Gastroenterology Commons^™

Rapid Development Of Hepatocellular Carcinoma After Eradication Of Hepatitis C Virus With Directly Acting Antiviral Treatment, Fakhar Ali Qazi Arisar, Saeed Hamid

Section of Gastroenterology

Hepatitis C is a major risk factor for the development of hepatocellular carcinoma (HCC), arising typically on a background of liver cirrhosis. Treatment of hepatitis C has been revolutionized by the addition of oral direct-acting antivirals (DAAs) with sustained virological response (SVR) rates above 90%. There is a recent concern under debate about the increased risk of early HCC recurrence in patients with chronic hepatitis C who were treated with direct-acting antivirals. Nonetheless, these reports mostly focused on patients who were cirrhotic and were already treated for HCC. We report 4 cases of treatment naive, chronic hepatitis C patients who …

Evaluation Of The Sharkcore, Benjamin L. Witt, Rachel E. Factor, Barbara E. Chadwick, Justin Caron, Ali A. Siddiqui, Douglas G. Adler

Division of Gastroenterology and Hepatology Faculty Papers

Background and Objectives:

EUS guided core biopsy was once rarely performed but is now entering mainstream practice. Neuroendocrine tumors often warrant core biopsy as sufficient tissue must be obtained to allow for special staining to ensure a correct diagnosis. Traditionally these lesions were sampled with FNA needles. We performed a retrospective pilot study to evaluate the clinical value and efficacy of the a new EUS core needle biopsy needle as compared to a standard EUS FNA needle in the evaluation of patients with known or suspected neuroendocrine tumors.

Methods:

A retrospective analysis of the first 10 patients (between January 2015 …

Curriculum For Neurogastroenterology And Motility Training: A Report From The Joint Anms-Esnm Task Force., C P Gyawali, E Savarino, A Lazarescu, S Bor, A Patel, R Dickman, A Pressman, A M Drewes, John Rosen, V Drug, M Saps, L Novais, M Vazquez-Roque, D Pohl, M A L Van Tilburg, A Smout, S Yoon, J Pandolfino, G Farrugia, G Barbara, S Roman

Manuscripts, Articles, Book Chapters and Other Papers

Although neurogastroenterology and motility (NGM) disorders are some of the most frequent disorders encountered by practicing gastroenterologists, a structured competency-based training curriculum developed by NGM experts is lacking. The American Neurogastroenterology and Motility Society (ANMS) and the European Society of Neurogastroenterology and Motility (ESNM) jointly evaluated the components of NGM training in North America and Europe. Eleven training domains were identified within NGM, consisting of functional gastrointestinal disorders, visceral hypersensitivity and pain pathways, motor disorders within anatomic areas (esophagus, stomach, small bowel and colon, anorectum), mucosal disorders (gastro-esophageal reflux disease, other mucosal disorders), consequences of systemic disease, consequences of therapy …

Lafora Disease Masquerading As Hepatic Dysfunction, Faisal Inayat, Waqas Ullah, Hanan T. Lodhi, Zarak H. Khan, Ghulam Ilyas, Nouman Safdar Ali, Hafez Mohammad A. Abdullah

Abington Jefferson Health Papers

Lafora disease is fatal intractable progressive myoclonic epilepsy. It is frequently characterized by epileptic seizures, difficulty walking, muscle spasms, and dementia in late childhood or adolescence. We chronicle here an unusual case of an asymptomatic young male soccer player who presented with elevated liver enzymes. Neurological examination was unremarkable. The diagnostic workup for hepatitis, infectious etiologies, autoimmune disorders, hemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency, and other related diseases was inconclusive. He subsequently underwent an uneventful percutaneous liver biopsy. Based on the pathognomonic histopathological findings, Lafora disease was considered the likely etiology. The present study is a unique illustration of this …

Immunoglobulin G4 Sclerosing Cholangitis: An Unusual Cause Of Obstructive Jaundice-Case Report And Literature Review., Pragya Shrestha, Brian Le, Brent Wagner, William Pompella, Paras Karmacharya

