Gastroenterology Commons^™

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 …

Identification Of Novel Regulatory Genes In Apap Induced Hepatocyte Toxicity By A Genome-Wide Crispr-Cas9 Screen., Katherine Shortt, Daniel P. Heruth, Nini Zhang, Weibin Wu, Shipra Singh, Ding-You Li, Li Qin Zhang, Gerald J. Wyckoff, Lei S Qi, Craig A. Friesen, Shui Qing Ye

Manuscripts, Articles, Book Chapters and Other Papers

Acetaminophen (APAP) is a commonly used analgesic responsible for more than half of acute liver failure cases. Identification of previously unknown genetic risk factors would provide mechanistic insights and novel therapeutic targets for APAP-induced liver injury. This study used a genome-wide CRISPR-Cas9 screen to evaluate genes that are protective against, or cause susceptibility to, APAP-induced liver injury. HuH7 human hepatocellular carcinoma cells containing CRISPR-Cas9 gene knockouts were treated with 15 mM APAP for 30 minutes to 4 days. A gene expression profile was developed based on the 1) top screening hits, 2) overlap of expression data from APAP overdose studies, …

A Rare Non-Oncological Pancreatic Mass: Eosinophilic Pancreatitis Diagnosis Through Eus-Fna, Andres Gelrud

All Publications

No abstract provided.

Functional Gastrointestinal Disorders And Gut-Brain Axis: What Does The Future Hold?, Kashif Mukhtar, Hasham Nawaz, Shahab Abid

Section of Gastroenterology

Despite their high prevalence, lack of understanding of the exact pathophysiology of the functional gastrointestinal disorders has restricted us to symptomatic diagnostic tools and therapies. Complex mechanisms underlying the disturbances in the bidirectional communication between the gastrointestinal tract and the brain have a vital role in the pathogenesis and are key to our understanding of the disease phenomenon. Although we have come a long way in our understanding of these complex disorders with the help of studies on animals especially rodents, there need to be more studies in humans, especially to identify the therapeutic targets. This review study looks at …

Persistent Risk For New, Subsequent New And Recurrent Hepatocellular Carcinoma Despite Successful Anti-Hepatitis B Virus Therapy And Tumor Ablation: The Need For Hepatitis B Virus Cure., Brianna J. Shinn, Aaron Martin, Robert M. Coben, Mitchell I. Conn, Jorge Prieto, Howard Kroop, Anthony J. Dimarino, Hie-Won Hann

Division of Gastroenterology and Hepatology Faculty Papers

Hepatitis B virus (HBV) is one of the most significant hepatocarcinogens. The ultimate goal of anti-HBV treatment is to prevent the development of hepatocellular carcinoma (HCC). During the last two decades, with the use of currently available anti-HBV therapies (lamivudine, entecavir and tenofovir disoproxil fumatate), there has been a decrease in the incidence of HBV-associated HCC (HBV-HCC). Furthermore, several studies have demonstrated a reduction in recurrent or new HCC development after initial HCC tumor ablation. However, during an observation period spanning 10 to 20 years, several case reports have demonstrated the development of new, subsequent new and recurrent HCC even …

Denture Misadventure: The Tooth About Your Colon., Rajesh Essrani Md, Patrick Hickey Do, Hiral N. Shah Md

Department of Medicine

Foreign body ingestion occurs mainly in a mentally impaired person, but rarely in healthy adults. A 48-year-old male was admitted with a recurrence of previously diagnosed right knee septic arthritis and accidentally ingested his dental bridge which was removed from a proximal ascending colon with a colonoscopy.

