Medical Specialties Commons^™

Initial Experience Of A Community Gastroenterology Practice With Ultra-Slim Colonoscopy: A Case Series., Rajesh Essrani Md, Patrick Hickey Do, Hiral N. Shah Md, Paola Blanco Md

Department of Medicine

No abstract provided.

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

Department of Medicine

No abstract provided.

Role Of 68ga-Dodatate Pet/Ct In Staging And Management Of Gastroenteropancreatic Neuroendocrine Tumor Management - A Case Series Report., Abdul Aleem Mbbs, Patrick Hickey Do, Shashin Shah Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

No Gastrointestinal Bleed Too Obscure: A Case Series Report Of Small Bowel Phlebectasias., Abdul Aleem Md, Anam Malik Md, Patrick Hickey Do, Anastasia Shnitser Md

Department of Medicine

No abstract provided.

Angiocatheter Guided Closure Of Gastrocutaneous Fistula Tract In The Absence Of Fluoroscopy, Travis Magdaleno Md, Hiral N. Shah Md, Shashin Shah Md

Department of Medicine

No abstract provided.

Development Of Pancreatic Cancer During Novel Therapy For Head And Neck Cancer With Pembrolizumab: A Case Report, Travis Magdaleno Md, Patrick Hickey Do, Shashin Shah Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Epstein-Barr Virus Mucocutaneous Colonic Ulcer In An Immunocompetent Patient., Travis Magdaleno Md, Eric Nellis Md, Paola Blanco Md

Department of Medicine

No abstract provided.

The Use Of Palliative Performance Score In Patients With End-Stage Liver Disease, Drew Kotler, Md, Mital Shah, Md, Sheela S. Reddy, Md, Jonathan M. Fenkel, Md, John Liantonio, Md, Dina Halegoua-De Marzio, Md

Department of Medicine Posters

● Palliative Care services are often underutilized in patients with End-Stage Liver Disease (ESLD) and often only initiated at the end of life

● The Palliative Performance Score (PPS) is an important tool used in Palliative Care to assess functional status

● PPS has five functional dimensions: ambulation, activity level and evidence of disease, self-care, oral intake, and level of consciousness

● The aim of this study is to determine if there is a correlation between Model for End-Stage Liver Disease (MELD) score and PPS in ESLD patients

● MELD is used to predict mortality and to prioritize liver transplant …

Restoration Of Completely Transected Common Bile Duct Continuity Using Single Operator Cholangioscopy, Saad Emhmed Ali, Houssam Mardini, Mohsin Salih, Steven J. Krohmer, Wesam M. Frandah

Internal Medicine

Common bile duct (CBD) injury, ranging from a partial tear to a complete transection, is a major surgical complication of cholecystectomy with significant morbidity and mortality. Proper management of these complex injuries depends on the type and extent of injury and time of recognition. Identifying and repairing injuries during cholecystectomy can prevent development of complications, but this only occurs in about one-third of cases. We report a novel technique to reconnect a transected CBD with assistance of single-operator cholangioscopy.

De Novo Descending Aorta Thrombus In A Patient With Metastatic Colorectal Cancer: A Case Report, Om Parkash, Adil Ayub, Buria Naeem, Saeed Hamid

Section of Gastroenterology

Thromboembolic events in patients with cancer are frequently reported in literature and usually involve the venous circulation. De novo thrombus formation in the arterial system without any underlying atherosclerosis, dissection or aneurysm is extremely rare. We report the case of a patient with metastatic colorectal carcinoma who developed a thrombus in the descending aorta without any intervention or risk factors. The patient presented with non-specific gastrointestinal symptoms. A CT scan revealed an aortic thrombus obstructing 70% of the lumen. She opted for no treatment of her thrombus and was later complicated by extensive lower limb emboli. Patients with aortic thrombosis …

Black Esophagus With Superimposed Candida In A Patient With B Cell Lymphoma: A Case Study., Christopher Lenivy Do, Patrick Hickey Do, Adam Peyton Do

Department of Medicine

No abstract provided.

