7^th Global Congress on Gastroenterology & Endoscopy September 12-14, 2016 Atlanta, Georgia, USA

Biography:

Amanda J Brisebois is an Internal Medicine and Palliative Care Specialist from Edmonton, Alberta, Canada. She has been practicing for 17 years, and has been focusing on the Integration of Palliative Care Principles in care of patients with chronic illness for the past 5 years. She is the current Facility Chief of Medicine at the Grey Nuns Hospital and also an Associate Clinical Professor at the University of Alberta. She has won numerous teaching awards, as well as grants to undertake her current work.

Abstract:

Background & Aim: Efforts are being focused on integrating palliative principles at the earlier stages of disease, and to create outpatient programs to focus on this type of integrated care.

Methods: To serve patients with cirrhosis, a non-cancer outpatient Palliative Care Clinic was formed and referral criteria were developed to make an attempt to capture patients in the last 6 months of life. ESAS-r (Edmonton system assessment scale) was attained for all the patients at each clinic visit. Data regarding their medication changes, goals of care, and stage of their disease, ER visits and hospitalizations were also recorded.

Results: In the outpatient clinic during 2013-2015, significant symptoms (score of 4 or more/10) were as follows: 70% pain, 90% fatigue, 60% drowsiness, 70% lack of appetite, 60% nausea, 40% shortness of breath, 30% depression and 40% anxiety. Patients had both compensated and de-compensated disease. KPS (Karnofsky Performance Status) average was over 60%, however, the death rate (30%) was high.

Conclusions: Analysis of the complete patient data for the initial 35 cirrhosis patients of the PPRISM clinic will be presented including information regarding referral success for various patient populations, symptom burden, goals of care documentation and follow up needs in this patient population. This study will guide future outpatient clinics by enhancing goals of care and advance care planning integration, patient and family involvement in health, and symptom care protocols for patients living with cirrhosis. A more detailed look at this data may also help future clinics to decide interdisciplinary needs of outpatients living with chronic illness.

Biography:

Kristie Briggs has received her ADN from Motlow State Community in Tullahoma, TN in 1999 and BSN from Middle Tennessee State University in Murfreesboro, TN in 2007. She is currently the Manager of Clinical Education for Erbe USA Inc., USA. She has worked as an Infection Control Coordinator and Chief Nursing Officer. She had published several continuing education booklets on Electrosurgery. She has provided many lectures to local/regional SGNA meetings around the country and also presented at the National SGNA.

Abstract:

Argon Plasma Coagulation™ (APC™) has been used in therapeutic interventional endoscopy since its introduction in 1992. In recent years, the range of clinical uses in endoscopy has expanded primarily due to the development of specialized modes and better techniques. APC can now offer individualized treatment options when combined with proper technique, enhancing desired tissue effects and optimize clinical outcomes. The history, advancements and where we are now; and the clinical benefits of APC in comparison to conventional electrosurgery will also be discussed. Clinical variables and safety considerations will also be covered along with APC’s ever-expanding role in therapeutic endoscopy.

Biography:

Sudha Kodali did her residency in Texas and her Fellowship at UAB in Gastroenterology and Hepatology. She is currently working as an Assistant Professor at UAB. She treats patients with liver diseases and her research interests include fatty liver, hepatitis C and granulomatous liver disease.  

Abstract:

We describe a young female with disseminated sarcoidosis presenting with refractory ascites. Sarcoidosis is a multisystem disease characterized by non-caseating granulomas of the liver and various other organs. Lungs are the most commonly involved organ systems. In about 70% patients, hepatic involvement can be seen, though only 10-30% of those actually have abnormal liver chemistry. Right upper quadrant pain, fatigue, jaundice and pruritis are the common presenting symptoms. Long standing complications include cirrhosis and sequelae of portal hypertension. Ascites can be secondary to cirrhosis/portal hypertension or cardiac/pulmonary hypertension. Peritoneal involvement can also lead to ascites even if liver is not involved. Liver biopsy shows non-caseating granulomas and imaging in the right clinical setting shows hepatosplenomegaly, low attenuation lesions in the liver and spleen. Differential diagnosis includes fungal infections (histoplasma, Mycobacterium), granulomatous liver disease (PBC (Primary Biliary Cirrhosis), PSC (Primary Sclerosing Cholangitis), malignancy. As most of the patients are asymptomatic, treatment is not needed in many. For the ones who need therapy, 1^st line agents are steroids and ursodiol. Itching can be disabling and the most challenging symptom to treat. In advanced liver disease, liver transplant may need to be considered. 0.0012% of all transplants in the USA are for sarcoidosis of the liver. Mortality rates have been reported between 1 to 5% usually from pulmonary, cardiac or CNS involvement.

Biography:

Dr.Vikas Leelavati Balasaheb Jadhav has completed Postgraduation in Radiology in 1994. He has a 19 Years of experience in the field of Gastro-Intestinal Tract Ultrasound & Diagnostic as well Therapeutic Interventional Sonography. He has four Indian Patents & an International Patent published on his name in the field of Gastro-Intestinal Tract Sonography & the Radiology, since 2008. He has delivered many Guest Lectures in Indian as well International Conferences in nearly 20 countries as an Invited Guest Faculty, since 2000. He is a Consultant Radiologist & the Specialist in Unconventional Gastro-Intestinal Tract Ultrasound & Diagnostic as well Therapeutic Interventional Sonologist in Pune, India.

