Gastroenterology Commons^™

Rising Incidence Of Acute Hepatitis A Among Adults And Clinical Characteristics In A Tertiary Care Center Of Pakistan, Yumna Shahid, Amna Subhan Butt, Iqra Jamali, Faisal Wasim Ismail

Section of Gastroenterology

Background: For decades, hepatitis A virus (HAV) has been a leading cause of acute hepatitis among children and was less prevalent among adults. However, recently a paradigm shift has been observed in the epidemiology of HAV, as evident by cases of acute hepatitis due to HAV among adults.
Aim: To estimate frequency of HAV in acute viral hepatitis and compare characteristics in HAV and hepatitis E virus (HEV) infection.
Methods: This was a trend analysis conducted at Aga Khan University Hospital Karachi (Sindh, Pakistan) from February 2024 to May 2024. Individuals aged 18 years and older diagnosed with acute viral …

Lower Cytoplasmic Expression Of Ddit4 Is Associated With Poor Prognosis In Gastric Cancer Patients, Masoumeh Dehghan Manshadi, Fatemeh Tajik, Leili Saeednejad Zanjani, Farideh Hashemi, Mandana Rahimi, Fahimeh Fattahi, Sadegh Safaei, Zahra Madjd, Roya Ghods

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

INTRODUCTION: DNA damage-inducible transcript 4 (DDIT4), also known as Redd1, Dig2, and RTP801 was identified to be upregulated in response to a variety of cellular stresses, including DNA damage, endoplasmic reticulum stress, and energy stress. Several studies have discovered that dysregulation of DDIT4 involved in various cancers with paradoxical expression and roles. Hence, this study was designed to investigate the clinical significance and prognostic value of DDIT4 in different subtypes of gastric cancer (GC).

MATERIALS AND METHODS: To evaluate the expression pattern of DDIT4 in GC tissues as well as adjacent normal tissue, we utilized immunohistochemistry on tissue microarray (TMA) …

Gene Expression Profiling Of Pancreatic Ductal Adenocarcinoma Cells In Hypercapnia Identifies Siah3 As A Novel Prognostic Biomarker, Nitzan Zohar, Ryan Maguire, Saed Khalilieh, Aditi Jain, Dmitriy Bosykh, Wilbur B. Bowne, Harish Lavu, Charles J. Yeo, Avinoam Nevler

Department of Surgery Faculty Papers

Hypercapnia is a key feature of the respiratory microenvironment in many pathologic conditions. It occurs both as a regional and as a systemic process, and it is associated with multiple metabolic changes such as mitochondrial dysfunction, decreased ATP production, and metabolic shift from glycolytic energy production to fatty acid metabolism. In the cancer tumor microenvironment, hypercapnia has been linked at times to enhanced cell migration, invasion, and chemoresistance. Our previous work has shown that hypercapnia-associated gene signatures can be used as prognostic biomarkers. However, unlike the hypoxia-inducible factor pathway, there are no validated targets to quantify hypercapnia. In this study, …

A Case Of Turmeric-Induced Hepatotoxicity With Hyperferritinemia, Nina R. Spitofsky, Albert A. Huang, Aria Jalalian, Stefanie Gallagher, Scott Fink

Department of Medicine Faculty Papers

Introduction: We present the first published case of turmeric-associated drug-induced liver injury (DILI) accompanied by significant ferritin elevation. Case Presentation: Our patient, a 59-year-old female with DILI caused by long-term ingestion of oral turmeric supplements, presented with painless jaundice on an annual exam. The patient’s liver function tests exhibited a hepatocellular pattern and hyperferritinemia (>2,000 ng/dL). Additional testing was negative except for heterozygosity for the H63D allele associated with hemochromatosis. A liver biopsy indicated acute hepatitis without fibrosis or stainable iron. Conclusion: Upon discontinuation of the supplement, liver enzymes normalized within a month. This case highlights the potential for …

A Peculiar Pancreatitis: Investigating The Adverse Effects Of Mesalamine, Elias Arellano Villanueva, Miguel Lopez, Alhasan Asaad, Jose Campo Maldonado

Research Symposium

Background: Acute pancreatitis (AP) is a leading cause of gastrointestinal-related hospitalizations in the United States, accounting for approximately 300,000 emergency department visits annually. It is characterized by parenchymal and peripancreatic fat necrosis accompanied by inflammation. The clinical diagnosis of AP is based on elevated serum amylase and lipase levels, characteristic imaging findings, and epigastric pain often radiating to the back. While gallstones and alcohol use are the most common causes of AP, drug-induced pancreatitis (DIP) is a rare but increasingly recognized etiology, contributing to 0.1–5% of cases. DIP is typically diagnosed by excluding other causes and is often associated with …

