Hepatology Commons^™

Patient Perspectives On Adherence To The New Hepatitis C Antiviral Medications: ‘A New Lease On Life’, Nicole M. Giordano, Anthony J. Brinn, Guadalupe Garcia-Tsao, Steve Martino

The Qualitative Report

This study explored patients’ perspectives about taking the new direct-acting antivirals (DAAs) for the treatment of Hepatitis C (i.e., sofosbuvir, simeprevir, ledipasvir/sofosbuvir, ombitasvir/paritraprevir/ritonavir and dasabuvir) to identify facilitators of medication adherence. The project was conducted using semi-structured interviews with 12 Veterans who successfully completed a treatment course on the new DAAs. The Veterans were recruited using purposive sampling. The data collected from the semi-structured interviews was analyzed using an adapted open coding method outlined by Auerbach and Silverstein (2003), with identification of relevant text sub-grouped into repeating ideas, and then creation of overarching themes and constructs. Results obtained provide insight …

Ribavirin Dose Management In Hcv Patients Receiving Ombitasvir/Paritaprevir/Ritonavir And Dasabuvir With Ribavirin, J. J. Feld, D. E. Bernstein, Z. Younes, H. Van Vlierberghe, L. Larsen, F. Tatsch, P. Ferenci

Journal Articles

No abstract provided.

Cow's Milk Protein-Induced Villous Atrophy And Elevated Celiac Autoimmunity In Children With Celiac Disease On A Glutten-Free Diet: A Report Of Three Cases, Kristin Capone, Naire Sansotta, Pankaj Vohra, Stefano Guandalini

Pediatrics Research and Scholarship

Objective: To describe the serologic and histologic response of three patients with celiac disease who had persistent autoimmunity and villous atrophy despite a strict gluten-free diet, to the elimination of cow's milk protein.

Glecaprevir/Pibrentasvir In Patients With Hepatitis C Virus Genotype 1 Or 4 And Past Direct-Acting Antiviral Treatment Failure, F. Poordad, S. Pol, A. Asatryan, M. Buti, D. Shaw, C. Hezode, F. Felizarta, R. W. Reindollar, D. E. Bernstein, F. J. Mensa, +10 Additional Authors

Journal Articles

No abstract provided.

Extracorporeal Cellular Therapy (Elad) In Severe Alcoholic Hepatitis: A Multinational, Prospective, Controlled, Randomized Trial, J. Thompson, N. Jones, A. Al-Khafaji, S. Malik, D. Reich, S. Munoz, R. Macnicholas, T. Hassanein, A. Duddempudi, R. Subramanian, +33 Additional Authors

Journal Articles

No abstract provided.

All Ttg Positive Patient Do Not Have Celiac Disease, Pankaj Vohra, Kalyan Ray Parashette, Rajmohan Dharmaraj, Angela Deubel, Richardo Castillo, Jacqueline Fridge

Pediatrics Research and Scholarship

Tissue transglutaminase antibody IgA level (tTG) is an excellent screening test for celiac disease in the presence of adequate IgA levels. Most labs while screening for Celiac disease (CD) will do the IgA levels automatically. However the serological test is not a diagnostic test.

Expression Of The Microrna-143/145 Cluster Is Decreased In Hepatitis B Virus-Associated Hepatocellular Carcinoma And May Serve As A Biomarker For Tumorigenesis In Patients With Chronic Hepatitis B, Qi Zhao, Xiangfei Sun, Chao Liu, Tao Li, Juan Cui, Chengyong Qin

School of Computing: Faculty Publications

The aims of the present study were to identify the expression profile of microRNA (miR)‑143/145 in hepatitis B virus (HBV)‑associated hepatocellular carcinoma (HCC), explore its association with prognosis and investigate whether the serum miR‑143/145 expression levels may serve as a diagnostic indicator of HBV‑associated HCC. The microRNA (miRNA) chromatin immunoprecipitation dataset was obtained from The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus databases, and analyzed using the Wilcoxon signed‑rank test. It was observed that the expression of miR‑143 and miR‑145 was decreased 1.5‑fold in HBV‑associated HCC samples compared with non‑tumor tissue in the TCGA and the GSE22058 datasets …