Abstract:

TransAbdominal Sonography of the Stomach & Duodenum can reveal following diseases. Gastritis & Duodenitis. Acid Gastritis. An Ulcer, whether it is superficial, deep with risk of impending perforation, Perforated, Sealed perforation, Chronic Ulcer & Post-Healing fibrosis & stricture. Polyps & Diverticulum. Benign intra-mural tumours. Intra-mural haematoma. Duodenal outlet obstruction due to Annular Pancreas. Gastro-Duodenal Ascariasis. Pancreatic or Biliary Stents. Foreign Body. Necrotizing Gastro-Duodenitis. Tuberculosis. Lesions of Ampulla of Vater like prolapsed, benign & infiltrating mass lesions. Neoplastic lesion is usually a segment involvement, & shows irregularly thickened, hypoechoic & aperistaltic wall with loss of normal layering pattern. It is usually a solitary stricture & has eccentric irregular luminal narrowing. It shows loss of normal Gut Signature. Enlargement of the involved segment seen. Shouldering effect at the ends of stricture is most common feature. Enlarged lymphnodes around may be seen. Primary arising from wall itself & secondary are invasion from peri-Ampullary malignancy or distant metastasis. All these cases are compared & proved with gold standards like surgery & endoscopy.

Some extra efforts taken during all routine or emergent ultrasonography examinations can be an effective non-invasive method to diagnose primarily hitherto unsuspected benign & malignant Gastro-Intestinal Tract lesions, so should be the investigation of choice.

Biography:

Inga Peter has completed her PhD in Genetic Epidemiology from Tel Aviv University, Israel and Post-doctoral studies from Tufts University, Boston. She is an Associate Professor in the Department of Genetics and Genomic Sciences at the Icahn School of Medicine at Mount Sinai, New York. She has published over 100 papers in reputed journals and served as a Reviewer on numerous panels. She has significantly contributed to the field of IBD by establishing a large bio-bank of IBD patients with over 4,000 DNA, tissue and stool samples linked to extensive clinical data and by leading numerous genetic and microbiome studies.

Abstract:

Crohn’s disease (CD) and ulcerative colitis are inflammatory conditions, collectively referred to as inflammatory bowel disease (IBD), which results from defects in the regulation of mucosal immune responses to enteric bacteria in genetically susceptible individuals. Multiple lines of evidence suggest a genetic contribution to the pathogenesis of IBD, which include racial and ethnic differences in disease prevalence, familial aggregation and link to other genetic syndromes. Recent genome-wide association studies (GWAS) have identified >200 genetic variants associated with IBD risk, some of which have functions in biological pathways of pathogen recognition, internalization and autophagy. However, GWAS-identified loci have explained less than a quarter of the heritability estimated for IBD and many are confined to noncoding regions, requiring further studies to understand their role in disease pathogenesis. Recently, next generation sequencing efforts, most successful in isolated populations and individuals with early age of onset and/or significant family history of IBD, identified rare coding variants associated with IBD risk that are more amenable to functional studies than GWAS loci. Also, a number of genetic variants have been linked to adverse events resulting from IBD therapies, particularly thiopurine exposure, including bone marrow toxicity and pancreatitis. Yet, despite substantial progress in the field of genetics and genomics of IBD, reliable tools to identify individuals at risk, determine disease progression and predict response to therapies are still lacking. More comprehensive approaches that incorporate clinical, genetic, epigenetic, metabolomic, and microbiome data need to be developed to allow for an early diagnosis and personalized treatment for IBD.

Biography:

Senior Consultant at Med. II Horst Schmidt Klinik Wiesbaden. Obtained PhD during 01/2012  Habilitation in the field of diagnostic methods of gastrointestinal endoscopy at University of Mainz.

Abstract:

Today there is a paradigm shift in modern gastrointestinal endoscopy, whereby the aim of modern endoscopy is to identify premalignant conditions and early neoplastic changes, in order to make a therapeutical impact on their natural history.

Computer chip and endoscopic image enhancement technologies provide opportunities to visualize normal and abnormal tissues within the gastrointestinal tract, supplying clinicians with information that complements conventional white-light endoscopy. This is important due to the fact, that the prognosis of patients with malignancies in the gastrointestinal tract is strictly dependent on early detection of premalignant and malignant lesions. Equipped with this information, endoscopists can obtain today in vivo optical diagnosis of lesion histology at the time of the endoscopic procedure to help to identify subtle mucosal and structural changes that harbour precancerous cells.

Based on that fact also the development of new and effective endoscopic therapies means that neoplastic lesions can now be treated with improved patient outcomes.

Looking on the available imaging modalities, each with implications on cost, training and lesion detection, we describe in this review the scientific rationale behind the major commercially available techniques as well as offering a glimpse at possible future directions.

Biography:

Milagros Pichardo, MD finished her medical training in 2009 from Universidad Nacional Pedro Henriquez Urena. Currently she is in her second year of Internal Medicine Program at Damas Hospital in Ponce, PR, USA.