A Case Of Microscopic Colitis Masquerading As Chronic Inflammatory Diarrhea, Corey Haines, Sophia Moon, Giani Tah, Diana Acosta Pozo, Alejandro Aquino, Fatimah Bello

Research Symposium

Introduction: Microscopic colitis is an idiopathic, inflammatory form of colitis that is characterized by a normal macroscopic appearance of bowel but abnormal histological appearance on microscopy. Microscopic colitis can be subdivided into two histological subtypes: collagenous and lymphocytic. The collagenous subtype is characterized by proliferation of collagenous connective tissue that forms a thick subepithelial collagen band while the lymphocytic subtype is characterized by lymphocytic infiltrates and little to no proliferation of connective tissue. Classically, microscopic colitis presents with chronic, nonbloody, watery diarrhea lasting more than one month. It is typically associated with weight loss, abdominal pain, tenesmus, and nocturnal stools. …

Prognostic Determinants Of Liver And Intrahepatic Bile Duct Carcinomas: A Seer Database Analysis, Aura Calderon, Ivan Mogollon, Everardo Cobos

Research Symposium

Introduction: The incidence of liver and intrahepatic bile duct carcinomas has risen significantly in the United States, necessitating a deeper understanding of survival outcomes and prognostic determinants. This study examines survival rates based on disease stage at diagnosis and explores the influence of demographic factors such as sex, race, ethnicity, and age.

Objectives: The primary objective is to evaluate survival rates stratified by disease stage and demographic variables using data from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2021.

Methods: Data were extracted from the SEER database for patients diagnosed with primary hepatic and intrahepatic bile …

Gut-Spine Connection: Unexplored Pathways To Improving Outcomes In Spinal Health And Disease, Anesu K. Murambadoro, Julia Saifetiarova, Priya Kale, Victor A. Bob-Yellowe, Paul Bonilla, Aun A. Bangash, Isabella Ortigoza, Anjana Ganesh, Mohammed S. Razzaque

Research Symposium

Introduction: Lumbar spinal fusion is among the most expensive procedures in the Medicare system, with costs exceeding $33 billion annually. Improving recovery outcomes for these procedures is critical, and emerging research suggests that microbiome-targeted therapies could play a key role. There is growing evidence linking spinal health with gut microbiota alterations, particularly through the gut-spine axis, which involves the gut-disc, gut-bone, and gut-immune interactions. This bidirectional relationship between gut microbiota and spinal health offers a novel approach for understanding recovery mechanisms. Additionally, magnesium deficiency, which is prevalent, may exacerbate both gut dysbiosis and poor bone health, contributing to chronic skeletal …

Engineering A Novel Treg Population To Control Autoimmune Diabetes, Sofia Colon Guzman, Elly Puckett, Ryan T. Fischer, Mary Markiewicz

Posters

Purpose Type 1 diabetes (T1D) in an autoimmune disorder where T cells attack  islet cells, which are the pancreatic cells responsible for insulin production. T1D affects about 1 in 500 children in the United States and is one of the most common chronic diseases in pediatrics. Currently, insulin is the most effective treatment for T1D However, it does not change the underlying disease, and patients still experience many complications throughout their lifetimes. With a significant increase in the prevalence of T1D in children and adolescence in the past two decades, it’s important to explore therapies that alter the immune …

Ethical Considerations Of Percutaneous Endoscopic Gastrostomy Tube Placement In A Patient With Creutzfeldt-Jakob Disease And Advanced Dementia, Toni Habib, Niamh Siobhán Mulrooney, Yisroel Grabie, Mohammad Maruf, Sophia Kasapira

HCA Healthcare Journal of Medicine

Background

Creutzfeldt-Jakob disease (CJD) is a rapidly progressive neurodegenerative condition that is not easily diagnosed and has no curative treatments available, essentially requiring palliative measures, including tube feeding. Nonetheless, data shows that the endoscope used for percutaneous endoscopic gastrostomy (PEG) tube insertion can be a vector for CJD transmission.

