Gastroenterology Commons^™

Gastric-Type Enteric Duplication Cyst In The Tail Of A Bifid Pancreas In Association With Complete Intestinal Malrotation, Muhammad Awais, Abdul Rehman, Noor Ul-Ain Baloch

Department of Biological & Biomedical Sciences

Abstract are not provided by the author/publisher

Downregulation Of Thromboxane A2 And Angiotensin Ii Type 1 Receptors Associated With Aging-Related Decrease In Internal Anal Sphincter Tone., Ipsita Mohanty, Jagmohan Singh, Satish Rattan

Division of Gastroenterology and Hepatology Faculty Papers

Aging-associated decrease in internal anal sphincter (IAS) tone (AADI) is a major contributor in the rectoanal incontinence (RI). To determine the pathogenesis of AADI, we investigated the effect of aging on GPCR activation and related downstream signaling. We particularly investigated two GPCRs that characterize IAS smooth muscle cells (SMCs): thromboxane A ₂ and angiotensin II type 1. Two groups of Fischer 344 rats (6-month-old [young group] and 26-month-old [old group]) were employed to determine the GPCR function by isometric contraction, the expressions of GPCRs, and their downstream regulatory signaling proteins (regulator of G-protein signaling 2, RGS2; GPCR Kinase 5, GRK5; …

Discontinuation Of Proton Pump Inhibitor Use Reduces The Number Of Endoscopic Procedures Required For Resolution Of Walled-Off Pancreatic Necrosis., Patrick C. Powers, Ali Siddiqui, Reem Z. Sharaiha, Grace Yang, Enad Dawod, Aleksey A. Novikov, Amy Javia, Cynthia Edirisuriya, Arish Noor, Tayebah Mumtaz, Usama Iqbal, David .E Loren, Thomas E. Kowalski, Natalie Cosgrove, Yordano Alicea, Amy Tyberg, Iman Andalib, Michel Kahaleh, Douglas G. Adler

Division of Gastroenterology and Hepatology Faculty Papers

Background and Objectives: Endoscopic drainage/debridement of symptomatic walled off necrosis (WON) using lumen-apposing metal stents (LAMS) is both safe and effective. While endoscopic management of WON is the standard approach to treatment, the ideal concomitant medical therapy remains unclear. The purpose of this study was to further elucidate the effect of proton pump inhibitor (PPIs) therapy on the technical and clinical success of endoscopic treatment of WON.

Methods: Two hundred and seventy-two patients in 8 centers with WON managed by endoscopic drainage using LAMS were evaluated. Patients were followed for at least 6 months following treatment. The patients were divided …

A Review Of First Year Fellow Endoscopic Skills And Time To Proficiency, Antoinette Adjowa O. Walker, Dalya El Tawil, Jennifer Colombo, Nicholas Clark, Kimberly J. Reid

Posters

Through this quality improvement project, we have assessed the current fellows' upper endoscopy skill level during their first year and determined that the time to achieving proficiency is significantly longer than desired. The goal is to prepare new fellows for endoscopy prior to the beginning of their rotations with a curriculum that includes assigned reading materials, videos, and simulated endoscopic cases, to promote safety and increase satisfaction of patients by improving the readiness, skill level, and the confidence of first year inexperienced fellows.

Pediatric Ppi Use And Fractures, Nathan R. Fleishman, Troy Richardson, Thomas M. Attard

Posters

This study compared the rate of fracture among pediatric patients exposed to proton pump inhibitors to the rate among patients without exposure, and also considered the fracture location among children exposed to proton pump inhibitors.

Xanthogranulomatous Pyelonephritis: Synchronous Upper And Lower Gastrointestinal Bleed, Muhammad Usman Mirza, John Van Taunay, Muhammad Waleed, Shiva Shankar Vangimalla, Sharana Hegde, Muhamad Alhaj Moustafa

Medical College Documents

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic granulomatous destructive process of the renal parenchyma. It is caused by a chronic inflammatory process due to recurrent urinary tract infections and/or obstructing renal calculi. Rarely, it presents with advanced complications including abscesses and fistula formations. In this article, we report a unique presentation of XGP with simultaneous upper and lower gastrointestinal bleeding in the setting of XGP with reno-gastric and reno-colic fistulas.

Suffering In Silence: Is Gastroparesis Underdiagnosed?, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In this introduction to Volume 6, Issue 2, the editor-in-chief of the Journal of Patient-Centered Research and Reviews offers additional comment to the clinical review of diabetic gastroparesis authored by Farmer and colleagues (p. 148), regarding the problem of undiagnosed disease. Increased awareness of this entity and appropriate questioning regarding symptoms of diabetic gastroparesis in the primary care setting may prevent the “suffering in silence” experienced by many patients with this complication.

