Tag Archives: Gastroenterology

UTSW Residents Take Over DDW

Washington DC this past weekend was filled with residents from UTSW presenting their excellent work.

Current second-year residents Kristina Tzartzeva and Joseph Obi presented their research “Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients with Cirrhosis”. In this systematic review and meta-analysis, Drs Tzartzeva and Obi demonstrate the addition of AFP to ultrasound significantly increases the sensitivity for early HCC detection in patients with cirrhosis. This research was completed with Dr. Rich, a current GI fellow at UTSW, and the principal investigator Dr. Singal. Drs Parikh, Marrero, Yopp, and Waljee were also contributing authors on the study.

Second-year resident Ahana Sen presented her research “A Systematic Review of Failures Across the Colorectal Cancer Screening Process” in which she observes multiple causes for underuse and overuse and deviations from established guidelines for colorectal cancer screening. She postulates it would be possible to improve the effectiveness of CRC screening if these steps could be targeted. Dr Murphy was the principal investigator of this study, with significant contributions from Dr. Singal and Dr. Sigel.

 

Second-year resident Taylor Derousseau presented “Delayed Gastric Emptying in Pre-Lung Transplant Testing is Associated with Post-Transplant Acute Cellular Rejection Independent of Reflux”. In this study, Dr Derousseau retrospectively reviewed a database of prospectively collected data of patients undergoing lung transplant evaluation at UTSW. He finds an association with patients who had delayed gastric emptying also developing acute cellular rejection after lung transplant. Importantly, many of these patients with delayed gastric emptying were asymptomatic. Dr. Gavini was the principal investigator on this study, with contributions from Dr. Chan, Dr. Lo, and Dr. Kaza.

 

Komal DDW

Intern Komal Patel presented her work “Use of Fresh Frozen Plasma to Correct Coagulopathy in Patients with Variceal Bleeding” with Dr. Agrawal and Dr. Sarode. She retrospectively reviewed cases of patients who presented with  variceal hemorrhage to determine the effect of FFP on INR and outcomes, concluding this practice results in variable decreases in the INR and may be associated with rebleeding.

 

Lastly, third-year resident and rising Chief Resident Saroja Bangaru presented “Increased Use of Liver Transplantation as Therapeutic Option for Severe Alcoholic Hepatitis”. In this study, Dr. Bangaru surveyed transplant hepatologists about their practices and opinions with regards to liver transplantation in alcoholic hepatitis. Over half of respondents reported transplanting patients for severe AH, with excellent 1-year survival reported. Dr. Mufti was the principal investigator, with Dr. Pederson and Dr. Singal contributing to the work.

 

Help us congratulate our outstanding residents on their important work!

 

“Hold the burger, pass me the cornmeal and beans…”

In a recent article from Nature Communications published on April 28, 2015, Dr. Stephen J. D. O’keefe and his colleagues conducted an interesting study looking at how diet affects mucosal biomarkers of colon cancer risk. They performed 2-week food exchanges in which African-Americans were fed a traditional African diet of high fiber and low fat and Africans were fed western style diet (high fat and low fiber). Colonoscopies were done and biopsies showed less inflammation of the colon and increased production of butyrate, a fatty acid that is thought to protect from colon cancer, in those who ate the traditional African style diet compared to western. Although no direct correlation of diet and colon cancer risk is stated by the authors, the results suggest that diet can have a profound and rapid effect on mucosa which may affect development of colon cancer. Check out the NY Times article below as well as the abstract and original article from Nature Communications and thanks to Dr. Bedimo for the reference!

African Diet May Lead Away from Colon Cancer (NY Times)

Fat, fibre, and cancer risk in African Americans and rural Africans (Nature Communications)

Abstract

Rates of colon cancer are much higher in African Americans (65:100,000) than in rural South Africans (5:100,000). The higher rates are associated with higher animal protein and fat, and lower fibre consumption, higher colonic secondary bile acids, lower colonic short-chain fatty acid quantities and higher mucosal proliferative biomarkers of cancer risk in otherwise healthy middle-aged volunteers. Here we investigate further the role of fat and fibre in this association. We performed 2-week food exchanges in subjects from the same populations, where African Americans were fed a high-fibre, low-fat African-style diet and rural Africans a high-fat, low-fibre western-style diet, under close supervision. In comparison with their usual diets, the food changes resulted in remarkable reciprocal changes in mucosal biomarkers of cancer risk and in aspects of the microbiota and metabolome known to affect cancer risk, best illustrated by increased saccharolytic fermentation and butyrogenesis, and suppressed secondary bile acid synthesis in the African Americans.