Abstract:

Amyloidois is the term for a group of protein folding disorders characterized by the extracellular deposition of insoluble polymeric protein fibrils in tissues and organs. Amyloidosis is commonly systemic, occasionally organ-limited, and rarely a solitary localized mass. This latter presentation is commonly referred to as tumoral amyloidosis. Although reports exists of these often called “amyloidomas” showing up in almost every tissue/organ, the GI tract has a prevalence that is not well document making it an outstanding diagnostic challenge. A 66 year-old male with a history of IV drug abuse, comes to our hospital to be evaluated due to diarrhea that started 2 months ago; 3-5 depositions a day, watery in consistency no blood or mucus, associated with epigastric abdominal pain described as “burning” in nature, 7/10 intensity without radiation and a 50 pound weight loss. Denied fever, chills, shortness of breath, nausea or vomiting; symptoms were non consistently worsened with food ingestion and did not improve with OTCmedication for diarrhea. PMH was significant for HCV diagnosed 1 month ago. On physical exam the abdomen showed a prominent liver edge 5cm below the costal margin non tender, non-distended without ascites. Laboratory work-up upon admission showed metabolic acidosis, acute kidney injury, no electrolyte disturbances and an elevated TSH. Esophagogastroduodenoscopy (EGD) done the day after admission showed an esophagus that was normal and a friable mass in the antrum of the stomach that bled on contact, cold forceps biopsy was taken. A colonoscopy was also performed, with unremarkable findings; random biopsies taken. Pathology reports a tissue that on red Congo stain has apple-green birefringence indicative of amyloid fibrils in both colonic and gastric samples. The deposition of amyloid fibrils in other organs were sought out with negative results; thus giving the impression of single system involvement. Gastrointestinal amyloidosis causes severe malabsorption due to the deposition of the protein fibrils, explaining the patient’s chronic diarrhea and significant weight loss.  Since patient’s malabsorption caused wasting and malnourishment, total parenteral nutrition was indicated while the patient received chemotherapy for the treatment of amyloidosis. This case illustrates that there is an important risk of misunderstanding and diagnosis delay of patients that present with malabsorption. Even if the clinical symptoms are not obvious upon initial presentation, the hypothesis of gastrointestinal amyloidosis should be considered among the possible diagnosis of patients with chronic diarrhea and weight loss. In doing so, quality of life as well as morbidity improvement should be evident

Biography:

Will be updated soon

Abstract:

Intestinal carcinoid tumors are uncommon malignancies which grow slowly, and rarely cause any symptoms. Small bowel tumors can, at times, cause bowel obstruction and rarely bleeding. We present to you a 52 year old male who presented to the hospital for evaluation of melena. His endoscopy and colonoscopy came back negative and patient unfortunately, failed to get capsule endoscopy as an outpatient. One year later, patient presented with excruciating abdominal pain and was found to have small bowel obstruction with multiple transition points. Patient was found to have 4 nodular lesions in the small intestine which were found to be carcinoid tumor. Surgical resection definitely improved his outcome and patient did not need adjuvant therapy post-surgery. This patient was a diagnostic challenge due unusual presentation and negative CT scan imaging during both presentations. Carcinoid tumors are highly infiltrating tumors hence, high degree of suspicion should be kept for earlier detection and better outcome.

Biography:

Amanda J Brisebois is an Internal Medicine and Palliative Care Specialist from Edmonton, Alberta, Canada. She has been practicing for 17 years, and has been focusing on the Integration of Palliative Care Principles in care of patients with chronic illness for the past 5 years. She is the current Facility Chief of Medicine at the Grey Nuns Hospital and also an Associate Clinical Professor at the University of Alberta. She has won numerous teaching awards, as well as grants to undertake her current work.

Abstract:

Introduction & Aim: Patients with chronic illness often have chronic pain. In Edmonton, a non-cancer palliative care clinic has been instituted since 2013 in order to address symptom management in cirrhosis patients in the last years of life. Of the 40 patients seen to date, over 65% of them have had significant pain issues (pain scores of over 4 on a 10 point scale). Many of these patients were initiated on pharmacologic pain management, based on current pain management regimens in the literature. Through evaluation of success of treatment (defined as a decrease of 2 points on the 10 point scale), it was determined that many patients did not respond well to medical therapy, due to a variety of reasons. Within the clinic, mindfulness principles were encouraged through mobile technology, internet based and local mindfulness resources.

Methods: A total of 15 patients, representing ~10% of eligible patients approached and were enrolled with consent. Patient inclusion criteria were: Cirrhosis diagnosis; adults (≥18 years of age); significant symptom burden as per the Edmonton Symptom Assessment Scale (ESAS, score of ≥4 out of 10); and absence of uncontrolled hepatic encephalopathy, psychosis and bipolar disorder or suicidal intent. The online intervention were delivered by eMindful Inc. for over 3 weeks consisting of a live trainer providing video instruction (2 hrs/wk) complemented by daily individual practice (45 min/d).

Results: Data presented as results included: Stage of liver disease, medications and symptom burden. Adherence, completion and success of the MBSR program were discussed.

Biography:

Chi-Tan Hu has completed his MD from Taipei Medical University, Taipei, Taiwan and PhD from Cambridge University, UK. He has done his Postdoctoral studies from National Institute of Health, Bethesda, Maryland, USA. He is the Chief of Department of Gastroenterology, Buddhist Tzu Chi Hospital, Hualien, Taiwan. His research interests are on Transnasal Endoscopy, Helicobacter pylori, Irritable Bowel Syndrome and Hepatocellular Carcinoma. He has published more than 100 papers in the international journals.

