Medical Specialties Commons^™

A Review Of Barrett's Esophagus, Suzanne M. Zayan

Physician Assistant Scholarly Project Posters

Barrett’s Esophagus is a premalignant condition that predisposes patients to the development of esophageal adenocarcinoma.

•Esophageal adenocarcinoma dramatically rising over several decades; survival rates of less than 17% in a five year period.

•Management and treatment continues to evolve: use of radio-frequency ablation effective to treat low grade dysplasia

•Studies of risk factors and treatment options explored:

Efficacy and durability of endoscopic radiofrequency ablation for treatment of low grade dysplasia as option for metaplasia eradication

–Gastrointestinal pathologist expert reviews ensure identification of dysplasia prior to treatment
–Appropriate endoscopic surveillance intervals
–Gastroenterology guidelines for screening and surveillance for long term management …

Screening Of Exosomal Micrornas From Colorectal Cancer Cells, Cillian Clancy, Sonja Khan, Claire L. Glynn, Emma Holian, Peter Dockery, Pierce Lalor, James A.L. Brown, Myles Joyce, Michael J. Kerin, Roisin M. Dwyer

Forensic Science Publications

BACKGROUND: Cells release extracellular membrane vesicles including microvesicles known as exosomes. Exosomes contain microRNAs (miRNAs) however the full range within colorectal cancer cell secreted exosomes is unknown. OBJECTIVE: To identify the full range of exosome encapsulated miRNAs secreted from 2 colorectal cancer cell lines and to investigate engineering of exosomes over-expressing miRNAs. METHODS: Exosomes were isolated from HCT-116 and HT-29 cell lines. RNA was extracted from exosomes and microRNA array performed. Cells were engineered to express miR-379 (HCT-116-379) or a non-targeting control (HCT-116-NTC) and functional effects were determined. Exosomes secreted by engineered cells were transferred to recipient cells and the …

Clinical Practice Guidelines On The Management Of Variceal Bleeding, Javed Iqbal Farooqi, Hasnain Ali Shah, Anwaar A. Khan, Amjad Salamat, Altaf Alam, Abbas Khan Khattak, Nazish Butt, Muhammed Salih, Sher Sher Rehman, Arif Amir Nawaz, Nasir Khokhar, Ghias-Un-Nabi Tayyab, Javed Aslam Butt, Kashif Malik, Shakeel Ahmad Mirza, Mohammad Akram

Department of Medicine

Gastroesophageal variceal bleeding occurs in 30 - 50% of patients of liver cirrhosis with portal hypertension, with 20-70% mortality in one year. Therefore, it is essential to screen these patients for varices and prevent first episode of bleeding by treating them with β-blockers or endoscopic variceal band ligation. Ideally, the patients with variceal bleeding should be treated in a unit where the personnel are familiar with the management of such patients and where routine therapeutic interventions can be undertaken. Proper management of such patients include: initial assessment, resuscitation, blood volume replacement, vasoactive agents, prevention of associated complications such as bacterial …

Electrophysiological Changes In Patients With Liver Cirrhosis In A Tertiary Care Hospital In Karachi, Pakistan, Om Parkash, Ghulam Rehman Mohyuddin, Adil Ayub, Irfan Nazir, Arslan Arif Maan, Saeed Hamid

Section of Gastroenterology

Background: Electrophysiological changes in cirrhosis are well known but least investigated especially in our country hence we wanted to see electrophysiological changes especially QT interval in cirrhotic patients.

Methods: A cross-sectional study was conducted at Aga Khan University Hospital Karachi (AKUH) in which medical records (duration 2008-2010) of cirrhotic patients were reviewed.

