Gastroenterology Commons^™

Impact Of Pandemic On Epidemiology And Management Of Acute Colonic Pseudo Obstruction: Nationwide Clinical Data Research Network, Abhilash Perisetti Md, Hermant Goyal Md, Syed Mahanazuddin Phd, Mariajose Rojas Md, Mahesh Gajendran Md, Syed Ali Amir Sherazi Md, Shweta Gupta Md, Mbs, Ragesh Thandassery Md, Benjamin Tharian Md, Mrcp, Fracp, Neil Sharma Md

Other Specialties

Introduction Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie’s syndrome, is characterized by massive acute dilatation of the large intestine without a mechanical cause. Early recognition to identify serious adverse events such as ischemia/ perforation is critical to reducing mortality rates. COVID-19 pandemic led to a significant shift of resources for the treatment of patients with reduced utilization of endoscopy and imaging, which could have impacted outcomes in patients with ACPO. In this study, we aim to identify the change in the clinical outcomes in ACPO patients in 2020.

Methods All adult patients with a new diagnosis of intestinal obstruction …

National Trends In The Incidence Of Sporadic Malignant Colorectal Polyps In Young Patients (20-49 Years): An 18-Year Seer Database Analysis, Mark M. Aloysius Md, Hermant Goyal Md, Aman Ali Md, Niraj Shah Nd, Mahesh Gajendran Md, Abhilash Perisetti Md, Patrick Basu Md, Rajiv Chhabra Md, Benjamin Tharian Md

Other Specialties

Introduction:

Recent changes in the USPSTF guidelines recommend that CRC (Colorectal Cancer) screening in average-risk patients should commence at 45 years with the intent of finding sporadic premalignant or malignant polyps, allowing early endoscopic interventions to improve clinical outcomes. This study aims to find the incidence of sporadic malignant polyps in adult patients < 50 years of age) from the National Cancer Institute's SEER (Surveillance Epidemiology and End Results) database over a period of 18 years.

Methods:

We interrogated the SEER database (2000-2017) on patients aged 20-49 years diagnosed with at least a single malignant sporadic colorectal polyp. Data extraction was performed through a case listing session using SEER*Stat v8.3.9 on combined SEER 18 incidence registries using specific codes for CRC polyps with …

Use, Yield, And Risk Of Device-Assisted Enteroscopy In The United States: Results From A Large Retrospective Multicenter Cohort, Michael G. Noujaim, Alice Parish, Daniel Raines, Seth A. Gross, David Cave, Iris Vance, David Beyer, Diana Liu, Benjamin Hoffman, Zoe Lawrence, Gabriel Castillo, Tanya Pavri, Donna Niedzwiecki, Daniel Wild

School of Medicine Faculty Publications

Introduction: Since 2001, device-Assisted enteroscopy (DAE) has revolutionized the diagnostic and therapeutic capabilities for managing small bowel pathology. Though commonly performed, there have been no recent large studies to assess the use, yield, and risks of DAE and none that include all 3 DAE modalities. We hypothesized that DAE is safe with high diagnostic and therapeutic yields achieved within reasonable procedure duration and here we present a large retrospective multicenter US study evaluating the use, yield, and complications of DAE. Methods: After obtaining institutional review board approval, electronic records were used to identify all DAE's performed for luminal small bowel …

Spontaneous Bacterial Empyema In Cirrhosis Patients - A Systematic Review And Meta-Analysis, Saurabh Chandan Md, William Reiche Do, Shahab R. Khan Mbbs, Smit Deliwala Md, Banreet Dhindsa Md, Daryl Ramai Md, Abhilash Perisetti Md, Rajani Rangray Md, Sandeep Mukherjee Md

Other Specialties

Introduction:

Spontaneous bacterial empyema (SBE), defined as spontaneous infection of the pleural fluid, represents a distinct and often underdiagnosed complication of hepatic hydrothorax in patients with cirrhosis. Although the transudative nature of hepatic hydrothorax is well established, the characteristics and risk factors for SBE have not been well investigated. We performed a systematic review and meta-analysis on the incidence and risk factors for this elusive entity.