Reading Hospital Internal Medicine Residency

IgG4-related sclerosing cholangitis (IgG4-SC) is one of the most common extra-pancreatic manifestation of IgG4-related disease (IgG4-RD) and is clinically distinct from primary sclerosing cholangitis (PSC). IgG4-RD is an increasingly recognized immune-mediated fibroinflammatory systemic disease, mostly affecting middle-aged and older male populations that can affect multiple organs. The presence of extra-biliary clinical manifestations of IgG4-RD, such as parotid and lacrimal swelling, lymphadenopathy, autoimmune pancreatitis, and retroperitoneal fibrosis, if present could provide important clues to diagnosis. High serum IgG4 levels, characteristic radiological (e.g., sausage-shaped pancreas or periaortitis) or biopsy findings (high percentage of IgG4+ plasma cells, lymphoplasmacytic infiltrate, storiform fibrosis, or obliterative …

The Transfusion Threshold For Upper Gastrointestinal Bleeding Is A Hemoglobin Of 7.0 G/Dl Or Less, Matthew J. Ouellette , D.O., Katherine S. Lee , M.D., Daniel P. Noack, Aaron Simpson , M.D., Rana K. Zaban , D.O., Chelsea Gonzalez , D.O., Racha El-Ladki , D.O.

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Villanueva C, Colomo A, Bosch A, Concepcion M, Hernandez-Gea V, Aracil C. Transfusion strategies for acute upper gastrointestinal bleeding. New Eng J Med. 2013;368(1):11-21. doi: 10.1056/NEJMoa1211801

Early Oral Refeeding In Acute Pancreatitis Reduces Length Of Hospital Stay, Sylvie B. Polsky

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Lariño-Noia J, Lindkvist B, Iglesias-García J, Seijo-Ríos S, Iglesias-Canle J, Domínguez-Muñoz J. Early and/or immediately full caloric diet versus standard refeeding in mild acute pancreatitis: A randomized open-label trial. Pancreatology. 2014;14(3):167-173. doi: 10.1016/j.pan.2014.02.008.

Sex-Specific Associations Of Infants’ Gut Microbiome With Arsenic Exposure In A Us Population, Anne G. Hoen, Juliette C. Madan, Zhigang Li, Modupe Coker, Sara N. Lundgren, Hilary G. Morrison, Thomas J. Palys, Brian P. Jackson, Mitchell L. Sogin, Kathryn L. Cottingham, Margaret R. Karagas

Dartmouth Scholarship

Arsenic is a ubiquitous environmental toxicant with antimicrobial properties that can be found in food and drinking water. The influence of arsenic exposure on the composition of the human microbiome in US populations remains unknown, particularly during the vulnerable infant period. We investigated the relationship between arsenic exposure and gut microbiome composition in 204 infants prospectively followed as part of the New Hampshire Birth Cohort Study. Infant urine was analyzed for total arsenic concentration using inductively coupled plasma mass spectrometry. Stool microbiome composition was determined using sequencing of the bacterial 16S rRNA gene. Infant urinary arsenic related to gut microbiome …

Considerations For Best Practices In Studies Of Fiber Or Other Dietary Components And The Intestinal Microbiome, David M. Klurfeld, Cindy D. Davis, Robert W. Karp, Emma Allen-Vercoe, Eugene B. Chang, Benoit Chassaing, George C. Fahey Jr, Bruce R. Hamaker, Hannah D. Holscher, Johanna W. Lampe, Andre Marette, Eric Martens, Stephen J. O'Keefe, Devin J. Rose, Maria Saarela, Barbara O. Schneeman, Joanne L. Slavin, Justin L. Sonnenburg, Kelly S. Swanson, Gary D. Wu, Christopher J. Lynch

Food for Health: Publications

Considerations for best practices in studies of fiber or other dietary components and the intestinal microbiome. Am J Physiol Endocrinol Metab 315: E1087–E1097, 2018. First published August 21, 2018; doi:10.1152/ajpendo.00058.2018.—A 2-day workshop organized by the National Institutes of Health and U.S. Department of Agriculture included 16 presentations focused on the role of diet in alterations of the gastrointestinal microbiome, primarily that of the colon. Although thousands of research projects have been funded by U.S. federal agencies to study the intestinal microbiome of humans and a variety of animal models, only a minority addresses dietary effects, and a small subset is …

Progression Of Gastric Acid Production In Preterm Neonates: Utilization Of In-Vitro Method, Murali R. Palla, Shashidhar Harohalli, Tim N. Crawford, Nirmala Desai

Pediatrics Faculty Publications

Background: Limited studies are done regarding ability to produce gastric acid in preterm infants and most studies used in vivo method of assessing gastric pH.

