Exposing and Confronting Destructive Chronic Inflammation in Acid Reflux (GERD)

Principal Investigator: Marie-Pier Tétreault, PhD, Research Assistant Professor of Medicine (Gastroenterology and Hepatology), Northwestern University Feinberg School of Medicine Gastroesophageal reflux disease (GERD/acid reflux) affects over ¼ (up to 27 percent) of U.S. adults, resulting in more than 7 million patient visits annually. GERD leads to complications such as erosive esophagitis, Barrett’s esophagus and esophageal cancer. Learning more about the molecular basis for the development and progression of GERD is critical to improving treatment options and decreasing the risks for these esophageal conditions. Dr. Tetreault is looking at the role of the crucial mediator of inflammation IKKβ in the development of chronic GERD. The team will use molecular approaches to shut down the expression of IKKβ and evaluate the impact of this loss on the development of GERD. This project will also employ a new technology called single-cell RNA sequencing (scRNA-seq) that enables the rapid determination of the precise gene expression patterns of tens of thousands of individual cells. Employing scRNA-seq should help give greater insight into how IKKβ signaling impacts the regulation of the inflammatory process in chronic gastroesophageal reflux. Interrupting the disease process of GERD can crucially impact long term patient prognosis and risk of...

Atrantil Supplement for Methane Predominate Intestinal Bacterial Overgrowth

Principal Investigator: Darren Brenner, MD Intestinal bacterial overgrowth (IBO) occurs when excessive amounts of bacteria build up in the small intestine (which is usually nearly sterile). These bacteria ferment ingested food, producing hydrogen, methane, and carbon dioxide. These intestinal gases can induce GI symptoms, including abdominal pain, bloating, distention, diarrhea, and constipation. Antibiotics often help, but for some patients, disruptive digestive symptoms will persist. IBO is subcategorized into two types: 1.) small intestinal bacterial overgrowth and 2.) intestinal methanogenic overgrowth. Recent studies suggest that increased methane production may come from the overgrowth of a specific type of bacteria. No current therapies exist to treat methane predominate IBO. An initial study of the herbal supplement Atrantil has shown promise. Investigating the potential benefit of this “holistic” treatment, Dr. Brenner will conduct a trial of Atrantil in 30 patients at the Northwestern Medicine Digestive Health Center. Researchers will evaluate Atrantil’s impact on reducing methane levels, lessening symptoms, and enhancing quality of life. The team believes Atrantil could offer an inexpensive and safe treatment for...

Causes of Primary Sclerosing Cholangitis: The “Leaky Gut” Theory

Principal Investigator: Josh Levitsky, MD | Co-Principal Investigator: Imran Nizamuddin, MD Primary sclerosing cholangitis (PSC) causes chronic inflammation of the bile ducts and, over time, potential liver failure. What triggers PSC and how it is strongly linked to ulcerative colitis (UC) remains unclear. One theory is that a “leaky gut” allows toxic compounds from the intestines to erroneously enter the liver. Dr. Levitsky’s team intends to test this theory by measuring intestinal permeability in PSC patients. Intestinal permeability (leakiness) can be studied by comparing absorption of different simple sugar solutions. Study participants will drink several sugar solutions to compare absorption and elimination in the urine. Researchers anticipate that the sugar levels in the urine will be different between patients with PSC, patients with PSC and ulcerative colitis, and healthy patients. If this occurs, the team will evaluate therapies, such as antibiotics, to assess their impact on the “leaky gut.” This project may serve as an initial step toward developing personalized treatment options for patients who currently don’t have any therapeutic options—currently a high unmet need in the field of...

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...

Can we Improve Doctors’ Colonoscopy Skills with a “Report Card”?

Principal Investigator: Anna Duloy, MD Skills matter when it comes to screening colonoscopies for colon cancer, the second-leading cause of cancer death in the United States. Some doctors are more skilled than others at finding and removing precancerous polyps (known as adenomas) that may lead to cancer if left to grow. Unfortunately, though, the quality of performing this vital procedure varies widely between gastroenterology specialists, even at the best medical institutions. Most commonly, the quality of colonoscopy performance is measured by the adenoma detection rate (ADR):  the frequency of finding adenomas during routine screening colonoscopies. Patients whose physicians have high ADRs are less likely to develop colorectal cancer. While ADR fluctuates among individual doctors, the source of this variability remains a mystery. Constructive criticism can often help improve any endeavor. In prior work, gastroenterology and hepatology fellow Anna Duloy demonstrated that providing feedback regarding polyp detection can significantly improve colonoscopy performance by physicians. Thanks to a Digestive Health Foundation grant, Dr. Duloy’s research team plans to further expand upon on this work by providing new individualized colonoscopy skills feedback to Northwestern Medicine GI specialists. The study will focus on the physicians’ ability to remove polyps (polypectomy) and fully inspect the colon during colonoscopy. Investigators will use video grading by experts to develop pre- and post-scope report cards that will help the specialists to measure their individual performance and ongoing improvement. Patients who overcome their fears and/or other barriers to schedule and undergo a screening colonoscopy expect the very best of care. Increasing colonoscopy competency could further help to stop a common, fatal, digestive disease before it progresses or even...