Abstract:

An ultrathin endoscope was initially developed in the 1970s for the use in pediatric patients. In recent years, unsedated transnasal esophagogastroduodenoscopy (UT-EGD) has been used for diagnostic and therapeutic purposes such as percutaneous endoscopic gastrostomy, enteral tube placement, nasobiliary tube drainage and polypectomy. The satisfactory safety and tolerance profiles make UT-EGD an alternative to peroral conventional EGD with or without sedation. There is a trend toward performing transnasal laryngoscopy, transnasal esophagoscopy (especially for screening Barrett's esophagus) and UT-EGD in the office. However, many techniques related to UT-EGD are not standardized. Professor Hu proposed reporting the how, where, and grading of nasomucosal injury (grade 0, 1, 2 and 3) after transnasal endoscopy. He demonstrated that an endoscopic-guided method (EGNA) is better than the cotton-tippled applicator method (CTNA) of nasal anesthesia. Further, he revealed a cotton-tipped applicator primed gauze pledgetting (CTGP) method is more effective than EGNA. CTGP, which only needs a 5-min procedure, has achieved a painless nasal insertion and exertion. He has recently introduced anterior meatuscopy coupled with an endoscopic meatus scoring system (EMSS, grade 0, I, II and III), replacing sniff test to select an optimal meatus insertion route before UT-EGD. Documenting a meatus score is important because it may be correlated with the severity of nasomucosal injury and bleeding. In addition to the novel nasal anesthetic methodology, the techniques of endoscopic insertions from the anterior to posterior nasal cavities, nasopharynx to oropharynx, and hypopharynx to the esophagus will be demonstrated. He will also introduce techniques to avoid nasal bleeding and gag reflex.

Biography:

Guo-ming Shen is a Doctoral Supervisor and the Dean of the Graduate School of Anhui University of Chinese Medicine in China. He has published more than 50 papers in reputed journals and has been serving as Editorial Board Member of several medical magazines.          

Abstract:

Acupuncture at gastric Back-Shu and Front-Mu points has a regulating effect on gastric motility. According to the theory of traditional Chinese medicine, Front-Mu points located on the abdomen and Back-Shu points located on the back. The application of acupuncture at a combination of Back-Shu and Front-Mu points, which is based on the theory of Yin and Yang and the pathway of Qi, has synergistic effect and good clinical effectiveness. It has been demonstrated that the combination of gastric Front-Mu and Back-Shu point is effective for the regulation of motility in clinical practice. However, studies on the regulation mechanism underlying those phenomenons have been focused at the level of the spinal cord. Advances in the studies of Back-Shu and Front-Mu point combination focused on whether the superior nerve center involved in the regulation of zang-fu organs by this combinational acupuncture. In order to confirm whether this convergent effect could extend to the superior nerve center, we suggest a targeted convergence hypothesis: Gastric Shu and Mu point acupuncture signals gather not only in the spinal cord but also in a targeted way in the brain stem and hypothalamus in the higher central nervous system, achieving an integrative effect through the neural microcircuitry. Our previous studies found that gastric Shu and Mu may afferent signals primarily convey acupuncture input signals to different levels of the central nervous system, such as the spinal cord, medulla, brain stem, hypothalamus and sub-cortex. For the development of neuroimaging technique and brain science, we intend to investigate the neural mechanism of compatibility of gastric Shu and Mu point by fMRI, neural tracing and multi array electrode technique. It may also provide new ideas for research on compatibility of Back-Shu and Front-Mu points and the mechanism of central integration. 

Biography:

Sonia Shahid is a final year M.B.B.S student of Karachi Medical and Dental College, Karachi Pakistan. She has been a part of several national and international
researches and many are ongoing. She has attended several national and international seminars and conferences. She has good knowledge of clinical practices
and protocols in variety of settings. Sonia is an inquisitive student with a passion for education as a power for change and improvement in the healthcare field of
her country and is very ambitious in pursuing her career.

Abstract:

Objective: To determine the frequency of H.pylori infection causing gastritis and peptic ulcers in children and complications
related to it.
Introduction: Helicobacter pylori is a gramnegative, spiral organism that colonizes the gastric mucosa and causes primary antral gastritis and peptic ulcer disease. Helicobacter pylori infection is a common problem in pediatric practice, and its acquisition is related with poor socioeconomic conditions. The possible routes of transmission are feco–oral, oral–oral and gastro–oral. H. pylori causes chronic inflammation ( gastritis) by invading the lining of the stomach and thus can lead to ulcer formation. When the infection leads to an ulcer, symptoms may include abdominal pain, excessive burping, feeling bloated, nausea or vomiting, lack of appetite and unexplained weight loss. H. pylori infections can lead to peptic ulcers, but the infection or the ulcer itself can lead to more serious complications these include; interna bleeding, which can happen when a
peptic ulcer breaks through your blood vessel; obstruction, which can happen when an ulcer blocks the food from leaving your stomach;perforation, which can happen when an ulcer breaks through your stomach wall and peritonitis, which is an infection of the peritoneum, or the lining of the abdominal cavity
Methodology: This cross‐sectional study was conducted from July 2014 ‐ July 2016. Pediatric patients under 12 years of age were recruited in this study. A history and examination form designed from an application “Forms”,particularly for the study. Children were examined and endoscopic biopsy was done to find out the extent of infection. For data analysis SPSS 16.0
software was used.

Results: Out of 489 subjects, mainly mucosal erosions were revealed at endoscopy in 361 subjects (73.82%). Gastritis was found
in 272 subjects (75.3%), of whom 266 (54.4% of the total) were found to be infected with H. pylori. Gastritis and H. pylori
were noted in both the antrum and corpus in 75% of those infected children. In complications, internal bleeding was found in
35.67% children, obstruction in 21.45%, perforation in 19.7% and peritonitis in 23.18% Stepwise logistic regression analysis
revealed that the relative risk for H. pylori infection associated with gastritis was 5.8 (95% confidence interval), whereas the
relative risk for peptic ulcer was 6.5 (95% confidence interval).
Conclusion: The main predisposing factors identified in these studies were low socioeconomic status and poor hygiene. The
results may explain why the rate of infection is so high in poorer countries and in socioeconomic
groups characterized by
crowded living conditions, poor sanitary conditions, and lack of clean water.Endoscopy also allows determination of the
severity of gastritis with biopsies as well as the presence of ulcers.