Asge Guideline For Endoscopic Full-Thickness Resection And Submucosal Tunnel Endoscopic Resection, H. R. Aslanian, A. Sethi, M. S. Bhutani, A. J. Goodman, K. Krishnan, D. R. Lichtenstein, J. Melson, U. Navaneethan, A. J. Trindade, J. T. Maple, +7 Additional Authors

Journal Articles

© 2019 American Society for Gastrointestinal Endoscopy With the development of reliable endoscopic closure techniques and tools, endoscopic full-thickness resection (EFTR) is emerging as a therapeutic option for the treatment of subepithelial tumors and epithelial neoplasia with significant fibrosis. EFTR may be categorized as “exposed” and “nonexposed.” In exposed EFTR, the full-thickness resection is undertaken with a tunneled or nontunneled technique, with subsequent closure of the defect. In nonexposed EFTR, a secure serosa-to-serosa apposition is achieved before full-thickness resection of the isolated lesion. This document reviews current techniques and devices used for EFTR and reviews clinical applications and outcomes.

Comparative Performances Of Machine Learning Methods For Classifying Crohn Disease Patients Using Genome-Wide Genotyping Data, A. Romagnoni, S. Jégou, K. Van Steen, G. Wainrib, J. P. Hugot, L. Peyrin-Biroulet, M. Chamaillard, J. F. Colombel, S. Katz, Y. Sharma, +84 Additional Authors

Journal Articles

© 2019, The Author(s). Crohn Disease (CD) is a complex genetic disorder for which more than 140 genes have been identified using genome wide association studies (GWAS). However, the genetic architecture of the trait remains largely unknown. The recent development of machine learning (ML) approaches incited us to apply them to classify healthy and diseased people according to their genomic information. The Immunochip dataset containing 18,227 CD patients and 34,050 healthy controls enrolled and genotyped by the international Inflammatory Bowel Disease genetic consortium (IIBDGC) has been re-analyzed using a set of ML methods: penalized logistic regression (LR), gradient boosted trees …

Shorter Disease Duration Is Associated With Higher Rates Of Response To Vedolizumab In Patients With Crohn's Disease But Not Ulcerative Colitis., D. M. Faleck, A. Winters, S. Chablaney, P. Shashi, J. Meserve, A. Weiss, V. Kesar, K. Sultan, A. Swaminath, R. Ungaro, +24 Additional Authors

Journal Articles

BACKGROUND & AIMS: Patients with Crohn's disease (CD), but not ulcerative colitis (UC), of shorter duration have higher rates of response to tumor necrosis factor (TNF) antagonists than patients with longer disease duration. Little is known about the association between disease duration and response to other biologic agents. We aimed to evaluate response of patients with CD or UC to vedolizumab, stratified by disease duration.

METHODS: We analyzed data from a retrospective, multicenter, consortium of patients with CD (n = 650) or UC (n = 437) treated with vedolizumab from May 2014 through December 2016. Using time to event analyses, …

Volumetric Laser Endomicroscopy And Its Application To Barrett's Esophagus: Results From A 1,000 Patient Registry., M. S. Smith, B. Cash, V. Konda, A. J. Trindade, S. Gordon, S. Demeester, V. Joshi, C. Lee, D. V. Sejpal, K. Chang, +38 Additional Authors

Journal Articles

Volumetric laser endomicroscopy (VLE) uses optical coherence tomography (OCT) for real-time, microscopic cross-sectional imaging. A US-based multi-center registry was constructed to prospectively collect data on patients undergoing upper endoscopy during which a VLE scan was performed. The objective of this registry was to determine usage patterns of VLE in clinical practice and to estimate quantitative and qualitative performance metrics as they are applied to Barrett's esophagus (BE) management. All procedures utilized the NvisionVLE Imaging System (NinePoint Medical, Bedford, MA) which was used by investigators to identify the tissue types present, along with focal areas of concern. Following the VLE procedure, …

Lumen Apposing Metal Stents Are Superior To Plastic Stents In Pancreatic Walled-Off Necrosis: A Large International Multicenter Study., Y. Chen, J. Yang, S. Friedland, I. Holmes, R. Law, A. Hosmer, D. V. Sejpal, S. Inamdar, A. J. Trindade, M. A. Khashab, +30 Additional Authors

