Gastroenterology Commons^™

De-Implementation Of Fecal Occult Blood Testing In The Emergency Department And Hospital Units: A Quality Improvement Project, Adewale Ajumobi, Joline De Castro, Ammar Qureshi

Journal of Community Hospital Internal Medicine Perspectives

Background: Fecal occult blood tests (FOBT) are inappropriately used in patients with melena, hematochezia, coffee ground emesis, iron deficiency anemia, and diarrhea. The use of FOBT for reasons other than screening for colorectal cancer is considered low-value and unnecessary. Methods: Quality Improvement Project that utilized education, Best Practice Advisory (BPA) and modification of order sets in the electronic health record (EHR). The interventions were done in a sequential order based on the Plan-Do-Study-Act (PDSA) method. An annotated run chart was used to analyze the collected data. Results: Education and Best Practice Advisory within the EHR led to significant reduction in …

Antibiotic-Induced Gut Dysbiosis Elicits Gut-Brain Axis Relevant Multi-Omic Signatures And Behavioral And Neuroendocrine Changes In A Nonhuman Primate Model, Shivdeep S. Hayer, Mackenzie Conrin, Jeffrey French, Andrew K. Benson, Sophie Alvarez, Kathryn Dempsey, Anne Fischer, Zahraa Wajih Alsafwani, William Gasper, Mallory J. Suhr Van Haute, Haley R. Hassenstab, Shayda Azadmanesh, Missy Briardy, Skyler Gerbers, Aliyah Jabenis, Jennifer L. Thompson, Jonathan B. Clayton

Food for Health: Publications

Emerging evidence indicates that antibiotic-induced dysbiosis can play an etiological role in the pathogenesis of neuropsychiatric disorders. However, most of this evidence comes from rodent models. The objective of this study was to evaluate if antibiotic-induced gut dysbiosis can elicit changes in gut metabolites and behavior indicative of gut-brain axis disruption in common marmosets (Callithrix jacchus) – a nonhuman primate model often used to study sociability and stress. We were able to successfully induce dysbiosis in marmosets using a custom antibiotic cocktail (vancomycin, enrofloxacin and neomycin) administered orally for 28 days. This gut dysbiosis altered gut metabolite profiles, …

Gastric Lipomas: A Case Series And Review Of The Literature, Simone A. Jarrett, Sahana Tito, Matthew Chan, Dominic E. Jarrett, Kevin B. Lo, Richard Depalma

Einstein Health Papers

INTRODUCTION: The purpose of this case series was to review a rare subset of tumors known as gastric lipomas, which are typically found incidentally. The motivation for this study arose from the identification of 2 cases within our institution in a short period.

CASE PRESENTATION: The study involved a review of the diagnosis and management of 2 patients presenting with gastric lipomas at our institution after symptoms of gastrointestinal bleeding. With the advent of new radiologic investigations such as computed tomography and magnetic resonance imaging and advances in endoscopy, there are new approaches to identifying and managing these tumors. On …

Hypoxia-Activated Prodrug And Antiangiogenic Therapies Cooperatively Treat Pancreatic Cancer But Elicit Immunosuppressive G-Mdsc Infiltration, Arthur Liu, Seth T Gammon, Federica Pisaneschi, Akash Boda, Casey R Ager, David Piwnica-Worms, David S Hong, Michael A Curran

Faculty, Staff and Student Publications

We previously showed that ablation of tumor hypoxia can sensitize tumors to immune checkpoint blockade (ICB). Here, we used a Kras+/G12D TP53+/R172H Pdx1-Cre-derived (KPC-derived) model of pancreatic adenocarcinoma to examine the tumor response and adaptive resistance mechanisms involved in response to 2 established methods of hypoxia-reducing therapy: the hypoxia-activated prodrug TH-302 and vascular endothelial growth factor receptor 2 (VEGFR-2) blockade. The combination of both modalities normalized tumor vasculature, increased DNA damage and cell death, and delayed tumor growth. In contrast with prior cancer models, the combination did not alleviate overall tissue hypoxia or sensitize these KPC tumors to ICB therapy …

Video Endoscopy As Big Data: Balancing Privacy And Progress In Gastroenterology, Eugenia N. Uche-Anya, Sara Gerke, Tyler M. Berzin