Results: Three hundred and eighty cirrhotic patients' charts were studied, 227 (59.7 %) were male and mean age of this cohort was 52.8±12.6 years. The most common cause for CLD was Hepatitis C (CHC) in 260 (68.4%), NBNC in 56(14.7%) and HBV in 51 (13.4%). Only 225 …

Selective Induced Altered Coccidians To Immunize And Prevent Enteritis, Helieh S. Oz

Physiology Faculty Publications

Microbiomic flora in digestive tract is pivotal to the state of our health and disease. Antibiotics affect GI, control composition of microbiome, and shift equilibrium from health into disease status. Coccidiosis causes gastrointestinal inflammation. Antibiotic additives contaminate animal products and enter food chain, consumed by humans with possible allergic, antibiotic resistance and enigmatic side effects. Purposed study induced nonpathogenic, immunogenic organisms to protect against disease and abolish antibiotics’ use in food animals and side effects in man. Diverse species of Coccidia were used as model. Immature organisms were treated with serial purification procedure prior to developmental stages to obtain altered …

Consistent Prebiotic Effect On Gut Microbiota With Altered Fodmap Intake In Patients With Crohn's Disease: A Randomised, Controlled Cross-Over Trial Of Well-Defined Diets, Emma P. Halmos, Claus T. Christophersen, Anthony R. Bird, Susan J. Shepherd, Jane G. Muir, Peter R. Gibson

Research outputs 2014 to 2021

OBJECTIVES:

Altering FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) intake has substantial effects on gut microbiota. This study aimed to investigate effects of altering FODMAP intake on markers of colonic health in patients with Crohn’s disease.

METHODS:

After evaluation of their habitual diet, 9 patients with clinically quiescent Crohn’s disease were randomised to 21 days of provided low or typical (“Australian”) FODMAP diets with ≥ 21-day washout in between. Five-day fecal samples were collected at the end of each diet and analyzed for calprotectin, pH, short-chain fatty acids (SCFA) and bacterial abundance. Gastrointestinal symptoms were recorded daily.

RESULTS:

Eight participants …

Recommendations For The Development Of New Hospital Guidelines Due To The Effects Of Antibiotics On Clostridium Difficile Colitis, Megan Kohsel

Honors Theses

Clostridium difficile colitis is an infection that causes inflammation of the colon and diarrhea. This can even lead to death in some cases. The incidence of this infection and its overall effects have been on the rise throughout the last twenty years as antibiotics have been prescribed more frequently. Therefore, it is necessary that the rate of C. difficile infection is lowered by improved guidelines for hospitals, so that fewer people are infected and also that fewer antibiotics are prescribed to avoid the infection with C. difficle.

A Comparison Of Gastrointestinal Bacterial Population Between Indoor Cats And Outdoor Cats, Farhana Binti Ikmal Hisham

Honors Theses

This study used fecal samples from four indoor cats and four indoor-outdoor cats in order to identify the microbial communities in the gut of cats. This information was then used to compare the microbial phyla between both groups for any differences. Total microbial DNA was isolated from each fecal sample, and the 16S rRNA gene was sequenced using Illumina MiSeq high throughput method. The sequences were identified using the bioinformatics program mothur. The results show that indoor cats had a more diverse microbial community as compared to outdoor cats. Indoor cat samples had 26% more microbial species, and eight more …

Recurrent Hepatocellular Carcinoma In Patient With Crohn’S Disease: Incidental Or Expected Outcome Of Azathioprine?, Youssef Botros, Mary Mathews, Hiren Patel, Nihar Shah Md, Walid Baddoura, Andrew De La Torre

Gastroenterology

Hepatocellular carcinoma (HCC) usually occurs in patients with underlying risk factors such as liver cirrhosis and chronic hepatitis B. Although patients with Crohn's disease (CD) are at an increased risk to develop malignancies such as colon cancer, the incidence of HCC in this population is extremely rare. We report a case of 62-year-old male with long history of CD treated with azathioprine (AZA) and aminosalicylic acid (ASA) who was incidentally diagnosed with HCC, for which left hepatectomy was done. Four years later during routine follow-up, patient had another hepatic lesion and underwent resection of the mass. The mechanism of occurrence …