Methods:

A systematic and detailed search was run in June 2021 with the assistance of a medical librarian for studies reporting on the incidence, associations, and outcomes of SBE in cirrhosis patients. Meta-analysis was …

Activation Of The Innate Immune System In Children With Irritable Bowel Syndrome Evidenced By Increased Fecal Human Β-Defensin-2, Robert J Shulman, Sridevi Devaraj, Margaret Heitkemper

Children’s Nutrition Research Center Staff Publications

Background & aims: The role of the innate immune system in functional gastrointestinal pain disorders is unclear. We investigated the role of β-defensin-2 and gut permeability in childhood irritable bowel syndrome (IBS) and functional abdominal pain (FAP) symptom generation.

Methods: Fecal β-defensin-2 (and in a subset, gut permeability) was measured in children with IBS (n = 116), FAP (n = 33), and healthy control (HC) children (n = 72). IBS and FAP patients were recruited from tertiary and primary care, and HCs were recruited from primary care.

Results: β-defensin-2 concentration was greater in children with IBS (P = .003) and …

Pulmonary Artery Sling-An Extremely Rare Etiology Of Dysphagia, Khola Qamar, Abhinav Tiwari

Conference Presentation Abstracts

No abstract provided.

Hereditary Hemochromatosis As An Independent Risk Factor For Liver Cancer: A Matched Case-Control Study Of The National Inpatient Sample Database, Maryam Haider, Ali F. Alsbihi, Zaid Imam, Adnan Malik, Sana Iqbal, Mahum Nadeem, Ahmed J. Chaudhary

Conference Presentation Abstracts

No abstract provided.

Hepatic Schistosomiasis, Upper Gastrointestinal Bleeding, And Health Related Quality Of Life Measurements From The Albert Nile Basin, Christopher Opio, Francis Kazibwe, Lalitha Rejani, Narcis B. Kabatereine, Ponsiano Ocama

Internal Medicine, East Africa

Background: Health related quality of life measurements are vital elements of public health surveillance that uncover unmet health needs and predict the success of health interventions. We described health related quality of life measurements using the EuroQoL 5-dimension (EQ-VAS/EQ-5D) instrument and associated factors among patients with upper gastrointestinal bleeding (UGIB) and hepatic schistosomiasis at a rural health facility in the Albert Nile Basin, Uganda.

Methods and materials: This was a cross-sectional study at Pakwach Health Centre IV. Participants included adult inpatients and outpatients with a history of UGIB and ultrasound evidence of hepatic schistosomiasis. We evaluated and recorded …

Advances In Optical Gastrointestinal Endoscopy: A Technical Review, Yubo Tang, Sharmila Anandasabapathy, Rebecca Richards-Kortum

Faculty, Staff and Students Publications

Optical endoscopy is the primary diagnostic and therapeutic tool for management of gastrointestinal (GI) malignancies. Most GI neoplasms arise from precancerous lesions; thus, technical innovations to improve detection and diagnosis of precancerous lesions and early cancers play a pivotal role in improving outcomes. Over the last few decades, the field of GI endoscopy has witnessed enormous and focused efforts to develop and translate accurate, user-friendly, and minimally invasive optical imaging modalities. From a technical point of view, a wide range of novel optical techniques is now available to probe different aspects of light-tissue interaction at macroscopic and microscopic scales, complementing …

Outcomes Of Primary Versus Revisional Robotically Assisted Laparoscopic Roux-En-Y Gastric Bypass: A Multicenter Analysis Of Ten-Year Experience, Pouya Iranmanesh, John Fam, Thomas Nguyen, David Talarico, Kavita D Chandwani, Kulvinder S Bajwa, Melissa M Felinski, Leon V Katz, Sheilendra S Mehta, Stephan R Myers, Brad E Snyder, Peter A Walker, Todd D Wilson, Angielyn R Rivera, Connie L Klein, Shinil K Shah, Erik B Wilson

Faculty, Staff and Student Publications

BACKGROUND: Postoperative morbidity after laparoscopic bariatric surgery is considered higher for patients undergoing revisional versus primary procedures. The objective of this retrospective cohort study was to compare outcomes between patients undergoing primary versus revisional robotically assisted laparoscopic (RAL) Roux-en-Y gastric bypass (RYGB).

METHODS: Data of all patients who underwent RAL primary and revisional RYGB between 2009 and 2019 at two accredited, high-volume bariatric surgery centers-the Memorial Hermann - Texas Medical Center, Houston, TX, and the Tower Health, Reading Hospital, Reading, PA, were analyzed. Primary outcomes were early (< 30 days) and overall postoperative complications. Secondary outcomes included intraoperative complications, operative times, conversions to laparotomy, length of hospital stay, early (< 30 days) postoperative readmissions and deaths.

