Principal Investigator: Mary Rinella, MD The most common cause of liver injury in the United States, non-alcoholic fatty liver disease (NAFLD) occurs when extra fat builds up in liver cells. A serious offshoot of NAFLD, nonalcoholic steatohepatitis (NASH) can cause the liver to become inflamed. Those who develop NASH often require a liver transplant. Even after liver transplant, these patients face an uphill battle. They remain at particularly high risk of NASH recurrence, which can lead to graft failure and even death. Currently painful and invasive needle biopsies are the only way to diagnose and stage NASH. As NASH reoccurs, byproducts of the disease process appear in the blood that may provide important clues to disease progression. Supported by a grant from the Digestive Health Foundation, Mary Rinella, MD, a gastroenterology and hepatology faculty member and her co-investigators hope to develop a blood-based alternative by identifying biomarkers that can accurately indicate the onset or recurrence of NASH. The investigators will focus on patients who have undergone liver transplantation at Northwestern Memorial Hospital from 1987 to present. Their pilot study will look at participants from the “Mini-Liver” cohort: patients who have had liver biopsy after transplantation, several of whom have recurrent NASH. Plasma samples are collected from all patients in this group and immediately stored at the time of biopsy for future reference and research studies. Dr. Rinella’s study will involve the use of a validated blood serum-based biomarker panel test (OWLiver assay) that has shown great promise in diagnosing NASH in the non-transplant setting to test the existing biobanked plasma samples. The researchers will also review clinical data drawn...
Principal Investigator: Shireen Ahmad, MD More than 300 patients undergo bowel surgery every year at Northwestern Memorial Hospital for a variety of digestive diseases. Understandably, a chief concern is adequate pain relief. Most patients usually receive narcotic pain medications. While good for controlling pain, they come with a host of side effects ranging from nausea and constipation to sleepiness and confusion. Beginning in September 2016, Northwestern Memorial offered another option as part of a pilot program: intravenously-injected lidocaine. A numbing agent, it also provides pain relief but without the adverse side effects of narcotics. Additionally, lidocaine decreases inflammation and speeds recovery of bowel function after surgery. While many patients benefited from the lidocaine given at doses recommended by experts at other medical centers, a small number experienced side effects that required immediate cessation of the drug. Their metabolism of the pain reliever may have resulted in higher than expected (and higher than potentially safe) levels of lidocaine in the blood stream. Funded by a Digestive Health Foundation grant, a research team led by Shireen Ahmad, MD, an anesthesiology faculty member at Northwestern Medicine, will study blood levels of lidocaine in 40 patients at various times while they are receiving the medication. The aim is to identify predisposing characteristics that put certain patients at risk for lidocaine-induced side effects to better individualize the dosing, safety and effectiveness of the drug. A clearer understanding of the pharmacokinetics of the drug lidocaine will help to maximize its pain-killing properties while minimizing adverse side effects of this promising alternative to narcotics for pain...
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...
Principal Investigator: Emanuelle Araujo Lima Bellaguarda, MD The drug infliximab (Remicade) offers relief to millions of people with Crohn’s disease and ulcerative colitis. Yet, which dose is the best dose for effectively treating disease? The same dose does not work for all to prevent flare ups and improve quality of life. And how best to calibrate the dosage before the drug loses it efficacy and patients begin to experience the debilitating symptoms of their inflammatory bowel disease? Checking Remicade levels and adjusting the dosage after patients become unresponsive to the drug is already too late. Timing between infusions also becomes critical for modifying the dosage. Checking at the end of a dosage cycle doesn’t allow adequate time to adjust for the next infusion dose since it takes one week to turn around test results. Better personalizing the use of infliximab, Emanuelle Araujo Lima Bellaguarda, MD, a gastroenterology faculty member at Northwestern Medicine and her research team have designed a study to monitor and adjust dosing of the medication. In particular, they are interested in two key times during the therapeutic infusion timeline. The investigators hypothesize that adjusting infliximab at trough levels (the amount of drug present in the body at its lowest therapeutic concentration before the next dose) at weeks 12 and 28 may improve rates of sustained remission. This proactive screening approach has the potential to fully optimize the therapeutic effectiveness of infliximab for each and every patient. A study of this nature will require dedicated logistical coordination. Funding from the Digestive Health Foundation will support a study coordinator to manage patient enrollment, monitoring and outcomes during the...