Biography:

David Bamshad recieved his MD from St. Georges University School of Medicine. He has also completed a Master’s in Science. He is currently a resident of Internal Medicine at Brookdale University Medical Center in Brooklyn, NY. He has presented his work at major national conferences across the United States. His main academic focus is on health disparities and patient advocacy in medicine.
 

Abstract:

The United States Preventive Services Task Force  (USPSTF) recommends a screening colonoscopy for all average risk patients aged 50-75. Nonetheless, it remains the second leading cause of death related to cancer in the United States, and the third most common type of cancer overall. These statistics are represented disproportionately, as minority populations maintain a greater degree of incidence and mortality. A retrospective review at a major inner city teaching hospital was performed. Average risk first time screening colonoscopies over a 2-month period were analyzed. 122 charts were identified. Ages of males to females and African Americans (AA’s) were compared to Non-AA’s. In addition, the percentage of patients that underwent a screening colonoscopy only once experiencing gastrointestinal related symptoms was analyzed. The average first time screening age for average risk AA’s (n =70) was 59.34. Non-AA’s (n=25) had an average age of 59.76. The average male (n=42) was 59.86 while the average female (n=53)  was aged 59.38.  The percentage of patients that only underwent a colonoscopy once symptomatic was 22.13% (n = 27). Disparities between the USPSTF screening recommendations and the observed age among patients in an inner city hospital were identified . It illustrates the number of patients that only underwent a screening colonoscopy once they had gastrointestinal complaints. It questions the presence of cancer prevention conversations between physicians and patients in an inner city community, and emphasizes the staggering number of patients that are brought into the fold of screening behaviors either late altogether or because of incidental symptoms.

Biography:

Saif Khan has completed his BSc from the University of Bradford and is currently, a 4th year Medical student at the University of Glasgow. He has a keen interest
in Gastroenterology and has completed multiple projects in this subject. He has published many papers in reputed journals in collaboration with others. He also has
an interest in Imaging and is currently undertaking a project on MRCPs.

Abstract:

Aim: ERCP brush cytology is an established technique for diagnosing pancreato-biliary malignancies. However, its accuracy
remains modest with nearly half of malignancies missed. There is a lack of research assessing factors associated with negative
brush cytology results. The aim of our study is to analyze factors associated with negative brush cytology samples and their
ability to differentiate between malignant and benign samples.
Method: Data from all consecutive patients who had ERCP brush cytology in NHS Lanarkshire between January 2006 and
December 2015 was retrospectively collected and analyzed. 217 out of 232 patients were included in the final study; their
cytology, radiology and ERCP reports were analyzed. Age, ALT, ALP, bilirubin, CEA and CA 19-9 levels along with presence of
mass on imaging, mass size, stricture length and location were the factors assessed. Factors highlighted by univariate analysis
were further analyzed by binary logistic regression analysis.
Results: 138 patients had a malignancy of which 77 had a positive brush cytology sample (sensitivity: 55.8% and specificity:
97.5%). 138 patients had a negative sample and the likelihood of a false negative brush cytology increased with an increase in
bilirubin levels {OR 1.005; 95% CI: (1.002-1.008) p=0.001}, ALT levels {OR 1.003; 95% CI: (1.001-1.006) p=0.021} and age {OR
1.045; 95% CI: (1.012-1.079) p=0.01}. Using ROC curves optimal cut-offs for ALT and bilirubin were 84.5 U/L (sensitivity: 70%
and specificity: 70%) and 181.5 umol/L (sensitivity: 73% and specificity: 67%).
Conclusion: Increasing age, bilirubin and ALT levels are independent predictors of malignancy in a negative brush cytology
sample.

Biography:

Wasif Mohammad Ali is currently working as an Assistant Professor at Department of Surgery, J N Medical College, Aligarh Muslim University (AMU), Aligarh, India.

Abstract:

In this presentation, I want to share my 10 years experience of treating giant duodenal perforation (> 2 cm) by the novel technique of triple tube ostomy at our tertiary care centre. The closure of the giant duodenal perforations is still a matter of debate with wide array of options like classical technique of primary closure with and omentopaxy to more complicated ones like gastrojejunostomy with pyloric exclusion. But all these have a high mortality rate particularly in patients presenting with hemodynamic instability and added comorbid condition. We have managed such patients successfully with very low mortality rate using triple tube ostomy technique. This technique is still very unpopular despite good results; therefore the author wants to highlight the utility of this technique by presenting this paper.

Biography:

Chowdhry completed his MBBS from Rajasthan University, India in 2004. He is trained and board certified in Internal Medicine and Gastroenterology. Currently
working as an Assistant Professor at Case Western Reserve University- School of Medicine. He has published multiple papers in reputed Gastroenterogy and
Hepatology journals.

