Papers by Elizabeth Weinshel
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, Jan 18, 2017
…, 2008
Gastroenterology, Volume 134, Issue 4, Pages A-164, April 2008, Authors:Bani Chander; Robert Kule... more Gastroenterology, Volume 134, Issue 4, Pages A-164, April 2008, Authors:Bani Chander; Robert Kule; Peter J. Baiocco; Sita S. Chokhavatia; Donald P. Kotler; Michael Poles; Sondra Zabar; Elizabeth H. Weinshel. Gastroenterology ...
Gastroenterology, 2008
No abstract is available. To read the body of this article, please view the PDF online. ... © 200... more No abstract is available. To read the body of this article, please view the PDF online. ... © 2008 AGA Institute. Published by Elsevier Inc. All rights reserved. ... Visit SciVerse ScienceDirect to see if you have access via your institution. ... Advertisements on this site do not constitute ...
Gastroenterology
Identifying the source of lower gastrointestinal hemorrhage in patients with chronic liver diseas... more Identifying the source of lower gastrointestinal hemorrhage in patients with chronic liver disease and portal hypertension can be challenging. We present 2 cases of hemorrhage from rectal varices and a discussion on the differences between simple hemorrhoids and rectal varices. Evaluation of rectal bleeding in patients with portal hypertension is discussed and possible therapeutic options are described.
The American Journal of Gastroenterology, 1998
Objectives:In patients with chronic human immunodeficiency virus (HIV)-related diarrhea undergoin... more Objectives:In patients with chronic human immunodeficiency virus (HIV)-related diarrhea undergoing lower endoscopy, the decision to perform flexible sigmoidoscopy or colonoscopy is controversial. The purpose of this study is twofold: 1) to evaluate the diagnostic yield of colonoscopy in a large group of patients with chronic HIV-related diarrhea and negative stool studies, and 2) to determine whether colonoscopy is superior to flexible sigmoidoscopy in this setting.Methods:All HIV-infected patients with chronic diarrhea who were referred for diagnostic colonoscopy at Bellevue Hospital Center between January 1992 and December 1996 were identified. Patient charts, pathology reports, and endoscopy records were reviewed.Results:During the 5-yr study period, 317 consecutive patients with chronic unexplained diarrhea undergoing colonoscopy were identified. A potential cause of diarrhea was found in 116 patients (36.6%). Cytomegalovirus was the most common pathogen detected (24%). The yield of colonoscopy was significantly higher in patients with a CD4 count of < 100 cells/mm3 than in those with higher CD4 counts (44.8%vs 6.4%, p < 0.0001). Thirty percent of pathogens and 75% of lymphomas were identified only on biopsies taken from the proximal colon, well beyond the reach of the flexible sigmoidoscope. Importantly, 94% of the pathogens that were found only in the proximal colon were organisms for which effective therapy is currently available.Conclusions:Colonoscopy is superior to flexible sigmoidoscopy in HIV-infected patients with chronic unexplained diarrhea. If flexible sigmoidoscopy had been performed instead of colonoscopy, 30% of pathogens would have been missed and 75% of lymphomas would have escaped detection.
The American journal of gastroenterology, 1998
In human immunodeficiency virus (HIV)-infected patients with chronic unexplained diarrhea, upper ... more In human immunodeficiency virus (HIV)-infected patients with chronic unexplained diarrhea, upper endoscopy with small bowel biopsy and aspirate is often performed to identify treatable pathogens. The purpose of this study was to compare the diagnostic yield of duodenal with jejunal biopsy and aspirate. All HIV-infected patients with chronic unexplained diarrhea who were evaluated by upper endoscopy at Bellevue Hospital Center between January 1992 and January 1997 were identified. Data were collected by reviewing patient charts, endoscopy reports, and pathology records. During the 5-yr study period, 442 patients underwent upper endoscopy with sampling of the duodenum (N=173) or jejunum (N=269). A pathogen was identified in 123 patients (27.8%). Microsporidia was the most common organism detected (12.2%). The diagnostic yield of jejunal biopsy and aspirate was significantly higher than that obtained from the duodenum (32.3% vs 20.8%, p=0.009). Small bowel aspirates detected a pathogen...