Journal Articles

Background and study aims  The use of lumen apposing metal stents (LAMS) during EUS-guided transmural drainage (EUS-TD) of pancreatic walled-off necrosis (WON) has gained popularity. Data supporting their use in WON over plastic stents (PS), however, remain scarce. The aim of this study was to compare the clinical efficacy of LAMS (Axios, Boston Scientific) with PS in WON. Patients and methods  This was a multicenter, retrospective study involving 14 centers. Consecutive patients who underwent EUS-TD of WON (2012 - 2016) were included. The primary end point was clinical success defined as WON size ≤ 3 cm within a 6-month period …

Fine-Needle Biopsy Is Superior To Fine-Needle Aspiration Of Suspected Gastrointestinal Stromal Tumors: A Large Multicenter Study., A. J. Trindade, P. C. Benias, M. Alshelleh, A. N. Bazarbashi, B. Tharian, S. Inamdar, N. Sharma, C. Zelt, D. V. Sejpal, M. Ryou, +2 Additional Authors

Journal Articles

Background and study aims  There are numerous studies published on the diagnostic yield of the new fine-needle biopsy (FNB) needles in pancreas masses. However, there are limited studies in suspected gastrointestinal stromal tumors (GIST lesions). The aim of this study was to evaluate the diagnostic yield of a new fork-tip FNB needle. Patients and methods  This was a multicenter retrospective study of consecutive patients from prospectively maintained databases comparing endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) versus endoscopic ultrasound-guided FNB (EUS-FNB) using the fork-tip needle. Outcomes measured were cytopathology yield (ability to obtain tissue for analysis of cytology), ability to analyze the …

Changes In Vedolizumab Utilization Across Us Academic Centers And Community Practice Are Associated With Improved Effectiveness And Disease Outcomes., J. L. Koliani-Pace, S. Singh, M. Luo, R. Hirten, S. Aniwan, G. Kochhar, S. Chang, Y. Gao, A. Swaminath, P. S. Dulai, +25 Additional Authors

Journal Articles

BACKGROUND:Vedolizumab effectiveness estimates immediately after Food and Drug Administration (FDA) approval for ulcerative colitis (UC) and Crohn's disease (CD) are limited by use in refractory populations. We aimed to compare treatment patterns and outcomes of vedolizumab in 2 time frames after FDA approval. METHODS:We used 2 data sets for time trend analysis, an academic multicenter vedolizumab consortium (VICTORY) and the Truven MarketScan database, and 2 time periods, May 2014-June 2015 (Era 1) and July 2015-June 2017 (Era 2). VICTORY cumulative 12-month clinical remission, corticosteroid-free remission, and mucosal healing rates, and Truven 12-month hospitalization and surgery rates, were compared between Eras …

Gastrointestinal Bleeding In Patients With Acute Respiratory Distress Syndrome: A National Database Analysis., F. Siddiqui, M. Ahmed, S. Abbasi, A. Avula, A. H. Siddiqui, J. Philipose, H. M. Khan, T. M. Khan, L. Deeb, M. Chalhoub

Journal Articles

Background:The goal of our study was to determine the impact of gastrointestinal bleeding (GIB) on in-hospital outcomes among acute respiratory distress syndrome (ARDS) patients, and subsequently determine the potential risk factors for the development of GIB. Methods:ARDS patients with and without GIB were identified using the National Inpatient Sample (2002 - 2012). Linear regression analysis was used to assess impact of GIB on in-hospital mortality, length of stay and total charges. Univariate logistic regression was used to determine associated odds ratios (OR) for causes of ARDS and common comorbid conditions. Results:We identified 149,190 ARDS patients. The incidence of GIB was …

Digital Cholangioscopy Can Detect Residual Biliary Stones Missed By Occlusion Cholangiogram In Ercp: A Prospective Tandem Study., D. V. Sejpal, A. J. Trindade, C. Lee, L. S. Miller, P. C. Benias, S. Inamdar, G. Singh, M. Stewart, B. J. George, A. K. Vegesna