Objectives: To assess the feasibility of using an in vitro method of measuring gastric pH in babies ≤ 28 weeks gestational age (GA) and determine whether changes in gastric pH differ with gestational age, mode of delivery, and use of antenatal steroids.

Design/Methods: Prospective study that enrolled extremely low birth weight (ELBW) babies. Gastric aspirate collected before feeding. In vitro testing of gastric aspirates for pH were done on days of life 1, 3, 5, …

Assessment Of Malnutrition In Patients With Liver Cirrhosis Using Protein Calorie Malnutrition (Pcm) Score Verses Bio-Electrical Impedance Analysis (Bia), Om Parkash, Wasim Jafri, S. M. Munir, Romaina Iqbal

Section of Gastroenterology

Objective: Malnutrition is a common problem in patients with liver cirrhosis and tools for nutritional assessment are under debate. We conducted this study to assess prevalence of malnutrition in cirrhotic patients using PCM score and BIA. Additionally we compared BIA to PCM score for detecting malnutrition in this patient population.

Results: This was a cross sectional study conducted in two tertiary care hospitals of Karachi Pakistan on adults with liver cirrhosis. Malnutrition was assessed by PCM score using anthropometric measurements and biological specimens and (ii) Body cell mass was assessed using BIA. Malnutrition as estimated by the PCM score was …

Predictors Of Serious Findings On Bi-Directional Endoscopy In Young Patients With Anemia And Gi Symptoms, Faisal Aslam, A. B. Khalid, Faraz Siddiqui, Yamna Jadoon

Section of Gastroenterology

Background: Iron deficiency anemia (IDA) has been cited as the most common cause of anemia globally. Gastrointestinal (GI) lesions are amongst the common cause of IDA. Endoscopic evaluation is the most effective way to investigate the IDA. The aim of this study was to show the association of alarming GI symptoms with abnormal endoscopic findings and to cut off the burden and cost of unnecessary endoscopies.

Methods: This is cross sectional study of anemic patient who underwent upper and lower GI endoscopies in Aga Khan University Hospital, Karachi between July-December 2016.

Results: Total 243 patients were identified after excluding ineligible …

Treatment Of People Diagnosed With Chronic Hepatitis C Virus Infection, Marc Bulterys, Saeed Hamid

Section of Gastroenterology

No abstract provided.

Bowel Preparation Quality Scales For Colonoscopy., David Kastenberg, Gerald Bertiger, Stuart Brogadir

Division of Gastroenterology and Hepatology Faculty Papers

Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer-related death in the United States. Colonoscopy is widely preferred for CRC screening and is the most commonly used method in the United States. Adequate bowel preparation is essential for successful colonoscopy CRC screening. However, up to one-quarter of colonoscopies are associated with inadequate bowel preparation, which may result in reduced polyp and adenoma detection rates, unsuccessful screens, and an increased likelihood of repeat procedure. In addition, standardized criteria and assessment scales for bowel preparation quality are lacking. While several bowel preparation quality scales are referred …

High-Volume Hemofiltration Is Not Preferred For Hypertriglyceridemia-Induced Pancreatitis, Ian N. Monk

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of He WH, Yu M, Zhu Y, et al. Emergent triglyceride-lowering therapy with early high-volume hemofiltration against low-molecular-weight heparin combined with insulin in hypertriglyceridemic pancreatitis: A prospective randomized controlled trial. J Clin Gastroenterol. 2016;50(9):772-778. doi: 10.1097/MCG.0000000000000552.

