Digestive System Diseases Commons^™

Infection-Related Readmissions Are Rising Among Patients With Hepatorenal Syndrome: A Nationwide Analysis, Umer Farooq, Zahid I. Tarar, Ammad J. Chaudhary, Abdallah E. Alayli, Faisal Kamal, Chengdu Niu, Kamran Qureshi

Division of Gastroenterology and Hepatology Faculty Papers

Hepatorenal syndrome (HRS) is a unique form of renal dysfunction that results from circulatory hemodynamic dysfunction in advanced liver disease. We aimed to determine longitu- dinal trends in both all-cause and cause-specific readmissions for HRS in the United States. Using the National Readmission Database (2010–2018), we identified adult HRS patients during index admission via ICD codes. Fisher’s exact test and Cox regression analysis were used to compare pro- portions and compute adjusted p-values, respectively. Regression models were adjusted for gender, age, the Charlson comorbidity index, median household income, and hospital factors. A total of 169,522 HRS patients were included in …

Management Of Variceal Hemorrhage From Extensive Portal Vein Tumor Thrombus In Hepatocellular Carcinoma And Untreated Pheochromocytoma: A Case Report, Patrick Twohig, Kishan Patel, Tomoki Sempokuya, Chijoke Enweluzo, Lyudmila Muinov, Ishfaq Bhat

Graduate Medical Education Research Journal

Background: Over 600,000 people in the United States (U.S.) have liver cirrhosis. It is estimated that 30% of patients with compensated cirrhosis and 60% of patients with decompensated cirrhosis will develop varices in their lifetime, with an incidence rate of new varices at 9% per year. Fifty percent of patients with esophageal varices will experience bleeding at some time. Pheochromocytoma is a rare catecholamine secreting adrenal gland tumor that occurs in 2-8 people per every 1 million people in the general population. Standard treatment for variceal bleeding includes endoscopic band ligation and/or radiologic embolization along with non-selective beta blockers. However, …

Outcomes Of Endoscopic Submucosal Dissection In Cirrhotic Patients: First American Cohort, Robert Luke Pecha, Fares Ayoub, Ankur Patel, Abdullah Muftah, Michael W Wright, Mai A Khalaf, Mohamed O Othman

Faculty, Staff and Students Publications

BACKGROUND: Among patients with cirrhosis and pre-malignant or early malignant mucosal lesions, surgical intervention carries a much higher bleeding risk. When such lesions are discovered, endoscopic submucosal dissection (ESD) may offer curative therapy with lower risks than surgery and improved outcomes compared to traditional endoscopic resection.

AIM: To evaluate the outcomes of ESD in patients with cirrhosis.

METHODS: Patients with cirrhosis undergoing ESD between July 2015 and August 2022 were retrospectively matched in 1:2 fashion to controls based on lesion location, size, and anticoagulation use. Procedural outcomes were compared between groups.

RESULTS: A total of 64 Lesions from 59 patients …

Pain Management In Perforated Appendicitis: Transitioning To A Minimal Narcotic Strategy, Seth Saylors, Meredith Elman, Pablo Aguayo, Rebecca M. Rentea, Richard J. Hendrickson, David Juang, Charles L. Snyder, Jason D. Fraser, Tolulope A. Oyetunji Md Mph, Shawn D. St Peter, Nelimar Cruz-Centeno, Charles Marchese

Research Days

Introduction: Patient controlled analgesia (PCA) was previously standard for postoperative pain control in children with perforated appendicitis at our institution. We previously reported the equivocal outcome of intravenous (IV) acetaminophen as a pain control adjunct used to transition from PCA to oral narcotics. We have since transitioned to a PCA-free, multi-modal pain control regimen postoperatively in perforated appendicitis. Through observational study, we aim to describe the impact of our new pain control regimen on postoperative narcotic use.

Methods: Children– June 2020 at a single freestanding children’s hospital were reviewed. Details of their hospitalization, including demographic, operative, anesthesia, pain management, and …

Parallel Use Of Low-Complexity Automated Nucleic Acid Amplification Tests On Respiratory Samples And Stool With Or Without Lateral Flow Lipoarabinomannan Assays To Detect Pulmonary Tuberculosis Disease In Children, Laura Olbrich, Alexander W Kay, Stephanie Bjerrum, Bada Yang, Johanna Åhsberg, Ruvandhi R Nathavitharana, Andreas Lundh, Maunank Shah, Devan Jaganath

