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Tobi M, Antaki F, Rambus MA, Yang YX, Kaplan D, Rodriguez R, Maliakkal B, Majumdar A, Demian E, Tobi YY, Sochacki P, Ehrinpreis M, Lawson MG, McVicker B. The Non-Invasive Prediction of Colorectal Neoplasia (NIPCON) Study 1995-2022: A Comparison of Guaiac-Based Fecal Occult Blood Test (FOBT) and an Anti-Adenoma Antibody, Adnab-9. Int J Mol Sci 2023; 24:17257. [PMID: 38139086 PMCID: PMC10743815 DOI: 10.3390/ijms242417257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Given the need to improve the sensitivity of non-invasive methods to detect colorectal neoplasia, particularly adenomas, we compared a fecal test using a monoclonal antibody (Mab) raised against constituents of colonic adenomas designated Adnab-9 (Adenoma Antibody 9), recognizing an N-linked 87 kDa glycoprotein, to gFOBT, which is shown to reduce CRC mortality. p87 immunohistochemistry testing is significantly more sensitive (OR 3.64[CI 2.37-5.58]) than gFOBT (guaiac-based fecal occult blood test) for adenomas (<3 in number), advanced adenomas (OR 4.21[CI 2.47-7.15]), or a combination of the two (OR 3.35[CI 2.47-4.53]). p87 immunohistochemistry shows regional Paneth cell (PC) expression mainly in the right-sided colon and is significantly reduced in the ceca of African Americans (p < 0.0001). In a subset of patients, we obtained other body fluids such as urine, colonic effluent, and saliva. Urine tests (organ-specific neoantigen) showed a significant difference for advanced adenomas (p < 0.047). We conclude that fecal p87 testing is more sensitive than gFOBT and Adnab-9 and could be used to better direct the colonoscopy screening effort.
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Affiliation(s)
- Martin Tobi
- Department of Research and Development, John D. Dingell VAMC, Detroit, MI 48201, USA; (F.A.)
| | - Fadi Antaki
- Department of Research and Development, John D. Dingell VAMC, Detroit, MI 48201, USA; (F.A.)
| | - Mary Ann Rambus
- Department of Research and Development, John D. Dingell VAMC, Detroit, MI 48201, USA; (F.A.)
| | - Yu-Xiao Yang
- Department of Research and Development, Philadelphia VAMC, Philadelphia, PA 19104, USA (D.K.); (R.R.)
| | - David Kaplan
- Department of Research and Development, Philadelphia VAMC, Philadelphia, PA 19104, USA (D.K.); (R.R.)
| | - Rebecca Rodriguez
- Department of Research and Development, Philadelphia VAMC, Philadelphia, PA 19104, USA (D.K.); (R.R.)
| | | | - Adhip Majumdar
- Department of Research and Development, John D. Dingell VAMC, Detroit, MI 48201, USA; (F.A.)
| | - Ereny Demian
- Departments of Medicine, State University of Pennsylvania, State College, PA 16802, USA;
| | - Yosef Y. Tobi
- New York Medical College, Touro University, Valhalla, NY 10595, USA
| | - Paula Sochacki
- Department of Research and Development, John D. Dingell VAMC, Detroit, MI 48201, USA; (F.A.)
| | - Murray Ehrinpreis
- Detroit Medical Center, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Surapaneni S, Kiwan W, Chiu MK, Zingas A, Hussein S, Ehrinpreis M. The Curious Case of a Missing Gallbladder: An Unusual Presentation of a Cholecystoduodenal Fistula. Avicenna J Med 2021; 12:34-37. [PMID: 35586392 PMCID: PMC9110104 DOI: 10.1055/s-0041-1739541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Large gallstones could erode through gallbladder wall to nearby structures, causing fistulas, gastric outlet obstruction and gallstone ileus. They typically occur in elderly patients with comorbidities carrying therapeutic challenges. We present a case of a middle-aged woman who was thought to have symptomatic cholelithiasis. Extensive adhesions precluded safe cholecystectomy. While hepatobiliary iminodiacetic acid scan and magnetic resonance imaging with cholangiopancreatography (MRI-MRCP) failed to visualize the gallbladder, computed tomography (CT) was consistent with cholecystoduodenal fistula. A very large gallstone was seen endoscopically in the duodenum, which was broken down into pieces using a large stiff snare.