Obstetricians' And Gynecologists' Knowledge, Education, And Practices Regarding Chronic Hepatitis B In Pregnancy., Bolin Niu, Dina Halegoua-De Marzio, Jonathan M. Fenkel, Steven K. Herrine

Division of Gastroenterology and Hepatology Faculty Papers

Background: In pregnant women with high viral loads, third-trimester initiation of antiviral agents can reduce the risk of vertical transmission. We aimed to assess obstetricians' and gynecologists' (OB-GYN) knowledge and clinical practice when treating pregnant women with chronic hepatitis B virus (HBV).

Methods: All program directors (PDs) from 250 US OB-GYN residency programs were invited to anonymously complete an 18-item questionnaire. Descriptive statistics were calculated and analyzed.

Results: A total of 323 participants responded, including both PDs (n=51, response rate 21%) and residents (n=272, response rate 11%). Responding PDs (62% university-based vs. 32% community-based) came from various practice types. All …

Quality Assessment Of The Efficacy And Cost-Effectiveness Of Fecal Microbiota Transplant For Recurrent Clostridium Dfficile Infection., Eric Nellis Md, Shashin Shah Md

Department of Medicine

No abstract provided.

Covering The Cover, Wei Wu, Jingdi Chen, Qianshan Ding, Dongmei Yang, Honggang Yu, Jun Lin

Department of Medicine

Background/Aims: Endoscopic submucosal dissection has been widely accepted. At present, the number of antiplatelet (APT) users has been growing. Moreover, because of high risks of thromboembolism, some patients need to continuously receive APT agents. The relationship between hemorrhage and continuous therapy with low-dose aspirin (LDA) remains controversial.

Materials and Methods: A systematic search was conducted; studies were screened out- if data of no-anticoagulant/APT drugs use and interrupted and continued-LDA use were reported separately. The Newcastle-scale was chosen to assess the quality of the included studies. Review Manager 5.2 was used for quality assessment statistical analysis, and the odd ratio (OR) …

Gastrointestinal Bleeding From Supraduodenal Artery With Aberrant Origin, Qiong Han, Chenghao Qian, Gaby Gabriel, Steven Krohmer, Driss Raissi

Radiology Faculty Publications

Angiography and endovascular embolization play an important role in controlling acute arterial upper gastrointestinal hemorrhage, particularly when endoscopic intervention fails to do so. In our case, the patient presented with recurrent life-threatening bleed in spite of multiple prior endoscopic interventions and gastroduodenal artery embolization. Our teaching points focus on the role of angiography in acute upper gastrointestinal bleed and when to conduct empiric embolization, while reviewing the supraduodenal artery as an atypical but important potential culprit for refractory upper gastrointestinal bleed.

A Multi-Institutional Consensus On How To Perform Endoscopic Ultrasound-Guided Peri-Pancreatic Fluid Collection Drainage And Endoscopic Necrosectomy., Jintao Guo, Adrian Saftoiu, Peter Vilmann, Pietro Fusaroli, Marc Giovannini, Girish Mishra, Surinder S. Rana, Sammy Ho, Jan-Werner Poley, Tiing Leong Ang, Evangelos Kalaitzakis, Ali A. Siddiqui, Jose G. De La Mora-Levy, Sundeep Lakhtakia, Manoop S. Bhutani, Malay Sharma, Shuntaro Mukai, Pramod Kumar Garg, Linda S. Lee, Juan J. Vila, Everson Artifon, Douglas G. Adler, Siyu Sun

Division of Gastroenterology and Hepatology Faculty Papers

There is a lack of consensus on how endoscopic ultrasound (EUS)-guided pseudocyst drainage and endoscopic necrosectomy should be performed. This survey was carried out amongst members of the EUS Journal Editorial Board to describe their practices in performing this procedure. This was a worldwide multi-institutional survey amongst members of the EUS Journal Editorial Board in May 2017. The responses to a 22-question survey with respect to the practice of EUS-guided pseudocyst drainage and endoscopic necrosectomy were obtained. Twenty-two endoscopists responded to the questionnaire as follows: 72.7% (16/22) were of the opinion that lumen-apposing metal stents (LAMS) should be the standard …