Case Presentation

We discuss the case of an elderly patient diagnosed with CJD, requiring tube feeding. Multiple specialists were consulted, and they were unable to reach an agreement on the best approach. Eventually, the hospital ethics committee intervened, and the family agreed to comfort measures only. This case report sheds light …

Cold Snare Polypectomy In Pediatric Polyposis: A Multicenter Experience., Hunter J. Friesen, Thomas M. Attard, Andrew Y J Liman, Osamu W. Yasui, Catharine M. Walsh, Roberto Gugig, Monique T. Barakat

Manuscripts, Articles, Book Chapters and Other Papers

Background: Cold snare polypectomy (CSP) is a well-established and recommended technique in adult gastroenterology for the safe, efficient and complete removal of nonpedunculated lesions up to 10 mm, with piecemeal excision possible for larger lesions. However, the application of CSP in pediatric patients remains underexplored. This study summarizes a multicenter experience of CSP in pediatric polyposis patients, focusing on safety, efficacy and clinical outcomes. Methods: This retrospective study was conducted at two pediatric tertiary centers, encompassing patients aged 1 to 21 years with polyposis who underwent colonoscopy with CSP and hot snare polypectomy (HSP) between January 2022 and …

The Oral-Gut Microbiome Axis: Implications For Systemic And Oral Health, Sana Shariff, Manas Mandal

Annual Research Symposium

The bidirectional relationship between the oral and gut microbiomes has gained attention for its role in systemic and oral diseases. Dysbiosis, or microbial imbalance, disrupts these ecosystems, leading to inflammatory conditions. This research investigates the connection between these microbiomes, focusing on microbial translocation, disease correlation, and targeted interventions such as probiotics or dietary modifications to restore microbial homeostasis and reduce disease incidence.

Transcranial Magnetic Stimulation As A Treatment Modality For Functional Bowel Disorder And Irritable Bowel Syndrome And Possible Correlations With The Gut-Brain Axis: A Review, Lauren Draper, Devin Pfister, Ethan Zaugg

Annual Research Symposium

Functional Bowel Disorders (FBD), including Irritable Bowel Syndrome (IBS), are highly prevalent gastrointestinal conditions classified as Disorders of Gut-Brain Interactions (DGBIs) under the Rome IV criteria. These conditions, marked by abdominal pain, altered bowel habits, and significant psychological comorbidities, present substantial challenges in both diagnosis and treatment. Conventional therapies primarily target gut-centric mechanisms but often yield limited efficacy, underscoring the need for approaches that account for the complex interplay of the gut-brain axis in DGBI pathophysiology.

Glucagon-Like Peptide-1 Receptor Agonists Improve Metabolic Dysfunction-Associated Steatotic Liver Disease Outcomes, Brandon Havranek, Rebecca Loh, Beatriz Torre, Rachel Redfield, Dina Halegoua-De Marzio

Division of Gastroenterology and Hepatology Faculty Papers

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease and is associated with significant cardiovascular morbidity and mortality. This study aims to investigate the association of glucagon-like peptide-1 (GLP-1) agonists with major cardiovascular events, clinically significant portal hypertension events, and all-cause mortality in patients with MASLD. A large, population-based retrospective cohort study was conducted using the TriNetX platform, which provided real-time access to electronic health records of 634,265 adult patients with MASLD/MASH. Propensity score matching (PSM) was employed to create two cohorts: A GLP-1 agonists group and a control group without GLP-1 agonists usage. Hazard …

A Deep Learning-Based System For Automatic Detection Of Emesis With High Accuracy In Suncus Murinus, Zengbing Lu, Yimeng Qiao, Xiaofei Huang, Dexuan Cui, Julia Y H Liu, Man Piu Ngan, Luping Liu, Zhixin Huang, Zi-Tong Li, Lingqing Yang, Aleena Khalid, Yingyi Deng, Sze Wa Chan, Longlong Tu, John A Rudd

Children’s Nutrition Research Center Staff Publications

Quantifying emesis in Suncus murinus (S. murinus) has traditionally relied on direct observation or reviewing recorded behaviour, which are laborious, time-consuming processes that are susceptible to operator error. With rapid advancements in deep learning, automated animal behaviour quantification tools with high accuracy have emerged. In this study, we pioneere the use of both three-dimensional convolutional neural networks and self-attention mechanisms to develop the Automatic Emesis Detection (AED) tool for the quantification of emesis in S. murinus, achieving an overall accuracy of 98.92%. Specifically, we use motion-induced emesis videos as training datasets, with validation results demonstrating an accuracy of 99.42% for …

