Gastroenterology Commons^™

Effect Of Pooled Human Intravenous Globulin (Ivig) On The Reversal Of Cholinergic Inhibition Of Smooth Muscle By Immunoglobulins (Iggs) From Patients With Scleroderma (Ssc), Jagmohan Singh, Vaibhav Mehendiratta, Sergio A. Jimenez, Sidney Cohen, Anthony J. Dimarino, Satish Rattan

Division of Gastroenterology and Hepatology Faculty Papers

Poster presented at: Digestive Disease Week (DDW) International meeting in San Diego, California.

Backgrounds and Aims:

The gastrointestinal (GI) tract is the most common internal organ system affected in SSc. We and others have shown before that the SSc immunoglobulins (IgGs) cause selective blockade of muscarinic type-3 cholinergic (M3-R) in the GI tract. Presently, there is no effective treatment for SSc although numerous cytotoxic and immunomodulatory agents have been employed with limited success and are marred with serious side effects. Present studies investigated the reversibility of SScIgGs-caused M3-R blockade by the pooled Intravenous immunoglobulins (IVIG).

The Use Of Infliximab In Older Inflammatory Bowel Disease Patients, Stephanie M. Moleski, Christina C. Lindenmeyer, Patricia L. Kozuch

Department of Medicine Faculty Papers

Limited data suggest anti-tumor necrosis factor (TNF) antibodies have equal efficacy but higher morbidity and mortality in older compared to younger inflammatory bowel disease (IBD) patients(1).

Relative Telomere Length: A Novel Non-Invasive Biomarker For The Risk Of Non-Cirrhotic Hepatocellular Carcinoma In Patients With Chronic Hepatitis B Infection., Xiaoying Fu, Shaogui Wan, Hie-Won Hann, Md, Ronald E Myers, Phd, Richard S Hann, Jennifer Au, Bicui Chen, Jinliang Xing, Hushan Yang

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND AND AIMS: Telomere length has emerged as a promising risk predictor of various cancers including hepatocellular carcinoma (HCC). However, the majority of studies in this area measured telomere length in hepatocytes and one in lymphocytes with conflicting results. Moreover, no studies have been reported on using circulating DNA telomere length as a non-invasive HCC biomarker.

METHODS: We conducted a nested case-control study to determine the relative telomere length (RTL) in serum DNA from 140 hepatitis B virus (HBV)-related HCC cases and 280 frequency-matched cancer-free HBV controls.

RESULTS: Cases had a significantly longer RTL (median, 0.31; range, 0.02-2.31) than controls …

Primary Billiary Cirrhosis (Antimitochondrial Antibody Negative) Leading To Secondary Amyloidosis, Om Parkash, Aysha Almas

Section of Gastroenterology

A 49 years old lady presented with low-grade fever (99-100degreesF) for 2 years. During this time she was extensively worked-up for pyrexia of unknown origin but no diagnosis could be established. Her Initial blood work-up was all negative except high alkaline phosphatase and gamma GT (374 IU and 195 IU respectively). She later presented to our tertiary care centre with facial swelling, flushing and bilateral pedal swelling for 3 months. Along with generalized body swelling she had frothy urine. She was diagnosed as nephrotic syndrome on the basis of nephrotic range proteinuria. Her Renal biopsy done for workup of nephrotic …

High Clarithromycin Resistance And A Low Rate Of Recurrence And Reinfection Of Helicobacter Pylori Infection In Pakistan, Shahab Abid, Javed Yakoob, Wasim Jafri, Z Abbas, Khalid Mumtaz, Saeed Hamid, Rashida Ahmed

Section of Gastroenterology

No abstract provided.