Comparison Of The Diagnostic Accuracy Of Three Current Guidelines For The Evaluation Of Asymptomatic Pancreatic Cystic Neoplasms., Ming-Ming Xu, Shi Yin, Ali A. Siddiqui, Ronald R. Salem, Beth Schrope, Amrita Sethi, John M. Poneros, Frank G. Gress, Jeanine M Genkinger, Catherine Do, Christian A. Brooks, John A. Chabot, Michael D. Kluger, Thomas E. Kowalski, David E. Loren, Harry Aslanian, James J. Farrell, Tamas A. Gonda

Division of Gastroenterology and Hepatology Faculty Papers

Asymptomatic pancreatic cysts are a common clinical problem but only a minority of these cases progress to cancer. Our aim was to compare the accuracy to detect malignancy of the 2015 American Gastroenterological Association (AGA), the 2012 International Consensus/Fukuoka (Fukuoka guidelines [FG]), and the 2010 American College of Radiology (ACR) guidelines.We conducted a retrospective study at 3 referral centers for all patients who underwent resection for an asymptomatic pancreatic cyst between January 2008 and December 2013. We compared the accuracy of 3 guidelines in predicting high-grade dysplasia (HGD) or cancer in resected cysts. We performed logistic regression analyses to examine …

Structure-Based Design Of Hepatitis C Virus Vaccines That Elicit Neutralizing Antibody Responses To A Conserved Epitope, Brian G. Pierce, Elisabeth N. Boucher, Kurt H. Piepenbrink, Monir Ejemal, Chelsea A. Rapp, William D. Thomas Jr, Eric J. Sundberg, Zhiping Weng, Yang Wang

Food for Health: Publications

Despite recent advances in therapeutic options, hepatitis C virus (HCV) remains a severe global disease burden, and a vaccine can substantially reduce its incidence. Due to its extremely high sequence variability, HCV can readily escape the immune response; thus, an effective vaccine must target conserved, functionally important epitopes. Using the structure of a broadly neutralizing antibody in complex with a conserved linear epitope from the HCV E2 envelope glycoprotein (residues 412 to 423; epitope I), we performed structure-based design of immunogens to induce antibody responses to this epitope. This resulted in epitope-based immunogens based on a cyclic defensin protein, as …

Myo-Inositol Reduces Β-Catenin Activation In Colitis, Emily M. Bradford, Corey A. Thompson, Tatiana Goretsky, Guang-Yu Yang, Luz M. Rodriguez, Linheng Li, Terrence A. Barrett

Internal Medicine Faculty Publications

AIM

To assess dietary myo-inositol in reducing stem cell activation in colitis, and validate pβ-catenin^S552 as a biomarker of recurrent dysplasia.

METHODS

We examined the effects of dietary myo-inositol treatment on inflammation, pβ-catenin^S552 and pAkt levels by histology and western blot in IL-10^-/- and dextran sodium sulfate-treated colitic mice. Additionally, we assessed nuclear pβ-catenin^S552 in patients treated with myo-inositol in a clinical trial, and in patients with and without a history of colitis-induced dysplasia.

RESULTS

In mice, pβ-catenin^S552 staining faithfully reported the effects of myo-inositol in reducing inflammation and intestinal stem cell activation. In a …

Re-Tubularization Of Highly-Ischemic Anti-Mesenteric Border (Rehab): A Novel Bowel Preservation Technique In Complex Gastroschisis., Richard J. Hendrickson, Ashwini S. Poola, Katherine W. Gonzalez, Joel Lim, Tolulope A. Oyetunji

Manuscripts, Articles, Book Chapters and Other Papers

Complex gastroschisis with bowel necrosis poses an operative challenge. Surgeons must weigh the decision between resection versus preservation of ischemic bowel. As one of the leading causes of short bowel syndrome, aggressive resection in complicated gastroschisis subjects children to prolonged dependence on parenteral nutrition and its attendant complications. Herein, we describe a novel technique aimed towards bowel preservation in complex gastroschisis patients with severe bowel ischemia with the ultimate goal for enteral autonomy.