Journal Articles

Background and study aims  After stone removal in endoscopic retrograde cholangiopancreatography (ERCP), an occlusion cholangiogram (OC) is performed to confirm bile duct clearance. OC can miss residual stones that can lead to recurrent biliary symptoms. The aim of this study was to assess if digital peroral cholangioscopy (POC) increased the diagnostic yield of residual biliary stones that are missed with OC. Patients and methods  Patients having ERCP performed for choledocholithiasis were enrolled into the study only if they had one of the following criteria: dilated bile duct ≥ 12 mm and/or if lithotripsy was being performed. An OC was performed …

Mutational Load May Predict Risk Of Progression In Patients With Barrett's Oesophagus And Indefinite For Dysplasia: A Pilot Study, A. J. Trindade, M. J. Mckinley, M. Alshelleh, G. Levi, M. Stewart, K. J. Quinn, R. M. Thomas

Journal Articles

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Background and aims Mutational load (ML) has been shown to help risk-stratify those that may progress from non-dysplastic Barrett's oesophagus (BE) to dysplastic disease. Management of patients with BE and indefinite for dysplasia (BE-IND) is challenging and risk stratification tools are lacking. The aim of this pilot study is to evaluate the utility of ML for risk stratification in patients with BE-IND. Methods This is a single-centre, retrospective pilot study evaluating ML quantification in patients with BE-IND. Histology at …

Pooled Analysis Of The Efficacy And Safety Of Video Capsule Endoscopy In Patients With Implantable Cardiac Devices, R. Tabet, N. Nassani, B. Karam, Y. Shammaa, P. Akhrass, L. Deeb

Journal Articles

© 2019 Rabih Tabet et al. Background. To date, video capsule endoscopy (VCE) is still contraindicated by the FDA and the main manufacturers of Cardiac Implantable Electronic Devices (CIED) in patients with CIED, given a theoretical electromagnetic interference and possible device malfunction. Objectives. The objective of this study was to assess the safety profile and efficacy of VCE in patients with implantable cardiac devices through analyzing the risk of mutual interference. Methods. A systematic review of PubMed, Web of Science, and Embase databases was conducted. Peer-reviewed original articles, published in the English language and containing "capsule endoscopy" AND "pacemaker", "defibrillator" …

Acute Esophageal Necrosis: A View In The Dark, H. Khan, M. Ahmed, M. Daoud, J. Philipose, S. Ahmed, L. Deeb

Journal Articles

© 2019 The Author(s). Published by S. Karger AG, Basel. Acute esophageal necrosis (AEN), also known as Gurvits syndrome, black esophagus, or acute necrotizing esophagitis, is a rare clinical entity and an unusual reason for upper gastrointestinal bleeding. It is typically described in critically ill patients with multiple medical conditions, arising from a combination of ischemic insult to the esophageal mucosa due to low-flow vascular states, corrosive injury caused by reflux of acid and pepsin, and decreased function of the mucosal barrier systems and reparative mechanisms as occurs in malnourished and debilitated physical states. Patients with AEN tend to be …

Direct Oral Anticoagulants In Cirrhotic Patients: Current Evidence And Clinical Observations, S. Elhosseiny, H. Al Moussawi, J. M. Chalhoub, J. Lafferty, L. Deeb

Journal Articles

© 2019 Sherif Elhosseiny et al. The introduction of Direct Oral Anticoagulants (DOACs) to the pharmaceutical market provided patients and clinicians with novel convenient and safe options of anticoagulation. The use of this class of medications is currently limited to venous thromboembolic therapy and prophylaxis, in addition to stroke prophylaxis in patients with nonvalvular atrial fibrillation. Despite their altered hemostasis, patients with cirrhosis are thought to be in a procoagulant state and thus prone to thrombus formation. Patients with cirrhosis might benefit from the convenience of DOACs; however, the medical literature includes limited data on the efficacy and safety of …

