GI

How Should You Approach a Patient Co-infected with HIV and Hepatitis C?

June 11, 2009
How Should You Approach a Patient Co-infected with HIV and Hepatitis C?

Uzma Sarwar MD

Faculty Peer Reviewed

With advancement in therapy, life expectancy has significantly increased among HIV-infected patients, and patients are now more likely to succumb to chronic disease processes. At present, approximately one third of deaths in HIV patients are related to liver disease, which has become the leading cause of death amongst HIV patients. The risk of death from liver disease in HIV patients is inversely related to their CD4 count. Infection with hepatitis C virus (HCV) accounts…

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Should we treat asymptomatic autoimmune hepatitis?

April 30, 2009
Should we treat asymptomatic autoimmune hepatitis?

Bani Chander MD

Faculty Peer Reviewed

Autoimmune hepatitis (AIH) is a progressive, inflammatory disease of the liver of unknown etiology and may progress to cirrhosis. While it is does have a predilection for women, this disease entity crosses genders and ethnic groups, and may occur in both adults and children. AIH is characterized by a fluctuating course and is often associated with autoimmune features including hypergammaglobulinemia, circulating serum autoantibodies, and hepatitis with lymphoplasmacytic infiltration on liver biopsy . Autoimmune…

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Grand Rounds: Gastroesophageal Reflux Disease (GERD)

April 15, 2009
Grand Rounds: Gastroesophageal Reflux Disease (GERD)

Summary by Daniel Frenkel MD

Please also see the clinical vignette presented before grand rounds on the 1st of April.

In his grand rounds lecture on April 1st 2009, Dr. Fritz Francois enlightened us to some novel aspects of gastroesophageal reflux disease (GERD). Despite simple and effective treatment approaches such as acid suppression medication, Dr. Francois explored “why the issues are still burning?” by discussing the changing face of GERD, the connection to obesity, and it’s association with Helicobacter Pylori.…

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Grand Rounds: Purines, Alcohol, and Fatty Liver Disease

April 8, 2009
Grand Rounds: Purines, Alcohol, and Fatty Liver Disease

Commentary by Peter Shue MD, PGY-3

The medical grand rounds presentation on March 4, 2009 was delivered by a distinguished NYU faculty member and research investigator, Dr. Bruce Cronstein.  Although his training and research is primarily in rheumatology, he breathed new insight into mechanisms of fatty liver disease.  In his talk, he reviewed his own published experiments showing that fatty liver disease, similar to gout, is potentiated by elevations in adenosine. …

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Morning Report: Hepatorenal Syndrome

February 19, 2009
Morning Report: Hepatorenal Syndrome

Commentary by Catherine Lucero MD, PGY-3

Faculty Peer Reviewed

The patient is a 69-year old woman from El Salvador with a chief complaint of worsening abdominal distension for nine months. Three months earlier, the patient was told she had liver problems and was started on diuretics. Prior to presentation, the patient states that she stopped taking her medication and noticed increasing lower extremity edema and abdominal girth, as well as an unintentional 15-pound weight loss. The patient denied any other medical problems, including fever, chills,…

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Analgesia for Cirrhotics: A Practical Approach

November 20, 2008
Analgesia for Cirrhotics:  A Practical Approach

Commentary by Albert B. Knapp MD, NYU Clinical Professor of Medicine (Gastroenterology)

THE CASE:
WS, a 49 yo year old Caucasian male with a known 35 year history of alcohol abuse, now presents with jaundice, tense ascites and a left shoulder fracture following a bar room brawl last night. He is admitted to the orthopedic service for elective pinning but is presently in great pain. You are consulted in regards to pain management….

THE QUESTION:
How should you approach the use…

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How Do You Approach a Patient with Arthritis and Hepatitis C?

August 7, 2008
How Do You Approach a Patient with Arthritis and Hepatitis C?

Commentary by Peter Izmirly MD, NYU Division of Rheumatology

A 54 year old male with a past medical history significant for hepatitis C genotype 1a s/p ifn/ribavarin 2003-2004 with HCV Qual negative in 2005 presents with 3 weeks of bilateral wrist pain. The pain is worst with extension. His exam is notable for diffuse tenderness when pressure is applied to his wrists. He has no obvious swelling, erythema, deformity or subcutaneous nodules. The remainder of his musculoskeletal exam in unremarkable. In addition, he has no stigmata of cirrhosis. Labs…

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Dietary Issues after Bariatric Surgery

July 18, 2008
Dietary Issues after Bariatric Surgery

Commentary by Melissa Freeman MD, Endocrinology Section Editor

A new outpatient Bariatric Surgery Clinic recently opened at Bellevue Hospital Center. This clinic offers laparoscopic adjustable gastric banding to patients 18 years of age or older who meet specific BMI and medical criteria. This life-altering surgery is now covered by Medicaid and those who are uninsured can work with financial counselors to obtain funding through special HHC programs. While the surgeons diligently educate their patients on their dietary transitions and requirements after surgery, primary care physicians,…

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Should H. pylori Eradication Be Confirmed?

June 12, 2008
Should H. pylori Eradication Be Confirmed?

Commentary by Fritz Francois, MD, MS, NYU Division of Gastroenterology

Humans are essentially the only reservoir for Helicobacter pylori, which is estimated to colonize the stomach of about half the world’s population (1). Although the bacteria generally do not invade the mucosa, attachment to the epithelium leads to an inflammatory reaction with neutrophils, lymphocytes, plasma cells, and macrophages. Over time, the persistent inflammation leads to changes in the gastric mucosa that may predispose to the development of dysplasia(2).

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Class Act: Is there clinical evidence for use of probiotics in the treatment of IBS?

March 12, 2008
Class Act: Is there clinical evidence for use of probiotics in the treatment of IBS?

Class act is a feature of Clinical Correlations written by NYU 3rd and 4th year medical students. These posts focus on evidenced based answers to clinical questions related to patients seen by our students in the clinics or on the wards. Prior to publication, each commentary is thoroughly reviewed for content by a faculty member.

Commentary by Alexander Jow, MSIII

Irritable bowel syndrome (IBS) is a poorly understood disorder, commonly encountered in clinical practice; IBS accounts for more than one-third of…

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Meeting Perspectives: American Association for the Study of Liver Diseases

February 27, 2008
Meeting Perspectives: American Association for the Study of Liver Diseases

Last November, thousands of eager hepatologists descended on Boston to attend the AASLD Liver Meeting. While there was an enormous amount of hepatology information presented, one intrepid GI fellow, Ponni Perumalswami MD, has compiled a few of the most interesting presentations.

In a late-breaking abstract, major results were presented by Dr. Di Bisceglie from the HALT-C trial. This study is designed to examine the effect of prolonged antiviral therapy with peginterferon in prevention of the complications of advanced liver disease associated with hepatitis C. This has…

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Treatment of obesity with bariatric surgery: evidence and implications

November 15, 2007
Treatment of obesity with bariatric surgery: evidence and implications

Commentary by Jatin Roper MD PGY-3 and Christine Ren MD Associate Professor, Department of Surgery

Bariatric procedures to treat obesity involve the restriction of the gastric reservoir, bypass of part of the gastrointestinal tract, or both. Worldwide, an estimated 300 million people are obese, and in the United States, the percentage of adults who are obese increased from 15% in 1995 to 24% in 2005. (Obesity is defined as a Body Mass Index or BMI of 30 or more, measured as kg /…

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