Recurrent Hepatocellular Carcinoma In Patient With Crohn's Disease: Incidental Or Expected Outcome Of Azathioprine?, Youssef Botros, Mary Mathews, Hiren Patel, Nihar Shah Md, Walid Baddoura, Andrew De La Torre

Gastroenterology

Hepatocellular carcinoma (HCC) usually occurs in patients with underlying risk factors such as liver cirrhosis and chronic hepatitis B. Although patients with Crohn’s disease (CD) are at an increased risk to develop malignancies such as colon cancer, the incidence of HCC in this population is extremely rare. We report a case of 62-year-old male with long history of CD treated with azathioprine (AZA) and aminosalicylic acid (ASA) who was incidentally diagnosed with HCC, for which left hepatectomy was done. Four years later during routine follow-up, patient had another hepatic lesion and underwent resection of the mass. The mechanism of occurrence …

A Cytosolic Multiprotein Complex Containing P85Α Is Required For Β-Catenin Activation In Colitis And Colitis-Associated Cancer, Tatiana Goretsky, Emily M. Bradford, Hyunji Ryu, Maryam Tahir, Mary Pat Moyer, Tianyan Gao, Linheng Li, Terrence A. Barrett

Internal Medicine Faculty Publications

Wnt/β-catenin signaling is required for crypt structure maintenance. We previously observed nuclear accumulation of Ser-552 phosphorylated β-catenin (pβ-Cat^Ser-552) in intestinal epithelial cells (IEC) during colitis and colitis-associated cancer. Data here delineate a novel multiprotein cytosolic complex (MCC) involved in β-catenin signaling in the intestine. The MCC contains p85α, the class IA subunit of PI3K, along with β-catenin, 14-3-3ζ, Akt, and p110α. MCC levels in IEC increase in colitis and colitis-associated cancer patients. IEC-specific p85α-deficient (p85^ΔIEC) mice develop more severe dextran sodium …

Detection Of Genetic And Epigenetic Dna Markers In Urine For The Early Detection Of Primary And Recurrent Hepatocellular Carcinoma, Hie-Won Hann, Surbhi Jain, Ting-Tsung Chang, Chi-Tan Hu, Selena Lin, Wei Song, Ying-Hsiu Su

Division of Gastroenterology and Hepatology Posters

Poster presented at American Association of the Study of Liver Diseases (AASLD) meeting in San Francisco California.

Objective:

Develop a urine test using a panel of select genetic and epigenetic markers for the early detection of primary and recurrent HCC.

Introduction:

Hepatocellular carcinoma (HCC) or liver cancer is an aggressive disease and one of the fastest growing cancers by incidence in the United States. Early detection is the key for effective treatment of HCC as the 5-year survival rate is 26% in early stage HCC as compared to only 2% when found after spreading to distant organs. The current marker, …

A Rare Cause Of Obscure Occult Gastrointestinal Bleeding, Haroon Shahid, Md, Jason Korenblit, Md, Mba

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND

• Obscure gastrointestinal (GI) bleeding is defined as persistent or recurrent GI bleeding after negative evaluations with upper endoscopy and colonoscopy.
• Accounts for approximately 5% of GI bleeding.
• Obscure GI bleeding can further be classified as being overt or occult.

-Overt GI bleeding is clinically evident, with either hematemesis, hematochezia, or melena.

-Occult GI bleeding manifests as iron deficiency anemia or a positive fecal occult blood test.

• Our case demonstrates a rare cause of obscure occult GI bleeding.