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Affiliation(s)
- Sarvani Surapaneni
- Internal Medicine Department, Wayne State University, Detroit, Michigan, United States
| | - Wissam Kiwan
- Gastroenterology Division, University of Southern California, Los Angeles, California, United States
| | - Michael K. Chiu
- Department of Radiology, Wayne State University, Detroit, Michigan, United States
| | - Alkis Zingas
- Department of Radiology, Wayne State University, Detroit, Michigan, United States
| | - Shakir Hussein
- Department of Surgery, Wayne State University, Detroit, Michigan, United States
| | - Murray Ehrinpreis
- Gastroenterology Division, Wayne State University, Detroit, Michigan, United States
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3
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Kathi PR, Tama M, Thammineni N, Ehrinpreis M. Pseudodiverticulosis: a rare presentation of eosinophilic esophagitis. Clin J Gastroenterol 2020; 13:170-172. [DOI: 10.1007/s12328-019-01044-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 09/11/2019] [Indexed: 11/28/2022]
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Rutledge B, Jan J, Benjaram S, Sahni N, Naylor P, Philip P, Ehrinpreis M, Mutchnick M. Racial Diversity in Hepatocellular Carcinoma in a Predominately African-American Population at an Urban Medical Center. J Gastrointest Cancer 2019; 51:972-979. [PMID: 31792736 DOI: 10.1007/s12029-019-00342-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Surveillance, treatment, and outcomes for African-American (AA) populations with hepatocellular carcinoma (HCC) remain under evaluated. This study evaluated demographics, surveillance, therapy, and outcomes for a predominately AA population. METHODS The electronic medical records of a large health-care provider were used to identify 274 patients with visits for HCC between 2010 and 2017. Tumor size at diagnosis was defined by imaging with ≤ 5 cm being defined as "small." Surveillance for HCC was defined based on ultrasound (US) assessments. RESULTS Patients were primarily AA (78%) and male (76%) with an average age at diagnosis of 62 years. Hepatitis C virus (HCV) was more likely to be a risk factor for the development of HCC in AA as compared to non-AA (92% vs 67%; p < 0.005). Surveillance rates were low (16% for AA vs 7% for non-AA). An aspartate aminotransferase platelet ratio index (APRI) value > 0.7 within 2 years of tumor diagnosis was a strong predictor for the risk of the development of HCC (86% AA vs 79 % non-AA). In this study, race was not a factor in treatment or outcomes, and most patients received tumor ablative treatment. CONCLUSION Given the low surveillance rates and the demonstrated increased survival for patients with small tumors, ways to increase surveillance must be initiated. The results of this study demonstrate the need for physician/patient education on the importance of surveillance US. Further, this study supports routine assessment of APRI in AA patients in an effort to identify patients in whom intensive surveillance will significantly improve earlier detection of tumors.
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Affiliation(s)
- Brian Rutledge
- Department of Gastroenterology, Wayne State University School of Medicine, 3990 John R St 6 Hudson Room 6938, Detroit, MI, 48201, USA.
| | - Jenny Jan
- Department of Gastroenterology, Wayne State University School of Medicine, 3990 John R St 6 Hudson Room 6938, Detroit, MI, 48201, USA
| | - Sindhuri Benjaram
- Department of Gastroenterology, Wayne State University School of Medicine, 3990 John R St 6 Hudson Room 6938, Detroit, MI, 48201, USA
| | - Neha Sahni
- Department of Gastroenterology, Wayne State University School of Medicine, 3990 John R St 6 Hudson Room 6938, Detroit, MI, 48201, USA
| | - Paul Naylor
- Department of Gastroenterology, Wayne State University School of Medicine, 3990 John R St 6 Hudson Room 6938, Detroit, MI, 48201, USA
| | - Philip Philip
- Department of Oncology, Karmanos Cancer Institute/Wayne State University School of Medicine, Detroit, MI, USA
| | - Murray Ehrinpreis
- Department of Gastroenterology, Wayne State University School of Medicine, 3990 John R St 6 Hudson Room 6938, Detroit, MI, 48201, USA
| | - Milton Mutchnick
- Department of Gastroenterology, Wayne State University School of Medicine, 3990 John R St 6 Hudson Room 6938, Detroit, MI, 48201, USA
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Tariq T, Karabon P, Irfan FB, Goyal S, Mayeda MM, Parsons A, Judd S, Ehrinpreis M. Secondary angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease: Results from the nationwide inpatient sample. World J Gastrointest Endosc 2019; 11:504-514. [PMID: 31798771 PMCID: PMC6885446 DOI: 10.4253/wjge.v11.i10.504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/21/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease is associated with angiodysplasia of gastrointestinal tract leading to increased risk of gastrointestinal bleeding.
