Gastroenterology Commons^™

Host Gut Resistome In Gulf War Chronic Multisymptom Illness Correlates With Persistent Inflammation, Dipro Bose, Somdatta Chatterjee, Ethan Older, Ratanesh Seth, Patricia Janulewicz, Punnag Saha, Ayan Mondal, Jeffrey M Carlson, Alan W Decho, Kimberly Sullivan, Nancy Klimas, Stephen Lasley, Jie Li, Saurabh Chatterjee

Faculty, Staff and Student Publications

Chronic multisymptom illness (CMI) affects a subsection of elderly and war Veterans and is associated with systemic inflammation. Here, using a mouse model of CMI and a group of Gulf War (GW) Veterans' with CMI we show the presence of an altered host resistome. Results show that antibiotic resistance genes (ARGs) are significantly altered in the CMI group in both mice and GW Veterans when compared to control. Fecal samples from GW Veterans with persistent CMI show a significant increase of resistance to a wide class of antibiotics and exhibited an array of mobile genetic elements (MGEs) distinct from normal …

Alpha-Fetoprotein (Afp) And Afp-L3 Is Most Useful In Detection Of Recurrence Of Hepatocellular Carcinoma In Patients After Tumor Ablation And With Low Afp Level, Madison Force, Grace Park, Divya Chalikonda, Christopher G. Roth, Micah Cohen, Dina Halegoua-De Marzio, Hie-Won Hann

Department of Medicine Faculty Papers

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and is a leading cause of mortality worldwide. While there are many risk factors for HCC including alcohol, obesity, and diabetes, hepatitis B virus (HBV) and hepatitis C virus (HCV) infection still account for the majority of HCC worldwide. Globally, HBV is the leading risk factor for HCC. Patients with chronic hepatitis B (CHB) and advanced liver disease are at high risk for HCC. Screening for HCC is done routinely with ultrasound with or without alpha-fetoprotein (AFP) at six-month intervals. The combination of ultrasound and AFP has been …

Hepatocellular Carcinoma With Extrahepatic Blood Supply From Right Renal Artery, Amir Humza Sohail, Ahmad Musa, Muhammad Salman Khan, Hassan Raza Hashmi, Basit Salam, Collin E M. Brathwaite

Department of Radiology

Extrahepatic blood supply is seen in around 17-27% of hepatocellular carcinoma lesions. Evidence suggests that this extrahepatic supply most commonly originates from a right intercostal artery (70-83%) followed by left intercostal, omental and right renal arteries. Thus a comprehensive knowledge of variations in standard vascular anatomy and cognisance of factors influencing or predicting extrahepatic blood supply in HCC is instrumental in ensuring the success of surgical and interventional procedures. We present the unusual case of a 66-year-old male with HCC in Segment I of the liver with aberrant blood supply from the right renal artery in the absence of any …

Are Body Surface Area Based Estimates Of Liver Volume Applicable To Children With Overweight Or Obesity? An In Vivo Validation Study., Chelsea Hosey-Cojocari, Sherwin S. Chan, Chance S. Friesen, Amie L. Robinson, Veronica Williams, Erica Swanson, Daniel O'Toole, Jansynn Radford, Neil J. Mardis, Trevor N. Johnson, J Steven Leeder, Valentina Shakhnovich

Manuscripts, Articles, Book Chapters and Other Papers

The liver is the primary organ responsible for clearing most drugs from the body and thus determines systemic drug concentrations over time. Drug clearance by the liver appears to be directly related to organ size. In children, organ size changes as children age and grow. Liver volume has been correlated with body surface area (BSA) in healthy children and adults and has been estimated by functions of BSA. However, these relationships were derived from "typical" populations and it is unknown whether they extend to estimations of liver volumes for population "outliers," such as children with overweight or obesity, who today …

Colonic Migration Of A Nephroureteral Stent Through A Colovesical Fistula, Nicholas Pigg, Kevin Carr, Julio Zayas, Eduardo Franca