Aortoduodenal Syndrome: A Rare Case Of Duodenal Obstruction Due To Endovascular Aneurysm Endoleak., Raksha Adhikari, Parth Patel, Christopher Tait

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Aortoduodenal syndrome results from expansion of an abdominal aortic aneurysm, leading to symptoms of upper gastrointestinal obstruction. Endovascular aneurysm repair of large or symptomatic aortic aneurysms has become an important treatment modality for patients with abdominal aortic aneurysm. However, a large proportion of these grafts are complicated by endoleaks that can lead to a spectrum of significant symptoms. We present a case of rapidly worsening gastrointestinal obstructive symptoms in a patient with an already repaired aortic stent graft and a solitary kidney, found to be due to a type III endoleak that improved after emergent repeat endovascular aneurysm repair.

Association Between Early Immunosuppression Center Variability And One-Year Outcomes After Pediatric Liver Transplant., Vikram K. Raghu, Scott D. Rothenberger, James E. Squires, Elizabeth Eisenberg, Anna L. Peters, Jennifer Halma, Swati Antala, Irini D. Batsis, Ke-You Zhang, Amy G. Feldman, Daniel H. Leung, Steven J. Lobritto, John Bucuvalas, Simon P. Horslen, George V. Mazariegos, Emily R. Perito

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Despite the existence of institutional protocols, liver transplant centers often have variability in early immunosuppression practices. We aimed to measure within-center variability in early immunosuppression after pediatric liver transplant (LT) and examine its association with one-year outcomes.

METHODS: We analyzed pediatric LTs from 2013 to 2018 in the United Network for Organ Sharing registry, with data aggregated by center. We categorized induction regimen as corticosteroids only vs. T-cell depleting antibody vs. non-T-cell depleting antibody. Primary exposures were coefficient of immunosuppression variability (CIV) in (1) induction and (2) mycophenolate mofetil (MMF) use. Primary outcomes were one-year graft survival, patient survival, …

American Society For Gastrointestinal Endoscopy Guideline On The Diagnosis And Management Of Gerd: Methodology And Review Of Evidence, Asge Standards Of Practice Committee, Madhav Desai, Wenly Ruan, Nirav C Thosani, Manuel Amaris, J Stephen Scott, Ahmed Saeed, Barham Abu Dayyeh, Marcia Irene Canto, Wasif Abidi, Omeed Alipour, Stuart K Amateau, Natalie Cosgrove, Sherif E Elhanafi, Nauzer Forbes, Divyanshoo R Kohli, Richard S Kwon, Larissa L Fujii-Lau, Jorge D Machicado, Neil B Marya, Saowanee Ngamruengphong, Swati Pawa, Sunil G Sheth, Nikhil R Thiruvengadam, Bashar J Qumseya

Faculty, Staff and Student Publications

This clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for strategies to diagnose and manage GERD. This document was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework and serves as an update to the prior ASGE guideline on the role of endoscopy in the management of GERD (2014). The updated guideline addresses the indications for endoscopy in patients with GERD, including patients who have undergone sleeve gastrectomy (SG) and peroral endoscopic myotomy (POEM). It also discusses endoscopic evaluation of gastroesophageal junctional integrity comprehensively and uniformly. Important, this guideline discusses …

Spectrum Of Venous Thromboembolism In Adult Patients With Ulcerative Colitis In Pakistan: A Single Center Retrospective Study, Masood Muhammad Karim, , Hafsa Shaikh, Faisal Wasim Ismail

Department of Medicine

Background: Patients with inflammatory bowel disease are at a 2-8-fold higher risk of developing venous thromboembolism (VTE) as compared to the general population. Although the exact pathogenesis is unclear, the literature suggests that increased risk of thromboembolic events in such patients occurs as a result of increased coagulation factors, inflammatory cytokines, and reduction in anticoagulants leading to a prothrombotic state.
Aim: To assess the prevalence, risk factors, management, and outcome of ulcerative colitis (UC) patients who develop VTE.
Methods: This was a retrospective chart review done in The Gastroenterology Department of The Aga Khan University Hospital. Data was collected from …

Lumen-Apposing Metal Stent Placement In Severe Sepsis Secondary To Afferent Limb Syndrome, Nicholas Noverati, Faisal Kamal

Division of Gastroenterology and Hepatology Faculty Papers

No abstract provided.