Faculty, Staff and Students Publications

This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To compare the diagnostic accuracy of the parallel use of low-complexity automated nucleic acid amplification tests on respiratory and stool specimens in children and lateral flow urine lipoarabinomannan amongst children with HIV versus each assay alone for detecting pulmonary tuberculosis. Secondary objectives To compare the diagnostic accuracy of low-complexity automated nucleic acid amplification tests on respiratory and stool specimens in combination versus each sample type alone. To investigate the following sources of heterogeneity: clinical setting, signs and symptoms of pulmonary tuberculosis disease, screening positivity by chest …

Parallel Use Of Low-Complexity Automated Nucleic Acid Amplification Tests And Lateral Flow Urine Lipoarabinomannan Assays To Detect Tuberculosis Disease In Adults And Adolescents Living With Hiv, Stephanie Bjerrum, Bada Yang, Johanna Åhsberg, Ruvandhi R Nathavitharana, Laura Olbrich, Devan Jaganath, Alexander W Kay, Andreas Lundh, Maunank Shah

Faculty, Staff and Students Publications

This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To compare the diagnostic accuracy of parallel use of lateral flow urine lipoarabinomannan on urine and low-complexity automated nucleic acid amplification tests on respiratory samples versus each test alone for detection of tuberculosis disease in adults and adolescents living with HIV who present with presumptive tuberculosis. Secondary objectives To investigate the following sources of heterogeneity: clinical setting; signs and symptoms of tuberculosis; screening positivity for tuberculosis disease by chest x-ray, C-reactive protein elevation, and molecular World Health Organization-recommended rapid diagnostics; seriously ill; advanced HIV; and CD4 …

Recent Advances In The Prevention And Treatment Of Decompensated Cirrhosis And Acute-On-Chronic Liver Failure (Aclf) And The Role Of Biomarkers, Jonel Trebicka, Ruben Hernaez, Debbie Lindsay Shawcross, Alexander L Gerbes

Faculty, Staff and Students Publications

The progression of cirrhosis with clinically significant portal hypertension towards decompensated cirrhosis remains clinically challenging and the evolution towards acute-on-chronic liver failure (ACLF), with one or more extrahepatic organ failures, is associated with very high mortality. In the last decade, significant progress has been made in the understanding of the mechanisms leading to decompensation and ACLF. As portal hypertension advances, bacterial translocation across an impaired gut barrier culminates in endotoxaemia, systemic inflammation and cirrhosis-associated immune dysfunction (CAID). Gut-derived systemic inflammation and CAID have become the logical targets for innovative therapies that prevent hepatic decompensation episodes and the progression to ACLF.Furthermore, …

Clinical Outcomes For Patients With Nafld And Acute Hepatitis: An Analysis Of The National Inpatient Sample, Dakota B. Pastore, Tony Elias, Peter Senatore

Rowan-Virtua Research Day

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease in the United States and has been found to play a significant role in cardiovascular disease risk through several mechanisms including dyslipidemia, insulin resistance, coagulability, and inflammation. Acute-on-chronic liver disease continues to contribute to worse health outcomes via acute hepatitis.

Methods: This case-control study investigated the relationship between NAFLD and acute hepatitis using data extracted from the National Inpatient Sample (NIS) Database for the years 2019 and 2020. The NIS was searched for hospitalizations of adult patients with acute hepatitis with and without NAFLD. Using …

Case Report: Diverticulitis Involving A Meckel’S Diverticulum, Samuel M. Thalathoti, Russell A. Mordecai

Rowan-Virtua Research Day

We report a case of a 65-year-old female who presented with abdominal pain and was diagnosed with diverticulitis involving a Meckel‘s Diverticulum. The differential diagnosis of abdominal pain is vast, in this age group includes, but is not limited to appendicitis, diverticulitis, cholecystitis, and small bowel obstruction. In the absence of complicated features, conservative management with oral antibiotics and close outpatient follow is advised. However, in the case of complicated diverticulitis and a rare manifestation such as a Meckel’s Diverticulum, careful management is indicated.

Dense Colon Scarring After Infliximab For Acute Severe Ulcerative Colitis, Rahul Patel, Sriya Vutukuru, Neethi Dasu, Charles Snyder

Rowan-Virtua Research Day

Introduction: Infliximab is a monoclonal antibody against tumor necrosis factor alpha used in the treatment of ulcerative colitis. It has been shown to be efficacious in patients with moderate to severe ulcerative colitis and/or those who have failed intravenous steroids. We present a unique finding of profoundly dense colonic scarring after a year of infliximab therapy in a patient with acute severe ulcerative colitis.