Faculty Scholarly Works

Tens of millions of gastrointestinal (GI) endoscopy videos and images are generated annually in the United States (¹). A single 15-minute endoscopic procedure, recorded at 30 frames per second, generates approximately 27,000 high-definition images, representing a treasure trove of potential data. In the era of artificial intelligence (AI) and machine learning (ML), this data stream will not only fuel innovative and clinically impactful research in gastroenterology for both academic and commercial purposes, but also introduce ethical and legal concerns that merit consideration. Gastroenterologists are now faced with navigating new questions around data privacy and data ownership that have …

Pharmacotherapy For Primary Biliary Cholangitis: An Assessment Of Medication Candidacy And Rates Of Treatment, Nicholas Macdonald, Rebecca Loh, Jonathan Fenkel, David Sass, Dina Halegoua-De Marzio

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Ursodeoxycholic acid is the preferred first-line therapy for primary biliary cholangitis. Alternative therapies, such as obeticholic acid, are recommended for patients who cannot tolerate ursodeoxycholic acid or who have an inadequate response to ursodeoxycholic acid monotherapy. Prior investigations have suggested that as many as 30% of patients with primary biliary cholangitis may have never received treatment with ursodeoxycholic acid. No prior investigations have examined usage rates of obeticholic acid in the treatment of primary biliary cholangitis.

METHODS: All patients with an ICD-10 diagnosis of primary biliary cholangitis who had any records within the health system were included. A review …

Preclinical Repurposing Of Sitagliptin As A Drug Candidate For Colorectal Cancer By Targeting Cd24/Ctnnb1/Sox4-Centered Signaling Hub, Jing-Wen Shih, Alexander T H Wu, Ntlotlang Mokgautsi, Po-Li Wei, Yan-Jiun Huang

Faculty, Staff and Student Publications

Despite significant advances in treatment modalities, colorectal cancer (CRC) remains a poorly understood and highly lethal malignancy worldwide. Cancer stem cells (CSCs) and the tumor microenvironment (TME) have been shown to play critical roles in initiating and promoting CRC progression, metastasis, and treatment resistance. Therefore, a better understanding of the underlying mechanisms contributing to the generation and maintenance of CSCs is crucial to developing CSC-specific therapeutics and improving the current standard of care for CRC patients. To this end, we used a bioinformatics approach to identify increased CD24/SOX4 expression in CRC samples associated with poor prognosis. We also …

Relationship Between Genotype And Disease Phenotype For Gluten-Related Disorders, Michael Roberts, Nadine Grzeskowiak, Stephen Bricher

Faculty Publications

We investigated gluten-related disorders (GRD) in intestinal biopsy-proven subjects to determine the relation between genotype (i.e., Human Leukocyte Antigen (HLA) DQ alleles) and phenotype (i.e., antibody levels and clearly defined symptoms). Subjects had known DQ genotypes, information on IgA anti-Endomysial antibodies (EMA) and/or anti-tissue Trans Glutaminase (tTG) antibodies (tTGA). Subjects also answered a survey characterizing gastrointestinal, skin, and neural symptoms. Though all were biopsy-proven, HLA genotypes included all combinations of DQ2.5, DQ2.2, DQ8, DQ7.5, DQ5, and DQ6. Subject antibody levels were proportional to the number of DQ2.5 haplotypes, and subjects with non-CD-associated haplotypes did not have positive antibody scores (despite …

A Clot To Worry About: Venous Thromboembolism In Severe Ulcerative Colitis, Jin Yun, Do, Donald Lum

Books, Presentations, Posters, Etc.

Introduction: Patients with inflammatory bowel disease (IBD) have an estimated three-fold higher risk of venous thromboembolism (VTE) compared to the general population. We present a case of a 19-year-old female with phlegmasia curelea dolens and massive pulmonary embolism in the setting of severe ulcerative colitis. Case Presentation : • 19-year-old female with iron deficiency anemia and three-month history of hematochezia, recently started on oral contraceptive pills. • Presented with acute left lower extremity pain, swelling, and cyanosis concerning for phlegmasia curulea dolens and compartment syndrome. • Underwent emergent thrombectomy, venoplasty, and fasciotomies. • Post-operatively, course complicated by obstructive shock and …

Diagnostic Accuracy Of Bowel Ultrasonography In Patients With Inflammatory Bowel Disease: A Systematic Review And Meta-Analysis, Sheza Malik, Sruthi Venugopalan, Bettina Gabrielle Tenorio, Shahab R. Khan, Priyadarshini Loganathan, Udayakumar Navaneethan, Babu P. Mohan

Ateneo School of Medicine and Public Health Publications

Background

Bowel ultrasonography (BUS) is emerging as a promising noninvasive tool for assessing disease activity in inflammatory bowel disease (IBD) patients. We evaluated the diagnostic accuracy of BUS in IBD patients against the gold standard diagnostic method, standard colonoscopy.