In The Clinic: Celiac Disease

The gluten-free craze has struck, with up to 29% of Americans trying to rid their diet of the  protein found in wheat, rye and barley! Everything from cookies, to pizza, to soy sauce are now gluten-free, with restaurants catering specifically to this clientele. Is there an epidemic of celiac disease? Am I going to catch it too? The ACP’s “In the Clinic” series will help you figure out how to approach the next patient that asks if they should be cutting back on wheat:

Celiac Disease

ACP In The Clinic: Celiac Disease

UTSW Resident Publishes in JAMA Internal Medicine!

One of our residents, Udayan Shah (PGY-01), published an article online in JAMA Internal Medicine this week, “When Documentation Supersedes Patient Communication – An Example From An Endoscopy Unit” along with Dr. Deepak Agrawal from the division of Digestive and Liver Disease at UT Southwestern. The article focuses on question surveys that providers ask to patients including physicians and nurses. The authors discuss the utility of these surveys to patient care and why these surveys have become common in health care settings. Are these surveys mandated by an authorizing body like CMS or the Joint Commission? Do these surveys lead to better patient care and outcomes? Check out the article below to read more about this!

udayan shah

#clinicalpearls: Hepatitis B & D

  • Hepatitis B
    • HBsAg → active infection
    • HBsAb → past infection or vaccination against hepatitis B
    • HBeAg → active replication of the virus
    • AntiHBc IgM → acute infection
    • AntiHBc IgG → chronic infection
    • Chronic, and carrier states will have positive HBsAg and Anti-HBcIgG. How can these two conditions be differentiated?
      • Chronic → Increased LFTs
      • Carrier → Normal LFTs
  • Hepatitis D: requires Hepatitis B infection to be present
    • Anti-HBc IgM + Hepatitis D virus → acute co-infection and will not worsen hepatitis
    • Anti-HBc IgG + Hepatitis D virus → acute super-infection and can cause fulminant hepatitis

Ascites – not just a cirrhosis thing…

At morning report this week, our residents and faculty had a great discussion on non-cirrhotic etiologies for portal hypertension and ascites. There is a great review article from Hepatology in 2011 by Schouten, et al, “Idiopathic Noncirrhotic Portal Hypertension”, which describes the different etiologies and how to evaluate patients with portal hypertension not due to cirrhosis. Also includes an extensive table of noncirrhotic causes of portal hypertension. Key points below from the article:

  • Worldwide, most common cause of noncirrhotic portal hypertension (NCPH) is schistosomiasis.
  • In Western countries, more common causes include intrahepatic and extrahepatic etiologies such as Budd-Chiari, primary biliary cirrhosis, PSC, congenital hepatic fibrosis, portal vein thrombosis, sarcoidosis, lymphoma compressing the portal vein.
  • However, if none of the diagnosis mentioned above is made for the patient, then consider idiopathic noncirrhotic portal hypertension (INCPH).
  • Proposed pathophysiology of INCPH:
    • Strong expression of inducible NO synthetase (iNOS) and endothelial NO synthetase (eNOS) in the sinus-lining of the cells leading to splenomegaly and increased splenic venous flow and portal hypertension
    • Obliteration of the portal venous microcirculation leading to increased intrahepatic resistance
  • Etiology of INCPH can be divided into 5 categories: chronic infection, exposure to toxins, thrombophilia, immunological disorders, and genetic disorders.
  • Most common immunosupressive medications associated with INCPH are thiopurines such as azathioprine and 6-mercaptopurine
  • Management: no current universal guidelines regarding GI bleed prophylaxis, anticoagulation for risk of thrombus, and liver transplantation with few case reports

Check out the article below!

Idiopathic Noncirrhotic Portal Hypertension

Noon Conference: Complications of Cirrhosis

If you missed it, you should definitely check it out! Dr. Mufti gave a great talk on the complications of cirrhosis. I promise, despite how much experience we have with cirrhosis, you will learn a lot from this review! You can listen to his lecture on the resident website as well.

(A note to email subscribers, you may not be able to see the slides from the email, to view, go to the full site by clicking the link above)