Abstract:

In the last two decades human genome sequence analysis has helped to identify six new members of IL-1 family. IL-36 α,
β, and γ, previously known as IL-1F6, IL-1F8, and IL-1F9 respectively, these ligands bind to a heterodimeric receptor IL-
36 receptor (IL-36R, also known as "IL-1 receptor-related protein 2") and then recruit IL-1R accessory protein (IL-1RAcP)
there by activating NF-kB and mitogen activated protein kinase (MAPK) pathway.(Dinarello et al., 2010, Towne et al., 2004)
Epithelial cells express IL-36 and recent studies suggest important inflammation regulatory role for these novel cytokines
in gut inflammation and psoriasis although there is ambiguity regarding the ability of IL-36 ligands to induce Th1, Th2 or
Th17 immune response (Towne et al., 2004, Ramadas et al., 2012, Johnston et al., 2011). Recent data suggests increased IL-
36α expression in eosinophilic esophagitis and Ulcerative colitis indicating a possible role in Th2 type immune response.
Other reports show IL-36 signaling, induce Th1 polarization of naïve CD4+ T cells (Vigne et al., 2012) and induction of
Th-17 immune response in lung disease and Psoriasis. (Gresnigt et al., 2012, Ramadas et al., 2011) IL-36 Receptor antagonist
(previously IL-1F5) and IL-38 (IL-1F10) also binds to IL-36 R and act as an antagonist for the biological activities of IL-36.
(Towne et al., 2004, van de Veerdonk et al., 2012, Dinarello et al., 2010, Blumberg et al., 2007) IL-37 (IL-1F7) is the newest
member of the IL-1 family with potent anti-inflammatory role in gut and liver. IL-37 is expressed in tonsils, skin, esophagus,
and placenta as well as carcinomas of the breast, prostate, colon, skin and lung. (Kumar et al., 2002) Mice with IL-37 expression
are protected from DSS induced colonic inflammation indicating a potential role in inflammatory bowel disease. (McNamee et
al., 2011). The novel members of IL-1 family are an area of active investigation and we anticipate new data regarding their role
in gut homeostasis and intestinal inflammation in near future, with potential therapeutic implications.

Biography:

Amy  is a  PTSD peer-peer specialist, artist, author, speaker for RAINN, writer for The Huffington Post, award-winning health advocate, actress and playwright.  In 2012, she wrote, directed and starred in a one woman musical about her life, Gutless & Grateful, touring theatres across the country for three years, earning rave reviews and accolades since it’sBroadwayWorld Award-nominated NYC debut.    As an visual artist, her art has won accolades in multiple galleries and in dozens of solo art shows.  Her mixed media creativity workshops emphasize creativity as an essential mindset.

Amy’s “beautiful detour” has inspire her passionate desire to create and help others.  As a health advocate, she's written feature articles for Phoenix Magazine, and has spoken to hundreds of nurses and doctors as the Eastern Regional Recipient of the Great Comebacks Award.  Her Washington Post and On Being with Krista Tippet, and is a regular contributor for numerous publications including Elite Daily, The Mighty, Indie Chicks and Career Girl Daily.  Her story has appeared on the TODAY Show, CBS, Cosmopolitan, Seventeen Magazine, among others.  

Amy's passion for the arts as a means of healing and expression inspired her to devise storytelling workshops for the Transformative Language Arts Network National Conference, the Eating Recovery Center Foundation, and The League for the Advancement of New England Storytelling. 

Determined to bridge the gap of communication between wellness resources on college campuses and students, Amy devised storytelling programs especially for colleges and universities to address the issue and is touring colleges campuses with her program combining mental health advocacy, sexual assault awareness and Broadway Theatre.

For information on keynote presentations, workshops and signature talkbacks, (and specialized versions for corporations, college campuses, survivors, healthcare professionals, and artists) visitamyoes.com. 

Abstract:

In 2005, A mild stomachache led to a total gastrectomy 48 hours later.  In this presentation, I will be serving as my own case study.  How does psychological trauma affect the body and how can it inform both medical and mental health professionals?  At 17 I was sexually abused for eight months, causing severe stress, invoking the “freeze” response in trauma.  Withholding this secret caused severe anxiety and panic attacks.  Two weeks after I finally disclosed my secret, I developed a blood clot on the mesenteric artery leading to gangrene of the intestines.  My stomach literally burst to the ceiling of the OR, both my lungs collapsed, I required 122 units of blood, and I was in a coma for months.  27 surgeries later, and six full years unable to eat or drink, I was reconstructed with the intestines that remained.  How can stress lead to such physical traumas?  How can the mind so dramatically affect the physical body?

Psychological stress has a profound effect on the body and illness.  When stress occurs, the hypothalamus secretes CRH that signals a reaction through a hormone signal pathway.  ACTH is then released, but when this chain of events is turned on repeated in times of high stress like PTSD, the organs can never rest, inducing various physical illnesses and tissues damage.    There is a large effect that this has on the stomach and intestines, causing various digestive problems.  Mental disorders can also be caused when stress quickly activates our system, causing quick alarmed reactions that can lead health damage. As I experienced my abuse and relived it over and over again, the pathway repeated itself relentlessly, and therefore, digestive damage was eventually caused.

Biography:

Dimitrios Tsamis has studied Medicine and thereafter completed his PhD from National and Kapodistrian University of Athens, Greece. He is a General Surgeon in special interest in Colorectal Surgery. He has published more than 33 papers in reputed journals and has been serving as an editorial board member.

Abstract:

Studies dealing with laparoscopic colectomy for cancer have reached to conflicting results in regards to various inflammatory cytokines. The aim of this study was to detect differences of proinflammatory cytokines between conventional and laparoscopic colectomy for cancer.

30 patients who underwent laparoscopic colectomy were with 30 patients treated by “open” surgery. CRP, IL -1, -6, -8 and IFN-γ serum levels were measured preoperatively, at 24 hrs and at the 7th POD.