Case: A female in her early 60s presented to the hospital with a three month history of rectal bleeding and intermittent fevers. A colonoscopy was done which demonstrated severe Mayo 3 left-sided colitis, consistent with a …

Gut Microbiome And Nutrition Interplay In Regulating And Improving Autism Spectrum Disorder Related Social Symptoms, Irenonsen Juliet Eigbe, Christian Moya Gamboa, Jana Gjini, Jaydeep Mukherjee, Susrut Dube

Rowan-Virtua Research Day

The composition of the gut microbiome has been shown to play a role in the onset of neurological disorders, including Autism Spectrum Disorder(ASD). A small variety of recent research articles identify a possible link between onset and severity of ASD related behaviors and the composition of the gut microbiome. The purpose of this review is to identify gaps in the current understanding of the role that nutrition plays in changing the gut microbiome and subsequently altering the onset and severity of behavioral phenotypes in children with ASD. Inclusion criteria comprises peer-reviewed publications relating to children with autism. Exclusion criteria consists …

Health Benefits Of Saccharomyces Boulardii As A Probiotic, Devashri Parikh, Maftuna Kurbonnazarova, Ravij Upadhyay, Andrea Iannuzzelli

Rowan-Virtua Research Day

Saccharomyces boulardii (SB), a budding yeast, within the Saccharomyces genus. It commonly used as a probiotic that has been isolated from lychee and mangosteen fruit. S. boulardii is not known to acquire resistant genes and does not last in the intestine after 3-5 days of discontinuing the ingestion. The clinical efficacy of this probiotic yeast is known to improve various diarrhea such as pediatric diarrhea, antibiotic-associated diarrhea, acute diarrhea, and traveler’s diarrhea. Additionally, when used as an adjuvant to treatment for Helicobacter pylori and Clostridium difficile infections, it improves bacterial eradication, prevents relapse, reduces adverse reactions and treatment-associated diarrhea.

Several …

Ultrasound Versus Radiography For Evaluating Surgical Necrotizing Enterocolitis, Sayed H. Aftab, Santiago Martinez-Correa, Minh-Huy Huynh, Wondwossen T. Lerebo, Jorge Delgado, Rebecca Denis, Misun Hwang

Rowan-Virtua Research Day

Purpose:

Necrotizing enterocolitis (NEC) is an abdominal inflammatory condition that is common in premature neonates. Although abdominal radiograph (AR) remains the imaging standard for NEC, it may miss up to 50% of early signs of NEC and has been described to have a sensitivity as low as 15.4% for detecting pneumoperitoneum. Abdominal ultrasound (US) is portable, non-invasive, and allows real-time bowel integrity, movement, and perfusion assessment. We aim to evaluate the concordance between US and AR in detecting NEC features and the diagnostic performance of both modalities in detecting pneumoperitoneum.

Methods and materials:

We conducted an IRB-approved retrospective, cross-sectional, single-center …

Gut Microbiota Changes After Cholecystectomy: Unraveling The Microbial Mysteries - A Systematic Review, Maftuna Kurbonnazarova, Arthi Rameshkumar, Olivia R. Siciliano, Samrat Gollapudi, Katarina Rusinak, Alissa Brotman O’Neill

Rowan-Virtua Research Day

Aims: This review aims to expand upon previous research examining change in gastrointestinal microbiota before and after cholecystectomy.

Methods: A systematic review, combined with a pooled analysis, was conducted to assess gut microbiota dysbiosis post-cholecystectomy, utilizing 71 articles retrieved from 3 databases, with 13 undergoing full-text appraisal. The publication dates ranged from 2018 to 2023.

Results: Results suggested a greater degree of microbiota alteration in symptomatic post-cholecystectomy patients, characterized by a decrease in the Firmicutes/Bacteroidetes ratio, Bifidobacterium and Lactococcus, alongside increased levels of harmful microbiota such as Prevotella, Sutterella, Proteobacteria, Verrucomicrobia, Blautia obeum, and Veillonella species. Interestingly, an increase in …

A Case Of Esophagogastric Junction Outflow Obstruction Resulting To Megaesophagus In A 37-Year-Old Male, Dean Esma, Robin Lahr, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Esophagogastric junction outflow obstruction (EGJOO) is a major motility disorder characterized by an increase of > 15 mmHg in the integrated relaxation pressure (IRP) with or without problems in esophageal motility. This presents as dysphagia, chest pain, regurgitation, heartburn, cough, and a globus sensation, with dysphagia. Severe cases may lead to a megaesophagus causing compression of mediastinal structures.6 Its similarity to other esophageal disorders urge an investigation to improve its identification and treatment. This report presents a case of EGJOO in a 37-year-old cachectic male patient with dysphagia and vomiting, eventually determined to be EGJOO with diagnostic manometry.