AIM To determine the nationwide prevalence, trends, predictors and resource utilization of angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease hospitalizations.
METHODS The Nationwide Inpatient Sample database from 2009 to 2014, was utilized to conduct a retrospective study on patients with angiodysplasia associated- gastrointestinal bleeding and end-stage renal disease. Hospitalizations with end-stage renal disease were included in the Nationwide Inpatient Sample database and a subset of hospitalizations with end-stage renal disease and angiodysplasia-associated gastrointestinal bleeding were identified with International Classification of Diseases, 9th revision, Clinical Modification codes for both end-stage renal disease (585.6) and Angiodysplasia (569.85, 537.83).
RESULTS The prevalence of angiodysplasia-associated gastrointestinal bleeding was 0.45% (n = 24709) among all end-stage renal disease patients (n = 5505252) that were hospitalized. Multivariate analysis indicated that the following were significant factors associated with higher odds of angiodysplasia associated-gastrointestinal bleeding in end-stage renal disease patients: an increasing trend from 2009-2014 (P < 0.01), increasing age (P < 0.0001); African American race (P = 0.0206); increasing Charlson-Deyo Comorbidity Index (P < 0.01); hypertension (P < 0.0001); and tobacco use (P < 0.0001). Diabetes mellitus (P < 0.0001) was associated with lower odds of angiodysplasia associated-gastrointestinal bleeding in end-stage renal disease patients. In comparison with urban teaching hospitals, rural and urban nonteaching hospitals were associated with decreased odds of angiodysplasia associated-gastrointestinal hemorrhage.
CONCLUSION Angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease patients showed an increasing trend from 2009-2014. Advanced age, African American race, overall high comorbidities, hypertension and smoking were significant factors for angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease hospitalized patients.
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Affiliation(s)
- Tooba Tariq
- Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, United States
| | - Patrick Karabon
- Oakland University William Beaumont School of Medicine, Oakland University, Detroit, MI 48309, United States
| | - Furqan B Irfan
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, United States
| | - Sachin Goyal
- Department of Internal Medicine, Division of Gastroenterology, Detroit Medical Center/Wayne State University, Detroit, MI 48201, United States
| | - Matthew Masaru Mayeda
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, United States
| | - Austin Parsons
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, United States
| | - Stephanie Judd
- Department of Internal Medicine, Division of Gastroenterology, Detroit Medical Center/Wayne State University and John D Dingell VA Medical Center, Detroit, MI 48201, United States
| | - Murray Ehrinpreis
- Department of Internal Medicine, Division of Gastroenterology, Detroit Medical Center/Wayne State University, Detroit, MI 48201, United States
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Kathi PR, Tama M, Ehrinpreis M, Mutchnick M, Westerhoff M, Mowers J, Fontana RJ. Vanishing bile duct syndrome arising in a patient with HIV infection sequentially treated with trimethoprim/sulfamethoxazole and dapsone. Clin J Gastroenterol 2019; 13:276-280. [PMID: 31317370 DOI: 10.1007/s12328-019-01022-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/10/2019] [Indexed: 02/05/2023]
Abstract
Trimethoprim/sulfamethoxazole is well known to cause intra-hepatic cholestasis which in rare instances can be prolonged and lead to vanishing bile duct syndrome. The risk regarding the potential for cross-reactivity between structurally related molecules such as dapsone and trimethoprim/sulfamethoxazole in causing hepatotoxicity is scarce. Herein, we report a case of vanishing bile duct syndrome following dapsone use in a patient with HIV infection and a recent history of trimethoprim/sulfamethoxazole-induced cholestasis. The patient had severe and protracted cholestasis during 2 years of follow-up and eventually died of liver failure.
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Affiliation(s)
| | - Maher Tama
- Division of Gastroenterology and Hepatology, Wayne State University, Detroit, MI, USA
| | - Murray Ehrinpreis
- Division of Gastroenterology and Hepatology, Wayne State University, Detroit, MI, USA
| | - Milton Mutchnick
- Division of Gastroenterology and Hepatology, Wayne State University, Detroit, MI, USA
| | - Maria Westerhoff
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan Mowers
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Robert John Fontana
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
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7
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Rutledge BP, Devara A, Benjaram S, Judd S, Ehrinpreis M. Transplant-Amenable Hepatocellular Carcinoma in a Fontan Patient. Case Rep Gastroenterol 2019; 13:275-279. [PMID: 31341459 PMCID: PMC6639574 DOI: 10.1159/000501198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/24/2019] [Indexed: 12/17/2022] Open
Abstract
The Fontan circulation alters a patient's physiology and imparts long-term risks related to chronically elevated systemic venous pressure. An increasing number of patients with Fontan physiology are surviving into adulthood and are at risk of hepatic sequalae. The ideal timeline and method of hepatic surveillance in the Fontan population remains to be defined. In this case, the patient was diagnosed with hepatocellular carcinoma more than 20 years after undergoing the Fontan procedure and was a candidate for combined heart-liver transplant. That her disease progressed prior to organ availability supports the argument for hepatic surveillance in this population.