CRP and IL-6 postop values (24 h and 7th POD) were significantly higher than baseline at both groups (p=0.001), but the respective values at the 7th POD were less than at 24 h (p=0.001). IL-1 and -8 levels did not show any differences. A higher INF-γ measurement was demonstrated at 24 h compared to baseline at the laparoscopic group only (p=0.05). This difference was not maintained at the 7th POD. Relative differences at cytokines concentration showed that INF-γ increment noted at the laparoscopic group was more accentuated than the respective IL-1 value changes (p=0.09 and p=0.024, respectively). INF-γ levels at 24 h and the 7th POD were significantly less at the “open” compared to the laparoscopic group of patients (p=0.001).

This matched case-control study verifies the already reported lack of differences regarding the IL-1. Controversy still exists on likely IL-6 differences. IL-8 does not seem to play an important role on immunologic differences. INF-γ seems to have a more active presence following the laparoscopic colectomies potentially contributing to an immunologic “advantage” by counteracting “harmful” cytokines, such as IL-1.

Biography:

Junqi HE has completed his PhD from Chinese Academy of Medical Sciences and Peking Union Medical College and postdoctoral studies from Emory University. He is professor in the Department of Biochemistry and Molecular Biology in Capital Medical University. He is the director of Beijing International Cooperation Base for Science and Technology on China-UK Cancer Research. He has published more than 40 papers in reputed journals.   

Abstract:

PI3K/AKT pathway, which is frequently altered in gastric carcinoma, can  be negatively regulated via dephosphorylation of PIP3 to PIP2 by PTEN. In the present study, PDZK1 was identified as a novel binding protein of PTEN, in which the interaction was mediated by the PDZ2 and PDZ3 domain of PDZK1 with the last four amino acids (ITKV) in the carboxyl terminus of PTEN (PTEN-CT). Our data from PDZK1 overexpression and siRNA-mediated knockdown experiments further demonstrated that by associating with PTEN, PDZK1 inhibits the phosphorylation of PTEN. In addition, overexpression of PDZK1 down-regulated AKT and ERK signals. Consistent with these results, PDZK1 suppressed gastric cancer cell proliferation, impeded the formation of anchorage independent colonies in soft agar and retarded the growth of xenografts in nude mice. Furthermore, PDZK1 was significantly downregulated in gastric cancer tissues in comparison to that in normal gastric tissues. Collectively, this study shows that downregulation of PDZK1 expression enhances the PTEN inactivation, which may contribute to the carcinogenesis of gastric cancer.

Biography:

Wei Gong has completed his PhD at the age of 30 years from Southern Medical University, China. After 6 years’ strict training at home and abroad, he is good at most endoscopic techniques, such as ESD, STER, POEM, ERCP, et al. Presently, he is the vice director of endoscopic center of Nanfang Hospital, Southern Medical University, a famous center in China. He has published more than 15 papers in reputed journals. In 2015, he was given the International Award by ACG (American College Gastroenterology) because of his excellent research work of novel endoscopic techniques.

Abstract:

Peroral endoscopic myotomy (POEM) has recently been described as a novel treatment for achalasia in humans. We aimed to assess the clinical effectiveness and safety of POEM for treating esophageal achalasia performed by a gastroenterologist in a single endoscopic center within 4 years. Between June 2011 to May 2015, POEM was performed in 115 consecutive patients with achalasia. The Eckardt score and manometry were used to evaluate the outcomes. POEM was successfully performed in all cases. Mean procedure time was 48.7 min (range 35–93) and mean myotomy length was 9.2 cm (range 7–15). Mucosal perforations occurred in 7 (6%) patients during submucosal tunnel creation, major bleeding occurred in 8 (7%) patients, and 6 (5.7%) patients suffered pneumothorax immediate after procedure. All the complications were managed conservatively. During a mean follow-up period of 25 months (range 6–59.4 months), treatment success was achieved in 106/115 patients (93.5%). Mean LES pressure was 54.5 mmHg (28.5–81.4) and 16.4 mmHg (4.8–25.3) before and after the procedure (P < 0.05), respectively. Mean Eckardt score was 6.2 (3–11, median 6) and 0.5 (0–2, median 1) before and after POEM, respectively (P < 0.05). 20 patient (17.3%) developed mild reflux symptoms and required intermittent medication with proton pump inhibitors during the follow-up. Our study demonstrated that POEM is a safe, and effective treatment for achalasia. Further studies are warranted to evaluate the long-term efficacy and to compare POEM with other treatment modalities.

Biography:

Romany Helmy Thabet is Assistant Professor of Pharmacology, Faculty of Medicine, Northern Borders University, Saudi Arabia. His latest publications is titled ''Genetic variants in 6-mercaptopurine pathway as potential factors of hematological toxicity in acute lymphoblastic leukemia'' in Pharmacogenomics  Journal, 2015.

Abstract:

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD). The hallmark of UC lesions is infiltration of the intestine by mononuclear cells, predominantly lymphocytes. There is growing epidemiological evidence that suggest implication of vitamin D deficiency in the development of IBD and also its influence on disease severity. C-reactive protein (CRP) levels are often used in the follow-up of patients with IBD. Adhesion molecules such as intercellular adhesion molecule (ICAM) and E-selectin are cell surface-expressed glycoproteins that play a prominent role in leukocyte recruitment and proliferation in the inflamed colon. The aim of the present descriptive study is to investigate the role of vitamin D, CRP and the adhesion molecules ICAM and E-selectin in prediction of severity of UC.  Samples of blood were taken from 24 diagnosed cases of UC for measurement of serum levels of vitamin D, CRP, ICAM and E-Selectin by enzyme-linked immunosorbent assay (ELISA). Severity index for UC cases and its correlation with the aforementioned measures was determined. Comparing to control groups formed by individuals without clinical and/or laboratory signs of UC, UC patients showed significant increased levels (p<0.001) of sICAM-1, E-selectin and CRP in serum samples. On the contrary, vitamin D levels were significantly decreased in UC patients. Strong correlation was statically determined between vitamin D deficiency, CRP, adhesion molecules and UCEIS.  In conclusion, the present work confirmed the role of vitamin D deficiency, adhesion molecules notably ICAM and E-selectin and the acute phase biomarker CRP in pathogenesis of UC. 