Diabetic Gastroparesis: Perspectives From A Patient And Health Care Providers, Adam D. Farmer, Caroline E. Bruckner-Holt, Susanne Schwartz, Emma Sadler, Sri Kadirkamanthan

Journal of Patient-Centered Research and Reviews

Gastroparesis is defined as a delay in gastric emptying in the absence of mechanical obstruction in the stomach. Gastroparesis has a number of causes, including postsurgical, secondary to medications, postinfectious, idiopathic, and as a complication of diabetes mellitus, where it is underrecognized. The cardinal symptoms of diabetic gastroparesis are nausea, early satiety, bloating, and vomiting. Diabetic gastroparesis is more common in females and has a cumulative incidence of 5% in type 1 diabetes and 1% in type 2 diabetes. It is associated with a reduction in quality of life and exerts a significant burden on health care resources. The pathophysiology …

Endothelial Dysfunction In Adolescents And Young Adults With Nonalcoholic Liver Disease, Cristiana G. Moise, Octavian Istrătoaie, Ionuț Donoiu, Edme R. Mustafa, Georgică C. Târtea, Diana R. Tudorașcu, Ion Rogoveanu

Journal of Mind and Medical Sciences

Nonalcoholic liver disease is a global public health problem that increases cardiovascular morbidity and mortality in these patients. This paper discusses endothelial dysfunction among patients (adolescents and young adults) with nonalcoholic liver disease.

On the one hand, evidence suggests that cardiovascular disease is the leading cause of mortality in patients with advanced nonalcoholic liver disease and that nonalcoholic fatty liver is associated with an increased risk of cardiovascular disease independent of the presence of cardiovascular risk factors and metabolic syndrome components.

On the other hand, nonalcoholic liver disease, especially the non-inflammatory form of nonalcoholic steatohepatitis, may not only be a …

Immune And Inflammatory Pathways In Non-Alcoholic Steatohepatitis (Nash). An Update, Sorina Cezara Coste, Ionela Popovici, Andreea Maria Stefan, Iulia Breaban, Adela Sitar Taut, Simina Tarmure Sarlea, Angela Cozma, Dorel Sampelean, Olga Hilda Orasan, Vasile Negrean, Lucia Maria Procopciuc

Journal of Mind and Medical Sciences

Non-alcoholic steatohepatitis (NASH), also known as fatty liver disease (FLD), is a major public health problem. It is considered to be the hepatic manifestation of the metabolic syndrome. Chronic inflammation of the liver is an essential key in the progression from simple hepatic steatosis to steatohepatitis, the evolutionary stage of fatty liver disease. Moreover, the innate immune system plays a crucial role in the progression of hepatic inflammation. For this reason, it is of utmost importance to elucidate the connections between immune mechanisms, Toll-like receptor cytokine signalling, in order to find new effective treatments. Further studies are necessary to test …

Chronic Urticaria Associated With Helicobacter Pylori., Rajesh Essrani Md, Matthew Sullivan Do, Hiral N. Shah Md

Department of Medicine

A 31-year-old male presented with a complaint of chronic pruritus with diffuse urticarial wheals for the past seven months. He underwent extensive workup and was found to have positive Helicobacter pylori (H. pylori) stool antigen test. He was treated with bismuth subsalicylate, metronidazole, tetracycline, and omeprazole for two weeks. Pruritus and urticarial wheals disappeared in four weeks after therapy was started.

Patient Perception Of Telephone Follow-Up After Resection For Colorectal Cancer: Is It Time For An Alternative To The Out-Patient Clinic?, Marcus Gilmartin, Nicholas Leaver, George Hall, Helena Fawdry, Seung Lee, James Nicholson, Ramya Kalaiselvan, Raj Rajaganeshan

Patient Experience Journal

The economic reality of modern healthcare provides a timely reminder to clinicians of their duty to provide outstanding and cost-effective care. Although multiple guidelines outline investigation, management and surveillance of colorectal cancer, none advocate a particular delivery method. Nurse-led telephone follow-up in multiple specialties has demonstrated equivalent clinical outcomes and patient satisfaction when compared to traditional outpatient department follow-up. This paper aims to compare nurse-led telephone and outpatient follow-up, following surgical resection of colorectal cancer (CRC), focusing on patient perceptions. This cross-sectional study distributed adapted patient satisfaction questionnaire (PS-Q 18) to patients undergoing surveillance following CRC resection via either nurse-led …

Esophageal Necrosis: A Rare Complication Of Diabetic Ketoacidosis – A Case Report, Ricky Buckshaw Do, Ethan S. Stern Do, Robert Andrews Md, Frederic Stelzer Md

Department of Medicine

No abstract provided.

The Value Of Quick Sepsis-Related Organ Failure Assessment Scores In Patients With Acute Pancreatitis Who Present To Emergency Departments: A Three-Year Cohort Study., Alexander Hallac, Nishant Puri, David Applebury, Kurt Myers, Parag Dhumal, Ashish Thatte, Wichit Srikureja

Articles, Abstracts, and Reports

Background: Distinguishing sepsis from other inflammatory syndromes continues to be a clinical challenge. The goal of risk stratification tools is to differentiate sepsis from other conditions. We compare the ability of quick sepsis-related organ failure assessment (qSOFA) and systemic inflammatory responses syndrome (SIRS) scores to predict prolonged length of stay (LOS) among patients who presented to the emergency department and hospital ward with acute pancreatitis (AP).

