Principal Investigator: Lisa B. VanWagner, MD The portal vein carries blood from digestive organs to the liver. Portal hypertension occurs when pressure increases within this vein due to blockage in blood flow through the liver. Cirrhosis, or scarring, of the liver is the most common cause. This condition often results in fluid build-up in the abdomen and bleeding from veins in the esophagus that can impair quality of life and even lead to death due to intestinal bleeding or infection. An artificial shunt procedure known as TIPS (transjugular intrahepatic portosystemic shunt) helps reduce portal hypertension. It works by connecting two veins: the portal vein that carries blood from the digestive organs to the liver and the hepatic vein that carries blood from the liver to the right part of the heart. While the lifesaving procedure may cause heart failure in some patients because of increased blood flow directly to the heart, others experience improvement in heart function. However, predicting outcomes for these patients is currently unknown. Dr. VanWagner’s study aims to better understand changes in heart function after a TIPS procedure to better intervene and prevent heart failure in these at-risk...
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...
Principal Investigator: Nikhilesh Mazumder, MD, MPH Severe damage to the liver can profoundly affect a variety of body systems. Patients with cirrhosis suffer from excess fluid in the legs, abdomen, and chest. Medications can reduce fluid buildup but dosing is not an exact science. Inaccurate dosing can harm the kidneys, cause confusion, and even land patients in the hospital. To avoid these complications, clinicians rely on a multitude of blood and imaging tests that often require expensive equipment, drawing blood, or specially trained staff. Dr. Mazumder’s team seeks to simplify the process by testing the benefit of a decades-old technique called the Valsalva maneuver in combination with a finger photoplethysmography device (similar to a noninvasive bedside pulse oximeter). Patients hold their breath for 10 seconds, and the device measures changes in blood flow to the finger. Safely and successfully tested in individuals with heart problems to predict levels of fluid overload, the...
Principal Investigator: Richard M. Green, MD A chronic bile duct and liver disease, Primary Sclerosing Cholangitis (PSC) affects more than 50,000 Americans and can progress to cirrhosis, liver failure, and bile duct cancer. Currently, the only effective therapy is liver transplantation. Better understanding the pathogenesis of PSC is urgently needed to develop new therapies. In recent cell culture and animal studies, Dr. Green and his colleagues focused on a protective cell signaling pathway: the unfolded protein response (UPR). They found that the UPR is activated when bile flow is impaired, and mice lacking UPR genes in their liver are highly susceptible to injury from bile duct obstruction. Now moving forward with the first human investigations examining UPR, Dr. Green aims to determine how it is activated in the bile ducts of patients with PSC. The team plans to study bile duct tissues obtained during endoscopic procedures performed for bile duct obstruction. The identification of “protective” genes and proteins could lead to new drug targets and, ultimately, the development of novel medical...
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...