World journal of gastroenterology : WJG, Jan 14, 2015
To assess and teach cultural competency skills at the fellowship training level through the use o... more To assess and teach cultural competency skills at the fellowship training level through the use of objective structured clinical examinations (OSCEs). We revised four scenarios to infuse a specific focus on cross-cultural care, and to render them appropriate for gastroenterology fellows. Three are discussed here: (1) Poor Health Literacy; (2) Disclosing/Apologizing for a Complication to a Patient Who Mistrusts the Healthcare System; and (3) Breaking Bad News to a Fatalistic Patient. A fourth case emphasizing shared decision-making will be described elsewhere. Four stations were completed by fellows and observed live by four faculty members, and the fellows' performance was assessed. Eleven fellows from four programs participated in the four OSCE. In the "Poor Health Literacy" case, 18% (2/11) of participants recognized that the standardized patient (SP) had below-basic health literacy. None successfully evaluated the SP's reading skills in a culturally-sensitive ma...
The American journal of gastroenterology, 2010
Digestive diseases and sciences, 2000
The aim of this study was to determine the outcome of patients with HIV-associated esophageal dis... more The aim of this study was to determine the outcome of patients with HIV-associated esophageal disease refractory to empiric antifungal therapy, both before and after the introduction of protease inhibitors. We reviewed the medical records of 629 consecutive HIV-infected patients with odynophagia, dysphagia, or both esophageal symptoms refractory to at least one week of empiric antifungal therapy who underwent endoscopy between January 1992 and January 1997 at Bellevue Hospital Center. Endoscopy identified an etiology in 96.2% of patients, with cytomegalovirus ulcers (40.0%) and idiopathic ulcers of the esophagus (26.67%) being the most common lesions found. Overall, 91.4% of patients had a response to disease-specific therapy. In patients taking protease inhibitors, recurrent symptoms were less common (26.5% vs 36.7%, P = 0.03) and median survival was longer (172 vs 125 weeks. P = 0.006) than in those who were not treated with these potent antiretroviral medications. Protease inhibi...
The American journal of gastroenterology, 1999
The American journal of gastroenterology, 1999
In the general population, acute upper gastrointestinal hemorrhage (UGIH) is a common problem tha... more In the general population, acute upper gastrointestinal hemorrhage (UGIH) is a common problem that results in significant morbidity and mortality. The aim of this study was to determine the etiology, clinical outcome, and risk factors for rebleeding and mortality in a large cohort of human immunodeficiency virus (HIV)-infected patients with acute UGIH. We reviewed the medical records of consecutive HIV-infected patients with acute UGIH who were referred for an endoscopic evaluation from January 1992 through January 1997 at Bellevue Hospital Center. During the 5-yr study period, 297 HIV-infected patients with acute UGIH were evaluated by endoscopy. Gastroduodenal ulcers (25.6%), esophageal ulcers (21.5%), and Kaposi's sarcoma (19.2%) were the three most common causes of acute UGIH. Fifteen percent of patients rebled within 30 days and independent predictors of rebleeding included a CD4 count of <200 cells/mm3, inpatient status, a hemoglobin of <8 g/dl, major stigmata of hem...
The American Journal of Gastroenterology, 2010
Gastroenterology (GI) training programs must develop the teaching skills of their faculty and pro... more Gastroenterology (GI) training programs must develop the teaching skills of their faculty and provide feedback to their fellows. Many faculty feel uncomfortable offering feedback or identifying specific areas for improvement to the fellows. We developed an Observed Structured Clinical Exam (OSCE) to assess fellows&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; skills and provided faculty with specific criteria to rate the fellows&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; performance. We propose that OSCEs can serve as tools for faculty development in delivering effective feedback. Faculty completed a Web-based training module and received written guidelines on giving feedback. Four OSCE stations were completed by each fellow with faculty using standardized checklists to assess the fellows&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; skills. Afterwards, faculty rated each program component and assessed their comfort level with feedback. Eight faculty members and 10 fellows from 5 GI training programs in NYC participated. 100% of the faculty agreed that feedback is an important learning tool, should include the learner&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s self-assessment, and that feedback skills could improve with practice. Compared to faculty skills prior to the program, 87.5% of the faculty agreed that they focused more on specific behaviors and 75% agreed that giving negative feedback was now easier. OSCEs can serve as practicums for faculty development in giving constructive feedback.
The American Journal of Gastroenterology, 2011
The American Gastroenterological Association fellowship curriculum identifies geriatric component... more The American Gastroenterological Association fellowship curriculum identifies geriatric components for gastroenterology (GI) training; however, few tools are available for this purpose. Using an objective structured clinical examination (OSCE), we aimed to assess ACGME competencies of communication, professionalism, and geriatric-specific patient care among GI fellows. We developed an informed-consent case involving a geriatric patient who needs surveillance colonoscopy. We used a validated faculty skills checklist to rate fellows across three competency domains. Fifteen fellows from four GI training programs participated. Although the fellows excelled at communication and professionalism, only 51% excelled at geriatric-specific patient-care skills. Fellows were least likely to demonstrate collaboration with the patient, to assess patient understanding, and to explain the limits of the test. Communication and geriatric-specific skills were correlated. OSCEs are a feasible method for assessing geriatric-related ACGME competencies for fellows. The results highlight the need for curriculum development.
Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 1996
Patients infected with human immunodeficiency virus (HIV) are at risk for a variety of liver dise... more Patients infected with human immunodeficiency virus (HIV) are at risk for a variety of liver diseases. We undertook a retrospective study of 501 HIV-seropositive patients to assess the yield of percutaneous liver biopsy. The most common indications for liver biopsy were liver test abnormalities (89.5%), fever for 2 weeks (71.9%), and hepatomegaly (52.0%). The most common biopsy-derived diagnosis was Mycobacterium avium complex (MAC), seen in 87 (17.4%) biopsies. Mycobacterium tuberculosis was found in 13 biopsies (2.6%). In 28 biopsies (5.6%) mycobacteria was seen, but speciation of the organism was not possible. Chronic active viral hepatitis was seen in 60 biopsies (12.0%). Opportunistic hepatic infection from other organisms was found in 14 biopsies (2.8%). The most common neoplasm was lymphoma, which was seen in 12 biopsies (2.4%). MAC infection of the liver was associated with elevated alkaline phosphatase (p = 0.01). Among patients with fever for 2 weeks after an extensive negative workup including bone marrow biopsy, 58.2% had a diagnosis by liver biopsy. Overall, 64.3% of liver biopsies yielded a histopathological diagnosis, 45.7% of which were potentially treatable. We could not evaluate whether liver biopsy had a positive effect on patient outcome and survival, nor did we attempt to prove that liver biopsy resulted in a change in treatment or a change in preprocedure clinical diagnosis. Thus, questions about the efficacy of liver biopsy cannot be answered. Liver biopsy may be a helpful diagnostic tool in HIV-positive patients with fever, liver test abnormalities or hepatomegaly.
World Journal of Gastroenterology, 2011
To determine the expression and clinical significance of transcriptional intermediary factor 1 ga... more To determine the expression and clinical significance of transcriptional intermediary factor 1 gamma (TIF1γ), Smad4 and transforming growth factor-beta (TGFβR) across a spectrum representing colorectal can-cer (CRC) development.
Obesity Surgery, 2004
Background: The role of upper endoscopy (EGD) in obese patients prior to bariatric surgery is con... more Background: The role of upper endoscopy (EGD) in obese patients prior to bariatric surgery is controversial. The aim of this study was to evaluate the diagnostic yield and cost of routine EGD before bariatric surgery.
Obesity Surgery, 2008
We hypothesized that laparoscopic adjustable gastric banding (LAGB) reduces weight and modulates ... more We hypothesized that laparoscopic adjustable gastric banding (LAGB) reduces weight and modulates ghrelin production, but largely spares gastrointestinal endocrine function. To examine this hypothesis, we determined plasma concentrations of appetite-control, insulinotropic, and digestive hormones in relation to LAGB. Twenty-four patients undergoing LAGB were prospectively enrolled. Body mass index (BMI) was measured and blood samples obtained at baseline and 6 and 12 months post-surgery. Plasma concentrations of leptin, acylated and total ghrelin, pancreatic polypeptide (PP), insulin, glucose-dependent insulinotropic peptide (GIP), active glucagon-like peptide-1 (GLP-1), gastrin, and pepsinogens I and II were measured using enzyme-linked immunoassays. Median percent excess weight loss (%EWL) over 12 months was 45.7% with median BMI decreasing from 43.2 at baseline to 33.8 at 12 months post-surgery (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Median leptin levels decreased from 19.7 ng/ml at baseline to 6.9 ng/ml at 12 months post-surgery (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In contrast, plasma levels of acylated and total ghrelin, PP, insulin, GIP, GLP-1, gastrin, and pepsinogen I did not change in relation to surgery (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Pepsinogen II levels were significantly lower 6 months after LAGB but returned to baseline levels by 12 months. LAGB yielded substantial %EWL and a proportional decrease in plasma leptin. Our results support the hypothesis that LAGB works in part by suppressing the rise in ghrelin that normally accompanies weight loss. Unchanged concentrations of insulinotropic and digestive hormones suggest that gastrointestinal endocrine function is largely maintained in the long term.
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Papers by Elizabeth Weinshel