Methods: We compiled a retrospective database of all adult patients hospitalized for AP during 2015 - 2018 at a single tertiary care center. Independent

Results: The sensitivity and specificity of an SIRS score of …

Metastatic Melanoma To The Stomach: A Rare Cause Of Upper Gastrointestinal Bleeding, Ricky Buckshaw Do, Robert V. Decker Md, Shashin Shah Md

Department of Medicine

No abstract provided.

The Time Is Now For Mandatory Liver-Focused Clinical Experiences In Medical School., Alexander Y. Pan, Lauren D. Feld, Jeanne M. Farnan, Steven K. Herrine, Adam E. Mikolajczyk

Division of Gastroenterology and Hepatology Faculty Papers

The national burden of chronic liver disease is steadily increasing and is only expected to worsen with the ongoing obesity and opioid epidemics fueling growth in the prevalence of nonalcoholic fatty liver disease and a resurgence of new hepatitis C infections. Our letter highlights the disparity between the rising prevalence of chronic liver disease and the proportion of medical students who receive exposure to patients with liver disease as part of their medical education. A more comprehensive survey of clerkship directors is needed to further corroborate this data, which may lead to reforms in medical school curricula to better address …

Aortoduodenal Fistula Forms From Primary Aortic Stump Graft In A Two-Time Multi-Visceral Transplant Patient With Presentation Of Gastrointestinal Bleed And Bowel Perforation: A Case Report, Brielle Corrente

Graduate Student Research Symposium

Usually not diagnosed until open laparotomy, aortoduodenalfistulas (ADF) are one of the rarest complications of intestinal transplant surgery. With an incidence rate of only 0.04% at autopsy and only 250 documented cases since the early 1800’s, aortoduodenal fistulas are the most deadly complications of intestinal transplantation with a mortality rate of 100% without surgical intervention. A 39 year old, two-time multi-visceral transplant African American female patient suffered from a primary aortoduodenal fistula formation in a primary modified multi-visceral transplant aortic stump graft site. With emergency open laparotomy repair, revascularization of the secondary multi-visceral transplant was performed, saving the life of …

A265 Lymphocytic Esophagitis: A Single Tertiary Center’S Experience With This Emerging Clinical Entity., C Shams, M Co, M Cappell

Conference Presentation Abstracts

Background: Various disorders can produce esophagitis. Lymphocytic esophagitis (LE) has emerged as another clinical entity responsible for esophagitis symptoms. Although increasingly reported pathologically, the clinical characteristics of LE have not been well characterized. Aims: The present study extends the clinicopathologic characterization of LE by comprehensive analysis of 30 affected patients and identifies specific clinical presentations significantly associated with LE. Methods: Thirty patients were identified from January 2000-December 2016 that satisfied diagnostic criteria for LE by lower esophageal biopsy; (1) high concentration of intraepithelial lymphocytes and (2) few granulocytes (ratio of lymphocytes:granulocytes >50:1). Controls, selected from patients undergoing esophagogastroduodenoscopy (EGD) during …

A Rare Case Of Wilson Disease In A 72-Year-Old Patient., Christopher Cao, Timothy Colangelo, Raja Koteswar Dhanekula, Daniel Brandt, Indira Laothamatas, Manish Thapar, Steven K. Herrine, Jesse M. Civan

Division of Gastroenterology and Hepatology Faculty Papers

Wilson disease is an autosomal recessive disorder of abnormal copper metabolism that is prevalent in the younger population, rarely presenting in patients older than 40 years. Clinical presentation may be variable, and diagnosis is often aided by clinical and biochemical tests. We report the case of a 72-year-old woman who presented with acute liver failure initially of unclear etiology. Our patient was initially managed for presumed drug-induced liver injury but ultimately diagnosed with Wilson disease on the basis of clinical presentation, laboratory testing, liver biopsy, quantitative hepatic copper, and abnormal genetic testing.

Nonalcoholic Fatty Liver Disease And The Pnpla3 Gene, Lori Houghton-Rahrig, Debra Schutte, Jenifer I. Fenton, Jennifer Awad

Peer Reviewed Articles

Nonalcoholic fatty liver disease (NAFLD) is a rapidly emerging worldwide public health concern strongly associated with obesity, insulin resistance/diabetes type 2, and the metabolic syndrome (Younossi et al., 2011). It is the most common cause of liver disease in the world (World Gastro - enterology Organisation [WGO], 2012). Defined as a total liver weight comprised of more than 5% fat, NAFLD can progress from simple fatty liver disease to nonalcoholic steatohepatitis with or without fibrosis, liver cirrhosis, liver cancer, or liver failure resulting in premature death (Levene & Goldin, 2012). The development and progression of NAFLD is influenced by genetic …