RESULTS: Data of 1072 patients were analyzed, including 806 primary and 266 …

Reduced Incidence Of New Gastrointestinal Cancers Diagnosis During Covid-19 Pandemic, Abhilash Perisetti Md, Syed Mahanazuddin Phd, Rachana Yendala Md, Hermant Goyal Md, Benjamin Tharian Md, Mariajose Rojas Md, Neil Sharma Md

PCI Publications and Projects

Introduction- Gastrointestinal cancers such as esophageal, gastric, colon, liver, and pancreas cancers present a significant global challenge. The burden of these cancers depends mainly on early recognition and treatment initiation. COVID-19 pandemic led to a strain on multiple healthcare systems resulting in stay-at-home restraints, which might have impacted early recognition of these cancers. The data about the the incidence of GI cancers during the pandemic is scarce.

Methods- All adult patients with a new diagnosis of GI cancers in 2020 were compared with the patients in 2019. ICD-10 codes were utilized to identify these patient from TriNetX, a federated cloud-based …

Improved Resection Rates In Locally Advanced Pancreatic Cancer (Lapc) Following Eus-Fni Of Large Surface Area Microparticle Paclitaxel (Lsam Pac), Neil Sharma Md, C Max Schmidt Md, Sushil Jain Md, Joseph Mccollom Do, Holly Maulhardt Bs, Shelagh Verco Bsc, Phd, Mariajose Rojas Md, Saurabh Gupta Md, Chetan Mittal Md, Christina Zelt, Ashley Rumple Rn, Bsn, James Verco Bs, Ccra, Abhilash Perisetti Md, Gere S. Dizerega Md

PCI Publications and Projects

Introduction:

LAPC is generally defined as unresectable disease without evidence of metastatic spread, and reports suggest between 8-25% of these patients may become resectable following current standard of care (SOC) therapy. EUS-FNI allows for the delivery of drug therapies directly into the tumor, which led to the development of LSAM pac currently being evaluated in LAPC and other solid tumors by means of direct injection, where the particles of pure drug act as a depot releasing paclitaxel over several weeks.

Methods:

Clinical study [NCT # 03077685] enrolled patients with LAPC, confirmed non-surgical despite SOC therapy, to additionally receive LSAM pac …

Inpatient Palliative Care Is Less Utilized In Rare, Fatal Extrahepatic Cholangiocarcinoma: A Ten-Year National Perspective, Zahra Mojtahedi, Ji Won Yoo, Karen Callahan, Neeraj Bhandari, Donghui Lou, Katayoon Ghodsi, Jay J. Shen

School of Medicine Faculty Research

Background—Extrahepatic cholangiocarcinoma (ECC) is a rare, morbid, fatal cancer with distressing symptoms. Maintaining a high quality of life while reducing hospital charges and length of stay (LOS) for the end-of-life period remains a major challenge for the healthcare system. Palliative care utilization has been shown to address these challenges; moreover, its use has increased in recent years among cancer patients. However, the utilization of palliative care in rare cancers, such as ECC, has not yet been explored. Objectives—To investigate palliative care utilization among ECC patients admitted to US hospitals between 2007 and 2016 and its association with patient demographics, clinical …

Risk Factors For Recurrence Of Clostridioides Difficile In Hospitalized Patients, Diaa Alrahmany, Benjamin J Ereshefsky, Wasim S El Nekidy, Gehan Harb, Laura Pontiggia, Islam M Ghazi

Institute of Emerging Health Professions Faculty Papers

Background: Diarrhea and pseudomembranous colitis associated with Clostridioides difficile - a spore-forming anaerobic Gram-positive bacillus - is a major infection in hospitalized patients with a profound impact on clinical and economic outcomes. Recurrence (rCDI) is common and predisposes to further episodes with poor outcomes.

Method: We aimed to identify a wide range of risk factors for recurrence to guide stewardship initiatives. After ethical approval, we commenced collecting demographic and clinical data of patients older than 18 years with clinically and microbiologically confirmed C. difficile infection. Data were statistically analyzed using R software.