Primary Billiary Cirrhosis (Antimitochondrial Antibody Negative) Leading To Secondary Amyloidosis, Om Parkash, Aysha Almas

Department of Medicine

A 49 years old lady presented with low-grade fever (99-100°F) for 2 years. During this time she was extensively worked-up for pyrexia of unknown origin but no diagnosis could be established. Her Initial blood work-up was all negative except high alkaline phosphatase and gamma GT (374 IU and 195 IU respectively). She later presented to our tertiary care centre with facial swelling, flushing and bilateral pedal swelling for 3 months. Along with generalized body swelling she had frothy urine. She was diagnosed as nephrotic syndrome on the basis of nephrotic range proteinuria. Her Renal biopsy done for workup of nephrotic …

Comparing Risk Factors Of Hiv Among Hijra Sex Workers In Larkana And Other Cities Of Pakistan: An Analytical Cross Sectional Study, Arshad Altaf, Aysha Zahidie, Ajmal Agha

Community Health Sciences

Background

In 2005, Pakistan was first labeled as a country with concentrated epidemic of Human Immunodeficiency Virus (HIV). This was revealed through second generation surveillance conducted by HIV/AIDS Surveillance Project (HASP). While injection drug users (IDUs) were driving the epidemic, subsequent surveys showed that Hijra (transgender) sex workers (HSWs) were emerging as the second most vulnerable group with an average national prevalence of 6.4%. An exceptionally high prevalence (27.6%) was found in Larkana, which is a small town on the right bank of river Indus near the ruins of Mohenjo-Daro in the province of Sindh. This paper presents the risk …

Single-Chain Vαvβ T Cell Receptors Function Without Mispairing With Endogenous Tcr Chains1, David H. Aggen, Adam S. Chervin, Thomas M. Schmitt, Boris Engels, Jennifer D. Stone, Sarah A. Richman, Kurt H. Piepenbrink, Brian M. Baker, Philip D. Greenberg, Hans Schreiber, David M. Kranz

Food for Health: Publications

Transduction of exogenous T cell receptor (TCR) genes into patients’ activated peripheral blood T cells is a potent strategy to generate large numbers of specific T cells for adoptive therapy of cancer and viral diseases. However, the remarkable clinical promise of this powerful approach is still being overshadowed by a serious potential consequence: mispairing of the exogenous TCR chains with endogenous TCR chains. These “mixed” heterodimers can generate new specificities that result in graft-versus-host reactions. Engineering TCR constant regions of the exogenous chains with a cysteine promotes proper pairing and reduces the mispairing, but, as we show here, does not …

Short Course Adjuvant Terlipressin In Acute Variceal Bleeding: A Randomized Double Blind Dummy Controlled Trial, Zahid Azam, Saeed Hamid, Wasim Jafri, Mohammad Salih, Zaigham Abbas, Shahab Abid, Hasnain Shah

Section of Gastroenterology

Background & Aims: Terlipressin is recommended for 3-5 days as adjuvant to endoscopic variceal band ligation (EVBL) in esophageal variceal bleeding (EVB). We assessed whether terlipressin can be administered for a shorter period of time to Patients with EVB.

Methods: All eligible EVB Patients received 24 h of open label terlipressin at presentation. After successful EVBL, Patients were randomized to receive active or dummy terlipressin for the next 48 h. We excluded Patients with failure to achieve initial hemostasis, bleeding gastric varices, known hepatoma, and/or portal vein thrombosis, advanced cirrhosis (Child-Pugh score >= 12), and Patients on a ventilator. …

Balloon-Occluded Retrograde Transvenous Obliteration For The Treatment Of Gastric Varices., Alia S Dadabhai, Jonathan M Fenkel, Daniel B Brown, Loren Laine

Division of Gastroenterology and Hepatology Faculty Papers

Clinical Perspectives in Hepatology aims to engage two experts with opinions supporting differing perspectives on the management of a case. Typically, the case represents an area of debate or evolving practice in clinical hepatology.

The patient presented below gives us the opportunity to discuss balloon-occluded retrograde transvenous obliteration (BRTO) for treatment of gastric varices. Although described since the mid-1990s and accepted as effective therapy, particularly in Japan, BRTO is used sporadically in the United States and Europe. In fact, it is not mentioned in the U.S. (AASLD) or European (EASL/Baveno V) guidelines. Hopefully, increased awareness of and expertise in this …

Randomized Controlled Trial Of Interferon Gamma Versus Amantadine In Combination With Interferon Alpha And Ribavirin For Hepatitis C Genotype 3 Non-Responders And Relapsers, Z Abbas, Sajjad Raza, Saeed Hamid, Wasim Jafri

Section of Gastroenterology

OBJECTIVES: To evaluate the efficacy and safety of triple combination regimens comprising of interferon alpha-2b (IFN-alpha) and ribavirin plus either IFN-gamma or amantadine in genotype 3 patients, responders or relapsers to interferon plus ribavirin combination.

