Digestive System Diseases Commons^™

Gallbladder Ascariasis Presenting As Acalculous Biliary Colic, Carmen A. Urbina, Luigi G. Cubeddu, Luigi X. Cubeddu

HCA Healthcare Journal of Medicine

We detail a case of gallbladder ascariasis, presenting as an acute episode of acalculous biliary colic, nausea, bloating, an unremarkable abdominal ultrasound, and negative helminth and protozoa stool smears. A follow-up ultrasound provided unexpected images consistent with gallbladder infection by Ascaris lumbricoides. Repeat ultrasonography performed 10 days after anthelmintic therapy showed no live worms and 2 newly appearing echogenic areas suggestive of gallbladder calculi that were confirmed following elective cholecystectomy. The case course highlights key clinical, diagnostic, and management considerations in gallbladder ascariasis and underscores the value of repeated ultrasonographic evaluation in affected patients.

Psychological Adaptation In Colorectal Cancer Survivors: Pilot Study Findings, Anuja L. Sarode, Emily M. Su, Amber Kerstetter-Fogle, Steve Paciorek, Erica L. Laipply

HCA Healthcare Journal of Medicine

Background

In this pilot study, we examined psychological impacts of colorectal cancer (CRC), focusing on cancer-related posttraumatic stress disorder (CR-PTSD) symptoms, posttraumatic growth (PTG), and their relationship with coping strategies in surgically treated CRC patients.

Methods

This prospective pre- and postoperative pilot study assessed CRC patients at 2 time points, pre- and postoperative. Psychological symptoms were evaluated using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) and the PTG Inventory Short Form (PTGI-SF). Coping strategies were assessed using the Brief Coping Orientation to Problems Experienced (COPE) instrument. Changes in CR-PTSD, PTG, and coping …

Coping Beyond Cancer: Exploring Fear Of Recurrence In Colorectal Cancer Survivors—A Pilot Investigation, Emily M. Su, Steve Paciorek, Erica L. Laipply, Anuja L. Sarode

HCA Healthcare Journal of Medicine

Background

Evidence is limited on the fear of cancer recurrence (FCR) among colorectal cancer (CRC) survivors in the US, especially regarding patterns and trends of post-recovery coping mechanisms. This pilot mixed-methods study quantified FCR, examined its associations with Brief COPE domains, and contextualized coping through qualitative analysis.

Methods

Twenty-three patients who successfully underwent CRC surgery were included in this pilot study. Fear of cancer recurrence was measured using the FCR Inventory (FCRI) Short Form, and coping strategies were assessed with the Brief Coping Orientation to Problems Experienced (COPE) survey. Descriptive statistics summarized participant characteristics, FCR, and COPE scores. Spearman correlation …

Locoregional Therapy Pressure-Enabled Drug Delivery For Liver Cancers, Thomas Eggleston, Bassem Fayek, Jacqueline Kowalke, Mina Makary

Student Papers, Posters & Projects

Hepatic malignancies account for a substantial portion of global cancer mortality, with hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (IHC), and metastatic liver disease representing the most common diagnoses. While surgical resection and liver transplantation remain curative options for eligible patients, most patients are diagnosed at stages unsuitable for surgery. This has shifted medical management towards locoregional therapies (LRTs) which are often catheter-directed. Of these interventions, the use of conventional end-hole catheters for therapeutic infusion has been a mainstay of treatment, but this method is constrained by retrograde particle escape and elevated tumoral interstitial fluid pressure. Together, these factors limit drug penetration …

The Effect Of Empiric Initiation Of Treatment On Outcomes Among Patients Presenting With Extrapulmonary Mycobacterium Tuberculosis Infection In A Community Hospital Setting, Talha Awwal, Faisal Raja Kh, Hanya Awaba, Waseem Anwar, Jinma Ren, Muhammad Aamir Safdar, Saqib Walayat, John J. Farrell

Journal of Community Hospital Internal Medicine Perspectives

Background: Extrapulmonary tuberculosis (EPTB) accounts for ~20% of Mycobacterium tuberculosis infections in Pakistan. Diagnostic delays are common and may worsen outcomes. We evaluated whether empiric treatment initiation improves outcomes among patients with EPTB at a large public hospital in Islamabad, Pakistan. Methods: Retrospective cohort of consecutive EPTB cases at Pakistan Institute of Medical Sciences (January–June 2016). Patients were categorized as clinically diagnosed (symptoms/radiology) or laboratory-supported (histology, microbiology, or biochemical tests). Standard Directly Observed Therapy Short-course (DOTS) based regimens were used. Outcomes were treatment success, failure, loss to follow-up, and mortality; groups were compared using chi-square testing. Results: Of 317 EPTB …

