Digestive System Diseases Commons^™

Gallstone Ileus: A Case Report, Jarrett Koper, Liz Bowers, Jonathan Leggett

South Atlantic Division GME Research Day 2022

No abstract provided.

Not Just An Accident: A Case Of Insulinoma, Asanka Ekanayake, Harrison Stubbs, Dominique Broutin, Olga Karasik, Mustafa Kinaan

North Florida Division GME Research Day 2022

No abstract available.

Severe Mixed Mitral Valve Disease Due To Massive Mitral Annular Calcification: A Case Report And Literature Review, Fateh Ali Tipoo Sultan, Sheema Saadia

Section of Cardiology

We present an unusual case of massive mitral annular calcification (MAC) leading to severe mixed mitral valve disease, viz severe mitral regurgitation and severe mitral stenosis. To our knowledge, severe mixed mitral valve disease secondary to MAC is extremely rare. The patient (a 65-year-old lady) presented with worsening shortness of breath and signs of congestive heart failure. Echocardiographic examination revealed massive mitral annular calcification. Despite the massive annular calcification, she had experienced neither embolism nor endocarditis in the past. Because of severe symptomatic mitral regurgitation and mitral stenosis, surgery was advised; however, the patient declined it.

Unusual Case Of Isolated Pancreatitis Secondary To Blunt Abdominal Trauma, Haroutiun Hamzoian, Reuben Plasencia, Ndifreke Ekpa, Elias Georg

Gulf Coast Division GME Research Day 2022

No abstract provided.

Progressive Endoscopic Approach To Balloon Dilation For Benign Esophageal Strictures, Chad J. Cooper

Theses and Dissertations--Clinical and Translational Science

Benign esophageal strictures are a frequently encountered problem in clinical practice. The management of benign esophageal strictures have slowly evolved over the decades based on “expert opinion.” Despite vast amounts of data about the efficacy and safety of dilation, unfortunately there is no consensus on a systematic and safe approach that is efficient, limits complications and provides long lasting improvement of dysphagia. Our group designed a progressive approach to endoscopic balloon dilation based on tailoring certain technical aspects of the dilation process.

Most studies in the literature concluded that endoscopic dilation is safe and effective in relieving dysphagia caused by …

A Qualitative Investigation Of Organizational Challenges And Facilitators To Screening Individuals Experiencing Homelessness For Hepatitis C Virus (Hcv) In Houston, Texas, Alane Celeste-Villalvir, J Michael Wilkerson, Christine Markham, Lourdes Rodriguez, Vanessa Schick

Faculty, Staff and Student Publications

BACKGROUND: Individuals experiencing homelessness may be at a disproportionately high risk for hepatitis C (HCV) because they may be more likely to engage in HCV risk behaviors. Community organizations that provide services to these vulnerable individuals can effectively screen, diagnose, and navigate them into HCV care. However, screening people experiencing homelessness for HCV at such organizations is limited by various challenges that remain understudied, including budgetary considerations and strategies to improve teamwork and communication. Accordingly, this study investigated the organizational challenges and facilitators to HCV screening of individuals experiencing homelessness as reported by homeless services providers.

METHODS: Staff (N = …

Treating Gut Feelings: A Systematic Review Of Psychological Treatments For Pediatric Inflammatory Bowel Disease, Venus Mirbod

Theses and Dissertations

Psychological comorbidities and psychosocial challenges are prevalent among children and adolescents with Inflammatory Bowel Disease (IBD). However, a comprehensive review of the availability and effectiveness of psychological treatments for pediatric IBD patients is lacking. This systematic review aimed to determine the availability and efficacy of psychological interventions for children and adolescents with IBD. The systematic review was conducted in accordance with PRISMA guidelines and performed using two electronic databases, PsycINFO and PubMed, from inception until March 2022. Databases were searched for English-language, controlled trials of psychological interventions for children and adolescents with IBD. Outcomes of interest included: depression, anxiety, health-related …

Palliative Endoscopic Salvage Of A Functionally Obstructed Gastrojejunostomy - Report Of Technique, Elias A Chamely, Bryan Hoang, Nadim S Jafri, Melissa M Felinski, Kulvinder S Bajwa, Peter A Walker, Jaideep Barge, Erik B Wilson, Putao Cen, Shinil K Shah

Faculty, Staff and Student Publications

BACKGROUND: Gastric outlet obstruction secondary to foregut gastrointestinal malignancies can be managed with a variety of medical, endoscopic, and surgical options. Laparoscopic gastrojejunostomy is an option for those patients who are able to tolerate an operation as a long-term palliative option. This operation may be associated with some significant postoperative technical and nontechnical complications, including delayed gastric emptying. This paper describes an incision-less, endoscopic option that we propose can be used to salvage a functionally obstructed gastrojejunostomy.