The Relationship Between Central Venous Catheter And Post-Operative Complications In Patients Undergoing Hepatic Resection, David C. O'Connor

Theses and Dissertations

The Relationship Between Central Venous Catheter and Post-operative Complications in Patients Undergoing Hepatic Resection

David C. O’Connor, Ph.D., DNAP, CRNA

A dissertation submitted in partial fulfillment of the requirements for the degree of

Doctor of Philosophy at Virginia Commonwealth University

Virginia Commonwealth University, 2018

Dissertation Chair: Clarence J. Biddle, Ph.D., CRNA

Hepatic resection is indicated for primary and secondary malignancies. Use of a low central venous pressure technique is associated with decreased blood loss in these cases. This technique has evolved; central venous catheters and high dose morphine are no longer used, and patients are extubated earlier. The purpose of …

A Multicenter Comparative Trial Of A Novel Eus-Guided Core Biopsy Needle (Sharkcore, Mariam Naveed, Ali A. Siddiqui, Thomas E. Kowalski, David E. Loren, Ammara Khalid, Ayesha Soomro, Syed M. Mazhar, Joseph Yoo, Raza Hasan, Silpa Yalamanchili, Nicholas Tarangelo, Linda J. Taylor, Douglas G. Adler

Division of Gastroenterology and Hepatology Faculty Papers

Background and Objectives: The ability to obtain adequate tissue of solid pancreatic lesions by EUS-guided remains a challenge. The aim of this study was to compare the performance characteristics and safety of EUS-FNA for evaluating solid pancreatic lesions using the standard 22-gauge needle versus a novel EUS biopsy needle.

Methods: This was a multicenter retrospective study of EUS-guided sampling of solid pancreatic lesions between 2009 and 2015. Patients underwent EUS-guided sampling with a 22-gauge SharkCore (SC) needle or a standard 22-gauge FNA needle. Technical success, performance characteristics of EUS-FNA, the number of needle passes required to obtain a diagnosis, diagnostic …

Insulin Therapy And Autoimmune Disease With Relevance To Non Alcoholic Fatty Liver Disease, Ian James Martins

Research outputs 2014 to 2021

The diabetes epidemic is now expected by the year 2050 to become a global pandemic with approx. 592 million affected in both the developed and developing world. The treatment of diabetes by insulin therapy has been the focus for many diabetics with the improvement and prevention of various diseases such as cardiovascular disease, kidney disease and neurodegeneration. The global nonalcoholic fatty liver disease (NAFLD) epidemic has now become of major concern to diabetes with critical interest in insulin therapy to reverse and stabilize autoimmune disease with relevance to NAFLD and the diabetes pandemic. Dietary components that activate anti-aging genes improve …

Practice Survey: Adherence Monitoring And Intervention In Pediatric Gastroenterology And Hepatology., Michele H. Maddux, Shawna Ricks, Julie A. Bass, James F. Daniel, Ellen Carpenter, Kimberely Radford

Manuscripts, Articles, Book Chapters and Other Papers

Purpose: Despite significant medication nonadherence rates among youth with pediatric gastroenterology and hepatology disorders, little is known about current adherence practices in pediatric gastroenterology care. This study summarizes current practices surrounding adherence monitoring and intervention in pediatric gastrointestinal (GI) and hepatologic care in the USA.

Participants and methods: One hundred and fifty-four pediatric GI providers completed an online survey designed to examine current practices surrounding adherence monitoring and intervention, specific strategies used to monitor and treat poor adherence, and the barriers currently experienced in relation to adherence monitoring and intervention.