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Affiliation(s)
| | - Anupama Devara
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | - Stephanie Judd
- Wayne State University School of Medicine, Detroit, Michigan, USA
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Verkhovsky E, Naylor P, Benjaram S, Das Kundumadam S, Ehrinpreis M, Mutchnick M. Racial disparity in chronic hepatitis B infection in a predominately African American urban clinic population. AIMS Medical Science 2018. [DOI: 10.3934/medsci.2018.4.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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9
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Stubbs A, Naylor P, Ravindran K, Benjaram S, Reddy N, Mutchnick S, May E, Ehrinpreis M, Mutchnick M. Racial diversity in mortality and morbidity in urban patients with hepatitis C. J Viral Hepat 2016; 23:439-46. [PMID: 26818494 DOI: 10.1111/jvh.12504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/24/2015] [Indexed: 12/24/2022]
Abstract
Defining mortality for Caucasians and African American patients with chronic hepatitis C with respect to racial diversity is critical for counselling patients on therapy options. The objective of this study was to define racial diversity influence on mortality and morbidity of 3724 consecutive hepatitis C virus (HCV)-infected patients seen in an urban clinic between 1995 and 2008. Mortality, as of 2011, was defined using the SSA National Death Index and correlated with early visit medical information. The HCV chronically infected patient population consisted of 2879 African Americans (AA), 758 Caucasians and 87 other, and the majority were not treated for their infection prior to 2011. The average time to death from first visit was 5 years, the average age at death was 55 years, and despite racial diversity, AA were just as likely to be reported dead as Caucasians (23% AA vs 22% Caucasians). Cirrhosis and fibrosis (liver biopsy, AST Platelet Ratio Index or Fibrosis-4) at first visit as well as low albumin, diabetes, renal impairment and cardiac symptoms were associated with increased mortality. Treated patients who cleared the virus (sustained viral response (SVR); AA = 59; Caucasians = 40) had lower mortality than patients who were not treated (AA: 5% vs 27%; Caucasians 5% vs 26%). Hence, we find that race is not a factor in the early mortality of patients with chronic HCV infection and achieving a SVR reduced mortality. Unexpectedly, nonresponding AA also benefited by a lower mortality. African American patients with kidney disease and low albumin were at highest risk and should be treated as soon as identified.
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Affiliation(s)
- A Stubbs
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - P Naylor
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - K Ravindran
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - S Benjaram
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - N Reddy
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - S Mutchnick
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - E May
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - M Ehrinpreis
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - M Mutchnick
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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Tama M, Naylor P, Patel S, Altawil J, Gulati D, Antaki F, Mutchnick MG, Ehrinpreis M. Overestimate of Fibrosis by FIBROSpect® II in African Americans Complicates the Management of their Chronic Hepatitis C. J Clin Transl Hepatol 2016; 4:12-9. [PMID: 27047767 PMCID: PMC4807138 DOI: 10.14218/jcth.2015.00053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 02/02/2016] [Accepted: 02/04/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Evaluation of advanced fibrosis in patients with hepatitis C virus (HCV) infection is used to facilitate decisions on treatment strategy and to initiate additional screening measures. Unfortunately, most studies have predominately Caucasian (Cau) patients and may not be as relevant for African Americans (AA). AIMS This study specifically addresses the issue of defining minimal vs. significant fibrosis in African Americans (AA) with chronic hepatitis C (CHC) using noninvasive assays. METHODS All patients (n = 319) seen between 1 January 2008 and 30 June 2013 for whom a FibroSpect II® (FSII) assay was performed and had data for calculation of aspartate aminotransferase (AST) platelet ratio index (APRI) and Fibrosis-4 (FIB-4) were identified using the medical records. RESULTS When liver biopsy score and FSII assay results for the AA patients with CHC were compared, 31% of AA had advanced FSII fibrosis scores (F2-F4) despite a biopsy score of F0-F1. In contrast, 10% of Cau over-scored. The AA false positive rate was 14% for APRI and 34% for FIB-4. Combining FSII with either APRI (7% false positive) or FIB-4 (10% false positive) improved the false positive rate in AA to 7% (FSII + APRI) and 10% (FSII + FIB-4) but reduced the sensitivity for significant fibrosis. CONCLUSIONS The FSII assay overestimates fibrosis in AA and should be used with caution since these patients may not have significant fibrosis. If the APRI or FIB-4 assay is combined with the FSII assay, minimal fibrosis in AA can be defined without subjecting the patients to a subsequent biopsy.