Comparative Analysis Of Health Outcomes In Gastric Cancer: Robotic Vs. Laparoscopic Gastrectomy, Maftuna Kurbonnazarova

Rowan-Virtua Research Day

Exploring the most effective surgical approach for gastrectomy is crucial for determining superior health outcomes in patients. This research compares robotic and laparoscopic techniques with the aim of pinpointing the optimal method, offering valuable insights for improved postoperative well-being.

The Role Of B Cell Activation State And Sex In Aryl Hydrocarbon Receptor Mediated Induction Of Chemokine Receptor 9 And Alpha4beta7 Expression In Vitro, Logan Bauerle

Master's Theses

Defense of mucosal tissues from microbial infection and allergy is reliant on continual production of antibodies. The aryl hydrocarbon receptor (AhR) is known to regulate B cell development and is associated with suppression of systemic humoral immunity. Recent attention has been paid to the role of the AhR in altering expression of cell adhesion molecules (CAMs). B cells express CAMs and chemokine receptors to migrate around the body for localized secretion of antibodies. AhR agonists promote B cell migration to the small intestine through upregulation of chemokine receptor 9 (CCR9) and integrin α₄β₇. Both the AhR …

Non-Alcoholic Fatty Liver Disease: Role Of Pnpla3 And Its Association With Environmental Chemicals, Shakil A. Saghir, Ata Abbas, Saleh Alfuraih, Ajay Sharma, Jean Latimer, Yadollah Omidi, Rais Ansari

Pharmacy Faculty Articles and Research

Globally, non-alcoholic fatty liver disease (NAFLD) is on the rise with 30-32%, 27-33%, 35-48%, 36%, 9-20%, and 36-38% prevalence in Asia, Europe, North America, South America, Africa, and Australia, respectively. Approximately, 5-10% of NAFLD proceeds to hepatitis called non-alcoholic steatohepatitis (NASH). NASH often progresses to liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Precise mechanism(s) for the development of HCC is not fully understood in NAFLD and NASH patients. Higher insulin levels in type 2 diabetes (T2D) can result in lipolysis of adipose tissue activating lipid synthesizing enzymes such as fatty acid synthase and stearoyl-CoA desaturase-1, resulting in lipid accumulation in …

Pragmatic Strategies To Address Health Disparities Along The Continuum Of Care In Chronic Liver Disease, Mayur Brahmania, Shari Rogal, Marina Serper, Arpan Patel, David Goldberg, Amit Mathur, Julius Wilder, Jennifer Vittorio, Andrew Yeoman, Nicole E Rich, Mariana Lazo, Ani Kardashian, Sumeet Asrani, Ashley Spann, Nneka Ufere, Manisha Verma, Elizabeth Verna, Dinee Simpson, Jesse D Schold, Russell Rosenblatt, Lisa Mcelroy, Sharad I Wadhwani, Tzu-Hao Lee, Alexandra T Strauss, Raymond T Chung, Ignacio Aiza, Rotonya Carr, Jin Mo Yang, Carla Brady, Brett E Fortune

Faculty, Staff and Students Publications

Racial, ethnic, and socioeconomic disparities exist in the prevalence and natural history of chronic liver disease, access to care, and clinical outcomes. Solutions to improve health equity range widely, from digital health tools to policy changes. The current review outlines the disparities along the chronic liver disease health care continuum from screening and diagnosis to the management of cirrhosis and considerations of pre-liver and post-liver transplantation. Using a health equity research and implementation science framework, we offer pragmatic strategies to address barriers to implementing high-quality equitable care for patients with chronic liver disease.

Interrogating Therapeutic Resistance To Oncogenic Krasg12c-Based Therapies In Colorectal Cancer, Oluwadara Coker

Dissertations and Theses (Open Access)

Colorectal cancer is the second leading cause of cancer-related deaths and the third most common cancer in the United States. Although KRAS is mutated in 50% of patients with metastatic CRC (mCRC), it has historically been a challenging therapeutic target. The recent approval of novel covalent inhibitors selective for KRASG12C mutation have entered the clinic, which has not only marked a major milestone in cancer drug discovery but has also intensified efforts to directly target other KRAS mutations that have also successfully entered the clinic. However, treatment-associated resistance mechanisms have long threatened to attenuate clinical benefit through either adaptive or …