Attempted Salvage Therapy Through Initiation Of Vedolizumab As An Inpatient In Two Patients With Refractory Active Ulcerative Colitis, Matthew Sullivan Do, Paola Blanco Md, Shashin Shah Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

In The Groove: A Case Series Of Groove Pancreatitis, Matthew Sullivan Do, Jeffrey Brodsky Md, Shashin Shah Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Neurofibromatosis Type 1 With Ampullary Somatostatinoma, Small Bowel Gists, And Extra-Adrenal Composite Pheochromocytoma-Ganglioneuroma, Patrick Hickey Do, Rohit Sharma Md, Shanth A. Goonewardene Md, Shashin Shah Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Primary Esophageal Adenocarcinoma With Colon Metastases After Esophagectomy, Bonnie Patek Do, Hiral N. Shah Md, Shashin Shah Md

Department of Medicine

No abstract provided.

The Trial Of Calcium And Vitamin D For The Prevention Of Colorectal Adenomas, John A. Baron, Elizabeth L. Barry, Leila A. Mott, Judy R. Rees

Dartmouth Scholarship

BACKGROUND Epidemiologic and preclinical data suggest that higher intake and serum levels of vitamin D and higher intake of calcium reduce the risk of colorectal neoplasia. To further study the chemopreventive potential of these nutrients, we conducted a randomized, double-blind, placebo-controlled trial of supplementation with vitamin D, calcium, or both for the prevention of colorectal adenomas. METHODS We recruited patients with recently diagnosed adenomas and no known colorectal polyps remaining after complete colonoscopy. We randomly assigned 2259 participants to receive daily vitamin D3 (1000 IU), calcium as carbonate (1200 mg), both, or neither in a partial 2Å~2 factorial design. Women …

Investigation Of Potential Early Histologic Markers Of Pediatric Inflammatory Bowel Disease, Julie A. Bass, Craig A. Friesen, Amanda D. Deacy, Nancy Neilan, Julia M. Bracken, Valentina Shakhnovich, Vivekanand Singh

Manuscripts, Articles, Book Chapters and Other Papers

© 2015 Bass et al. Background: Early manifestations of pediatric inflammatory bowel disease (IBD) can be relatively nonspecific. Initial mucosal biopsies may not be conclusive, delaying the diagnosis until subsequent biopsies demonstrate typical histologic features of IBD. We hypothesized that certain inflammatory cell types may be utilized as early histologic indicators of IBD in children. Methods: A retrospective analysis compared histologic findings from initially inconclusive or negative endoscopic studies in 22 patients who were subsequently diagnosed with IBD (after diagnostic endoscopy) to those of 20 comparison patients with functional abdominal pain matched for age, gender, and study type. A pediatric …

Multiple Intussusceptions Associated With Polycythemia In An Anabolic Steroid Abuser , A Case Report And Literature Review, Y. Cavanagh, Nihar Shah Md, A. B. Thomas, A. Gupta

Gastroenterology

Intussusceptions are generally associated with mechanical lead points or localized inflammation that function as foci for intestinal telescoping. We present the case of a patient whose abuse of anabolic steroids resulted in the development of multiple simultaneous intussusceptions. Our patient had no additional identifiable risk factors for intussusception. Consistent with previous reports, corticosteroid induced polycythemia and its consequent hyperviscosity led to intravascular sludging and mesenteric ischemia with associated bowel wall thickening. The localized intestinal induration then served as mechanical foci for intussusception. Due to the illicit nature of anabolic androgenic steroid (AAS) abuse, the physiologic effects of supraphysiologic doses are …

Hereditary Hemochromatosis., Om Parkash, Muhammad Akram

Department of Medicine

Objective: To describe the clinical and laboratory features of hereditary hemochromatosis associated liver disease in a tertiary care hospital.

Study Design: Observational study.

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2002 to October 2012.

Methodology: Charts of patients with Hereditary Hemochromatosis (HHC) were reviewed. Data collected and analyzedconsisting of clinical presentations, liver function tests, serum ferritin, transferrin saturation, hepatic imaging and histologyin patients with HHC.

