Elizabeth H Weinshel, M.D.

Association of overexpression of TIF1gamma with colorectal carcinogenesis and advanced colorectal adenocarcinoma
Jain, Shilpa; Singhal, Shashideep; Francis, Franto; Hajdu, Cristina; Wang, Jin-Hua; Suriawinata, Arief; Wang, Yin-Quan; Zhang, Miao; Weinshel, Elizabeth H; Francois, Fritz; Pei, Zhi-Heng; Lee, Peng; Xu, Ru-Liang
2011 Sep 21;17(35):3994-4000, World journal of gastroenterology : WJG
AIM: To determine the expression and clinical significance of transcriptional intermediary factor 1 gamma (TIF1gamma), Smad4 and transforming growth factor-beta (TGFbetaR) across a spectrum representing colorectal cancer (CRC) development. METHODS: Tissue microarrays were prepared from archival paraffin embedded tissue, including 51 colorectal carcinomas, 25 tubular adenomas (TA) and 26 HPs, each with matched normal colonic epithelium. Immunohistochemistry was performed using antibodies against TIF1gamma, Smad4 and TGFbetaRII. The levels of expression were scored semi-quantitatively (score 0-3 or loss and retention for Smad4). RESULTS: Overexpression of TIF1gamma was detected in 5/26 (19%) HP; however, it was seen in a significantly higher proportion of neoplasms, 15/25 (60%) TAs and 24/51 (47%) CRCs (P < 0.05). Normal colonic mucosa, HP, and TAs showed strong Smad4 expression, while its expression was absent in 22/51 (43%) CRCs. Overexpression of TGFbetaRII was more commonly seen in neoplasms, 13/25 (52%) TAs and 29/51 (57%) CRCs compared to 9/26 (35%) HP (P < 0.05). Furthermore, there was a correlation between TIF1gamma overexpression and Smad4 loss in CRC (Kendall tau rank correlation value = 0.35, P < 0.05). The levels of TIF1gamma overexpression were significantly higher in stage III than in stage I and II CRC (P < 0.05). CONCLUSION: The findings suggest that over-expression of TIF1gamma occurs in early stages of colorectal carcinogenesis, is inversely related with Smad4 loss, and may be a prognostic indicator for poor outcome
— id: 140416, year: 2011, vol: 17, page: 3994, stat: Journal Article,

Informed consent in the older adult: OSCEs for assessing fellows' ACGME and geriatric gastroenterology competencies
Shah, Brijen; Miler, Roy; Poles, Michael; Zabar, Sondra; Gillespie, Colleen; Weinshel, Elizabeth; Chokhavatia, Sita
2011 Sep;106(9):1575-1579, American journal of gastroenterology
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: OSCEs are a feasible method for assessing geriatric-related ACGME competencies for fellows. The results highlight the need for curriculum development
— id: 149732, year: 2011, vol: 106, page: 1575, stat: Journal Article,

Observing Handoffs and Telephone Management in GI Fellowship Training
Williams, Renee; Miler, Roy; Shah, Brijen; Chokhavatia, Sita; Poles, Michael; Zabar, Sondra; Gillespie, Colleen; Weinshel, Elizabeth
2011 Aug;106(8):1410-1414, American journal of gastroenterology
OBJECTIVES: Gastroenterology (GI) training programs are mandated to teach fellows interpersonal communication and professionalism as basic competencies. We sought to assess important skill sets used by our fellows but not formally observed or measured: handoffs, telephone management, and note writing. We designed an Observed Standardized Clinical Examination (OSCE) form and provided the faculty with checklists to rate fellows' performance on specific criteria. METHODS: We created two new scenarios: a handoff between a tired overnight senior fellow on call and a more junior fellow, and a telephone management case of an ulcerative colitis flare. Fellows wrote a progress notes documenting the encounters. To add educational value, we gave the participants references about handoff communication. Four OSCE stations-handoff communication, telephone management, informed consent, and delivering bad news-were completed by fellows and observed by faculty. RESULTS: Eight faculty members and eight fellows from four GI training programs participated. All the fellows agreed that handoffs can be important learning opportunities and can be improved if they are structured, and that handoff skills can improve with practice. CONCLUSIONS: OSCEs can serve as practicums for assessing complex skill sets such as handoff communication and telephone management
— id: 135568, year: 2011, vol: 106, page: 1410, stat: Journal Article,