Neonatal Graves' Disease With Maternal Hypothyroidism., Gangaram Akangire, Alain Cuna, Charisse I. Lachica, Ryan T. Fischer, Sripriya Raman, Venkatesh Sampath

Manuscripts, Articles, Book Chapters and Other Papers

Neonatal Graves' disease presenting as conjugated hyperbilirubinemia is a diagnostic challenge because the differential includes a gamut of liver and systemic diseases. We present a unique case of neonatal Graves' disease in a premature infant with conjugated hyperbilirubinemia born to a mother with hypothyroidism during pregnancy and remote history of Graves' disease. Infant was treated with a combination of methimazole, propranolol, and potassium iodide for 4 weeks. Thyroid function improved after 8 weeks of treatment with full recovery of thyroid function, disappearance of thyroid-stimulating antibodies, and resolution of failure to thrive and conjugated hyperbilirubinemia. This case provides several clinical vignettes …

Endoscopic Resolution And Recurrence Of Gastric Antral Vascular Ectasia After Serial Treatment With Argon Plasma Coagulation, Shashank Garg, Bilal Aslam, Nicholas Nickl

Internal Medicine Faculty Publications

AIM

To evaluate long-term endoscopic resolution and recurrence rate of gastric antral vascular ectasia (GAVE) after argon plasma coagulation (APC) treatment.

METHODS

This was an IRB-approved retrospective single center study that included patients endoscopically treated for GAVE between 1/1/2008 to 12/31/2014. The primary and secondary end points of the study were rate of endoscopic resolution of GAVE after APC treatment and recurrence rate of GAVE after endoscopic resolution, respectively. Endoscopic resolution of GAVE was defined as no endoscopic evidence of GAVE after treatment with APC. Recurrence of GAVE was defined as endoscopic reappearance of GAVE after prior resolution.

RESULTS

Twenty …

Bioactivity Of Oral Linaclotide In Human Colorectum For Cancer Chemoprevention., David S. Weinberg, Jieru E. Lin, Nathan R. Foster, Gary Della'zanna, Asad Umar, Drew Seisler, Walter K. Kraft, David M. Kastenberg, Leo C. Katz, Paul J. Limburg, Scott A. Waldman

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Guanylate cyclase C (GUCY2C) is a tumor-suppressing receptor silenced by loss of expression of its luminocrine hormones guanylin and uroguanylin early in colorectal carcinogenesis. This observation suggests oral replacement with a GUCY2C agonist may be an effective targeted chemoprevention agent. Linaclotide is an FDA-approved oral GUCY2C agonist formulated for gastric release, inducing fluid secretion into the small bowel to treat chronic idiopathic constipation. The ability of oral linaclotide to induce a pharmacodynamic response in epithelial cells of the colorectum in humans remains undefined. Here, we demonstrate that administration of 0.87 mg of oral linaclotide daily for 7 days to healthy …

Response To Comment On Ahsan Ali Syed Et Al (J Pak Med Assoc 2017; 67: 400-404 Frequency Of Worsening Liver Function In Severe Dengue Hepatitis Patients Receiving Paracetamol: A Retrospective Analysis Of Hospital Data, Syed Ahsan Ali

Section of Gastroenterology

No abstract provided.

How An Alloreactive T-Cell Receptor Achieves Peptide And Mhc Specificity, Yuan Wang, Nishant K. Singh, Timothy T. Spear, Lance M. Hellman, Kurt H. Piepenbrink, Rachel H. Mcmahan, Hugo R. Rosen, Craig W. Vander Kooi, Michael I. Nishimura, Brian M. Baker

Food for Health: Publications

T-cell receptor (TCR) allorecognition is often presumed to be relatively nonspecific, attributable to either a TCR focus on exposed major histocompatibility complex (MHC) polymorphisms or the degenerate recognition of allopeptides. However, paradoxically, alloreactivity can proceed with high peptide and MHC specificity. Although the underlying mechanisms remain unclear, the existence of highly specific alloreactive TCRs has led to their use as immunotherapeutics that can circumvent central tolerance and limit graft-versus-host disease. Here, we show how an alloreactive TCR achieves peptide and MHC specificity. The HCV1406 TCR was cloned from T cells that expanded when a hepatitis C virus (HCV)-infected HLA-A2− individual …

