Gastroenterology Commons^™

Global Burden Of Five Major Types Of Gastrointestinal Cancer, Arjun Singh

Division of Gastroenterology and Hepatology Faculty Papers

Gastrointestinal (GI) cancers cause major global morbidity and mortality, with over 5 million new cases and 3.5 million deaths in 2020. The most prevalent GI malignancies are colorectal, gastric, liver, oesophageal, and pancreatic cancers. Marked geographic variations exist, with high incidence in developed regions contrasting with high mortality in developing areas. These patterns reflect disparities in risk factors and cancer control capacities. However, GI cancer incidence is rising with economic growth and lifestyle changes. Poor prognosis and increasing burden underscore the critical need for expanded prevention and research. This review examines global epidemiology, risks, prevention, detection, treatment, and priorities for …

Setting Up An Ambulatory Gi Endoscopy Suite In The Usa-Anesthesia And Sedation Challenges, Basavana Goudra

Department of Anesthesiology Faculty Papers

Gastrointestinal endoscopy units, both freestanding and associated with ambulatory surgical centers, are on the increase, and the trend is likely to continue. The concept is relatively new, and there are insufficient guidelines and a general dearth of information for prospective planners and physicians. Debate continues in areas such as the selection of patients, appropriateness of procedures, and access to tertiary care. Leaders often scramble to address both critical and non-critical issues, often after the center has opened to the public. They often encounter issues which were not anticipated. In this review, we have provided comprehensive and concise information on the …

Dietary Acculturation Is Associated With Altered Gut Microbiome, Circulating Metabolites, And Cardiovascular Disease Risk In Us Hispanics And Latinos: Results From Hchs/Sol, Yi Wang, Guo-Chong Chen, Zheng Wang, Kai Luo, Yanbo Zhang, Yang Li, Amanda C Mcclain, Marta M Jankowska, Krista M Perreira, Josiemer Mattei, Carmen R Isasi, Maria M Llabre, Bharat Thyagarajan, Martha L Daviglus, Linda Van Horn, David Goldsztajn Farelo, Luis E Maldonado, Steven R Levine, Bing Yu, Eric Boerwinkle, Rob Knight, Robert D Burk, Robert C Kaplan, Qibin Qi, Brandilyn A Peters

Faculty, Staff and Student Publications

Background: Dietary acculturation, or adoption of dominant culture diet by migrant groups, influences human health. We aimed to examine dietary acculturation and its relationships with cardiovascular disease (CVD), gut microbiota, and blood metabolites among US Hispanic and Latino adults.

Methods: In the HCHS/SOL (Hispanic Community Health Study/Study of Latinos), US exposure was defined by years in the United States (50 states and Washington, DC) and US nativity. A dietary acculturation pattern was derived from 14 172 participants with two 24-hour dietary recalls at baseline (2008-2011) using least absolute shrinkage and selection operator regression, with food groups as predictors of US …

Antitumor Effects Of Resveratrol Opposing Mechanisms Of Helicobacter Pylori In Gastric Cancer, Daniela Trautmann, Francesca Suazo, Keila Torres, Layla Simón

Faculty, Staff and Student Publications

Gastric cancer is an aggressive and multifactorial disease. Helicobacter pylori (H. pylori) is identified as a significant etiological factor in gastric cancer. Although only a fraction of patients infected with H. pylori progresses to gastric cancer, bacterial infection is critical in the pathology and development of this malignancy. The pathogenic mechanisms of this bacterium involve the disruption of the gastric epithelial barrier and the induction of chronic inflammation, oxidative stress, angiogenesis and metastasis. Adherence molecules, virulence (CagA and VacA) and colonization (urease) factors are important in its pathogenicity. On the other hand, resveratrol is a natural polyphenol with …

Sump Syndrome: The Forgotten Cause Of Painless Jaundice In The Elderly, Mark Ayoub, Amna Anees