Teaching the competencies: using observed structured clinical examinations for faculty development
Alevi, David; Baiocco, Peter J; Chokhavatia, Sita; Kotler, Donald P; Poles, Michael; Zabar, Sondra; Gillespie, Colleen; Ark, Tavinder; Weinshel, Elizabeth
2010 May;105(5):973-977, American journal of gastroenterology
OBJECTIVES: 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' skills and provided faculty with specific criteria to rate the fellows' performance. We propose that OSCEs can serve as tools for faculty development in delivering effective feedback. METHODS: 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' skills. Afterwards, faculty rated each program component and assessed their comfort level with feedback. RESULTS: 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'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. CONCLUSIONS: OSCEs can serve as practicums for faculty development in giving constructive feedback
— id: 109575, year: 2010, vol: 105, page: 973, stat: Journal Article,

Improving handoff communication: a gastroenterology fellowship performance improvement project
Malter, Lisa; Weinshel, Elizabeth
2010 Mar;105(3):490-492, American journal of gastroenterology
— id: 107931, year: 2010, vol: 105, page: 490, stat: Journal Article,

The "Buddy" Study: Are There Benefits to Having Bariatric Surgery With a "Buddy?"
Nekee Pandya, Nekee; Jay, Melanie; Lobach, Iryna; Weinshel, Elizabeth H; Ren-Fielding, Christine
2010 ;138(5 Suppl 1):S481-S481 #T1068, Gastroenterology
— id: 109862, year: 2010, vol: 138, page: S481, stat: Journal Article,

Teaching the Competencies: Using Objective Structured Clinical Encounters for Gastroenterology Fellows
Chander, Bani; Kule, Robert; Baiocco, Peter; Chokhavatia, Sita; Kotler, Don; Poles, Michael; Zabar, Sondra; Gillespie, Colleen; Ark, Tavinder; Weinshel, Elizabeth
2009 May;7(5):509-514, Clinical Gastroenterology & Hepatology
BACKGROUND AIMS: Objective structured clinical encounters (OSCEs) are used widely to educate and assess the competence of medical students and residents; they generally are absent from fellowship training. The Accreditation Council for Graduate Education has cited OSCEs as a best practice for assessing the 6 core competencies. This article reports on the use of an OSCE to assess the competence of second-year gastroenterology fellows in the difficult-to-assess core competencies: interpersonal and communication skills and professionalism. METHODS: We developed a 4-station, faculty-observed OSCE with 4 standardized patients. Information gathering, relationship development, patient education, and counseling skills were assessed. Professionalism skills assessed included obtaining informed consent, delivering bad news, managing difficult situations, and showing interdisciplinary respect. In each station, faculty and standardized patients completed an 18- to 24-item checklist evaluating fellows' performance and provided feedback to the fellows. Nine fellows and 5 faculty from 4 gastroenterology training programs in NYC participated. RESULTS: Fellows and faculty generally highly rated the realism of the OSCE and favorably rated the OSCE for its difficulty and their overall experience. Across all cases, fellows were rated as receiving 'well dones' for 56.4% of the communication items (SD, 18.3%) and for 79.1% of the professionalism items (SD, 16.4%). CONCLUSIONS: Integrating OSCEs into gastroenterology fellowship training may help enhance communication skills and prepare fellows for dealing with difficult clinical situations and provides mechanisms for constructive feedback. OSCEs developed collaboratively can assist in program self-evaluation and reduce costs by sharing resources, in addition to fulfilling Accreditation Council for Graduate Education mandates
— id: 97798, year: 2009, vol: 7, page: 509, stat: Journal Article,