Biography:

Omar Bashandy is gastroenterologiest and Endoscopiest working in Dakhla Oasis general hospital western desert Egypt had Master degree in internal medicin Ain Shams univ And well trained on performing upper and lower GIT endoscopy

Abstract:

Portal hypertension is a major complication of liver cirrhosis and can be a direct cause of variceal hemorrhage and of bleeding related death.

Oesophageal variceal bleeding is one of the most dreaded complications of liver cirrhosis because of its high mortality

Prevalence of varices in patients with cirrhosis is 60-80% with incidence increasing 5% per year. The American Association of the Study of Liver Disease and the Baveno V Consensus Conference on portal hypertension recommended that all cirrhotic patients should be screened for the presence of O.V when liver cirrhosis is diagnosed Identification of non-invasive predictors of O.V and portal gastropathy will able us to carry out UGE in selected group patients thus avoiding unnecessary intervention and at the same time not missing the patients at risk of bleeding.
Serotonin (5-hydroxytryptamine, 5HT) has been the subject of intense biological research since its synthesis in 1951.Erspamer and Asero.originally isolated a potent vasoconstrictor substance from the intestine, which they called enteramine.

About 95% of serotonin in the body is found in the GI tract, of which90%is in enterochromaffin cells (ECs) and 10% in enteric neurons. The remaining of serotonin (5%) is found in the brain.

As serotonin cannot cross the blood-brain barrier, the brain must synthesize its own serotonin.

Virtually all of the serotonin in the blood is derived from the GI tract With respect to the liver, it was found that serotonin has the ability to regulate hepatic blood flow at both the portal and sinusoidal levels

Serotonin is able to induce the contraction of fenestrae which is achieved via a rapid influx of extracellular Ca2+ leading to activation of the myosin light chain In these cells serotonin also inhibits cAMP production, and activates phospholipase A2, causing the release of arachidonic acid The exact significance of these findings has not been fully qualified, it is, however, well established that SEC fenestrae play an important role in the exchange of fluid, solutes and particles between the parenchyma and the blood.

Serotonin may therefore play a role in regulating the exchange of various fluids, solutes and particles across the space of Disse. Serotonin in these cells may also exert complex control over various aspects of inflammation and immunity since arachidonic acid is a precursor of various prostaglandins, prostacyclin, and thromboxane.

Biography:

Will be updated soon

Abstract:

Introduction: Gilbert's syndrome is a functional disorder of the UDP glucuronosyltransferase enzyme defect in the liver causing to decreased secretion of bilirubin to bile. As a result of this disease, serum bilirubin gets above than normal levels. In these patients, there are some studies showing lower cardiovascular risks. In this study, we aimed to investigate the relationship between laboratory results and bilirubin levels in a large number of patients with Gilbert’s syndrome.

Materials & Methods: We collected the data of 1203 Gilbert's syndrome patients and 1155 healthy control groups. The mean age of the patients and the control group were 24.1±6.2 and 23.8±5.1 years respectively (p=0.127). The total and indirect bilirubin values of the patients and control groups were 1.72±0.52 and 0.59±0.21; 0.51±1.53 and 0.44±0.19 mg/dl, respectively.

Results: The mean erythrocyte sedimentation rate (ESR) was significantly lower in patients with Gilbert's syndrome (4.5±4.7 and 5.4±3.3 mm/h, p<0.001). Neutrophil / lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) was high in patients with Gilbert syndrome than in controls (2.68±1.08 and 1.44±0.5; p<0.001 and 10.01±3.8 and 6.8±2.01; p<0.001). Hematocrit levels were similar. Hb levels were higher in patients with Gilbert's syndrome (15.7±1.18 and 15.2±0.98 g/dl, p<0.001). The average MCV values were lower in these patients (83.2±6.1 and 88.5±4.3 fl, p<0.001). Indirect bilirubin levels were associated with RDW (Red Cell Distribution Width) and neutrophil count (Pearson's r=0.141 and 0.087 respectively, p<0.001 and p=0.048). RDW (β=0.164 and p <0.001) and patient age (β=-0.091, p=0.038), were significant parameters associated with indirect bilirubin values in the regression analysis conducted in patients respectively.

Discussion: The mean erythrocyte sedimentation rate was lower in patients with Gilbert's syndrome. This is consistent with data from previous studies which stated the lower cardiovascular risk in these patients. However, verifying this information could not be obtained by the other parameters such as NLR or PLR, which reflects inflammatory conditions. Conversely, the higher NLR and PLR rates in these patients may be due to greater amount of neutrophils or platelets, compared to lymphocytes proportionately. Futhermore, having the lower level of MCV in Gilbert’s syndrome patients, lower erythrocyte volume and also higher bilirubin levels due to increased erythrocyte turnover of some patients, suggests the possibility of thalassemia intermediate forms.