Cardiac Mri T2* In Liver Transplant Candidates: Application And Performance Of A Novel Imaging Technique To Identify Patients At Risk For Poor Posttransplant Cardiac Outcomes., Sara M Lewin, Kimberly Kallianos, M Ilan Nevah, Susan Zhao, Oren K Fix, Gabriel C Brooks, Teresa De Marco, Atif N Qasim, Karen G Ordovas, Neil Mehta

Articles, Abstracts, and Reports

Background: In end-stage liver disease, alterations in iron metabolism can lead to iron overload and development of iron overload cardiomyopathy. In liver transplant candidates, evaluation for cardiac iron overload and dysfunction can help to identify candidates at increased risk for peritransplant morbidity and mortality, though recommendations for pretransplant evaluation of cardiac iron overload are not standardized. Cardiac Magnetic Resonance Imaging T2* (CMRI-T2*) is a validated method to quantify cardiac iron deposition, with normal T2* value of 20 ms or greater. In this study, we sought to identify the incidence and predictors of iron overload by CMRI-T2* and to evaluate the …

Complement Factor D Protects Mice From Ethanol-Induced Inflammation And Liver Injury., Rebecca L Mccullough, Megan R Mcmullen, Megan M Sheehan, Kyle L Poulsen, Sanjoy Roychowdhury, Dian J Chiang, Michele T Pritchard, Juan Caballeria, Laura E Nagy

Articles, Abstracts, and Reports

Complement plays a crucial role in microbial defense and clearance of apoptotic cells. Emerging evidence suggests complement is an important contributor to alcoholic liver disease. While complement component 1, Q subcomponent (C1q)-dependent complement activation contributes to ethanol-induced liver injury, the role of the alternative pathway in ethanol-induced injury is unknown. Activation of complement via the classical and alternative pathways was detected in alcoholic hepatitis patients. Female C57BL/6J [wild type (WT)], C1q-deficient ( C1qa

Exploring The Excluded Stomach: A Case Series Of Novel Endoscopic Techniques To Diagnose Gastric Cancer In The Excluded Stomach After Roux-En-Y Gastric Bypass Surgery, Saeed Ali, Abdelkader Chaar, Wesam Frandah, Rola Altoos, Zeeshan Sattar, Muhammad Hasan

Internal Medicine

Gastric cancer is the fifth most common malignancy worldwide and the fourth leading cause of cancer-related deaths. The diagnosis is usually made by direct visualization with supporting histopathology. However, patients with gastric bypass surgery pose a challenge in diagnosis due to the difficulty in the evaluation of the excluded stomach. We present two cases of gastric cancer in the excluded stomach after Roux-en-Y gastric bypass (RYGB) surgery was diagnosed using two different endoscopic approaches.

A Bibliometric Analysis Of The Top 100 Cited Articles On Hepatic Magnetic Resonance Imaging., Waqas Ullah, Hafez Mohammad A. Abdullah, Ejaz Ahmad, Mamoon Ur Rashid, Muhammad Bashir, Asad Ur Rahman, Asrar Ahmad, Abu Hurairah

Abington Jefferson Health Papers

The purpose of this study is to guide the readers to the impact of the articles published on hepatic magnetic resonance imaging (MRI). We searched Scopus using 10 different search terms for hepatic MRI. The selected studies were thoroughly reviewed by two independent authors and any disagreement was sorted out by mutual consensus. The list of articles and journals was downloaded into an excel spreadsheet. Only the top 100 cited articles were selected by mutual consensus among all the authors. These articles were further read in the full-text form and were further categorized into subgroups. Three authors independently reviewed the …

Placement Of Lumen-Apposing Metal Stents To Drain Pseudocysts And Walled-Off Pancreatic Necrosis Can Be Safely Performed On An Outpatient Basis: A Multicenter Study, Douglas G. Adler, Janak Shah, Jose Nieto, Kenneth Binmoeller, Yasser Bhat, Linda Jo Taylor, Ali A. Siddiqui

Division of Gastroenterology and Hepatology Faculty Papers

Backgrounds and Objectives: No study on the use of lumen-apposing fully covered self-expanding metal stent (LAMS) to drain pancreatic fluid collections (PFCs) has evaluated outcomes of patients in the outpatient setting. The objective of this multicenter study was to evaluate the clinical outcomes, success rate, and adverse events of the LAMS for endoscopic ultrasound (EUS)-guided transmural drainage of patients with symptomatic PFCs on an inpatient versus an outpatient basis.

Methods: This was a multicenter, retrospective study conducted at 4 tertiary care centers. Results: We identified eighty patients with PFCs in whom EUS-guided transmural drainage using the LAMS was performed. The …