Lap-band impact on the function of the esophagus
Gamagaris, Zoi; Patterson, Carlie; Schaye, Verity; Francois, Fritz; Traube, Morris; Fielding, Christine J; Fielding, George A; Youn, Allison Heekoung; Weinshel, Elizabeth H
2008 Oct;18(10):1268-1272, Obesity surgery
BACKGROUND: The laparoscopic adjustable gastric band (LAGB) has been widely used to treat morbid obesity. There is conflicting data on its long-term effect on esophageal function. Our aim was to assess the long-term impact of the LAGB on esophageal motility and pH-metry in patients who had LAGB who had normal and abnormal esophageal function at baseline. METHODS: Consecutive patients referred for bariatric surgery were prospectively enrolled. A detailed medical history was obtained, and esophageal manometric and 24-h pH evaluations were performed in standard fashion preoperatively and 6 and 12 months postoperatively; patients served as their own controls. RESULTS: Twenty-two patients completed manometric evaluation. Ten patients had normal manometric parameters at baseline; at 6 months, mean lower esophageal sphincter (LES) residual pressure increased significantly from baseline (3.9 +/- 2 vs. 8.9 +/- 4 mmHg, p = 0.014). At 12 months, the mean peristaltic wave duration increased from 3.6 +/- 1 at baseline to 6.8 +/- 2 s, p = 0.025 and wave amplitude decreased during the same period (98.7 +/- 22 vs. 52.3 +/- 24, p = 0.013). LES pressure and percent peristalsis did not differ significantly pre- and post-LAGB. Twelve patients had one or more abnormal manometric findings at baseline; at 12 months, LES pressure in these 12 patients decreased significantly (31.1 +/- 10 vs 23.6 +/- 7, p = 0.011) and wave amplitude was significantly reduced (125.9 +/- 117 vs 103 +/- 107, p = 0.039). LES residual pressure did not change significantly pre- and post-LAGB. Twenty-two individuals were evaluated for impact of Lap-Band on esophageal acid exposure. Sixteen of these patients had normal esophageal pH-metry values at baseline and had no significant changes in 12 months in any pH-metry measurement. Six patients had abnormal pH-metry values at baseline. Among these patients, time with pH < 4.0 and Johnson/DeMeester score did not change significantly during follow-up. There was a significant decrease in the number of reflux episodes from baseline to 6 months (159 +/- 48 vs. 81 +/- 61, p = 0.016). CONCLUSIONS: Abnormal manometric findings are frequently encountered post-LAGB. Increases in LES residual pressure and peristaltic wave duration were the most significant changes. LAGB is not associated with an increase in total esophageal acidification time. Further evaluation of the clinical significance of manometric abnormalities is warranted
— id: 91869, year: 2008, vol: 18, page: 1268, stat: Journal Article,

The Effect of Laparoscopic Gastric Banding Surgery on Plasma Levels of Appetite-Control, Insulinotropic, and Digestive Hormones
Shak, Joshua R; Roper, Jatin; Perez-Perez, Guillermo I; Tseng, Chi-hong; Francois, Fritz; Gamagaris, Zoi; Patterson, Carlie; Weinshel, Elizabeth; Fielding, George A; Ren, Christine; Blaser, Martin J
2008 Sep;18(9):1089-1096, Obesity surgery
BACKGROUND: 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. METHODS: 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. RESULTS: 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 < 0.001). Median leptin levels decreased from 19.7 ng/ml at baseline to 6.9 ng/ml at 12 months post-surgery (p < 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 > 0.05). Pepsinogen II levels were significantly lower 6 months after LAGB but returned to baseline levels by 12 months. CONCLUSIONS: 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
— id: 78623, year: 2008, vol: 18, page: 1089, stat: Journal Article,

Gender differences and bariatric surgery outcome
Khaykis, I; Ren, CJ; Fielding, GA; Huberman, W; Wolfe, B; Youn, H; Hong, S; Francois, FF; Weinshel, E
2007 SEP ;102(9):891-559, American journal of gastroenterology
— id: 98043, year: 2007, vol: 102, page: 891, stat: Journal Article,

Prospective Evaluation of the Use and Outcome of Admission Stool Guaiac Testing: The Digital Rectal Examination on Admission to the Medical Service (DREAMS) Study
Bini, Edmund J; Reinhold, Jean-Pierre; Weinshel, Elizabeth H; Generoso, Ramon; Salman, Loay; Dahr, Georges; Pena-Sing, Ivan
2006 Oct;40(9):821-827, Journal of clinical gastroenterology
BACKGROUND: Although physicians often perform fecal occult blood testing at the time of hospital admission, the practice of admission stool guaiac (ASG) testing has not been evaluated prospectively. The aim of this study was to determine the frequency and outcomes of digital rectal examination (DRE) and ASG testing in patients admitted to the hospital. METHODS: We prospectively evaluated 2143 patients admitted to the medical service at our hospital over a 1-year period. A detailed clinical history was obtained, and the proportion of patients who had DRE and ASG testing, the frequency of positive tests, and the results of follow-up testing were determined. RESULTS: A DRE was performed in 1539 of the 2143 subjects (71.8%), and 1.8% had abnormal findings, 21.8% had a normal examination, and the result of ASG testing was the only documented finding in the remaining 76.4% of patients. ASG testing was performed in 1342 of the 2143 subjects (62.6%), and the ASG test was positive in 237 persons (17.7%). However, only 161 (67.9%) of those with a positive ASG test had further diagnostic testing and a colonic source of occult gastrointestinal blood loss was detected in 68 (42.2%) of these 161 persons. CONCLUSIONS: Although DRE and ASG testing are commonly performed on admission to the hospital, documentation of the findings and follow-up of positive tests are poor. These findings highlight the need to improve physician training on the appropriate use and documentation of the DRE and fecal occult blood testing
— id: 68742, year: 2006, vol: 40, page: 821, stat: Journal Article,