Role Of Differentially Expressed Microrna-139-5p In The Regulation Of Phenotypic Internal Anal Sphincter Smooth Muscle Tone., Jagmohan Singh, Ipsita Mohanty, Sankar Addya, Benjamin Philllips, Hwan Mee Yong, Steven S. An, Raymond B. Penn, Satish Rattan

Division of Gastroenterology and Hepatology Faculty Papers

The present study focused on the role of microRNA-139-5p (miRNA-139-5p) in the regulation of basal tone in internal anal sphincter (IAS). Applying genome-wide miRNA microarrays on the phenotypically distinct smooth muscle cells (SMCs) within the rat anorectrum, we identified miRNA-139-5p as differentially expressed RNA repressor with highest expression in the purely phasic smooth muscle of anococcygeus (ASM) vs. the truly tonic smooth muscle of IAS. This pattern of miRNA-139-5p expression, previously shown to target ROCK2, was validated by target prediction using ingenuity pathway (IPA) and by qPCR analyses. Immunoblotting, immunocytochemistry (ICC), and functional assays using IAS tissues and cells subjected …

Decreasing Cost In The Gi Endoscopy Suite By Utilizing Best Sedation Practices, Casey Brianne Mancini

Doctoral Projects

Colorectal cancer is a leading cause of cancer death in the United States (Mandel, Tanner, Lichtenstein, Metz, Katzka, Ginsberg, & Kochman, 2008; Siegel, DeSantis, & Jemal, 2014). Because this lethal disease claims lives of many people every year, more patients are undergoing screening colonoscopies, which have greatly aided in decreasing the number of colorectal cancer deaths (Siegel et al., 2014). The most common form of sedation for colonoscopies is moderate sedation with a benzodiazepine and an opioid (Cohen, Hightower, Wood, Miller, & Aisenberg, 2004; Lera dos Santos, et. al., 2013). However, sedation by anesthesia providers using propofol is becoming more …

Interdependency Of Egf And Glp-2 Signaling In Attenuating Mucosal Atrophy In A Mouse Model Of Parenteral Nutrition, Yongjia Feng, Farok R. Demehri, Weidong Xiao, Yu-Hwai Tsai, Jennifer C. Jones, Constance D. Brindley, David W. Threadgill, Jens J. Holst, Bolette Hartmann, Terrence A. Barrett, Daniel H. Teitelbaum, Peter J. Dempsey

Internal Medicine Faculty Publications

BACKGROUND & AIMS: Total parenteral nutrition (TPN), a crucial treatment for patients who cannot receive enteral nutrition, is associated with mucosal atrophy, barrier dysfunction, and infectious complications. Glucagon-like peptide-2 (GLP-2) and epidermal growth factor (EGF) improve intestinal epithelial cell (IEC) responses and attenuate mucosal atrophy in several TPN models. However, it remains unclear whether these 2 factors use distinct or overlapping signaling pathways to improve IEC responses. We investigated the interaction of GLP-2 and EGF signaling in a mouse TPN model and in patients deprived of enteral nutrition.

METHODS: Adult C57BL/6J, IEC-Egfr^{knock out (KO)} and IEC-pik3r1^KO mice receiving …

Nobody Really Knows How To Perform Endoscopic Necrosectomy., Douglas G. Adler, Ali A. Siddiqui

Division of Gastroenterology and Hepatology Faculty Papers

No abstract provided.

Clinical Characteristics And Outcome Of Budd-Chiari Syndrome At A Tertiary Care Hospital In Pakistan., Om Parkash, Aysha Khan, Saeed Hamid

Section of Gastroenterology

OBJECTIVE: To determine the clinical characteristics of Budd-Chiari syndrome (BCS), its causes and outcome at a tertiary care hospital.

STUDY DESIGN: An observational study

.PLACE AND DURATION OF STUDY: The Aga Khan University Hospital,Karachi, from 2004 to 2014.

METHODOLOGY: Aretrospective analysis of data was conducted. Apredesigned questionnaire was filled from medical records of patients with BCS. Clinical features, etiology, management and outcome was noted from 2004 to 2014. Descriptive statistics were determined.

RESULTS: Forty-five patients' charts were reviewed; 26 (57.8%) were male patients. The median (IQR) age at diagnosis was 26.0 (20.5 to 34.5) years. Primary BCS was seen in …