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Affiliation(s)
- Maher Tama
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Paul Naylor
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
- Correspondence to: Paul Naylor, Gastroenterology, 603 Hudson Bldg, Harper University Hospital, 3990 John R, Detroit, MI 48201, USA. Tel: +1-313-745-8601, Fax: +1-313-745-8843, E-mail:
| | - Suhag Patel
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Johnny Altawil
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Dhiraj Gulati
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Fadi Antaki
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Milton G. Mutchnick
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Murray Ehrinpreis
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
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Reddy N, Naylor P, Hakim Z, Asbahi R, Ravindran K, May E, Ehrinpreis M, Mutchnick M. Effect of Treatment for CHC on Liver Disease Progression and Hepatocellular Carcinoma Development in African Americans. J Clin Transl Hepatol 2015; 3:163-168. [DOI: 10.14218/jcth.2015.000013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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12
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Reddy N, Naylor P, Hakim Z, Asbahi R, Ravindran K, May E, Ehrinpreis M, Mutchnick M. Effect of Treatment for CHC on Liver Disease Progression and Hepatocellular Carcinoma Development in African Americans. J Clin Transl Hepatol 2015; 3:163-8. [PMID: 26623262 PMCID: PMC4663197 DOI: 10.14218/jcth.2015.00013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/14/2015] [Accepted: 05/18/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS African Americans (AA) historically have a low response rate to hepatitis C therapies, and there is limited information available for this patient population regarding the development and treatment of chronic hepatitis C (CHC). The aim of this study was to evaluate liver disease progression and hepatocellular carcinoma (HCC) development in AA with CHC. METHODS Between 1995 and 2008, 246 AA patients with CHC were identified from a database of patients and followed until 2012-2013 (average 8 years) or the development of HCC after 2008. RESULTS Viral clearance (intent to treat; sustained virus response (SVR)) was achieved in 15% of patients with interferon based therapies with or without ribavirin. AA patients who achieved an SVR (n=22) did not develop HCC or new onset cirrhosis, whereas the HCC incidence in untreated AA patients was 23% (51/203). Patients who achieved an SVR also had improved fibrosis, as defined by the AST Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) score, relative to nonresponders and untreated patients. CONCLUSIONS The severity of liver disease at the first visit (except for cirrhosis) correlated with the development of HCC, but because of the overlap in values between patients, these measurements were not useful for predicting individual risk. Since cirrhosis at the first visit was not a predictive factor, treatment with newer antiviral therapies is the best option for reducing the incidence of advanced liver disease and its harmful outcomes in the AA population.
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Affiliation(s)
- Naveen Reddy
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
| | - Paul Naylor
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
| | - Zaher Hakim
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
| | - Redwan Asbahi
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
| | - Karthik Ravindran
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
| | - Elizabeth May
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
| | - Murray Ehrinpreis
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
| | - Milton Mutchnick
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
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Reddy A, May E, Ehrinpreis M, Mutchnick M. Latent hepatitis B is a risk factor for hepatocellular carcinoma in patients with chronic hepatitis C. World J Gastroenterol 2013; 19:9328-9333. [PMID: 24409059 PMCID: PMC3882405 DOI: 10.3748/wjg.v19.i48.9328] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 09/05/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the potential association between hepatocellular carcinoma (HCC) in patients with chronic hepatitis C (CHC), cirrhosis and latent hepatitis B (LHB) infection, defined as the absence of detectable serum hepatitis B surface antigen (HBsAg) and the presence of hepatitis B core antibody (HBcAb).
