Barrett’s Esophagus (BE) occurs when damaging acid reflux causes the lining of the esophagus to change from normal to pre-cancerous tissue. Although BE can be effectively treated with acid-blocking medications, some patients with more advanced disease often require endoscopic therapy to remove the abnormal tissue. While many experience successful outcomes with this treatment option, some 5 to 25 percent will redevelop the disease; recurrence puts patients at increasing high risk for esophageal cancer or adenocarcinoma. With a five-year survival rate of about 20 percent, this deadly cancer has increased by a factor of more than seven in the past 40 years. Many risk factors contribute to BE, including gender, with men are at higher risk than women; chronic heartburn and acid reflux, especially before age 30; and smoking. Interesting, the disorder has developed with increasing frequency in non-smoking young men between the ages of 20 to 45. Sri Komanduri, MD, Director of Interventional Endoscopy at Northwestern Medicine and his research team previously found that persistent acid reflux in patients who have undergone endoscopic therapy likely causes recurrent BE. Currently, these patients must undergo placement of an uncomfortable transnasal catheter over a 24-hour period to assess and measure persistent acid reflux. This testing helps gastroenterology specialists to determine the best treatment options: a combination of medications and endoscopic treatment or perhaps a referral for surgery. Due to costs and patient intolerance, though, this type of reflux testing has proven to be impractical. Studies of patients without endoscopically-treated BE have suggested consistent changes in the lining of esophageal biopsy samples, which strongly indicate uncontrolled acid reflux. Extrapolating from this observation, Dr....
Principal Investigator: Nirmala Gonsalves, MD Previously thought to be a rare disorder, Eosinophilic Esophagitis (EoE) has emerged as a common cause of swallowing problems (dysphagia) and esophageal dysfunction in adults. The condition arises when inflammatory cells called “eosinophils” wreak havoc on the esophagus by creating inflammation. Over time, the inflamed esophagus begins to undergo abnormal structural changes that can severely impede the passage of food and make it extremely difficult to eat or drink and live a normal life. EoE can lead to increased risk of food impactions, often requiring immediate medical attention. Occurring in 1 to 2 individuals per 10,000, EoE’s prevalence rivals that of other immunologically-related disease such as inflammatory bowel disease and can cause similar debilitating pain and discomfort. While diet changes and medications such as topical corticosteroids work well, matching the best treatment to the right patient remains challenging. Funded by a Digestive Health Foundation grant, Northwestern Medicine researchers led by Nirmala Gonsalves, MD, a faculty member in the Division of Gastroenterology and Hepatology, hope to uncover genetic differences between EoE patients that could lead to better predictors of treatment response and more personalized care. Northwestern Medicine currently has one of the world’s largest cohorts of adults being diagnosed and treated with EoE. Some 700 esophageal tissue samples from these patients, collected at various points in their disease progression, provide an invaluable resource for study. Dr. Gonsalves’ research team plans to mine Northwestern’s comprehensive clinical database (NUCATS) in combination with sophisticated genetic testing and analysis of tissue biopsies. The grant will allow investigators to embark on what will be the largest molecular-phenotype association study of...
Introducing a groundbreaking research technology, the The Digestive Health Foundation became a founding supporter in 2017 of a powerful new resource for digestive health medical research: The Digestive Health Foundation BioRepository. As one of only a few GI biorepositories of its kind in the world, the DHF BioRepository stores, organizes, and makes accessible (digitally, in real time) blood and tissue samples from patients and family members diagnosed with one or more of the digestive disorders treated at the Northwestern Medicine Digestive Health Center. Digestive disease research using the DHF BioRepository will leverage the latest advances in information technology with cutting-edge biologic and molecular research techniques to better understand gastrointestinal diseases and to help develop better treatment options for patients. Across GI sub-specialties, from liver and pancreatic cancers, esophageal diseases/swallowing disorders, inflammatory bowel disease (Crohn’s Disease and ulcerative colitis), GERD, IBS, bariatric surgery, nutritional issues, and many more, the extensive and growing patient network at Northwestern Medicine provides a diverse and valuable resource of participants. After a patient chooses to participate, Northwestern Medicine directly links the patient’s anonymized electronic medical record, physiologic diagnostic test results, imaging results, and patient-directed quality of life indicators to a tissue bank that will include: samples obtained during endoscopy (biopsies), blood, urine, and stool. The DHF BioRepository’s depth of capacity will enable physician scientists around the world to pursue large scale research studies into the mechanisms of digestive diseases. Discoveries about the natural history and progression of digestive disease is providing the insight necessary to develop new diagnostic tools, better treatments, and eventual cures for digestive disease patients and future generations. — The Digestive Health...
Principal Investigator: A. Aziz Aadam, MD From development to implementation, new medical advancements often don’t enter into mainstream usage without education and training. Introduced in the 1990s in Japan, minimally-invasive endoscopic submucosal dissection (ESD) has become the standard of care for not only treating but also, most importantly, curing early gastrointestinal cancers. While widely accepted practice in Japan and Eastern countries, ESD hasn’t yet gain a foothold in western countries—mainly due to lack of available training from specialists skilled in performing ESD. Medical centers with the highest volumes of GI procedures typically provide the best ESD training experiences. At the moment, most of those centers operate outside of the United States. Endoscopists with an interest in learning the leading-edge technique must travel abroad and even with the instruction they receive, usually require more education and guidance to shorten the learning curve. Interest in developing ESD programs in this country has grown: Northwestern Medicine launched its ESD program in January 2016, joining the 15 to 20 centers in the country performing ESD. Supported by a grant from the Digestive Health Foundation, investigators led by A. Aziz Aadam, MD, in Northwestern Medicine’s Division of Gastroenterology and Hepatology, plan to bring much-needed ESD training closer to home. By creating an original video series, they intend to develop a premier educational tool for endoscopists from Western countries. Dr. Aadam and his co-investigators, including two Japanese endoscopic experts, will produce six 3D animated videos based on real-world examples. The videos will illustrate in detail the best strategies for treating the most commonly encountered lesions in the GI tract, focusing on those found in the...
Principal Investigator: Amanda Guentner, MD No one wants to hear the “C” word. Even the slightest hint of a cancer risk is, understandably, frightening—even when all signs point to a positive outcome. Chronic regurgitation of stomach acid can damage the esophagus and eventually lead to a condition known as Barrett’s esophagus (BE). Patients with BE are at risk for esophageal adenocarcinoma (cancer of the esophagus), which strikes about 3 to 4 Americans out of 100,000 each year. While a variety of advanced treatments such as endoscopic eradication therapy (EET) help to prevent cancer well before it ever starts, many patients overestimate their cancer risk. Being referred for treatment appears to further ramp up their anxiety. Despite patient education prior to and after EET, individuals facing a series of treatments often forget what they may have been told about their diagnosis, cancer risk and/or short- and long-term prognosis. This perceived lack of information, which has been linked to overall patient satisfaction, often pushes them over the top. Supported by the Digestive Health Foundation, researchers in Northwestern Medicine’s Division of Gastroenterology and Hepatology are evaluating the use of multimedia to enhance the patient experience pre- and post-EET therapy. Recent studies have shown them to be successful with patients who’ve undergone general and orthopaedic surgical procedures. The investigators plan to create an educational video for patients undergoing EET for Barrett’s esophagus through Northwestern’s Digestive Health Center and measure its impact on reducing patient anxiety. Led by GI fellow Amanda Guentner, MD, the team will produce a short video to reinforce the information patients typically receive during face-to-face consultations with their gastroenterologist and/or...
