electronic Theses and Dissertations

A rising problem in agriculture is the increase of antibiotic-resistant Salmonella cases associated with chicken eggs, which transmit infection to humans. To counter this, new approaches to combat Salmonella in chickens and desiccated on eggshells are vital in the prevention of human foodborne illness. Disrupting signaling pathways with naturally occurring compounds provides a potential novel avenue for prevention of Salmonella infections, as this would disrupt sensing of these environments and inhibit subsequent optimal gene expression. Starting with signals identified in previous studies, salicylic acid was found to inhibit Salmonella desiccation survival on both eggshells and plastic. To expand upon this, …

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, …

The Effects Of A Low Fodmap Diet On People With Irritable Bowel Syndrome: A Literature Review, Emily Stalder

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Irritable Bowel Syndrome (IBS) is a very common gastrointestinal disorder around the world. There is no known etiology or cure for the disorder, which leaves researchers to develop coping mechanisms for this prevalent issue. A high percentage (10%-15%) of the general population, mostly in Western, industrialized areas, suffer from IBS. A low FODMAP diet (LFD) is something that has been gaining a following over the past 20 years, which has led to research on its ability to minimize symptoms of IBS. The purpose of this literature review is to see what current research has to offer on the LFD’s ability …