Results: Practices varied greatly in terms of when and how …

Bleeding In Locally Invasive Pelvic Malignancies: Is Hypofractionated Radiation Therapy A Safe And Effective Non-Invasive Option For Securing Hemostasis? A Single Institution Perspective, Muhammad Shuja, Saadiya Nazli, Muhammad Atif Mansha, Asif Iqbal, Reham Mohamed, Mutahir A. Tunio, Eyad F. Alsaeed, Mushabbab Asiri, Yasser Bayoumi

Department of Anaesthesia

Introduction: Control of bleeding due to locally invasive disease is of paramount importance in the management of cancer patients. This study was undertaken to explore the outcomes of palliative intent hypofractionated radiation therapy (HRT) in advanced stage pelvic malignancies that presented with bleeding. Methods: This study enrolled patients treated with palliative intent hypofractionated radiation therapy from July 2015 to November 2017. In the inclusion criteria, all these patients had the common presenting complaint of bleeding from the tumor. These patients were not treated with radiation therapy before for the same indication. Patients with known bleeding disorders and those undergoing parallel …

The Natural History Of Severe Acute Liver Injury., David G Koch, J L Speiser, V Durkalski, R J Fontana, T Davern, B Mcguire, R T Stravitz, A M Larson, I Liou, Oren K Fix, M L Schilsky, T Mccashland, J E Hay, N Murray, O S Shaikh, D Ganger, A Zaman, S B Han, R T Chung, R S Brown, S Munoz, K R Reddy, L Rossaro, R Satyanarayana, A J Hanje, J Olson, R M Subramanian, C Karvellas, B Hameed, A H Sherker, W M Lee, A Reuben

Articles, Abstracts, and Reports

OBJECTIVES: Acute liver failure (ALF) is classically defined by coagulopathy and hepatic encephalopathy (HE); however, acute liver injury (ALI), i.e., severe acute hepatocyte necrosis without HE, has not been carefully defined nor studied. Our aim is to describe the clinical course of specifically defined ALI, including the risk and clinical predictors of poor outcomes, namely progression to ALF, the need for liver transplantation (LT) and death.

METHODS: 386 subjects prospectively enrolled in the Acute Liver Failure Study Group registry between 1 September 2008 through 25 October 2013, met criteria for ALI: International Normalized Ratio (INR)≥2.0 and alanine aminotransferase (ALT)≥10 × …

Assessment Of The Visual Analogue Score In The Evaluation Of The Pruritus Of Cholestasis, Nora Bergasa, E Jones

NYMC Faculty Publications

Background and Aims: A visual analogue score (VAS), based on application of a visual analogue scale, has been widely used to assess pruritus in clinical studies of patients with cholestatic liver disease. A VAS is a numerical score of the severity of the perception of pruritus, and, hence, is inherently subjective. The objective of this study was to assess the reliability of a VAS as an index of pruritus in cholestatic patients. Methods: In 8 patients with chronic pruritus due to primary biliary cholangitis, values for a VAS of pruritus were compared with corresponding measurements of scratching activity, which were …

Transforming Growth Factor-Β In Liver Cancer Stem Cells And Regeneration, Shuyun Rao, Jaideep Banerjee, Sobia Zaidi, Wilma Jogunoori, Raul Sebastian, Bao-Ngoc Nguyen, Richard L. Amdur, +Several Additional Authors

Surgery Faculty Publications

Cancer stem cells have established mechanisms that contribute to tumor heterogeneity as well as resistance to therapy. Over 40% of hepatocellular carcinomas (HCCs) are considered to be clonal and arise from a stem-like/cancer stem cell. Moreover, HCC is the second leading cause of cancer death worldwide, and an improved understanding of cancer stem cells and targeting these in this cancer are urgently needed. Multiple studies have revealed etiological patterns and multiple genes/pathways signifying initiation and progression of HCC; however, unlike the transforming growth factor β (TGF-β) pathway, loss of p53 and/or activation of β-catenin do not spontaneously drive HCC in …

Interdependency Of Egf And Glp-2 Signaling In Attenuating Mucosal Atrophy In A Mouse Model Of Parenteral Nutrition, Yongjia Feng, Farok R. Demehri, Weidong Xiao, Yu-Hwai Tsai, Jennifer C. Jones, Constance D. Brindley, David W. Threadgill, Jens J. Holst, Bolette Hartmann, Terrence A. Barrett, Daniel H. Teitelbaum, Peter J. Dempsey

Internal Medicine Faculty Publications

BACKGROUND & AIMS: Total parenteral nutrition (TPN), a crucial treatment for patients who cannot receive enteral nutrition, is associated with mucosal atrophy, barrier dysfunction, and infectious complications. Glucagon-like peptide-2 (GLP-2) and epidermal growth factor (EGF) improve intestinal epithelial cell (IEC) responses and attenuate mucosal atrophy in several TPN models. However, it remains unclear whether these 2 factors use distinct or overlapping signaling pathways to improve IEC responses. We investigated the interaction of GLP-2 and EGF signaling in a mouse TPN model and in patients deprived of enteral nutrition.