CASE DESCRIPTION: A 57-year old male patient had a history of pancreatic adenocarcinoma causing gastric outlet obstruction and underwent a previously created surgical …

Management Of Biliary Stones In Bariatric Surgery, Francisco Tustumi, João Emílio Lemos Pinheiro Filho, Lucas Cata Preta Stolzemburg, Leonardo Carvalho Serigiolle, Thiago Nogueira Costa, Denis Pajecki, Marco Aurélio Santo, Sérgio Carlos Nahas

Faculty, Staff and Student Publications

Morbidly obese and post-bariatric surgery patients are at increased risk for biliary stones formation. The complications related to biliary stones may impose complexity on their management. This study aimed to review the management of biliary conditions in obese and bariatric patients. In this study, a narrative review was performed of the medical, surgical, and endoscopic procedures for the management of biliary stones and their related complications. Knowing the main prophylactic and therapeutic interventions options is essential for clinicians to properly manage the biliary stones in patients candidates or submitted to bariatric surgery.

Plain language summary: Management of biliary stones in …

Why Test Results Are Still Getting "Lost" To Follow-Up: A Qualitative Study Of Implementation Gaps, Andrew J Zimolzak, Umber Shahid, Traber D Giardina, Sahar A Memon, Umair Mushtaq, Lisa Zubkoff, Daniel R Murphy, Andrea Bradford, Hardeep Singh

Faculty, Staff and Students Publications

BACKGROUND: Lack of timely follow-up of abnormal test results is common and has been implicated in missed or delayed diagnosis, resulting in potential for patient harm.

OBJECTIVE: As part of a larger project to implement change strategies to improve follow-up of diagnostic test results, this study sought to identify specifically where implementation gaps exist, as well as possible solutions identified by front-line staff.

DESIGN: We used a semi-structured interview guide to collect qualitative data from Veterans Affairs (VA) facility staff who had experience with test results management and patient safety.

SETTING: Twelve VA facilities across the USA.

PARTICIPANTS: Facility staff …

Associations Of Duration, Intensity, And Quantity Of Smoking With Risk Of Gastric Intestinal Metaplasia, Aaron P Thrift, Andre G Jove, Yan Liu, Mimi C Tan, Hashem B El-Serag

Faculty, Staff and Students Publications

GOAL: Determine whether various dimensions of smoking increase risk for gastric intestinal metaplasia.

BACKGROUND: Cigarette smoking has been implicated in the etiology of gastric cancer, but it is not clear if smoking is a risk factor for gastric intestinal metaplasia, a precursor lesion of gastric cancer.

MATERIALS AND METHODS: We compared data from 385 gastric intestinal metaplasia cases and 1577 controls without gastric intestinal metaplasia recruited into a cross-sectional study at the Michael E. DeBakey VA Medical Center in Houston, Texas. All participants completed standardized questionnaires and underwent a study endoscopy with gastric mapping biopsies. Gastric intestinal metaplasia cases included …

Clinical Outcome And Gut Development After Insulin-Like Growth Factor-1 Supplementation To Preterm Pigs, Kristine Holgersen, Martin Bo Rasmussen, Galen Carey, Douglas G Burrin, Thomas Thymann, Per Torp Sangild

Faculty, Staff and Students Publications

BACKGROUND: Elevation of circulating insulin-like growth factor-1 (IGF-1) within normal physiological levels may alleviate several morbidities in preterm infants but safety and efficacy remain unclear. We hypothesized that IGF-1 supplementation during the first 1-2 weeks after preterm birth improves clinical outcomes and gut development, using preterm pigs as a model for infants.