The impact of adjustable laparoscopic gastric banding on esophageal motility
Gamagaris, Z; Patterson, C; Francois, F; Ren, C; Youn, H; Weinshel, E
2006 SEP ;101(9):S69-S69, American journal of gastroenterology
— id: 69308, year: 2006, vol: 101, page: S69, stat: Journal Article,

Positive predictive value of fecal occult blood testing in persons taking warfarin
Bini, Edmund J; Rajapaksa, Roshini C; Weinshel, Elizabeth H
2005 Jul;100(7):1586-1592, American journal of gastroenterology
BACKGROUND: In clinical practice, some physicians discontinue warfarin prior to fecal occult blood testing (FOBT). Although anticoagulant use is associated with an increased risk of overt gastrointestinal bleeding, the impact of warfarin on the positive predictive value of FOBT is unknown. METHODS: During a 5-yr period, we prospectively studied all patients taking warfarin who were referred for the evaluation of a positive FOBT. For each patient taking warfarin, we enrolled one age- and gender-matched control subject with a positive FOBT who was not taking anticoagulants. A detailed clinical history was obtained, and all subjects underwent colonoscopy and esophagogastroduodenoscopy. RESULTS: Lesions consistent with occult bleeding were identified in 59.0% of the 210 patients in the warfarin group and 53.8% of the 210 control subjects (p= 0.27). Although more lesions were identified by colonoscopy in the warfarin group than in control subjects (36.2%vs 25.7%, p= 0.02), there was no difference in the frequency of lesions identified by esophagogastroduodenoscopy (35.2%vs 39.5%, p= 0.43). Overall, adenomas > or =1 cm in diameter (16.2%) and colorectal carcinoma (9.5%) were the most common lesions identified by colonoscopy, while erosive gastritis (15.5%) and erosive duodenitis (11.0%) were the most frequent lesions found by esophagogastroduodenoscopy. Among individuals with colorectal cancer, 83.3% of patients in the warfarin group had early cancers (Dukes' stage A or B) compared with 50.0% of control subjects (p= 0.046). CONCLUSIONS: Warfarin use did not decrease the positive predictive value of FOBT. These findings suggest that warfarin should not be discontinued prior to FOBT
— id: 57718, year: 2005, vol: 100, page: 1586, stat: Journal Article,

Barriers to vaccination against hepatitis A and hepatitis B in patients with chronic hepatitis C virus infection: a national survey of US physicians
Chaudhari, S; Tenner, CT; Weinshel, EH; Bini, EJ
2005 APR ;128(4):A771-A771, Gastroenterology
— id: 72431, year: 2005, vol: 128, page: A771, stat: Journal Article,

National survey of physician knowledge and attitudes regarding vaccination against hepatitis A and B in patients with chronic liver disease due to hepatitis C virus infection
Chaudhari, S; Tenner, CT; Weinshel, EH; Bini, EJ
2005 APR ;128(4):A555-A556, Gastroenterology
— id: 72430, year: 2005, vol: 128, page: A555, stat: Journal Article,

Barriers to vaccination against hepatitis a and hepatitis B in patients with chronic hepatitis C virus infection: A national survey of family medicine and internal medicine physicians
Foont, JA; Chauchari, S; Tenner, CT; Weinshel, E; Bini, EJ
2005 APR ;20(2):184-184, Journal of general internal medicine
— id: 56291, year: 2005, vol: 20, page: 184, stat: Journal Article,

Knowledge and attitudes regarding vaccination against hepatitis A and B in patients with chronic hepatitis C virus infection: A comparison of Family Medicine and internal medicine physicians in the United States
Foont, JA; Chaudhan, S; Tenner, CT; Weinshel, EH; Bini, EJ
2005 APR ;20(2):136-136, Journal of general internal medicine
— id: 56290, year: 2005, vol: 20, page: 136, stat: Journal Article,