HCA Healthcare Journal of Medicine

We describe a case of a patient with a two-year history of prostate cancer who underwent placement of nephroureteral stents. He subsequently presented to the hospital with complications from prolonged retention of the stents, which ultimately lead to a secondary diagnosis of adenocarcinoma of the rectum. A colonoscopy performed approximately two weeks after a bilateral nephroureteral tube exchange demonstrated what was believed to be locoregional metastatic disease and a fistulous connection with the distal nephroureteral stents. Radiographic features of this complication are discussed together with proper management and possible complications of distal nephroureteral stents. Both nephroureteral stents were explanted, and …

Interventional Treatment With The Transjugular Intrahepatic Portosystemic Shunt (Tips) Procedure May Offer A Preferable Alternative To Systemic Anticoagulation In Patients With Cirrhosis And Portal Vein Thrombosis, Molly N. Pantelic

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising:

Wang Z, Jiang MS, Zhang HL, et al. Is post-tips anticoagulation therapy necessary in patients with cirrhosis and portal vein thrombosis? A randomized controlled trial. Radiology. 2016;279(3):943-951. https://doi.org/10.1148/radiol.2015150369

for a patient with cryptogenic cirrhosis, gastroesophageal varices, pancreatic cancer, and portal vein thrombosis.

Critical Need For Pharmacologic Treatment Options In Nafld: A Pediatric Perspective., Chance S. Friesen, Sherwin S. Chan, Jonathan B. Wagner, Chelsea Hosey-Cojocari, Iván L Csanaky, Valentina Shakhnovich

Manuscripts, Articles, Book Chapters and Other Papers

Nonalcoholic fatty liver disease (NAFLD) affects up to 70% of children with obesity and has become the number one etiology for liver transplant in the United States. Early, effective intervention is critical to prevent disease progression into adulthood. Yet, it is seldom achieved through lifestyle modification alone. Thus, children must be included in NAFLD pharmacology trials, which, to date, continue to focus primarily on adult populations. This commentary serves as a call to action.

Internal Hernia As A Late Complication Of Roux-En-Y Gastric Bypass Procedure, Samantha Purton, Gabriel Meshekow, My Myers, Edgar Mercado, Allan Katz

West Florida Division GME Research Day 2020

As the prevalence of obesity continues to rise, so does the popularity of bariatric surgery. Previously the Roux-en-Y gastric bypass was the most common bariatric procedure, but now falls second to the gastric sleeve. It remains a relevant procedure, however, accounting for 17% of bariatric procedures in 2018. Due to its prevalence, it is important that the radiologist be familiar with the procedure and its complications such as leak, obstruction, stricture, or, as in this case, internal herniation through a mesenteric defect. Internal hernias are more commonly associated with the laparoscopic approach versus open. This is likely due to fewer …

A Comparison Of The Diagnosis Of Gastroparesis In 4 H Pediatric Gastric Emptying Studies Versus 2 H Studies., Sarah T. Edwards, Jose Cocjin, Stephanie B. Theut, Douglas C. Rivard, Ashley K. Sherman, Craig A. Friesen

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: In adults, there is a consensus for standards to diagnose gastroparesis utilizing a gastric emptying study as the key diagnostic modality but there is no consensus for a standard in pediatrics. Additionally, some cost savings might be achieved if symptoms could be utilized to predict patients with gastroparesis. The aims of the current study were to confirm the sensitivity of a 4 h study in the pediatric population and to assess whether the severity of symptoms were predictive of delayed gastric emptying.