METHODS: Patients were randomized to receive IFN-alpha 3MU thrice a week, ribavirin 800-1200 mg per day with either IFN-gamma 2 MU thrice a week or amantadine 100 mg twice daily. Treatment was continued for 48 weeks in patients showing complete or partial (2 log reduction) early virological response (EVR) at 12 weeks and negative PCR at 24 weeks.

RESULTS: Total enrollments were 44; 25 were …

Relationship Between Vitamin B12, Folate And Homocysteine Levels And H. Pylori Infection In Patients With Functional Dyspepsia: A Cross-Section Study, Shahid Rasool, Shahab Abid, Mohammad Perwaiz Iqbal, Naseema Mehboobali, Ghulam Haider, Wasim Jafri

Section of Gastroenterology

Background

H. pylori infection has been associated with many micronutrient deficiencies. There is a dearth of data from communities with nutritional deficiencies and high prevalence of H. pylori infection. The aim of this study was to determine the impact of H. pylori infection on serum levels of vitamin B₁₂, folate and homocysteine in patients with functional dyspepsia (FD).

Methods

One hundred and thirty-two patients with FD undergoing gastroscopy were enrolled. The serum was analyzed for B₁₂, folate and homocysteine levels before gastroscopy. H. pylori infection was diagnosed by histopathological examination of gastric biopsies and urea breath …

Conformational Melding Permits A Conserved Binding Geometry In Tcr Recognition Of Foreign And Self Molecular Mimics, Oleg Y. Borbulevych, Kurt H. Piepenbrink, Brian M. Baker

Food for Health: Publications

Molecular mimicry between foreign and self antigens is a mechanism of T cell receptor cross reactivity and is thought to contribute to the development of autoimmunity. The αβ TCR A6 recognizes the foreign antigen Tax from the virus HTLV-1 when presented by the class I MHC HLA-A2. In a possible link with the autoimmune disease HAM/TSP, A6 also recognizes a self peptide from the neuronal protein HuD in the context of HLA-A2. We found here that the complexes of the HuD and Tax epitopes with HLA-A2 are close but imperfect structural mimics, and that in contrast with other recent structures …

Nutritional Status In Patients With Hepatitis C, Faisal Wasim Ismail, Rustam A. Khan, Lubna Kamani, Ashfaq A. Wadalawala, Hasnain Ali Shah, Saeed Hamid, Wasim Jafri

Section of Gastroenterology

Objective: To assess the nutritional status via the SGA (subjective global assessment) screening tool of patients at all stages of hepatitis C virus (HCV) liver disease.
Study design: Descriptive study.
Place and duration of study: Out-patient Clinics of the Aga Khan University Hospital, Karachi, conducted from October 2009 to January 2011.
Methodology: Patients with hepatitis C virus infection and their HCV-negative attendants were enrolled from the outpatient clinics, and categorized into 4 groups of 100 patients each: healthy controls (HC), those with chronic hepatitis C infection (CHC), compensated cirrhotics (CC) and decompensated cirrhotics (DC). The validated subjective global assessment (SGA) …

Irritable Bowel Syndrome And Psychiatric Disorders In Pakistan: A Case Control Study., Amna Subhan Butt, Mohammad Salih, Wasim Jafri, Javed Yakoob, Mohammad Wasay, Saeed Hamid

Section of Gastroenterology

Background:The psychiatric disorders like anxiety and depression could have a profound influence on onset, expression, and course of Irritable bowel syndrome (IBS). Aim: To estimate the frequency and strength of association of common mental disorders (CMDs) in Patients with IBS and Patients with other chronic diseases, that is, migraine and hypertension. Method: This was a case control study. Individuals aged 18-70 years diagnosed as IBS were enrolled as cases. The control groups consisted of Patients without IBS but diagnosed to have a chronic disease, that is, migraine or HTN. Self-Reporting Questonnaire-20(SRQ-20) was used as a screening tool for the …

Hepatocellular Carcinoma In Hepatitis D: Does It Differ From Hepatitis B Monoinfection?, Z Abbas, Qureshi M, Saeed Hamid, Wasim Jafri

Section of Gastroenterology

Background/Aim: Hepatitis D virus (HDV) superinfection in patients with chronic hepatitis B leads to accelerated liver injury, early cirrhosis, and decompensation. It may be speculated that hepatocellular carcinoma (HCC) may differ in these patients from hepatitis B virus (HBV) monoinfection. The aim of this study was to compare clinical aspects of hepatocellular carcinoma in patients of hepatitis D with HBV monoinfection.