Methods

Major databases were searched from inception to May 2023 for studies on BUS diagnostic accuracy in IBD. Outcomes of interest were pooled sensitivity, specificity, positive (PPV), and negative (NPV) predictive values. Endoscopic confirmation served as ground truth. Standard meta-analysis methods with a random-effects model and I2 statistics were applied. Risk of bias was assessed using the Quality Assessment of Diagnostic …

Kvx-053, A Protein Tyrosine Phosphatase 4a3 Inhibitor, Ameliorates Sars-Cov-2 Spike Protein Subunit 1 - Induced Acute Lung Injury In Mice, Pavel A. Solopov, Ruben Manuel Luciano Colunga Biancatelli, Tierney Day, Betsy Gregory, Elizabeth R. Sharlow, John S. Lazo, John D. Catravas

Bioelectrics Publications

The Acute Respiratory Distress Syndrome (ARDS), often preceded by acute lung injury (ALI), is characterized by the accumulation of inflammatory fluid in the lung alveoli, leaky alveolar epithelium and endothelium, and overexpression of pro-inflammatory cytokines. This progression from ALI to ARDS is a major contributor to the high mortality observed in COVID-19 patients. The Spike protein of SARS-CoV-2 binds to lung ACE2 and, in addition to facilitating viral cell entry, it plays an important role in the development of ALI and ARDS, especially in the later phases of COVID-19 as well as long COVID. Protein tyrosine phosphatase (PTP) 4A3 is …

The Utility Of Cologuard In A Real-World Community Setting, Abhinav K. Rao, Shivam Kalra, Danny Tran, Angeli Patel, Ibrahim Al-Saadi, Levi C. Diggins, Ian Whitaker, Shannon Kang, Kunaal Patel, Eyad Gharaibeh, Ali Khalifa, Don C. Rockey, Brett Van Leer-Greensberg

South Atlantic Division GME Research Day 2024

No abstract provided.

A Challenging Diagnosis Of Intestinal Tuberculosis Mimicking Crohn's Disease, Justin Sanchez, Gabriel Gonzales, Monte Troutman

North Texas GME Research Forum 2024

Intestinal tuberculosis (ITB) is an underrecognized disease that shares many clinical, radiologic, endoscopic, and pathologic features with Crohn's disease, making differentiation difficult. This poses a significant problem as initiation of immunosuppressives for an assumed diagnosis of CD in a patient with ITB can lead to exacerbation of infection and life-threatening consequences. A 30-year-old Nepali man with a medical history only significant for Raynaud disease presented with a febrile illness, right lower quadrant abdominal pain, and productive cough over the course of a month. He immigrated from Nepal 3 years prior to presentation, denying other risk factors or specific symptoms of …

Elucidating The Role Of Fatty Acid Synthase In Apc-Driven Colorectal Cancer, Courtney O. Kelson

Theses and Dissertations--Toxicology and Cancer Biology

Globally, colorectal cancer (CRC) is the second leading cause of cancer related deaths. Currently, there is a growing incidence rate for individuals aged 20-49 years. Genetic and environmental factors contribute to the risk of this cancer. Early detection of CRC allows for the most effective treatment option in which surgical resection of the primary tumor occurs along with adjuvant chemotherapy. This therapeutic approach contributes to 5-year survival rate of 91%. However, surgical procedures and chemotherapy struggles against metastatic and relapsed CRC resulting in 5-year survival rate of 14%. Inefficacious treatments for relapsed and metastatic diseases emphasizes the need for more …

Advancing School Nursing Practice: A Novel Approach To Screening For Gastrointestinal Disorders In Children, Ashley Bunting, Isabella Cavlan