METHODS: Adult C57BL/6J, IEC-Egfr^{knock out (KO)} and IEC-pik3r1^KO mice receiving …

Performance Of Non-Invasive Tests To Predict Significant Liver Fibrosis In Patients With Morbid Obesity, Ahmed Bakhshwin, Patricia Latham

GW Research Days 2016 - 2020

Non-Alcoholic Fatty Liver Disease (NAFLD) affects more than 90% of patients with morbid obesity (MO) and approximately 30% have significant liver fibrosis and/or cirrhosis. Liver biopsy is the gold standard for diagnosis of significant liver fibrosis and cirrhosis; however, several non-invasive tests have been suggested to predict the presence or absence of significant liver fibrosis and to avoid liver biopsy in these patients. The aim of this study was to determine the ability of these tests to predict significant liver fibrosis, specifically in patients with MO.

Methods:

Liver biopsies from patients with MO undergoing gastric bypass surgery were studied in …

Clostridium Septicum Aortitis With Synchronous Ascending Colon And Rectal Adenocarcinoma., Deepanshu Jain, Andrew C. Kistler, Patricia L. Kozuch

Division of Gastroenterology and Hepatology Faculty Papers

Clostridium septicum (C. septicum) aortitis is a rare condition frequently associated with colon adenocarcinoma and carries a poor prognosis. We report the case of a 66-year-old man who presented with abdominal pain, blood in the stool, fever and chills. Laboratory tests were significant for leukocytosis and microcytic anemia. Abdominal imaging revealed a right colon mass and aortitis. Colonoscopy confirmed the right colon mass and also discovered a rectal mass, both adenocarcinomas. Treatment consisted of antibiotics, aortic repair, right hemi-colectomy and later trans-anal excision of the rectal mass. Blood cultures and the aortic specimen grew C. septicum. The patient improved and …

Nutritional Approaches To Achieve Weight Loss In Nonalcoholic Fatty Liver Disease., Christine C Hsu, Erik Ness, Kris V Kowdley

Articles, Abstracts, and Reports

Nonalcoholic fatty liver disease (NAFLD) can range in spectrum from simple hepatic steatosis to nonalcoholic steatohepatitis (NASH), which is characterized by lipotoxicity, hepatocellular ballooning, and inflammation and can progress to cirrhosis. Weight loss is the cornerstone treatment for NAFLD and NASH. Various randomized controlled trials have shown that weight loss of ≥5-10% leads to significant improvements in hepatic steatosis. Diets high in sodium and fructose have been implicated in the pathogenesis of NAFLD. Although some clinical studies suggest that an isocaloric high-fructose diet does not worsen NAFLD, these clinical studies are often short in duration. More recently, the Dietary Approaches …

Feasibility, Safety, And Outcomes Of A Single-Step Endoscopic Ultrasonography-Guided Drainage Of Pancreatic Fluid Collections Without Fluoroscopy Using A Novel Electrocautery-Enhanced Lumen-Apposing, Self-Expanding Metal Stent., Joseph Yoo, Linda Yan, Raza Hasan, Sanaa Somalya, Jose Nieto, Ali A. Siddiqui

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND AND OBJECTIVES: There are currently limited data available regarding the safety of endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) using the lumen-apposing metal stent without fluoroscopic guidance. This study aims to evaluate clinical outcomes and safety of EUS-guided drainage of PFC using the electrocautery-enhanced lumen-apposing metal stents (EC-LAMSs) without fluoroscopic guidance.

METHODS: We conducted a retrospective study on patients with symptomatic PFC who underwent EUS-guided drainage using EC-LAMS without fluoroscopy. All patients were followed clinically until resolution of their PFC. Technical success (successful placement of EC-LAMS), number of patients who achieved complete resolution of PFC without additional …