Journal of Community Hospital Internal Medicine Perspectives

Painless jaundice is a common presentation of abdominal malignancy seen in elderly patients. While malignancy may be a common cause of obstructive jaundice in that population group, anchor bias should always be avoided. We present a case of an elderly woman who presented with painless jaundice and weight loss. She had a very remote history of cholecystitis. She was found to have Sump syndrome due to a stricture at the Choledochoduodenostomy (CDD) site. She underwent endoscopic retrograde cholangiopancreatography (ERCP) with stent placement which shortly led to resolution of her jaundice. Biopsy from the stricture site came back negative for malignancy.

Necrotizing Sarcoid Granulomatosis With Hepatic Involvement And Reversible Noncirrhotic Portal Hypertension., Vivek V Jasti, Adam J Hanje

Ambulatory and Primary Care Articles

Necrotizing sarcoid granulomatosis falls within the spectrum of sarcoidosis and is characterized by features of necrosis and granulomatous vasculitis. Like classical sarcoidosis, it can affect numerous organ systems, and there is a wide range of disease activity. Few cases of necrotizing sarcoid granulomatosis have been reported in the liver. We present a case of necrotizing sarcoid granulomatosis associated with noncirrhotic portal hypertension.

Juvenile Polyposis Syndrome In Children: The Impact Of Smad4 And Bmpr1a Mutations On Clinical Phenotype And Polyp Burden., Shlomi Cohen, Anat Yerushalmy-Feler, Isabel Rojas, Claudia Phen, David A. Rudnick, Colleen B. Flahive, Steven H. Erdman, Ramit Magen-Rimon, Ivana Copova, Thomas M. Attard, Andrew Latchford, Warren Hyer

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: A constitutional disease-causing variant (DCV) in the SMAD4 or BMPR1A genes is present in 40%-60% of patients with juvenile polyposis syndrome (JPS). The aim of this study was to characterize the clinical course and polyp burden in children with DCV-positive JPS compared to DCV-negative JPS.

METHODS: Demographic, clinical, genetic, and endoscopic data of children with JPS were compiled from eight international centers in the ESPHGAN/NASPGHAN polyposis working group.

RESULTS: A total of 124 children with JPS were included: 69 (56%) DCV-negative and 55 (44%) DCV-positive (53% SMAD4 and 47% BMPR1A) with a median (interquartile range) follow-up of 4 (2.8-6.4) …

The Time-Dependent Association Between Irritable Bowel Syndrome And All-Cause And Cause-Specific Mortality: A Prospective Cohort Study Within The Uk Biobank, Fangyu Li, Yukiko Yano, Lola Étiévant, Carrie R Daniel, Shreela V Sharma, Eric L Brown, Ruosha Li, Erikka Loftfield, Qing Lan, Rashmi Sinha, Baharak Moshiree, Maki Inoue-Choi, Emily Vogtmann

Faculty, Staff and Student Publications

Introduction: Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders, but few studies have evaluated mortality risks among individuals with IBS. We explored the association between IBS and all-cause and cause-specific mortality in the UK Biobank.

Methods: We included 502,369 participants from the UK Biobank with mortality data through 2022. IBS was defined using baseline self-report and linkage to primary care or hospital admission data. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality using multivariable Cox proportional hazards regression models within partitioned follow-up time categories (0-5, >5-10, and >10 …

Genetic Deletion Of Galectin-3 Inhibits Pancreatic Cancer Progression And Enhances The Efficacy Of Immunotherapy, Daowei Yang, Xinlei Sun, Rohan Moniruzzaman, Hua Wang, Citu Citu, Zhongming Zhao, Ignacio I Wistuba, Huamin Wang, Anirban Maitra, Yang Chen

Faculty, Staff and Student Publications

Background & aims: Pancreatic ductal adenocarcinoma (PDAC) has a desmoplastic tumor stroma and immunosuppressive microenvironment. Galectin-3 (GAL3) is enriched in PDAC, highly expressed by cancer cells and myeloid cells. However, the functional roles of GAL3 in the PDAC microenvironment remain elusive.

