Browsing by Subject "gastroenterology"
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Item AGA White Paper: Roadmap for the Future of Colorectal Cancer Screening in the United States(Elsevier, 2020) Melson, Joshua E.; Imperiale, Thomas F.; Itzkowitz, Steven H.; Llor, Xavier; Kochman, Michael L.; Grady, William M.; Schoen, Robert E.; Burke, Carol; Shaukat, Aasma; Rabeneck, Linda; Ladabaum, Uri; Bresalier, Robert; Spiegel, Brennan; Yee, Judy; Wang, Thomas; Lieberman, David; Komanduri, Srinadh; Muthusamy, V. Raman; Dey, Neelendu; Medicine, School of MedicineItem Effect of moxibustion on the expression of GDNF and its receptor GFRα3 in the colon and spinal cord of rats with irritable bowel syndrome(Sage, 2019-08) Qi, Qin; Wu, Huangan; Jin, Xiaoming; Jin, Duiyin; Wang, Yuanyuan; Wang, Cun; Liu, Yanan; Wang, Xiaomei; Anatomy and Cell Biology, School of MedicineBackground: Moxibustion treatment has been found to ameliorate clinical symptoms including abdominal pain, diarrhoea and constipation in patients with irritable bowel syndrome (IBS). Herein we investigated the mechanisms underlying the use of moxibustion in a rat model of IBS. Methods: In our study, an IBS model was established in rats by colorectal distension (CRD) stimulus and mustard oil enema. The rats were randomly divided into a normal group, model group, mild moxibustion group, electroacupuncture group, probiotic group and dicetel group. Abdominal withdrawal reflex (AWR) scores were determined within 90 min of the last treatment. The expression of GDNF/GFRα3 protein and mRNA in the colon and spinal cord were detected by immunohistochemistry and quantitative real-time-PCR, respectively. Results: The IBS model rats had significantly higher AWR scores than the normal group (P<0.01). After mild moxibustion treatment, the AWR score was significantly reduced (20 mm Hg, P<0.05; 40 mm Hg, 60 mm Hg and 80 mm Hg, P<0.01). The model group showed significantly more colonic glial cell line-derived neurotrophic factor (GDNF/GFRα3 (GDNF family receptor α3) protein and mRNA expression in the colon and spinal cord than the normal group (P<0.01). Compared with the model group, the expression of GDNF/GFRα3 protein and mRNA in the colon and spinal cord of the rats were significantly decreased in the mild moxibustion group (colon: GDNF and GFRα3 protein, P<0.01; GDNF and GFRα3 mRNA, P<0.01; spinal cord: GDNF and GFRα3 protein, P<0.01; GDNF mRNA, P<0.05, GFRα3 mRNA, P<0.01). Conclusions: Our data suggest that moxibustion therapy may mitigate CRD-induced increases in the expression of GDNF and its receptor GFRα3 in the colon and spinal cord in a rat model of IBS.Item Improvement of Osteoporosis Screening among Inflammatory Bowel Disease Patients at Gastroenterology Fellows’ Clinics(Hindawi, 2020-06-19) Wehbeh, Antonios; Phatharacharukul, Parkpoom; Fayad, Nabil F.; Medicine, School of MedicineIntroduction Individuals with inflammatory bowel disease (IBD) have an increased risk of osteoporosis compared to the general population. We aimed to improve the osteoporosis screening rate in the IBD patient population of the gastroenterology (GI) fellows' continuity clinics. Methods Baseline preintervention data were collected on patients seen from July through September of 2018. Four simplified criteria for osteoporosis screening were extrapolated from 3 national guidelines. Among patients who met any of these criteria, we determined the baseline screening rate. Fellows were then educated with a didactic session and handout material, and a standardized template was incorporated into clinic notes. Following this intervention, screening rates were reassessed from December 2018 through February 2019. Results During the preintervention phase, fellows saw 80 patients with IBD. Dual-energy X-ray absorptiometry (DEXA) scan was obtained in 44% of IBD patients who qualify for screening at the county hospital clinic compared to 21% of veterans' clinic IBD patients. In the postintervention period, screening rates remarkably improved to 100% in the county hospital clinic and to 75% in the veterans' clinic. Overall, the screening rate increased by 56% (P < 0.001). Conclusions A large percentage of IBD patients at risk for osteoporosis did not have appropriate bone mass density testing. Educating GI fellows and adding a template to clinic notes were effective in significantly improving the number of patients at risk of osteoporosis to receive appropriate screening test, a DEXA scan. Similar educational interventions should be considered for providers caring for IBD patients to prevent complications of osteoporosis in these patients.Item Lessons Learned From and Future Opportunities for Global Health Endeavors by 2 Academic Gastroenterology Units(Elsevier, 2019) Carr, Thomas A.; Okello, Samson; Some, Fatma F.; Corey, Kathleen E.; Medicine, School of MedicineItem A not-so-sweet diagnosis: secondary biliary cirrhosis from a “lollipop” stone(Elsevier, 2016-07) Gromski, Mark A.; Vuppalanchi, Raj; Sherman, Stuart; Fogel, Evan L.; Department of Medicine, IU School of MedicineItem A Truth Unraveled: Unpredictable Collagenous Gastritis Explains Vague Upper Abdominal Symptoms(2021-06-11) Lugo, Adrian; Cho, Isaac S.; Martyn, Colin; Fraser, Scott; Lynch, Lori; Gislason, GardarCollagenous gastritis (CG) is a rare disease characterized by subepithelial deposition of collagen bands and inflammatory cell infiltrates in the lamina propria. Owing to the rare occurrence, little is known about its clinical manifestations which are both diverse and nonspecific. Furthermore, the pathogenesis of CG remains unclear although there are reported associations with autoimmune conditions including celiac disease and type I diabetes. Currently, there is no effective treatment for this disease. A 64-year-old female with a history of gastroesophageal reflux disease and hypothyroidism presented to the clinic for evaluation of nausea, bilious emesis, early satiety, and an unintentional weight loss of 10 pounds within the past few months. There were no alleviating or aggravating factors and she denied any changes in her bowel function or a familial history of colon cancer. Physical exam demonstrated left lower quadrant fullness. A stool-DNA screening test was negative. Esophagogastroduodenoscopy (EGD) demonstrated a diffusely nodular and congested appearance mainly in the antrum without bleeding, consistent with gastritis. Biopsies were obtained which revealed collagenous gastritis but negative immunoperoxidase staining for lymphoma, Congo red stain for amyloid, and immunohistochemical staining for Helicobacter pylori. A repeat EGD with biopsy demonstrated patchy, mild villous blunting with very few intraepithelial lymphocytes. Antibodies could not be obtained as the patient was lost to follow-up. Patients often present to the clinic with vague gastrointestinal symptoms that warrant endoscopic evaluation. In this case report, we were able to demonstrate the findings of collagenous gastritis, a rare condition that has been reported less than 300 times at the time of this report. This particular case highlights the importance of obtaining the histopathology as it may allow clinicians to rule out reversible causes that may be amenable to treatment prior to making a diagnosis of an untreatable condition such as CG. Furthermore, the second biopsy of our patient suggests that this disease may be linked to celiac disease which is consistent with other reports that suggest CG being related to other autoimmune conditions. Thus, it is of vital importance to create a wider recognition of this condition’s histopathologic features and to examine its clinical associations in order to standardize a more effective therapy for this untreatable disease.