Devices For Endoscopic Hemostasis Of Nonvariceal Gi Bleeding (With Videos), M. A. Parsi, A. R. Schulman, H. R. Aslanian, M. S. Bhutani, K. Krishnan, D. R. Lichtenstein, J. Melson, U. Navaneethan, A. J. Trindade, J. T. Maple, +4 Additional Authors

Journal Articles

© 2019 American Society for Gastrointestinal Endoscopy Background: Endoscopic intervention is often the first line of therapy for GI nonvariceal bleeding. Although some of the devices and techniques used for this purpose have been well studied, others are relatively new, with few available outcomes data. Methods: In this document, we review devices and techniques for endoscopic treatment of nonvariceal GI bleeding, the evidence regarding their efficacy and safety, and financial considerations for their use. Results: Devices used for endoscopic hemostasis in the GI tract can be classified into injection devices (needles), thermal devices (multipolar/bipolar probes, hemostatic forceps, heater probe, argon …

Endoscopic Identification Of Endoluminal Esophageal Landmarks For Radial And Longitudinal Orientation And Lesion Location, F. Emura, R. Gomez-Esquivel, C. Rodriguez-Reyes, P. Benias, J. Preciado, M. Wallace, L. Giraldo-Cadavid

Journal Articles

© The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. AIM To characterize esophageal endoluminal landmarks to permit radial and longitudinal esophageal orientation and accurate lesion location. METHODS Distance from the incisors and radial orientation were estimated for the main left bronchus and the left atrium landmarks in 207 consecutive patients using white light examination. A sub-study was also performed using white light followed by endoscopic ultrasound (EUS) in 25 consecutive patients to confirm the findings. The scope orientation throughout the exam was maintained at the natural axis, where the left esophageal quadrant corresponds to the area …

The Role Of Vitamin D In Elderly Inflammatory Bowel Disease Patients, D. Kagolanu, I. Levine, S. Katz

Journal Articles

© 2019 Gastro-Hep Communications Inc. All rights reserved. The role of vitamin D has long been discussed in many chronic diseases, and its significance in inflammatory bowel disease has recently gained attention. This article reviews vitamin D homeostasis, the involvement of vitamin D in the pathophysiol-ogy of inflammatory bowel disease, and vitamin D deficiency as a result of inflammatory bowel disease. In addition, this article explores the possibility of age, specifically in the elderly population, as a risk factor for developing vitamin D deficiency in patients with inflammatory bowel disease.

Advanced Imaging In Surveillance Of Barrett's Esophagus: Is The Juice Worth The Squeeze?, S. A. Cerrone, A. J. Trindade

Journal Articles

No abstract provided.

Ileal Adenocarcinoma With Liver Metastasis In Patient With Crohn's Disease: A 9-Year Survival., J. P. Kothadia, D. H. Nagaraju, S. Katz, H. Bruckner, S. H. Itzkowitz, M. Schwartz

Journal Articles

Small bowel adenocarcinoma is a rare but well-known complication of Crohn's disease. The diagnosis of small bowel adenocarcinoma remains difficult since its presentation is highly variable and mimics active or obstructive Crohn's disease. The diagnosis is often delayed and typically detected only at surgery in an advanced stage with a poor prognosis. We report a case of metastatic ileal adenocarcinoma in a patient with Crohn's disease with prolonged survival. Our case describes serial promising treatment options of these advanced malignancies and raises a possible role for checkpoint immunotherapy.