Methods: We generated a novel transgenic mouse model (LSL-KrasG12D/+;Trp53loxP/loxP;Pdx1-Cre;Lgals3-/- [KPPC;Lgals3-/-]) that allows the genetic depletion of GAL3 from both cancer cells and myeloid cells in spontaneous PDAC formation. Single-cell RNA-sequencing analysis was used to identify the alterations in the tumor microenvironment upon GAL3 depletion. We investigated both the cancer cell-intrinsic function and immunosuppressive function of GAL3. We also evaluated …

Severe Febrile Neutropenia And Pancytopenia In A Patient With Advanced Hepatocellular Carcinoma Treated With Atezolizumab And Bevacizumab: A Case Report, Shadi Chamseddine, Michael Lapelusa, Kristen Carter, Van Nguyen, Yehia I Mohamed, Yara Sakr, Cristhiam M Rojas-Hernandez, Rikita I Hatia, Manal Hassan, John A Goss, Khaled M Elsayes, Asif Rashid, Ryan Sun, Hop Sanderson Tran Cao, Hesham M Amin, Ahmed O Kaseb

Faculty, Staff and Student Publications

BACKGROUND: Immune checkpoint inhibitors (ICIs), agents that stimulate T-cell function, have become the standard first-line treatment for unresectable hepatocellular carcinoma (HCC). However, they may also cause immune-related adverse events (irAEs), which are rare and have not been extensively reported. Here, we describe a case of severe febrile neutropenia and pancytopenia after atezolizumab plus bevacizumab (atezo/bev) therapy and its treatment course.

CASE DESCRIPTION: The combination of atezo/bev was initiated as the first-line treatment for a man in his early 50s, who was diagnosed with unresectable HCC. The first treatment cycle was administered in the outpatient setting, and the patient developed a …

Trends, Predictors, And Outcomes Of Hepatic Encephalopathy Treatment At A Quaternary Transplant Center From 2012-2022, Patrick Twohig, Thoetchai Peeraphatdit, Kaeli Samson, Makayla Schissel, Lynette M. Smith, Kyaw Min Tun, Ellen Tan, Kyle Scholten, Jason Barbaretta, Kevin Brittan, Timothy Mccashland

Graduate Medical Education Research Journal

Background: Hepatic encephalopathy (HE) is a devastating complication of cirrhosis that increases mortality. Many patients do not receive guideline recommended HE treatment.

Our aim is to evaluate trends in HE treatment over time, variables associated with receiving treatment, and outcomes based on the type of treatment received.

Methods: Retrospective single-center cohort study of hospitalized patients with HE from July 2012 – June 2022. HE treatment was defined as receiving lactulose, rifaximin, or combination therapy.

Results: A total of 1,683 unique patients were included, 72% of patients received HE treatment. Fewer HE patients received any treatment in 2022 (65.9%) compared to …

Small Intestinal Bacterial Overgrowth, Sandesh R. Parajuli, Anish C. Paudel, Anthony Donato

Transformative Medicine

No abstract provided.

An Incidentally Found Mass On The Remnant Stomach After A Roux-En-Y Gastric Bypass, Jennifer E. Geller, Santosh Swaminathan, Kristin Noonan

Abington Jefferson Health Papers

BACKGROUND: Incidentally found masses are a widely discussed area of medicine, and there are conflicting opinions as to how to deal with these findings, particularly in the stomach-which has limited documentation in the literature. Here we present a middle-aged female who was found to have an incidentally found mass on her remnant stomach 10 years after a Roux-en-Y gastric bypass (RYGB) surgery.