METHODS: Preterm pigs were given vehicle or recombinant human IGF-1/binding protein-3 (rhIGF-1, 2.25 mg/kg/d) by subcutaneous injections for 8 days (Experiment 1, n = 34), or by systemic infusion for 4 days (Experiment 2, n = 19), before collection of blood and organs for analyses.

RESULTS: In both …

The Texas Collaborative Center For Hepatocellular Cancer: Reducing Liver Cancer Mortality In Texas Through Coordination, Collaboration And Advocacy, Ariel C Harrison, Fasiha Kanwal, Sumeet K Asrani, Aaron P Thrift, Chris I Amos, Maria L Jibaja-Weiss, Jane R Montealegre, Jessica P Hwang, Amit G Singal, Hashem B El-Serag

Faculty, Staff and Students Publications

Texas has the highest age-adjusted incidence rate of hepatocellular carcinoma (HCC) in the United States. To address cancer prevention and early detection through research, Cancer Prevention and Research Institute of Texas (CPRIT) has funded the Texas Collaborative Center for Hepatocellular Cancer (TeCH) to facilitate liver cancer research, education and advocacy activities. This paper describes the organizational structure, program measures, the actions completed and future plans of TeCH. This center is comprised of several cores and committees including the Administrative Core, Steering Committee, Data and Biospecimen Core, Scientific Committee, Clinical Network Committee, and the Community Outreach Committee. Each core and committee …

Widening Health Disparities: Increasing Cholangiocarcinoma Incidence In An Underserved Population, Disha Kumar, Varun Bansal, Syed A Raza, Aaron P Thrift, Hoda M Malaty, Robert J Sealock

Faculty, Staff and Students Publications

BACKGROUND AND AIMS: Cholangiocarcinoma is a relatively rare malignancy with high mortality. In the U.S., incidence rates of cholangiocarcinoma have increased, particularly affecting younger age groups and Hispanic and Asian individuals. We investigated the incidence of cholangiocarcinoma in a largely under-represented, minority population.

METHODS: We performed a retrospective cohort study from 2005 to 2017 among adults in a county-funded healthcare system in Harris County, Texas. Incidence rate ratios were computed to compare age-standardized rates using U.S. standard population between 2 time periods: 2005-2011 and 2012-2017.

RESULTS: We identified 139 cholangiocarcinoma cases (64% intrahepatic, 36% extrahepatic). The median age at diagnosis …

Physical Activity And Diet Quality In Relation To Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study In A Representative Sample Of Us Adults Using Nhanes 2017–2018, Natalia I Heredia, Xiaotao Zhang, Maya Balakrishnan, Carrie R Daniel, Jessica P Hwang, Lorna H Mcneill, Aaron P Thrift

Faculty, Staff and Students Publications

The association of physical activity (PA) and diet quality with non-alcoholic fatty liver disease (NAFLD) and NAFLD-related fibrosis have never been examined in a representative sample of U.S. adults using a more precise form of measuring NAFLD. The purpose of this study was to assess the associations of PA and diet quality (Healthy Eating Index [HEI]-2015) with NAFLD and a subset with advanced fibrosis (F3-4) as assessed by vibration-controlled transient elastography with controlled attenuation parameter in a representative sample of U.S. adults. This cross-sectional analysis uses data from 2017-2018 National Health and Nutrition Examination Survey. NAFLD was defined as controlled …

Depression And Anxiety Are Common Among Patients With Cirrhosis, Ruben Hernaez, Jennifer R Kramer, Aisha Khan, Jessica Phillips, Katharine Mccallister, Kassie Chaffin, Adriana Portela Hernandez, Hannah Fullington, Cynthia Ortiz, James-Michael Blackwell, Adam Loewen, Yan Liu, Jasmin A Tiro, Simon C Lee, Amit G Singal

Faculty, Staff and Students Publications

BACKGROUND & AIMS: Depression and anxiety can have negative effects on patients and are important to treat. There have been few studies of their prevalence among patients with cirrhosis. We aimed to characterize the prevalence and risk factors for depression and anxiety in a large multi-center cohort of patients with cirrhosis.