METHODS: This retrospective analysis is comprised of 185 cirrhotic patients with HCC who were hepatitis C virus antibody (HCV Ab) (+) and HBsAg(-) at Wayne State University between 1999 and 2008. From these, 108 patients had HCV polymerase chain reaction confirmation of viremia while the remaining (77) were considered to have CHC on the basis of a positive HCV Ab and the absence of any other cause of liver disease. Controls were drawn from our institutional database from the same time period and consisted of 356 HBsAg(-) age, race and gender matched patients with HCV RNA-confirmed CHC and without evidence of HCC. A subgroup of controls included 118 matched patients with liver cirrhosis. χ2 test and t test were used for data analysis.
RESULTS: Seventy-seven percent of patients in all 3 groups were African Americans. Patients with HCC had a significantly higher body mass index (P = 0.03), a higher rate of co-infection with human immunodeficiency virus (HIV) (P = 0.05) and a higher prevalence of alcohol abuse (P = 0.03) than the controls. More patients with HCC had LHB than controls (78% vs 39%, P = 0.01). Sixty three percent of patients with HCC were both hepatitis B surface antigen (HBsAb)(-) and HBcAb(+) compared to 23% of controls (P < 0.01). When compared to cirrhotic controls, the frequency of HBcAb(+) remained higher in patients with HCC (78% vs 45%, P = 0.02). Patients with HCC were more likely to be both HBsAb(-) and HBcAb(+) than the cirrhotic controls (63% vs 28%, P = 0.01). Although not statistically significant, 100% of CHC and HIV co-infected patients with HCC (n = 11) were HBcAb(+) when compared to controls (44%; n = 9).
CONCLUSION: These data suggest that LHB occurs at a significantly increased frequency in patients with CHC and HCC than in patients with CHC without HCC.
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Krishnamoorthi R, Nandagopal L, Ehrinpreis M. A rare cause of dysphagia in a HIV patient--esophageal pseudodiverticulosis. Acta Gastroenterol Belg 2013; 76:340-341. [PMID: 24261030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Esophageal pseudodiverticulosis is a rare clinical entity with a slight male predominance (1). The condition is caused by cystic dilation of the sub mucosal glands and hence is not true diverticulosis. This is usually a benign condition, affecting the distal third of esophagus. It has been associated with reflux esophagitis, strictures and candidiasis. Patients with esophageal pseudodiverticulosis may present with progressive dysphagia, though most cases are asymptomatic. Perforation (2), bleeding (3) and mediastinitis have rarely been described. To the best of our knowledge, the occurrence of this rare disease in HIV patients has been described only once before (4). We report the second case of esophageal pseudodiverticulosis occurring in a HIV patient.
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Affiliation(s)
- R Krishnamoorthi
- Department of Internal Medicine, Division of Gastroenterology, Wayne State University, Detroit, Michigan 48201, USA.
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15
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Saleh H, Walz D, Ehrinpreis M. Polypoid lesions of the gallbladder: diagnostic and management challenges. J Gastrointestin Liver Dis 2008; 17:251-253. [PMID: 18836615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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16
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Pawa S, Ehrinpreis M, Mutchnick M, Janisse J, Dhar R, Siddiqui FA. Percutaneous liver biopsy is safe in chronic hepatitis C patients with end-stage renal disease. Clin Gastroenterol Hepatol 2007; 5:1316-20. [PMID: 17904916 DOI: 10.1016/j.cgh.2007.07.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Liver biopsy is useful for staging fibrosis in chronic hepatitis C (CHC) patients with end-stage renal disease (ESRD) to determine renal transplant eligibility and to make CHC treatment decisions. There is concern about an increased risk associated with percutaneous liver biopsy (PCNB) in ESRD patients. We compared the safety of PCNB in CHC patients with and without ESRD. METHODS We reviewed PCNBs performed between 1996 and 2004 for technique, histology, and complications in 78 ESRD patients with CHC and in 241 control patients with CHC and no renal failure, randomly matched for age, sex, and race. Platelet counts, prothrombin, and partial thromboplastin times, but not bleeding times, were checked before biopsy. Deamino-8-D-arginine vasopressin was not given before the biopsy. RESULTS The mean age of the patients was 50 years; 72% were male, 97% were African American, and 3% were Caucasian. The control group had a significantly higher proportion of patients with advanced fibrosis (P < .04). Only 1 patient with ESRD (1.3%) developed a moderate complication. Five controls (2.1%) developed complications, 3 of which were severe. CONCLUSIONS Severe complications after PCNB are uncommon, and patients with ESRD and CHC are at no increased risk. Testing for bleeding time and the routine use of deamino-8-D-arginine vasopressin are not necessary before PCNB in patients with ESRD.