CASE PRESENTATION: We present the case of a 66-year-old female who is 10 years post-op from a RYGB. After a bout of self-resolving diarrheal illness prompted a computed tomography (CT) scan in the emergency department, she was diagnosed …

Association Between Helicobacter Pylori Infection, Mismatch Repair, Her2 And Tumor-Infiltrating Lymphocytes In Gastric Cancer, Carlos A Castaneda, Miluska Castillo, Luis A Bernabe, Joselyn Sanchez, Matteo Fassan, Katherine Tello, Ignacio Ivan Wistuba, Ivan Chavez Passiuri, Eloy Ruiz, Juvenal Sanchez, Fernando Barreda, Daniel Valdivia, Yaqueline Bazan, Milagros Abad-Licham, Claudio Mengoa, Hugo Fuentes, Paola Montenegro, Ebert Poquioma, Raul Alatrista, Claudio J Flores, Luis Taxa

Faculty, Staff and Student Publications

BACKGROUND: The influence of Helicobacter-pylori (H. pylori) infection and the characteristics of gastric cancer (GC) on tumor-infiltrating lymphocyte (TIL) levels has not been extensively studied. Analysis of infiltrating-immune-cell subtypes as well as survival is necessary to obtain comprehensive information.

AIM: To determine the rates of deficient mismatch-repair (dMMR), HER2-status and H. pylori infection and their association with TIL levels in GC.

METHODS: Samples from 503 resected GC tumors were included and TIL levels were evaluated following the international-TILs-working-group recommendations with assessment of the intratumoral (IT), stromal (ST) and invasive-border (IB) compartments. The density of CD3, CD8 and CD163 …

In-Silico Analysis Of Tmem2 As A Pancreatic Adenocarcinoma And Cancer-Associated Fibroblast Biomarker, And Functional Characterization Of Nsc777201, For Targeted Drug Development, Prateeti Srivastava, Vijesh Kumar Yadav, Tzu-Hao Chang, Emily Chia-Yu Su, Bashir Lawal, Alexander Th Wu, Hsu-Shan Huang

Faculty, Staff and Student Publications

Pancreatic adenocarcinoma (PAAD), known as one of the deadliest cancers, is characterized by a complex tumor microenvironment, primarily comprised of cancer-associated fibroblasts (CAFs) in the extracellular matrix. These CAFs significantly alter the matrix by interacting with hyaluronic acid (HA) and the enzyme hyaluronidase, which degrades HA - an essential process for cancer progression and spread. Despite the critical role of this interaction, the specific functions of CAFs and hyaluronidase in PAAD development are not fully understood. Our study investigates this interaction and assesses NSC777201, a new anti-cancer compound targeting hyaluronidase. This research utilized computational methods to analyze gene expression data …

Anomalous Presentation And Endoscopic Findings Of Acute Esophageal Necrosis: A Case Report, Ahmed Shehadah, Abdullah A. Orakzai, Sheza Malik, Alshaima Yousef, Ali Jaan, Patrick Okolo

Advances in Clinical Medical Research and Healthcare Delivery

Introduction:

Acute esophageal necrosis (AEN), is a rare disorder with an estimated incidence of 0.01-0.28%. It typically affects the distal third of the esophagus. Approximately 90% of patients with acute esophageal necrosis present with upper gastrointestinal (GI) bleeding, primarily due to ischemic insult or severe hemodynamic compromise. In this report, we describe a case in which the patient presented with odynophagia and dysphagia, but without upper GI bleeding. The patient exhibited pan mucosal involvement of the esophagus, which extended to the gastric antrum.

Case: A 55-year-old man with a history of type 2 diabetes mellitus and substance abuse presented with …

Feasibility And Safety Of Peroral Endoscopic Myotomy With Fundoplication In Patients With Achalasia: A Systematic Review And Meta-Analysis, Faisal Kamal, Muhammad Ali Khan, Wade Lee-Smith, Sachit Sharma, Ashu Acharya, Umer Farooq, Zahid Ejaz, Muhammad Aziz, Manesh Kumar Gangwani, Umar Hayat, Anand Kumar, Alexander Schlachterman, David E. Loren, Thomas E. Kowalski

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Achalasia can cause disabling symptoms that may substantially impair the quality of life. Peroral endoscopic myotomy (POEM) has shown promising results in the management of achalasia. In this meta-analysis we have evaluated the feasibility and safety of single-session POEM with fundoplication (POEM+F) in patients with achalasia.