STUDY: This was a single site, two part study. In the first part, results were reviewed for …

Upper Gastrointestinal Bleed Embolization With Onyx®: The "Tattoo Effect", Driss Raissi, Qian Yu, S. Houssam Mardini

Radiology Faculty Publications

Endoscopic intervention is well validated for the control of upper gastrointestinal bleeding (UGIB). In cases of refractory bleeding, transarterial embolization is a safe and effective alternative. Ethylene vinyl alcohol (EVOH) commonly known as Onyx^® is an inherently black liquid embolic approved for use in cerebrovascular arteriovenous malformations and is increasingly used as an embolic agent in multiple peripheral and visceral territories. Onyx^® has a uniquely undesirable property of causing black color discoloration when used in peripheral applications adjacent to the skin akin to a "tattoo effect." Knowledge of the agents used by the interventional radiologist, clinical correlation, and …

A Bibliometric Analysis Of The Top 100 Cited Articles On Hepatic Magnetic Resonance Imaging., Waqas Ullah, Hafez Mohammad A. Abdullah, Ejaz Ahmad, Mamoon Ur Rashid, Muhammad Bashir, Asad Ur Rahman, Asrar Ahmad, Abu Hurairah

Abington Jefferson Health Papers

The purpose of this study is to guide the readers to the impact of the articles published on hepatic magnetic resonance imaging (MRI). We searched Scopus using 10 different search terms for hepatic MRI. The selected studies were thoroughly reviewed by two independent authors and any disagreement was sorted out by mutual consensus. The list of articles and journals was downloaded into an excel spreadsheet. Only the top 100 cited articles were selected by mutual consensus among all the authors. These articles were further read in the full-text form and were further categorized into subgroups. Three authors independently reviewed the …

Subharmonic And Endoscopic Contrast Imaging Of Pancreatic Masses: A Pilot Study., Flemming Forsberg, Maria Stanczak, Andrej Lyshchik, David E. Loren, Patrick O'Kane, Ali Siddiqui, Thomas E. Kowalski, Cynthia Miller, Traci Fox, Ji-Bin Liu, John R. Eisenbrey

Department of Radiology Faculty Papers

OBJECTIVES: To use subharmonic imaging (SHI) to depict the vascularity of pancreatic masses compared to contrast-enhanced endoscopic ultrasound (EUS) and pathologic results.

METHODS: Sixteen patients scheduled for biopsy of a pancreatic mass were enrolled in an Institutional Review Board-approved study. Pulse-inversion SHI (transmitting/receiving at 2.5/1.25 MHz) was performed on a LOGIQ 9 system (GE Healthcare, Milwaukee, WI) with a 4C transducer, whereas contrast harmonic EUS (transmitting/receiving at 4.7/9.4 MHz) was performed with a radial endoscope (GF-UTC180; Olympus Corporation, Tokyo, Japan) connected to a ProSound SSD α-10 scanner (Hitachi Aloka, Tokyo, Japan). Two injections of the contrast agent Definity (Lantheus Medical …

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.

Itopride For Gastric Volume, Gastric Emptying And Drinking Capacity In Functional Dyspepsia, Shahab Abid, Wasim Jafri, Maseeh Uz Zaman, Rakhshanda Bilal, Safia Awan, Aamir Abbas

Section of Gastroenterology

AIM: To study the effect of itopride on gastric accommodation, gastric emptying and drinking capacity in functional dyspepsia (FD).

Methods: Randomized controlled trial was conducted to check the effect of itopride on gastric accommodation, gastric emptying, capacityof tolerating nutrient liquid and symptoms of FD. We recruited a total of 31 patients having FD on the basis of ROME III criteria. After randomization, itopride was received by 15 patients while 16 patients received placebo. Gastric accommodation was determined using Gastric Scintigraphy. ¹³C labeled octanoic breadth test was performed to assess gastric emptying. Capacity of tolerating nutrient liquid drink …

Role Of Assessment For Retreatment With Transarterial Chemoembolization Score In Decision Of Retreatment With Trans-Arterial Chemo-Embolization Sessions In Patients With Hepatocellular Carcinoma, Anwar Hussain Abbasi, Shahab Abid, Tanveer Ul Haq, Safia Awan

Department of Family Medicine

Background: The objective behind this study was to determine that Assessment for Retreatment with Transarterial chemoembolization (ART) score is really applicable in patients with hepatocellular carcinoma.
Methods: A cross sectional observational study was conducted on all patients with hepatocellular carcinoma of intermediate stage and undergone ≥2 Transarterial chemoembolization. ART score was assessed before and after each session of Transarterial chemoembolization. Multi-logistic regression analysis was performed to compare the final outcome of patients with ART score of ≥2.5 into groups with two and more than two Trans-arterial chemo-embolization sessions.
Results: A total of 100 HCC patients were recruited for final analysis. …