Nursing | Senior Theses

Background: Currently, mandated health screenings in California schools are limited to vision, hearing, and scoliosis; this leaves several other body systems unmonitored during the crucial years of childhood development. One such system is the gastrointestinal (GI) system, which plays a vital role in the normal growth, nutrition status, development, and overall health of children. Objective: By developing and implementing a GI-specific screening tool in the outpatient school setting, this research aims to increase the detection of GI disorders in children. Not only that, but school nurses can use this novel screening tool to promote early diagnosis, intervention, and …

Advancing School Nursing Practice: A Novel Approach To Screening For Gastrointestinal Disorders In Children, Ashley Bunting, Isabella Cavlan

Nursing | Student Research Posters

California schools currently only screen for vision and hearing, leaving many other health concerns unaddressed. Among these, gastrointestinal (GI) health is particularly significant, as digestive disorders can lead to severe consequences, like malnutrition and stunted growth. By incorporating routine GI screenings, school nurses can promote the early detection of disease, allowing for timely intervention and improved health outcomes in children.

Based on existing literature, we have developed a novel pediatric GI screening tool for school nurses to use in routine screenings, presented below.

Early Onset Colorectal Cancer: Research, Trends & Challenges, Sarah E. Smith

Capstone Showcase

Early onset colorectal cancer (EOCRC) incidence and mortality are rising in a global trend, contrasting with improvements seen in late-onset colorectal cancer (LOCRC). EOCRC appears to differ in presentation, histology, and pathology from LOCRC painting concerns of a more aggressive tumor profile. With incidence steadily climbing, there is still lacking awareness and guidance on screening for EOCRC. This article aims to provide background on EOCRC including epidemiology, risk factors, and traits, as well as to explore methods for adjusting provider screening criteria to combat this concerning trend.

The Contribution Of Amyloid Deposition In The Aortic Valve To Calcification And Aortic Stenosis, Romeesa Khan, Claudia M Di Gesù, Juneyoung Lee, Louise D Mccullough

Faculty, Staff and Student Publications

Trillions of microbes live symbiotically in the host, specifically in mucosal tissues such as the gut. Recent advances in metagenomics and metabolomics have revealed that the gut microbiota plays a critical role in the regulation of host immunity and metabolism, communicating through bidirectional interactions in the microbiota-gut-brain axis (MGBA). The gut microbiota regulates both gut and systemic immunity and contributes to the neurodevelopment and behaviors of the host. With aging, the composition of the microbiota changes, and emerging studies have linked these shifts in microbial populations to age-related neurological diseases (NDs). Preclinical studies have demonstrated that gut microbiota-targeted therapies can …

Outcomes Of Upper Gastrointestinal Bleeding In Hospitalized Covid-19 Patients In The United States: A Propensity-Score Matched Analysis Of A Large National Database, Moon Ryu, Mohammed Quazi, Niloy Ghosh, Karthik Gangu, Amir H Sohail, Asif Farooq, Babu S Maringanti, Aman Goyal, Anupa Patel, Muhammad S Khan, Abu B Sheikh

Faculty, Staff and Student Publications

Patients with cirrhosis that are hospitalized with COVID-19 infection have been found to have worse outcomes. No comparative study has been conducted between gastrointestinal (GI) bleeding in patients with cirrhosis who are diagnosed with COVID-19. We utilized the National Inpatient Sample (NIS) database to perform a retrospective analysis of 24, 050 patients diagnosed with cirrhosis and COVID-19. The identified patients were separated into variceal bleeding, nonvariceal bleeding, and no (or neither) GI bleeding groups. After performing propensity sample matching and multivariate analysis of mortality, we found no significant differences in mortality among the three groups. However, the variceal bleed group …

Promising Response Of Olaparib In Patient With Germline Atm-Mutated Metastatic Gastric Cancer, Kok Hoe Chan, Darius Rutazanaa, Curtis Wray, Nirav Thosani, Victor Yang, Putao Cen

Faculty, Staff and Student Publications

Gastric cancer ranks as the fifth leading cause of global cancer incidences, exhibiting varied prevalence influenced by geographical, ethnic, and lifestyle factors, as well as Helicobacter pylori infection. The ATM gene on chromosome 11q22 is vital for genomic stability as an initiator of the DNA damage response, and mutations in this gene have been associated with various cancers. Poly ADP-ribose polymerase (PARP) inhibitors, such as olaparib, have shown efficacy in cancers with homologous recombination repair deficiencies, notably in those with ATM mutations. Here, we present a case of a 66-year-old patient with germline ATM-mutated metastatic gastric cancer with very high …