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...

Examining whether a stent helps stomach emptying after cutting the pylorus muscle in patients with delayed stomach emptying

Principal Investigator: Aziz Aadam, MD; Co-Principal Investigator: Kevin Liu, MD Gastroparesis is a condition when the stomach does not empty correctly due to lack of stomach muscle coordination.  Many patients with chronic gastroparesis experience symptoms ranging from persistent nausea and vomiting to the inability to eat or drink. Lacking effective treatment options, patients with gastroparesis are at risk for inadequate nutrition and repeated hospitalizations. Endoscopic targeted therapies including placement of a tube to allow the stomach to empty into the small intestine (transpyloric stent) and G-POEM, an advanced minimally invasive procedure to cut the sphincter muscle in the pylorus, have recently shown promise by improving gastric emptying for patients.  The Aadam team intends to examine whether patients who improve with transpyloric stenting, which provides temporary relief, will also demonstrate improvement with G-POEM, which can provide a more durable, long-lasting solution. Northwestern is one of the few centers in the nation performing G-POEM and has one of the highest volumes for both advanced endoscopic therapies. This study offers great potential for significantly impacting this patient...

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...