Biotic Therapies For Irritable Bowel Syndrome: Current Interventions, Gina Wodarczyk, Maria Winte, Diana Mastellone, Termen Singh, Joshua Desipio, Sangita Phadtare

Division of Gastroenterology and Hepatology Faculty Papers

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by recurrent abdominal pain and changes in bowel habits without measurable disease processes. Recent research emphasizes the gut-brain-microbiome (GBM) axis and explores how microbiota influence gastrointestinal and central nervous system functions. Here, we first discuss a brief overview of various treatment approaches for IBS, focusing on interventions such as probiotics, prebiotics, or synbiotics that target the GBM axis in adults with IBS. Relevant trials discussed the use of probiotics, prebiotics, or synbiotics.

Specific Carbohydrate Diet Versus Mediterranean Diet In Adult Patients With Mild To Moderate Ulcerative Colitis: A Randomized Controlled-Feeding Trial, Albert Sheng-Yin Chen, Long Nguyen, Brianna Gray, Katherine Williams, Jenny Gurung, Lauren Canha, Jessica Mcgoldrick, Jane Hubbard, Hamed Khalili

Student Papers, Posters & Projects

Background and aims: This pilot randomized controlled-feeding trial compared the effect of Specific Carbohydrate Diet (SCD) and Mediterranean diet (MeD) in mild to moderate ulcerative colitis (UC).

Methods: Seventeen adults were randomized to a 6-week SCD (n = 8) or MeD (n = 9) intervention. Primary outcome was change in partial Mayo Clinic score (pMCS).

Results: The study was discontinued early due to significant dropout (n = 9, 52.9%). There was no significant between-group differences observed for pMCS change (SCD, -0.8; MeD, -1.3; p = 0.499) or secondary outcomes. Exploratory metagenomic analysis revealed enrichment of Parasutterella excrementihominis …

Navigating Complex Esophageal Perforations: A Case-Specific Approach To Successful Outcomes, Harsimran Kalsi, Anushree Rai, Kobina Essilfie-Quaye, Neeka Akhavan, Yaseen Perbtani, Tony S. Brar

HCA Healthcare Journal of Medicine

Esophageal perforation is a life-threatening condition requiring prompt diagnosis and effective management. While self-expanding metal stents (SEMS) are a first-line treatment, persistent leaks often necessitate adjunctive endoscopic interventions. A structured, multimodal approach is critical for optimizing outcomes and avoiding surgical intervention. A 44-year-old man developed an iatrogenic esophageal perforation following surgical leiomyoma enucleation. Initial treatment with overlapping fully covered self-expanding metal stents (FC-SEMS) failed to achieve closure, necessitating endoscopic suturing for defect reinforcement. Despite suturing, persistent leakage required placement of a larger-diameter FC-SEMS, secured with an endoscopic fixation system to prevent migration. Serial imaging confirmed successful defect closure, allowing the …

A Flare Beyond The Gut: Culture-Negative Skin Abscesses In Ulcerative Colitis, Jose J. Loayza Pintado, Mohammad Aqeel, Jorge Aboytes Trevino, Taiwo Ajani, Andres Suarez

Research Symposium

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease often complicated by extraintestinal manifestations, with skin involvement seen in up to 15% of patients. Typical lesions include erythema nodosum and pyoderma gangrenosum, but abscess-like cutaneous lesions are almost always assumed to be infectious. Rare case reports describe sterile, culture-negative abscesses arising during UC flares, yet their true prevalence is unknown. We present the case of a young man with UC who developed multiple aseptic skin abscesses in parallel with active proctitis.

Case Presentation: A 19-year-old man with prior Clostridioides difficile infection and subtotal colectomy (rectal preservation) presented with malaise, …

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 …

Transition To Noninvasive Testing From The Gold Standard Of Liver Biopsy, Heidi Bien, Sabina Choudhry, Christine Pocha, University Of South Dakota Sanford School Of Medicine & Avera Health System

Scholarship Pathways Program

Purpose: Metabolic dysfunction–associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease, represents a rapidly growing public health concern, affecting roughly 30% of the global population. MASLD encompasses a spectrum from simple steatosis to its more progressive form, metabolic dysfunction–associated steatohepatitis (MASH). Early and accurate assessment of liver disease is critical for risk stratification and management, yet the current gold standard-liver biopsy remains invasive, costly, and limited by sampling variability and interpretive subjectivity. Noninvasive imaging modalities, particularly magnetic resonance elastography (MRE), have emerged as promising alternatives, but their concordance with biopsy in real-world clinical practice remains underexplored.