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Affiliation(s)
- Swati Pawa
- Wayne State University School of Medicine, Detroit, Michigan, USA
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17
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Nagothu KK, Jaszewski R, Moragoda L, Rishi AK, Finkenauer R, Tobi M, Naumoff JA, Dhar R, Ehrinpreis M, Kucuk O, Majumdar APN. Folic acid mediated attenuation of loss of heterozygosity of DCC tumor suppressor gene in the colonic mucosa of patients with colorectal adenomas. Cancer Detect Prev 2004; 27:297-304. [PMID: 12893078 DOI: 10.1016/s0361-090x(03)00100-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Loss of heterozygosity (LOH) and/or inactivation of tumor suppressor genes are implicated in the initiation and progression of many malignancies, including colorectal cancer. Although accumulating evidence suggests a chemopreventive role for folate in colorectal cancer, regulatory mechanisms are poorly understood. The primary objective of the current investigation was to determine whether folic acid would prevent LOH of the three tumor suppressor genes, deleted in colorectal cancer (DCC), adenomatous polyposis coli (APC) and p53 in macroscopically normal appearing rectal mucosa of patients with adenomatous polyps. In addition, the effect of folic acid on rectal mucosal proliferation was determined. Twenty patients were randomized in a double-blind study to receive either folic acid 5mg once daily or identical placebo tablets for 1 year. Genomic DNA and total protein were extracted from the rectal mucosa at baseline and after 1 year of treatment and analyzed for LOH and protein levels of APC, DCC and p53 genes. In addition, paraffin-embedded mucosal specimens were analyzed for proliferating cell nuclear antigen (PCNA) immunoreactivity, as a measure of cellular proliferative activity. Folate supplementation prevented LOH of DCC gene in five out of five (100%) patients who demonstrated baseline heterozygosity, whereas two out of four (50%) placebo-treated patients with baseline heterozygosity demonstrated allelic loss. Mucosal protein levels of DCC were also reduced in 7 of 10 (70%) placebo-treated patients compared to only 2 of 10 (20%) of patients treated with folate. Levels increased, however, in eight and three patients in the folic acid and placebo groups, respectively (P<0.02). Folic acid caused no change in allelic status of either APC or p53 gene. Folate supplementation caused a small, but not statistically significant, 16% reduction in mucosal proliferation, whereas placebo treatment resulted in a 88% (P<0.05) increase in this parameter, when compared with the corresponding baseline values. Our results indicate that folic acid prevents an increase in proliferation and arrests LOH of DCC gene and also stabilizes its protein in normal appearing rectal mucosa of patients with colorectal adenomas. Taken together, our data suggest that one of the ways folate may exert its chemopreventive effect is by stabilizing certain tumor suppressor gene(s) and preventing further increases in proliferation.
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Affiliation(s)
- Kiran K Nagothu
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
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18
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Abstract
Oral phosphosoda is increasingly being used as a bowel preparation for colonoscopy, as it requires that a much smaller volume be ingested and is equally effective and less costly than polyethylene glycol-based electrolyte solutions. Oral phosphosoda has a good safety record, but complications of its use may occur. We describe a patient who died as a result of severe hyperphosphatemia after an oral phosphosoda bowel preparation. A 55-year-old man was admitted with rectal bleeding, abdominal pain, and vomiting. He had a history of diabetes, hypertension, and end-stage renal disease and had successful renal transplant 3 years prior. His initial serum creatinine, calcium, phosphate, and electrolyte levels were normal. He vomited after polyethylene glycol-based electrolyte solution, and an alternate bowel preparation with oral phosphosoda was recommended. He received 90 mL of oral phosphosoda as a single dose. Six hours later, he had cardiorespiratory arrest and was found to have hyperphosphatemia (serum phosphate, 17.8 mg/dL), a high anion gap acidosis, hypoxia, and oliguric renal failure. Resuscitation was unsuccessful. Autopsy showed ischemic colitis. We conclude that bowel preparation with phosphosoda may be associated with severe complications and should be avoided if there is any suggestion of impaired renal function or poor gut motility.