METHODS: We conducted a telephone-based survey of patients with cirrhosis at 3 health systems in the United States (a tertiary-care referral center, a safety net system, and a Veterans hospital) from April through December 2018. Of 2871 patients approached, 1021 (35.6%) completed the survey. Depression and anxiety were assessed …

The Autophagic Protein P62 Is A Target Of Reactive Aldehydes In Human And Murine Cholestatic Liver Disease, Colin T Shearn, Aimee L Anderson, Michael W Devereux, David J Orlicky, Cole Michel, Dennis R Petersen, Colin G Miller, Sanjiv Harpavat, Edward E Schmidt, Ronald J Sokol

Faculty, Staff and Students Publications

Inflammatory cholestatic liver diseases, including Primary Sclerosing Cholangitis (PSC), are characterized by periportal inflammation with progression to cirrhosis. The objective of this study was to examine interactions between oxidative stress and autophagy in cholestasis. Using hepatic tissue from male acute cholestatic (bile duct ligated) as well as chronic cholestatic (Mdr2KO) mice, localization of oxidative stress, the antioxidant response and induction of autophagy were analyzed and compared to human PSC liver. Concurrently, the ability of reactive aldehydes to post-translationally modify the autophagosome marker p62 was assessed in PSC liver tissue and in cell culture. Expression of autophagy markers was upregulated in …

Hepatic Pparα Is Destabilized By Sirt1 Deacetylase In Undernourished Male Mice, Ji Ho Suh, Kang Ho Kim, Margaret E Conner, David D Moore, Geoffrey A Preidis

Faculty, Staff and Students Publications

The nutrient sensing nuclear receptor peroxisome proliferator-activated receptor-α (PPARα) regulates the host response to short-term fasting by inducing hepatic transcriptional programming of ketogenesis, fatty acid oxidation and transport, and autophagy. This adaptation is ineffective in chronically undernourished individuals, among whom dyslipidemia and hepatic steatosis are common. We recently reported that hepatic PPARα protein is profoundly depleted in male mice undernourished by a low-protein, low-fat diet. Here, we identify PPARα as a deacetylation target of the NAD-dependent deacetylase sirtuin-1 (SIRT1) and link this to the decrease in PPARα protein levels in undernourished liver. Livers from undernourished male mice expressed high levels …

De Novo Glycine Synthesis Is Reduced In Adults With Morbid Obesity And Increases Following Bariatric Surgery, Hong Chang Tan, Jean W Hsu, E Shyong Tai, Shaji Chacko, Vieon Wu, Chun Fan Lee, Jean-Paul Kovalik, Farook Jahoor

Faculty, Staff and Students Publications

BACKGROUND: Glycine is a dietary non-essential amino acid that is low in obesity and increases following bariatric surgery. However, the exact mechanism responsible remains unclear and it is unknown whether hypoglycinemia is a cause or consequence of insulin resistance.

OBJECTIVE: Using multiple isotopically labeled tracers, we aimed to determine the underlying kinetic changes responsible for hypoglycinemia in obesity by: 1) Comparing glycine kinetics between participants with morbid obesity (BMI ≥ 32.5 kg/m

METHODS: [1,2-

RESULTS: Compared to controls, participants with morbid obesity had significantly lower plasma glycine concentrations at 163 (153-171) vs. 201 (172-227) µmol/L and significantly reduced

CONCLUSION: Hypoglycinemia …

Foxo1 Is Present In Stomach Epithelium And Determines Gastric Cell Distribution, Wendy M Mckimpson, Taiyi Kuo, Takumi Kitamoto, Sei Higuchi, Jason C Mills, Rebecca A Haeusler, Domenico Accili

Faculty, Staff and Students Publications

BACKGROUND AND AIMS: Stomach cells can be converted to insulin-producing cells by Neurog3, MafA, and Pdxl over-expression. Enteroendocrine cells can be similarly made to produce insulin by the deletion of FOXO1. Characteristics and functional properties of FOXO1-expressing stomach cells are not known.

METHODS: Using mice bearing a FOXO1-GFP knock-in allele and primary cell cultures, we examined the identity of FOXO1-expressing stomach cells and analyzed their features through loss-of-function studies with red-to-green fluorescent reporters.

RESULTS: FOXO1 localizes to a subset of Neurog3 and parietal cells. FOXO1 deletion ex vivo or in vivo using Neurog3-cre or Atp4b-cre increased numbers of parietal cells, …