 Methods: …

What Is The Role Of The Gut Microbiome In Modulating Immune Tolerance And The Development Of Allergic Disease In Infants?, Priyal Gajera

Rowan-Virtua Research Day

Introduction: The infant gut microbiome plays a critical role in immune system development during the early-life “window of immune education.”¹ Microbial colonization influences immune tolerance through mechanisms such as regulatory T-cell (Treg) induction, short-chain fatty acid (SCFA) production, and mucosal immune regulation. Disruptions in this process (dysbiosis) are associated with increased risk of allergic diseases, including food allergy, atopic dermatitis, and asthma. Environmental and maternal factors such as delivery mode, antibiotic exposure, and feeding practices significantly impact microbial composition and immune outcomes.²

Methods: A literature review was conducted using PubMed with search terms related to the gut microbiome, …

Atypical Presentation Of Alpha-Gal Syndrome Identified During Evaluation Of Transient Neurologic Symptoms, Austin J. Wong, Todd Schachter

Rowan-Virtua Research Day

Alpha-gal syndrome (AGS) is an IgE-mediated hypersensitivity reaction to galactose-α-1,3-galactose, typically associated with tick exposure and delayed allergic reactions to mammalian meat products. While most commonly presenting with urticaria, gastrointestinal symptoms, or anaphylaxis, atypical and systemic manifestations remain poorly characterized.

We present the case of a 39-year-old male with minimal vascular risk factors who developed acute onset shortness of breath, chest pressure, and transient neurologic symptoms concerning for a transient ischemic attack. Extensive cardiac, vascular, and autoimmune evaluation was largely unremarkable aside from abnormalities in lupus anticoagulation screening and elevated homocysteine and protein C levels.

Further evaluation revealed elevated alpha-gal–specific …

The Tensile Gallbladder Sign: A Case Report Of Acute Gangrenous Cholecystitis Diagnosed By A Rare Computed Tomography Finding, Lan D. Ngo, Trent R. Malcolm

Rowan-Virtua Research Day

Acute cholecystitis is one of the most common causes of acute abdominal pain in the emergency department, accounting for approximately 200,000 hospitalizations annually in the United States (Gallagher & Charles, 2022) Ultrasound is the established first-line imaging modality for suspected cholecystitis. However, compute tomography (CT) is increasingly obtained for undifferentiated abdominal pain and offers complementary, operator-independent evaluation.  The tensile gallbladder fundus sign is defined on CT as the absence of fundal flattening by the anterior abdominal wall due to elevated intraluminal pressure.

Acute Appendicitis With Concomitant Testicular Torsion, Thuc Vu, Clara Keum, Swet Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

This case report presents a 13-year-old male who presented to the emergency department with diffuse abdominal pain radiating to the right lower quadrant, accompanied by nausea and decreased appetite. Diagnostic evaluation revealed right-sided testicular torsion concurrent with acute appendicitis. Although acute appendicitis represents the most common surgical emergency in the pediatric population, clinicians must maintain a broad differential diagnosis to identify potential concomitant acute pathologies, including testicular torsion in this scenario.

Mental Health Comorbidities And Ibd Outcomes In Patients Treated With Anti–Il-23 Therapy, Jashanveer S. Johal, Archana Salek, Mahmoud Al-Bataineh, Bianca Patel, Om Patel, Yecheskel Schneider, Jason Hyman, Abdallah Hussein

Rowan-Virtua Research Day

Background: Depression and anxiety are prevalent in inflammatory bowel disease (IBD) and may adversely influence outcomes. We evaluated the impact of comorbid mood disorders on clinical outcomes among IBD patients treated with anti–IL-23 agents.

