Developing a Standardized Training System for Interpreting Esophageal Manometry Exam

Principal investigator:  Rena Yadlapati, MD Every physician strives for and every patient expects an accurate diagnosis—no matter what the health issue. Advancements in imaging and other technologies continue to enhance diagnostic capabilities for a range of diseases, including gastrointestinal disorders. But even the most sophisticated diagnostic tools can yield erroneous results in untrained and/or inexperienced hands. In the field of esophageal disorders, high-resolution esophageal manometry (HREM) is the gold standard for diagnosing certain disorders of the esophagus, including difficulty swallowing. The precision of HREM allows gastroenterologists to track esophageal motility or movement patterns to pinpoint functional problems of this essential digestive organ. While HREM provides invaluable information, the skill and knowledge of the GI specialists using this advanced technology varies widely across the country. From disparities in performance to interpretation of HREM data, the potential for inaccurate diagnosis that adversely impact patient care and quality of life is—unacceptably—too high. Already researchers at Northwestern Medicine have designed a web-based training program and conducted a pilot study: They observed learning curves for HREM among 20 gastroenterology trainees nationwide. Supported by a grant from the Digestive Health Foundation, the investigators led by Rena Yadlapati, MD, will now build on the success of their initial work. They plan to apply their methodology to a larger group of physicians (residents and faculty) with minimal experience with HREM to validate the existing data and determine key competency benchmarks. Dr. Yadlapati’s team will work with the Instructional Design & Development group at Northwestern University to create interactive training modules. They will then integrate interactive educational video and electronic handbooks, among other tools, into their training system....

How do Genetic Differences in Immunosuppressive Drug Metabolism Impact Outcomes for Liver Transplant

Principal investigator: Pranab Barman, MD  Variations in our genetic makeup determine who we are, from hair and eye color to how we respond to drugs. Today, the growing field of personalized medicine looks to our DNA to tailor treatment so that we receive precise and appropriate care. An emerging offshoot, pharmacogenomics looks specifically at the connections between genetics and drug metabolism. Liver transplant recipients must take immunosuppressive medications for a lifetime to prevent organ rejection. Due to unique genetic profiles, though, one drug often does not fit all. The differences in how these medicines are absorbed by individual recipient’s intestines and then processed by the liver range from harmful to ineffective. Too high a dosage—potential kidney problems. Too low a dosage—potential rejection of the new organ. Given the shortage of donor livers in this country and the long wait list of recipients, ensuring the success of every liver transplant is critically important. Thanks to a grant from the Digestive Health Foundation, researchers in Northwestern Medicine’s Division of Gastroenterology and Hepatology will evaluate the impact of drug metabolizing genes on patient outcomes after liver transplant. Taking advantage of Northwestern Medicine’s extensive biobank, the investigators will study blood samples previously collected from 50 liver transplant recipients. They hope to better understand the links between genetics and drug metabolism for this specific patient population. Pranab Barman, MD, and his research team are conducting pharmacogenomic studies focusing on seven specific genes associated with drug metabolism. Analyzing genetic variations between patients, the researchers plan to identify how much the recipient intestine and donor liver independently contribute to metabolizing these crucial medications. The ability to...

How Do We Improve Transitioning of Pediatric IBD Patients into Adult Practice

Principal investigator: Itishree Trivedi, MD Graduating from high school. Going away to college. Getting that first job. For many, these milestones mark the transition from childhood to adulthood, with parents and their children diligently preparing for them as they arise. Yet a young adult patient’s move from beloved pediatrician or family doctor to an unfamiliar adult care specialist is often abrupt. Learning to be in charge of your own health can be challenging, especially for those with chronic illnesses. Inflammatory bowel disease (IBD), often identified as ulcerative colitis or Crohn’s disease, affects 1.4 million Americans. About 30 percent of IBD patients are diagnosed with the disease before age 18. The journey from adolescent to adult can be bumpy for anyone, but IBD comes with its own set of hurdles. Typically inhibiting physical growth and often causing social and developmental stresses, the disease can lead to missed doctors’ appointments, increased use of emergency rooms, and higher healthcare costs. “Transition programs” to prepare youth for adult care have been used for patients with conditions such as Type 1 diabetes mellitus and organ transplantation. Requiring “buy-in” from healthcare practitioners to be successful, these programs help young adults bridge the transition gap. They’ve been shown to prevent the worsening of disease and reduce hospitalizations. Supported by a grant from the Digestive Health Foundation, a young clinical investigator in Northwestern Medicine’s Division of Gastroenterology and Hepatology now intends to do the same for young adults with IBD. Adapting the GotTransition toolbox (developed by the Center for Health Care Transition Improvement), Itishree Trivedi, MD, plans to develop the first such program specifically geared toward improving...

Assessing a New Imaging Probe to Evaluate Gastroesophageal Reflux

Principal investigator: Dustin A. Carlson, 3rd Year Fellow Gastroesophageal reflux disease (GERD) is a common condition that often involves heartburn and/or regurgitation. If left untreated, scarring of the esophagus or “food pipe” may result. GERD leads to millions of outpatient visits annually. For some individuals, increased laxity at the end of the muscular esophagus may contribute to GERD. Assessing the extent of this laxity helps to determine the most appropriate strategies for treating the disease and preventing further damage to the esophagus. The motility of the esophagus—a tube that moves food from the throat to the stomach via muscular movement—can reveal much about its function and well-being. Manometry tests are currently used to measure the strength and muscle coordination of a patient’s esophagus while swallowing. During the manometry test, a thin, pressure-sensitive tube is passed through the nose and down the esophagus. While effective, manometry sometimes causes significant discomfort for the patient, which could hinder the diagnostic evaluation. Funded by the Digestive Health Foundation, researchers in Northwestern Medicine’s Division of Gastroenterology and Hepatology are investigating the expanded use of a new device, the functional lumen imaging probe (FLIP). Already commercially available and FDA-approved, the FLIP offers a promising alternative to manometry. Because it can be quickly performed during a sedated upper endoscopy, FLIP is much more comfortable for patients than previous techniques. Led by Dustin Carlson, MD, the Northwestern team recently developed a novel, customized, patent-pending FLIP analysis technique. Dubbed FLIP topography, it allows for the assessment of esophageal motility. To further evaluate and substantiate FLIP’s clinical viability, the investigators will use the device and new technique in 40...