Results: A total of 22 patients were identified as having hemochromatosis. All subjects were men with a mean age of 53 ± 9.2 years at the time of diagnosis. …

Pathogen-Specific Burdens Of Community Diarrhoea In Developing Countries: A Multisite Birth Cohort Study (Mal-Ed), Sadia Shakoor, Shahida Qureshi, Furqan Kabir, Anita K. M. Zaidi, Zulfiqar Ahmed Bhutta, Imran Ahmed, Didar Alam, Syed Asad Ali, Muneera Rasheed, Sajid Bashir Soofi, Ali Turab, Aisha Khizar Yousafzai

Department of Pathology and Laboratory Medicine

Background: Most studies of the causes of diarrhoea in low-income and middle-income countries have looked at severe disease in people presenting for care, and there are few estimates of pathogen-specific diarrhoea burdens in the community.
Methods: We undertook a birth cohort study with not only intensive community surveillance for diarrhoea but also routine collection of non-diarrhoeal stools from eight sites in South America, Africa, and Asia. We enrolled children within 17 days of birth, and diarrhoeal episodes (defined as maternal report of three or more loose stools in 24 h, or one loose stool with visible blood) were identified through …

Proton Pump Inhibitors And Corticosteroids As Synergistic Risk Factors For Candida Esophagitis, Nihar Shah Md, Yana Cavanagh, Oleg Shulik, Pooja Patel, Vincent A. Debari, Walid Baddoura

Gastroenterology

Abstract:

Introduction: Inhaled & systemic steroids are one of the well-documented risks factors for Candida esophagitis. However, the role of gastric acid suppression remains controversial.

Methods:

We conducted a retrospective case-control study of 420 patients consisting of 84 cases of Candida esophagitis and 336 matched controls. Our cohort was gathered from subjects evaluated from 2001 to 2012. The diagnosis of Candida esophagitis was based on endoscopic and/or histological criteria.

Results:

On univariate analysis, proton pump inhibitors were associated with higher risk (OR = 2.14; 95 % CI: 1.30 to 3.54); steroid use also increased the risk (OR = 3.55; 95% …

Sex And Race And/Or Ethnicity Differences In Patients Undergoing Radiofrequency Ablation For Barrett's Esophagus: Results From The U.S. Rfa Registry., Sarina Pasricha, Nan Li, William J. Bulsiewicz, Richard I. Rothstein, Anthony Infantolino, Atilla Ertan, Daniel S. Camara, Evan S. Dellon, George Triadafilopoulos, Charles J. Lightdale, Ryan D. Madanick, William D. Lyday, Raman V. Muthusamy, Bergein F. Overholt, Nicholas J. Shaheen

Department of Medicine Faculty Papers

BACKGROUND: Little is known about differences in Barrett's esophagus (BE) characteristics by sex and race and/or ethnicity or these differences in response to radiofrequency ablation (RFA).

OBJECTIVE: We compared disease-specific characteristics, treatment efficacy, and safety outcomes by sex and race and/or ethnicity in patients treated with RFA for BE.

DESIGN: The U.S. RFA patient registry is a multicenter collaboration reporting processes and outcomes of care for patients treated with RFA for BE.

PATIENTS: Patients enrolled with BE.

INTERVENTIONS: RFA.

MAIN OUTCOME MEASUREMENTS: We assessed safety (stricture, bleeding, perforation, hospitalization), efficacy (complete eradication of intestinal metaplasia [CEIM]), complete eradication of dysplasia, …

Burn Injury Alters The Intestinal Microbiome And Increases Gut Permeability And Bacterial Translocation, Zachary M. Earley, Suhail Akhtar, Stefan J. Green, Ankur Naqib, Omair Khan '15, Abigail R. Cannon, Adam M. Hammer, Niya L. Morris, Xiaoling Li, Joshua M. Eberhardt, Richard L. Gamelli, Richard H. Kennedy, Mashkoor A. Choudhry