Methods: Using a global de-identified electronic health record network, adults with Crohn's disease or ulcerative colitis initiating an anti–IL-23 agent were identified. Cohort 1 included patients with a documented mood disorder (depression and/or anxiety) at or prior to treatment initiation; Cohort 2 included those without mood disorders. Propensity score matching (1:1) on demographics and comorbidities yielded 3,546 patients per cohort. Primary outcomes included inpatient/ED encounters, abscess/fistula, …

Risk Of Colorectal And Gastrointestinal Neoplasia In Inflammatory Bowel Disease Treated With Infliximab Versus Vedolizumab And Ustekinumab: A 5-Year Multicenter Retrospective Cohort Study, Jashanveer S. Johal, Archana Salek, Mahmoud Al-Bataineh, Bianca Patel, Abdallah Hussein, Om Patel, Jason Hyman, Yecheskel Schneider

Rowan-Virtua Research Day

Background: Inflammatory bowel disease (IBD) confers elevated colorectal cancer (CRC) risk, but comparative long-term neoplastic risks between anti-TNF and gut-selective or IL-12/23–targeted biologics remain incompletely defined. We evaluated 5-year risks of CRC and GI neoplasia in IBD patients treated with infliximab versus vedolizumab and ustekinumab.

Methods: Using the TriNetX federated research network, two parallel 5-year propensity score–matched cohort analyses were conducted among adults with Crohn's disease or ulcerative colitis initiating infliximab, vedolizumab, or ustekinumab between 2018–2024. Patients with prior CRC, colectomy, or baseline comparator biologic exposure were excluded. The infliximab–vedolizumab analysis matched 13,111 patients per cohort; the infliximab–ustekinumab analysis matched …

Bone Health And Healthcare Utilization Outcomes In Crohn’S Disease Patients Without Baseline Fracture Or Vitamin D Deficiency Treated With Infliximab Versus Adalimumab: A Propensity-Matched Cohort Study, Jashanveer S. Johal, Bianca Patel, Archana Salek, Mahmoud Al-Bataineh, Abdallah Hussein, Om Patel, Jason Hyman, Yecheskel Schneider

Rowan-Virtua Research Day

Background: Biologic therapies are central to Crohn's disease (CD) management, yet the comparative effects of infliximab and adalimumab on bone health and healthcare utilization remain poorly characterized in patients without baseline vitamin D deficiency or prior fractures.

Methods: A retrospective cohort study was conducted using the TriNetX U.S. Collaborative Network. Adult CD patients (≥18 years) initiating infliximab or adalimumab between 2018–2024 were included. Patients with ulcerative colitis, indeterminate colitis, or positive pregnancy tests were excluded. All patients had normal baseline vitamin D (≥20 ng/mL) and no history of pathological fracture. Propensity score matching (1:1) yielded 7,340 patients per cohort. Outcomes …

Acute Necrotizing Pancreatitis Due To Hypertriglyceridemia: A Case Report, Samantha Alyse Walkow, Pranaya Gade, Marina Bastawross, Ayesha Ain, Antonios Tsompanidis

Rowan-Virtua Research Day

Title: Acute Necrotizing Pancreatitis due to Hypertriglyceridemia: A Case Report

Background: Necrotizing pancreatitis is a severe complication of acute pancreatitis with a high risk of morbidity and mortality. Hypertriglyceridemia (HTG) is an uncommon but increasingly recognized etiology, often associated with more severe disease compared to biliary or alcoholic pancreatitis. Early recognition and targeted management are critical to prevent multiorgan failure.

Case Presentation: We present the case of a 39-year-old Hispanic male with a history of chronic hypertriglyceridemia and epilepsy who presented with acute onset of severe epigastric pain, nausea, and vomiting. Laboratory evaluation revealed markedly elevated serum triglycerides (TG) levels …

Point-Of-Care Intestinal Ultrasound Is Associated With Reduced Colonoscopy Utilization And Improved Clinical Decision-Making In Ibd, Lakumi Dias, Ashlyn Mcclelland, Amy Glasofer, Charalampos Papachristou, Yecheskel Schneider, Sanket Patel

Rowan-Virtua Research Day

Background:

Point-of-care intestinal ultrasound (IUS) enables real-time assessment of bowel inflammation, and it is underutilized in the United States. IUS provides visualization of bowel wall thickness, vascularity, and complications without radiation or bowel preparation. Prior studies demonstrate that IUS changes management and reduces reliance on invasive testing. This study hypothesizes that IUS will impact downstream clinical decision-making in a U.S. outpatient IBD cohort by decreasing invasive procedures and supporting appropriate treatment decisions.

Methods:

A retrospective cohort study was performed. Logistic regression and chi-square tests assessed associations between IUS use, colonoscopy referral, hospital utilization, and treatment modification. A derived “surveillance-due” variable …