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Affiliation(s)
- Nadeem Ullah
- Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA
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Siddiqui F, Mutchnick M, Kinzie J, Peleman R, Naylor P, Ehrinpreis M. Prevalence of hepatitis A virus and hepatitis B virus immunity in patients with polymerase chain reaction-confirmed hepatitis C: implications for vaccination strategy. Am J Gastroenterol 2001; 96:858-63. [PMID: 11280565 DOI: 10.1111/j.1572-0241.2001.03633.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Administration of vaccine for hepatitis A virus (HAV) and hepatitis B virus (HBV) is recommended for patients with chronic hepatitis C (CHC) because of the potential for increased severity of acute hepatitis superimposed on existing liver disease. The aim of this study is to determine the prevalence of antibodies directed against HAV and HBV in patients with CHC, analyze demographic and risk factors associated with this prevalence, and develop a cost-effective vaccination strategy. METHODS We reviewed records from 1092 CHC patients. Demographics and information regarding risk factors were obtained by history and questionnaire administered to all patients. The costs of vaccination and antibody testing were determined, based on standard laboratory and clinic charges at our institution. HAV and HBV markers were correlated to race, age, and risk factors. RESULTS Of the total population studied (n = 1092), 72% were African-Americans, 27% white, and 1% others. Of 671 CHC patients tested for anti-HAV IgG, 252 (38%) were positive. Of 743 CHC patients tested for HBV antibodies (anti-hepatitis B core IgG or anti-hepatitis B surface), 494 (67%) were positive. African-Americans are more likely to have antibodies to HAV and HBV (67% and 75%, respectively) compared to whites (27% and 20%). The prevalence of anti-HAV was 76% in patients >60 yr, 34% in the 40- to 60-yr-old age group, and 21% in patients <40 yr. The highest prevalence of HBV antibodies was found in patients between the ages of 40-60 yr. No HCV risk factors were associated with increased HAV risk. In CHC patients with HBV antibodies, however, illicit injection drug use was the predominant risk factor. CONCLUSIONS The prevalence of anti-HAV in patients with CHC was found to be similar to that of the general population in the United States (33% according to recent Centers for Disease Control data), consistent with the hypothesis that the two infections do not share risk factors. Because the prevalence of HAV immunity is low in CHC patients <40 yr, empiric HAV vaccination is cost effective. If two doses of vaccine are to be given, however, antibody testing of all HCV patients is indicated. In the subset of patients >60 yr of age or who are African-American, where the prevalence of HAV exposure is considerably higher, it would be cost effective to check the antibody ($36.00), before vaccination ($97.00). The prevalence of HBV antibodies, however, is significantly increased in patients with CHC compared with the general population (5.3% per the Centers for Disease Control), likely as a result of exposure to similar parenteral risk factors. HBV antibody testing ($26.00 per test) should, therefore, be undertaken in all CHC patients who are hepatitis B surface antigen negative, as this approach is cost-effective compared to empiric HBV vaccination ($438.00 for a three injection course).
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Affiliation(s)
- F Siddiqui
- Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA
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Meyerson S, Holtz T, Ehrinpreis M, Dhar R. Small bowel obstruction in pregnancy. Am J Gastroenterol 1995; 90:299-302. [PMID: 7847305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Small bowel obstruction (SBO) is an unusual complication of pregnancy. Our objective was to review our experience at two urban hospitals. METHODS To this end, we conducted a retrospective chart review of all pregnant patients with a discharge diagnosis of intestinal obstruction at Grace Hospital, Detroit, MI (January 1, 1972 to January 1, 1992) and Hutzel Hospital, Detroit, MI (January 1, 1977 to January 1, 1992). RESULTS During the study period, nine cases of SBO were identified and 150,386 deliveries occurred (one case per 16,709 deliveries). Patients' ages ranged from 16 to 37 yr. There were six primiparas. Cases of SBO by trimester: four in second, four in third, and one in puerperium. Previous abdominal surgery was documented in eight patients. Duration of symptoms before admission ranged from 3 h to 3 days. Primary symptoms were abdominal pain (89%), vomiting (89%), and obstipation (80%). At admission, only one patient was febrile, and four had hypoactive bowel sounds. Abdominal x-rays were compatible with SBO in seven patients. Ultrasound identified SBO in one of four cases. Patients were hospitalized 6 h to 23 days before surgery. The admission diagnosis was incorrect in four cases. One patient was treated conservatively and, at 36 wk, vaginally delivered a healthy infant. The eight surgical patients had lysis of adhesions, with one requiring resection of gangrenous small bowel. There were three fetal deaths (at 22, 24, and 30 wk of gestation). No maternal deaths occurred. CONCLUSION SBO is a rare, but often catastrophic, complication during pregnancy and the puerperium. Clinical suspicion is critical and should be increased in a patient with an abdominal scar. If suspected, prompt abdominal x-rays, ultrasound, and surgical consultation are warranted.
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Affiliation(s)
- S Meyerson
- Veterans Administration Hospital, Wilmington, Delaware
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