Intrahepatic Cholangiocarcinoma Presenting As Li-Rads 5 "Hcc", Raja K. Dhanekula, Md, Donald Mitchell, Md, John Farber, Md, Ashwin R. Sama, Md, Jesse M. Civan, Md

Division of Gastroenterology and Hepatology Posters

Background

• Hepatocellular Carcinoma (HCC), if within Milan Criteria, is an indication for liver transplantation.

• In contrast, intrahepatic cholangiocarcinoma (IHCC) is a contra-indication to liver transplantation due to high rates of recurrence.

• LI-RADS 5 classification (synonymous with OPTN-5) carries a near 100% positive predictive value for HCC, allowing prioritization of patients for liver transplantation without histological confirmation.

• The “LI-RADS M” classification indicates the presence of malignancy not meeting diagnostic criteria for HCC. In theory, IHCC lesions should be identified as LI-RADS M and not LI-RADS 5.

Pulse Shaping For Improved Diagnosis Of Portal Hypertension Using Subharmonic Aided Pressure Estimation, Ipshita Gupta, John R. Eisenbrey, Maria Stanczak, Anush Sridharan, Jaydev K. Dave, Ji-Bin Liu, Christopher Hazard, Colette Shaw, Susan Shamini-Noori, Jonathan M. Fenkel, Michael Soluen, Chandra Sehgal, Kirk Wallace, Flemming Forsberg

Department of Radiology Posters

Subharmonic aided pressure estimation (SHAPE) is based on the inverse relationship between the subharmonic amplitude of contrast microbubbles (obtained by transmitting at the fundamental frequency fo and receiving at fo/2) and the ambient pressure (see fig.1).

A noninvasive ultrasound based pressure estimation procedure would be a major development in the diagnosis of portal hypertension and less invasive than the current catheter-based hepatic venous pressure gradient (HVPG) measurement.

The hypothesis of this study was that portal vein pressures can be monitored and quantified noninvasively in humans using SHAPE.

First selected waveforms were optimized in vitro and in canines, then SHAPE was …

Hepatocellular Carcinoma After Locoregional Therapy: Magnetic Resonance Imaging Findings In Falsely Negative Exams., David Becker-Weidman, Jesse M. Civan, Sandeep P. Deshmukh, Christopher G. Roth, Steven K. Herrine, Laurence Parker, Donald G. Mitchell

Division of Gastroenterology and Hepatology Faculty Papers

AIM: To elucidate causes for false negative magnetic resonance imaging (MRI) exams by identifying imaging characteristics that predict viable hepatocellular carcinoma (HCC) in lesions previously treated with locoregional therapy when obvious findings of recurrence are absent.

METHODS: This retrospective institutional review board-approved and Health Insurance Portability and Accountability Act-compliant study included patients who underwent liver transplantation at our center between 1/1/2000 and 12/31/2012 after being treated for HCC with locoregional therapy. All selected patients had a contrast-enhanced MRI after locoregional therapy within 90 d of transplant that was prospectively interpreted as without evidence of residual or recurrent tumor. Retrospectively, 2 …

In-Vivo Ct Dosimetry During Virtual Colonoscopy, Jonathon W. Mueller

Dissertations and Theses (Open Access)

Virtual colonoscopy (VC) is a minimally invasive means for identifying colorectal polyps and colorectal lesions by insufflating a patient’s bowel, applying contrast agent via rectal catheter, and performing multi-detector computed tomography (MDCT) scans. The technique is recommended for colonic health screening by the American Cancer Society but not funded by the Centers for Medicare and Medicaid Services (CMS) partially because of potential risks from radiation exposure. To date, no in‐vivo organ dose measurements have been performed for MDCT scans; thus, the accuracy of any current dose estimates is currently unknown.

In this study, two TLDs were affixed to the inner …