Malnutrition and the Microbiome within IBD Populations
Fellow: Melissa Corson, MD
Mentors: Berkeley Limketkai, MD, PhD and Jonathan P. Jacobs, MD, PhD
The presence of protein-calorie malnutrition (PCM) within inflammatory bowel disease (IBD) is an important factor in the outcomes of these complex patients that can often be overlooked in a busy practice. An emerging field of study in gastrointestinal diseases, including IBD, is the effect of the microbiome. The microbiome has been shown to be implicated in the pathogenesis of IBD and changes in the microbiome based on both dietary intake and nutritional status have been observed. However, to our knowledge, there are no current studies investigating the microbiome in malnourished IBD patients. The aim of this study is to perform a prospective analysis of the gut microbiome of IBD patients diagnosed with PCM while undergoing nutritional therapy compared to a control group of non-malnourished IBD patients. The hypothesis is that the gut microbiome in malnourished IBD patients differs from that of non-malnourished IBD patients and providing nutritional therapy in the form of nutritional supplements and consultation with a dietician will alter the microbiome towards that of a non-malnourished IBD patient.
AnX/Ankon Navicam Magnetically Controlled Capsule Endoscopy Feasibility Study in Gastric Motility
Fellow: Dean Ehrlich, MD
Mentors: Lin Chang, MD, Jeffrey L. Conklin, MD, Alireza Sedarat, MD
Gastroparesis (GP) and functional dyspepsia (FD) are commonly diagnosed upper gastrointestinal (GI) disorders. A major barrier in the management of these disorders is the lack of a biologic marker that is highly correlated with symptoms and predicts response to treatment. The Navicam magnetically controlled capsule endoscopy (MCCE) system is FDA approved for visualization of the stomach. The MCCE is designed to allow the capsule to move around the stomach in real-time at the guidance of the operator. The ability to visualize and analyze gastric movement patterns in real time, without interference from an endoscope, has never been studied as a potential biomarker for GP or FD. The primary aim of this research project is to evaluate the feasibility of using the MCCE system in GP or FD.
Characterization of Liver Non-Parenchymal Cell Response to Hepatocyte Cholesterol Dysregulation in Diet-Induced Steatohepatitise
Fellow: Alexander Nguyen, MD, PhD
Mentor: Peter Tontonoz, MD, PhD
NAFLD has become the one of the most common liver diseases in America with the more severe subtype of nonalcoholic steatohepatitis (NASH) associated with progressive fibrosis, end-stage liver disease and hepatocellular carcinoma. NASH is characterized by dysregulated hepatocyte lipid metabolism and a subsequent inflammatory response mediated by liver non-parenchymal cell activation and immune cell recruitment. Prior studies have established a role for LXR-dependent cholesterol metabolism in the regulation of tissue inflammation. By dysregulating intracellular cholesterol transport and remodeling in hepatocytes, we will characterize hepatocyte-derived signaling pathways that activate liver non-parenchymal cells and promote liver inflammation through single-cell RNA sequencing. Identification of these paracrine signaling pathways may potentially lead to new prognostic tools and therapeutic agents for NASH.
Patient Navigation Program for Hospitalized Patients with Alcohol-Associated Liver Disease: A Feasibility Pilot Study
Fellow: Yun Wang, MD
Mentor: Arpan A. Patel, MD, PhD
The rates of alcohol use disorder and incidence of alcohol-associated liver disease (ALD) are rising. This creates a significant healthcare burden given the increased liver-related morbidity, mortality, and need for liver transplantation. Abstinence from alcohol is strongly recommended, however medical and behavioral therapies for alcohol use disorder (AUD) are underutilized. This study aims to assess the feasibility of employing a pilot navigation program to connect hospitalized patients with ALD with outpatient medical and behavioral therapies for AUD, and its effects on alcohol drinking patterns, re-admissions, and mortality.
Optimizing Perioperative Nutrition for Patients Undergoing Major Inflammatory Bowel Disease Surgery
Fellow: Andrew Weber, MD
Mentor: Berkeley Limketkai, MD, PhD
Despite major advances in medical management of inflammatory bowel disease (IBD), surgery remains a frequently utilized strategy for management of refractory and complicated disease. Malnutrition is commonly encountered in patients with IBD and presents a risk factor for adverse postoperative outcomes. Recent major nutrition society guidelines emphasize the importance of perioperative nutrition for patients with Crohn’s disease and ulcerative colitis undergoing surgery. This study will retrospectively evaluate the use of preoperative artificial nutrition for patients with IBD undergoing major gastrointestinal surgery and the impact of this nutritional support on important postoperative outcomes, collecting data though both a large nationwide database and a single tertiary health system. Additionally, we will develop and prospectively evaluate a novel mobile application based nutritional protocol for use in the preoperative setting, focusing on patients undergoing major IBD-related surgery.