Patients and Methods: A total of 92 consecutive HCC cases seropositive for antibody against HDV antigen (HDV group) were compared with 92 HBsAg-positive and anti-HDV-negative cases (HBV group).

Results: The features including sex, body mass index, presence of ascites, …

Replacement Gastrostomy Tube Causing Acute Pancreatitis: Case Series With Review Of Literature, Anish M. Shah, Nihar Shah Md, Joseph R. Depasquale

Gastroenterology

Context Percutaneous endoscopic gastrostomy (PEG) feedings are generally considered safe with few serious complications. Acute pancreatitis is a rare complication associated with replacement percutaneous endoscopic gastrostomy tubes.

Case report We report two cases of acute pancreatitis induced by migrated replacement percutaneous endoscopic gastrostomy tubes.

Conclusions Migration of a balloon into the duodenum can result in external manipulation of the ampulla of Vater thereby disturbing the flow of pancreatic secretions leading to acute pancreatitis. Recognition of this complication is important and should be included as potential etiology of acute pancreatitis in patients receiving percutaneous endoscopic gastrostomy feedings. Periodic examination and documentation …

Clinical Characteristics And Predictors Of Positive Stool Culture In Adult Patients With Acute Gastroenteritis, Muhammad Mehmood Riaz, Muhammad Junaid Patel, Muhammad Shoaib Khan, Muhammad Ali Anwar, M. Tariq, Harith Hilal, Safia Awan, Shahzad Razi

Section of Internal Medicine

OBJECTIVE: To identify the presenting features and spectrum of pathogens in adult patients with acute diarrhoea and to determine the predictors of stool culture positivity.

METHODS: A descriptive study was conducted in a tertiary care hospital from April 1, 2005 to March 31, 2006. Medical records of all consecutive adult patients with history of acute diarrhoea were reviewed between June 2006 to December 2006 for clinical characteristics and laboratory investigations.

RESULTS: A total of 454 patients were admitted from April 1, 2005 to March 31, 2006. Stool cultures were performed in 233 (50%) patients, 96 (42%) had positive results. Patients …

Patterns Of Acetaminophen Use At A Tertiary Care Center: Exposures Exceeding 4 Grams Daily, Jesse Civan, Victor Navarro, Jeffrey Riggio, Paul Adams, Steven Herrine, Simona Rossi

Jefferson Hospital Staff Papers and Presentations

Unintentional hepatotoxicity due to acetaminophen use at the recommended daily dose of up to four grams daily has increasingly been recognized as a significant problem. The phrase "therapeutic misadventure" has been coined in the literature, in reference to biochemical evidence of hepatocellular injury associated with acetaminophen use at recommended doses. Previous studies have documented a 25% to 40% incidence of two- to three-fold alanie aminotransferase (ALT) elevation, in healty volunteers administered one gram of acetaminophen every six hours.

The recognition of this problem is reflected in part by recent changes in FDA recommendations, including more stringent controls on the amount …

Self Expanding Metal Stents (Sems) For Management Of Peri-Pancreatic Fluid Collections (Pfc): A Single Center Experience, Whitney E. Jackson, Jason Korenblit, Vaibhav Mehendiratta, Jason Lewis, Ali A. Siddiqui, Thomas E. Kowalski, David E. Loren

Division of Internal Medicine Faculty Papers & Presentations

Background

Endoscopic management of peri-pancreatic fluid collections (PFC) with or without organizing necrosis has been shown to decrease morbidity and mortality compared to early surgical management. Plastic stents are often used for transmural drainage, although the use of self-expanding metal stents (SEMS) has been reported. Theoretical benefits of SEMS include a large diameter for drainage and facilitation of endoscopic necrosectomy. We report a single-center experience to evaluate the efficacy and safety of SEMS for management of PFC.

Methods

A single-center retrospective review was performed of patients undergoing endoscopic management of PFC using SEMS from January through November 2011. Electronic database …