Can a blood test predict patients at risk for significant confusion and disorientation after a shunt through the liver?

Principal Investigator: Daniel Ganger, MD; Co-Principal Investigator: Justin R. Boike, MD Chronic liver disease remains a significant burden on society, despite the ability to treat and cure hepatitis C. With the growing obesity epidemic in the United States, fatty liver disease will soon overtake hepatitis C as the primary cause of chronic liver disease and cirrhosis. While liver transplantation offers a cure, it is not an option for many individuals who face complications of cirrhosis such excessive fluid retention and internal bleeding. Transjugular intrahepatic portosystemic shunt (TIPS) procedures offer an effective tool for treating these complications. In some patients, though, TIPS can worsen liver failure and sometimes cause debilitating confusion called hepatic encephalopathy. It is believed that excessive shunting of blood flow from the liver may be the culprit. In this study, the researchers will study the ability of a new laboratory test to measure the percentage of blood shunted away from the liver to better predict those patients at greatest risk for hepatic encephalopathy after a TIPS procedure. This tool could dramatically help guide the use of TIPS and promote earlier use of TIPS in low-risk...

Evaluating a novel endoscopic ultra sound-guided technique for tissue acquisition for diagnosing pancreatic tumors

Principal Investigator: Sri Komanduri, MD; Co-Principal Investigator: Robert Schenck, MD The thought of potentially having cancer is stressful enough without undergoing an invasive biopsy to diagnose it and finding out that the procedure needs to be repeated due to inadequate sample collection. This project aims to optimize strategies for acquiring tissue samples to assist gastroenterologists (and pathologists) in diagnosing many diseases, including cancers. Relying on endoscopic ultrasound guidance, the two methods currently utilized are fine needle aspiration, which is the gold standard, and a new method called fine needle biopsy. Drs. Komanduri and Schenck are conducting the largest study to date to compare these different strategies. After collecting data from patients who have undergone one of these procedures over a five-year period, the investigator will perform advanced statistical modeling to determine the strategy that best optimizes patient outcomes (including obtaining accurate diagnoses and minimizing repeat invasive procedures) and costs. Once identified, this strategy will ultimately be implemented throughout the Northwestern Digestive Health Center to enhance patient...

Improving surgery recovery for children undergoing surgery for inflammatory bowel disease: Laying the groundwork

Principal Investigator: Mehul V. Rahul, MD; Co-Principal Investigator: Salva N. Balbale, MS, Doctoral Candidate Enhanced Recovery Protocols (ERPs) are evidence-based interventions that utilize perioperative education and counseling provided through surgery and recovery to safe discharge. ERPs have been found to decrease hospital length of stay, in-hospital costs, and complications among a variety of adult surgical populations, including those undergoing abdominal and gastrointestinal tract surgery. As many as 17 percent of the 70,000 children with IBD in the United States need surgery within five years of diagnosis to manage their disease. ERPs offer an opportunity to enhance the care of these young patients, yet these strategies are currently lagging in the pediatric setting. This study will lay the groundwork and provide a baseline assessment of ERPs in 15 pediatric surgical practice sites across the country. The investigators will evaluate the effectiveness and impact of ERPs on outcomes, and use their findings in the development of an implementation...

Measuring which aspects of living with IBD, including its treatments, may contribute to a patient developing post-traumatic stress (PTS), a chronic psychological reaction to a traumatic event characterized by flashbacks, nightmares, and hypervigilance

Principal Investigator: Tiffany Taft, PsyD Living with inflammatory bowel disease (IBD) is both physically and psychologically challenging and has the potential to negatively impact patient lives. As many as one-third of individuals with IBD demonstrate significant post-traumatic stress (PTS) symptoms, according to the first study of IBD-related PTS in the United States conducted by Dr. Taft and her team. Negative hospital experiences may play a substantial role. Further advancing this research, Dr. Taft aims to identify targets for early psychosocial counseling to better intervene and prevent the potential impact of undiagnosed PTS on patient outcomes. The novel study will include the use of online patient surveys to better understand PTS prevalence in IBD and to assess differences in illnesses and demographics traits between IBD patients with and without PTS. The next step will involve in-depth interview s with patients recruited from Northwestern’s and Rush University’s gastroenterology clinics. A clinical psychologist who specializes in working with adult IBD patients will conduct these interviews to gather information not easily collected via standardized tests to better evaluate PTS causes and guide...

Which molecular changes are causing the development of eosinophilic esophagitis?

Principal Investigator: Marie-Pier Tetreault, PhD Patients with eosinophilic esophagitis (EoE), a chronic immune/allergic condition affecting children and adults, develop difficulty swallowing food and food obstructions in the esophagus (food tube between the mouth and stomach).  Dr. Tetreault’s team has created a new mouse model that more accurately replicates the disease process of EoE and exhibit all the features observed in patients with the disease. This game changing animal model offers a unique opportunity to better understand the molecular mechanisms driving EoE. By performing “single-cell RNA sequencing”, Dr. Tetreault hopes to determine how changes in specific molecules in epithelial cells control the development of eosinophilic esophagitis. The team will perform these studies in mice that currently have the disease as well as in mice that have yet to show any obvious signs or symptoms. Dr. Tetreault believes that the early-stage disease models will help identify the initiating molecular events that lead to EoE and provide insight into the development of earlier intervention strategies now lacking in the field of...