Results: Of 204 patients included in the analysis, …

Characterization Of Gut Microbiome And Metabolome In Helicobacter Pylori Patients In An Underprivileged Community In The United States, Brian White, John Sterrett, Zoya Grigoryan, Lauren Lally, Jared Heinze, Hyder Alikhan, Christopher Lowry, Lark Perez, Joshua Desipio, Sangita Phadtare

Division of Internal Medicine Faculty Papers & Presentations

BACKGROUND Helicobacter pylori (H. pylori), a bacterium that infects approximately half of the world's population, is associated with various gastrointestinal diseases, including peptic ulcers, non-ulcer dyspepsia, gastric adenocarcinoma, and gastric lymphoma. As the burden of antibiotic resistance increases, the need for new adjunct therapies designed to facilitate H. pylori eradication and reduce negative distal outcomes associated with infection has become more pressing. Characterization of the interactions between H. pylori, the fecal microbiome, and fecal fatty acid metabolism, as well as the mechanisms underlying these interactions, may offer new therapeutic approaches.

AIM To characterize the gut microbiome and metabolome in H. …

Breaking The Pain Cycle Successfully In A Child With Severe Pain Due To Recurrent Pancreatitis: A Case Report, Ali Sarfraz Siddiqui, Mansoor Chandio

Department of Anaesthesia

Abdominal pain, due to pancreatic diseases like idiopathic recurrent pancreatitis and chronic pancreatitis, is difficult to manage with medications alone in some patients. The Coeliac plexus innervates abdominal organs including the liver, gallbladder, pancreas, etc. We are presenting a case of the successful pain man-agement of a 13-year-old boy with recurrent pancreatitis, by the application of coeliac plexus block. The patient was admitted to the hospital with severe abdominal pain in August 2019. Multimodal analgesia was provided to manage his pain, but he continued to have moderate to severe pain in the abdomen. So, he was scheduled for coeliac plexus …

Management Of Gastrointestinal Bleeding During Covid-19: Less Is More!, Hemant Goyal, Sonali Sachdeva, Abhilash Perisetti Md, Rupinder Mann, Saurabh Chandan, Sumant Inamdar, Benjamin Tharian

Other Specialties

No abstract provided.

'Scope' Of Acute Esophageal Obstruction In The Era Of Covid-19., Hemant Goyal, Abhilash Perisetti, Mahesh Gajendran, Aman Ali, Neil Sharma Md

Other Specialties

No abstract provided.

Direct-Acting Oral Anticoagulants Versus Warfarin In Relation To Risk Of Gastrointestinal Bleeding: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials., Mark M Aloysius, Abhilash Perisetti Md, Hemant Goyal, Umesha Boregowda, Mladen Jecmenica, Mahesh Cheryala, Anurag Bajaj, Bojana Milekic, Milos Babic, Pardeep Bansal, Greg H Enders

Other Specialties

Background: Direct-acting oral anticoagulants (DOACs) are increasingly used, with studies showing a lower risk of gastrointestinal bleeding (GIB), but overall data for GIB risk remains debatable. The objective was to assess non-fatal and fatal GIB risk in patients on DOACs compared with warfarin from randomized clinical trials (RCTs).

Methods: RCTs comparing warfarin and DOACs for various indications (atrial fibrillation, thromboembolism, insertion of mechanical heart valves) were included. The primary endpoint was any GIB event. Other clinical events, such as fatal GIB, and effects of age (≤60 years or older), time in therapeutic range for warfarin, and choice of individual DOACs …

Multisite Pain Is Highly Prevalent In Children With Functional Abdominal Pain Disorders And Is Associated With Increased Morbidity, Bruno P Chumpitazi, Tonya M Palermo, John M Hollier, Mariella M Self, Danita Czyzewski, Erica M Weidler, Margaret Heitkemper, Robert J Shulman

Children’s Nutrition Research Center Staff Publications

Objectives: To characterize the types of multisite pain experienced by children with functional abdominal pain disorders (FAPDs) and to examine differences in psychosocial distress, functional disability, and health-related quality of life in children with multisite pain vs abdominal pain alone.

Study design: Cross-sectional study of children ages 7-17 years (n = 406) with pediatric Rome III FAPDs recruited from both primary and tertiary care between January 2009 and June 2018. Subjects completed 14-day pain and stool diaries, as well as validated questionnaires assessing abdominal and nonabdominal pain symptoms, anxiety, depression, functional disability, and health-related quality of life.

Results: In total, …