Understanding Immune Signature of Foods in Eosinophilic Esophagitis

Principal Investigator: Joshua Wechsler, MD In Eosinophilic Esophagitis (EoE), a variety of foods trigger inflammation in the esophagus.  Diet elimination remains a mainstay treatment approach, with the number and type of food triggers varying between patients. Some respond well to eliminating a single food while others require the removal of multiple foods. Although no biomarkers or testing currently exist to help pinpoint specific triggers, previous studies have found a key role for white blood cells known as T-cells. This study will assess the novel association between individual food triggers and T-cell clonality. Dr. Wechsler and his team intend to examine esophageal biopsies for evidence of the specificity of immune response of white blood cells to specific foods. The researchers will use deep sequencing of the T-lymphocyte receptor to identify how frequently unique types of T-cells appear. The team hopes this data will help explain how the immune system “learns” to respond to specific foods and, ultimately, provide a potential...

A New Technology to Shine a Light on What Our Pulses Can Tell Us Principal Investigator: Nikhilesh Mazumder, MD, MPH

Principal Investigator: Nikhilesh Mazumder, MD, MPH Severe damage to the liver can profoundly affect a variety of body systems. Patients with cirrhosis suffer from excess fluid in the legs, abdomen, and chest. Medications can reduce fluid buildup but dosing is not an exact science. Inaccurate dosing can harm the kidneys, cause confusion, and even land patients in the hospital. To avoid these complications, clinicians rely on a multitude of blood and imaging tests that often require expensive equipment, drawing blood, or specially trained staff. Dr. Mazumder’s team seeks to simplify the process by testing the benefit of a decades-old technique called the Valsalva maneuver in combination with a finger photoplethysmography device (similar to a noninvasive bedside pulse oximeter). Patients hold their breath for 10 seconds, and the device measures changes in blood flow to the finger. Safely and successfully tested in individuals with heart problems to predict levels of fluid overload, the...

A Novel Protective Mechanism in the Bile Ducts of Patients with Primary Sclerosing Cholangitis

Principal Investigator: Richard M. Green, MD A chronic bile duct and liver disease, Primary Sclerosing Cholangitis (PSC) affects more than 50,000 Americans and can progress to cirrhosis, liver failure, and bile duct cancer. Currently, the only effective therapy is liver transplantation. Better understanding the pathogenesis of PSC is urgently needed to develop new therapies. In recent cell culture and animal studies, Dr. Green and his colleagues focused on a protective cell signaling pathway: the unfolded protein response (UPR). They found that the UPR is activated when bile flow is impaired, and mice lacking UPR genes in their liver are highly susceptible to injury from bile duct obstruction. Now moving forward with the first human investigations examining UPR, Dr. Green aims to determine how it is activated in the bile ducts of patients with PSC. The team plans to study bile duct tissues obtained during endoscopic procedures performed for bile duct obstruction. The identification of “protective” genes and proteins could lead to new drug targets and, ultimately, the development of novel medical...

Does an Inflammatory Bowel Disease Flare Impact the Results of the Prostate Specific Anitigen (PSA) Test Used to Screen for Prostate Cancer?

Principal Investigator: Shilajit D. Kundu, MD One million-plus Americans have IBD, accounting for more than two million ambulatory and emergency room visits annually. This health care utilization can lead to annual medical expenditures ranging from $5,000 to $8,000 per patient. Reducing unnecessary medical costs in this patient group is paramount. Take for example, PSA tests. While PSA screening can reduce prostate cancer deaths, false-positive elevations commonly occur, especially for patients with IBD. The Kundu research group recently found that men 65 and older with IBD, who underwent prostate cancer screening at Northwestern Memorial Hospital, had higher PSA values than non-IBD controls. In addition, men with IBD had a significantly higher risk of prostate cancer. However, whether the elevation in PSA is due to IBD-related inflammation versus a true reflection of an increased risk of prostate cancer remains unclear. Study findings may optimize how men with IBD are screened for prostate cancer by better assessing their risk while at the same time reducing needless medical...

Programmer Analyst to Improve Digestive Health Quality at Northwestern Medicine

Principal Investigator: Rajesh N. Keswani, MD Among the busiest digestive disease centers in the country, Northwestern Medicine (NM) manages some 35,000 GI endoscopy procedures and more than 42,000 outpatient clinic visits a year. NM clinicians strive to deliver high quality, patient-centered cost-effective care with every patient encounter. Improving the quality of care relies on measuring clinical performance (i.e., “quality metrics”), implementing interventions to improve care delivery, and then re-measuring quality following the interventions. Our group utilized this approach to markedly improve the quality of colonoscopy at Northwestern thereby reducing the risk of colon cancer death after colonoscopy in the patients we serve, and subsequently published this innovative work in a leading journal (American Journal of Gastroenterology, 2015). Although the NM digestive health group has considerable quality improvement expertise, each initiative requires an analyst who has the computer and statistical skills to collect patient and procedure data from the electronic health record and interpret that data in a continuous fashion. The lack of a dedicated analyst has been a persistent bottleneck to replicating this approach to quality improvement research. Funding of the programmer analyst position will now allow the group to support multiple novel quality improvement projects and improve the efficiency of current research...