The Role Of Activin A Signaling In Gastric Reflux-Related Diseases And The Progression To Esophageal Adenocarcinoma, Cedric J. Roudebush

Honors Undergraduate Theses

Gastroesophageal reflux disease (GERD), or acid reflux, affects 6-9 million people in the United States. It is characterized by a reflux of gastric acid and bile salts from the stomach into the esophagus, causing injuries to the esophagus known as Barrett's esophagus (BE). BE is the main risk factor for the development of esophageal adenocarcinoma (EAC), a devastating cancer in the esophagus whose molecular roots remain poorly understood. In recent years, evidence points to the esophageal epithelium itself as responsible for causing and promoting inflammation upon injury by gastric reflux, namely via an increase in inflammatory cytokine secretion. This project …

'I Think I'M Gonna Hurl': A Narrative Review Of The Causes Of Nausea And Vomiting In Sport, Patrick B. Wilson

Counseling & Human Services Faculty Publications

Exercise-associated gastrointestinal (GI) distress can negatively impact athletic performance and interfere with exercise training. Although there are a few universal underlying causes of GI distress, each symptom often has its own unique triggers and, therefore, its own prevention and management strategies. One of the most troubling GI symptoms an athlete can experience during training and competition is nausea/vomiting. The prevalence of nausea varies with several factors, two of the most important being exercise intensity and duration. Relatively brief, high-intensity exercise (e.g., sprinting, tempo runs) and ultra-endurance exercise are both associated with more frequent and severe nausea. The potential causes of …

Commentary: Adherence With A Low-Fodmap Diet In Irritable Bowel Syndrome: Are Eating Disorders The Missing Link?, Bruno P Chumpitazi, Ligia Alfaro-Cruz, Jasmine K Zia, Robert J Shulman, Margaret M Heitkemper

Articles, Abstracts, and Reports

No abstract provided.

Does Preprandial Oral Lactase Supplement Reduce Abdominal Pain In Lactose-Intolerant Adult Patients After A Lactose-Containing Meal?, Margaryta Tolchynska

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not preprandial oral lactase supplement reduces abdominal pain in lactose-intolerant adult patients after a lactose-containing meal.

STUDY DESIGN: A systematic review of three randomized, blinded, controlled primary research studies published between the years of 2010 and 2018.

DATA SOURCES: One randomized controlled trial (RCT), one randomized comparative study, and one randomized crossover study evaluating the efficacy of 9,000 units of preprandial oral lactase supplement in reducing abdominal pain due to lactose intolerance (LI). All studies were published in peer-reviewed journals and found via the use of PubMed, …

Blockade Of Fibroblast Activation Protein In Combination With Radiation Treatment In Murine Models Of Pancreatic Adenocarcinoma., Andrew J Gunderson, Tomoko Yamazaki, Kayla Mccarty, Michaela Phillips, Alejandro F Alice, Shelly Bambina, Lauren Zebertavage, David Friedman, Benjamin Cottam, Pippa Newell, Michael J. Gough, Marka R Crittenden, Pieter Van Der Veken, Kristina H Young

Articles, Abstracts, and Reports

Pancreatic ductal adenocarcinoma (PDAC) is characterized by a fibrotic stroma with a poor lymphocyte infiltrate, in part driven by cancer-associated fibroblasts (CAFs). CAFs, which express fibroblast activation protein (FAP), contribute to immune escape via exclusion of anti-tumor CD8+ T cells from cancer cells, upregulation of immune checkpoint ligand expression, immunosuppressive cytokine production, and polarization of tumor infiltrating inflammatory cells. FAP is a post-proline peptidase selectively expressed during tissue remodeling and repair, such as with wound healing, and in the tumor microenvironment by cancer-associated fibroblasts. We targeted FAP function using a novel small molecule inhibitor, UAMC-1110, and mice with germline knockout …

The Role Of Sphingosine Kinase 2 In Alcoholic Liver Disease, Eric K. Kwong

Theses and Dissertations

Alcoholic liver disease (ALD) is one of the most common liver diseases worldwide characterized by the accumulation of lipids within the liver, inflammation and the possibility of progressing to cirrhosis and liver failure. More importantly, there are currently no effective treatments for ALD and liver transplantation remains the only therapeutic option for end-stage liver disease. Previous studies have shown that ALD is a result of a combination of endoplasmic reticulum (ER) stress, lipid metabolism dysregulation and inflammation. It has been previously reported that alcohol disrupts gut microbiota homeostasis and causes increased endotoxins that contribute to the pathology of ALD. However, …