METHODS: We reviewed several databases from inception to July 08, 2022, to identify studies evaluating the feasibility and/or safety of single-session POEM+F for patients with achalasia. Our outcomes of interest included the technical success of POEM+F, adverse events, esophagitis and wrap integrity on follow-up upper endoscopy, total procedure time, and fundoplication time. Pooled …

Recurrent Upper Gastrointestinal Bleeding Due To Radiation-Induced Hemorrhagic Gastroduodenal Ectasia: A Review Of Current Treatment Options For Radiation-Induced Gastric Injury, Simone Jarrett, Rushi Kaushik Talati, Johann Hasbun, Wenqing Cao, Scott Smukalla

Einstein Health Papers

INTRODUCTION: Acute upper gastrointestinal bleeding is one of the most common medical emergencies that present to the hospital, and delineating the underlying etiology is essential to provide adequate definitive treatment. The purpose of this case report was to review the diagnosis and treatment of a rare complication known as radiation-induced hemorrhagic gastritis (RIHG) that can occur in patients with prior radiation exposure. The motivation for this study arose from the identification of a case within our institution.

CASE PRESENTATION: The study involved a review of the diagnosis and management of a patient who presented with anemia and recurrent episodes of …

A “Fishy” Situation, Rare Pathogen And Presentation In Prosthetic Valve Infective Endocarditis, Nichole Schtupak, Patrick Kennedy, Darko Pucar, Linda Godinez, Jodi-Ann Chin, Kristen Selema, Dipan Uppa, Antonio Lewis, Marcelo Helguera

DMSc Student Publications

Lactococcus garviae (L. garviae) is a gram-positive coccus belonging to the Streptococcaceae family. While primarily a pathogen in fish farms causing hemorrhagic sepsis, it can act as a rare opportunistic pathogen in humans. A 2021 case report by Bravo et al. documented less than 30 cases of infective endocarditis caused by L. garviae worldwide at that time. This case report describes the 27th documented case globally and 7th documented case in the USA of L. garviae causing infective endocarditis of a prosthetic valve.
L. garviae is found in unpasteurized dairy products, raw fish, and meat (pork, beef, and …

Efficacy And Safety Of Adagrasib Plus Cetuximab In Patients With Krasg12c-Mutated Metastatic Colorectal Cancer, Rona Yaeger, Nataliya V Uboha, Meredith S Pelster, Tanios S Bekaii-Saab, Minal Barve, Joel Saltzman, Joshua K Sabari, Julio A Peguero, Andrew Scott Paulson, Pasi A Jänne, Marcia Cruz-Correa, Kenna Anderes, Karen Velastegui, Xiaohong Yan, Hirak Der-Torossian, Samuel J Klempner, Scott E Kopetz

Faculty, Staff and Student Publications

Adagrasib, an irreversible, selective KRASG12C inhibitor, may be an effective treatment in KRASG12C-mutated colorectal cancer, particularly when combined with an anti-EGFR antibody. In this analysis of the KRYSTAL-1 trial, patients with previously treated KRASG12C-mutated unresectable or metastatic colorectal cancer received adagrasib (600 mg twice daily) plus cetuximab. The primary endpoint was objective response rate (ORR) by blinded independent central review. Ninety-four patients received adagrasib plus cetuximab. With a median follow-up of 11.9 months, ORR was 34.0%, disease control rate was 85.1%, and median duration of response was 5.8 months (95% confidence interval [CI], 4.2-7.6). Median progression-free survival was 6.9 months …