Student Publications & Research

Sepsis remains one of the leading causes of death in burn patients who survive the initial insult of injury. Disruption of the intestinal epithelial barrier has been shown after burn injury; this can lead to the translocation of bacteria or their products (e.g., endotoxin) from the intestinal lumen to the circulation, thereby increasing the risk for sepsis in immunocompromised individuals. Since the maintenance of the epithelial barrier is largely dependent on the intestinal microbiota, we examined the diversity of the intestinal microbiome of severely burned patients and a controlled mouse model of burn injury. We show that burn injury induces …

Development Of Hyperplastic Polyps Following Argon Plasma Coagulation Of Gastric Antral Vascular Ectasia, Nihar Shah Md, Yana Cavanagh, Dharmesh H. Kaswal, Sohail Shaikh

Gastroenterology

The etiology of gastric antral vascular ectasia (GAVE) syndrome or gastric hyperplastic polyps (HPs) is not fully understood. We report a case of gastric HP arising in a patient treated with argon plasma coagulation (APC) for GAVE syndrome. Despite unclear etiologic progression, this and previously reported cases suggest a temporal relationship between the treatment of GAVE and HP. A 68-year-old male with a history of coronary artery disease, congestive heart failure and diabetes type II who initially presented with symptomatic anemia 2 weeks after starting aspirin and clopidogrel therapy. Diagnostic esophagogastroduodenoscopy (EGD) demonstrated diffuse GAVE. He was treated with 5 …

Cecal Bascule After Colonoscopy - Case Report And Review Of Literature, Nihar Shah Md, Hiren Patel Md, Varun Patel Md, Robert Spira

Gastroenterology

Cecal bascule is a rare disease variant of a cecal volvulus. It consists of upward and anterior folding of the ascending colon, forming a flap valve, and occluding the bowel lumen resulting in proximal cecal dilatation. Herein, we present a case of a patient who developed persistent abdominal pain few hours after a colonoscopy. CT scan of the abdomen revealed an upward and anterior folding of the cecum. Subsequently the patient was taken to the operating room for a right hemi-colectomy. This case emphasizes the importance to consider cecal bascule as a differential diagnosis in patients with persistent abdominal pain …

Role Of Non-Selective Beta Blockers In Hepatocellular Carcinoma: An Analysis In Patients With Cirrhosis And Portal Hypertension, Hiren Patel, Abhishek Kumar, Nihar Shah Md, Ela Eris, Michael Maroules, Walid J. Baddoura, Vincent A. Debari

Gastroenterology

There are many different biochemical processes responsible for the hepatocelluar carcinoma (HCC) development that can be targeted for the prevention or halt progression of the HCC. Non-selective betablockers (NSBB) affects a multitude of intracellular biochemical and signaling pathways involved in carcinogenesis. Aim: To determine if NSBB may be protective for HCC in patients with cirrhosis and portal hypertension. Methods: We retrospectively enrolled 200 patients from medical records diagnosed with cirrhosis and portal hypertension between January 2001 and December 2013. Eighteen patients were excluded (taking selective beta-blocker and/or unavailable medical records). The etiology of cirrhosis, use of NSBB, demographics and the …

An Unusual Initial Presentation Of Hepatocellular Carcinoma As A Sellar Mass, Nihar Shah Md, Yana Cavanagh, Hamid Shaaban, Beth Stein, Sohail N. Shaikh, Dharmesh H. Kaswala, Walid Baddoura

Gastroenterology

Sellar masses are frequently adenomatous pituitary tumors. Metastatic disease is unusual, often mimicking the presentations of adenomas. Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy but unusual to have a pituitary metastasis (PM). A 65-year-old man presented with headache, diplopia, ptosis, decreased vision in the right eye and unintentional weight loss of 32lbs. Preliminary out-patient work-up revealed a mass in the pituitary region. Cranial imaging showed 3.1 cm × 3.2 cm × 4.4 cm lesion. Abdominal imaging (computed tomography and magnetic resonance imaging) demonstrated a lobulated, nodular and heterogeneous right lobe of the liver. Trans-sphenoidal resection of the …

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