Radiologic assessment of the upper gastrointestinal tract: does it play an important preoperative role in bariatric surgery?
Sharaf, Ravi N; Weinshel, Elizabeth H; Bini, Edmund J; Rosenberg, Jonathan; Ren, Christine J
2004 Mar;14(3):313-317, Obesity surgery
BACKGROUND: The role of upper GI series (UGIS) before bariatric surgery is controversial. The aim of this study was to evaluate the diagnostic yield and cost of routine UGIS prior to bariatric surgery. METHODS: The medical records of consecutive obese patients who underwent UGIS before bariatric surgery between April 2001 and October 2002 were reviewed. UGIS reports were reviewed by 2 experienced gastroenterologists, and the findings were divided into 4 groups based on predetermined criteria: group 0 (normal study), group 1 (abnormal findings that neither changed the surgical approach nor postponed surgery), group 2 (abnormal findings that changed the surgical approach or postponed surgery), and group 3 (results which were an absolute contraindication to surgery). Clinically important findings included lesions in groups 2 and 3. The cost of an upper GI series (154.80 USD) was estimated from the published 2002 New York State Medicare reimbursement schedule. RESULTS: During the 18-month study period, 171 patients were evaluated by UGIS prior to bariatric surgery. One or more lesions were identified in 48.0% of patients, with only 5.3% having clinically important findings. The prevalence of radiologic findings using the classification system above was as follows: group 0 (52.0%), group 1 (42.7%), group 2 (5.3%), and group 3 (0.0%). The most common findings identified were esophageal reflux (21.6%) and hiatal hernias (18.7%). The cost of performing routine UGIS on all patients before bariatric surgery was 2,941.20 USD per clinically important finding detected. CONCLUSIONS: Routine preoperative upper GI series before bariatric surgery had a low diagnostic yield, rarely revealing pathology that changed the surgical approach or postponed surgery
— id: 42670, year: 2004, vol: 14, page: 313, stat: Journal Article,

Endoscopy plays an important preoperative role in bariatric surgery
Sharaf, Ravi N; Weinshel, Elizabeth H; Bini, Edmund J; Rosenberg, Jonathan; Sherman, Alex; Ren, Christine J
2004 Nov-Dec;14(10):1367-1372, Obesity surgery
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. METHODS: The medical records of consecutive obese patients who underwent EGD prior to bariatric surgery between May 2000 and September 2002 were reviewed. Two experienced endoscopists reviewed all EGD reports, and findings were divided into 4 groups based on predetermined criteria: group 0 (normal study), group 1 (abnormal findings that neither changed the surgical approach nor postponed surgery), group 2 (abnormal findings that changed the surgical approach or postponed surgery), and group 3 (results that were an absolute contraindication to surgery). Clinically important findings included lesions in groups 2 and 3. The cost of EGD (430.72 US dollars) was estimated using the endoscopist fee under Medicare reimbursement. RESULTS: During the 28-month study period, 195 patients were evaluated by EGD prior to bariatric surgery. One or more lesions were identified in 89.7% of patients, with 61.5% having a clinically important finding. The prevalence of endoscopic findings using the classification system above was as follows: group 0 (10.3%), group 1 (28.2%), group 2 (61.5%), and group 3 (0.0%). Overall, the most common lesions identified were hiatal hernia (40.0%), gastritis (28.7%), esophagitis (9.2%), gastric ulcer (3.6%), Barrett's esophagus (3.1%), and esophageal ulcer (3.1%). The cost of performing routine endoscopy on all patients prior to bariatric surgery was 699.92 US dollars per clinically important lesion detected. CONCLUSIONS: Routine upper endoscopy before bariatric surgery has a high diagnostic yield and has a low cost per clinically important lesion detected
— id: 49346, year: 2004, vol: 14, page: 1367, stat: Journal Article,

Prevalence and predictors of herbal medication use in veterans with chronic hepatitis C
Siddiqui, Uzma; Weinshel, Elizabeth H; Bini, Edmund J
2004 Aug;38(7):605-610, Journal of clinical gastroenterology
OBJECTIVE: Herbal therapies are used by a substantial proportion of persons in the United States, and use of these supplements may be even higher in those with chronic liver disease. The aims of this study were to prospectively determine the proportion of US veterans with chronic hepatitis C that are currently taking vitamins and herbal medications and to evaluate factors associated with use of herbal preparations. METHODS: Patients with hepatitis C who were seen in the gastroenterology, infectious disease, and primary care clinics at the VA New York Harbor Healthcare System were invited to participate in this prospective study. For comparison, healthy patients without hepatitis C were enrolled from the primary care clinics at the same medical center. Patients were interviewed by trained research coordinators who obtained detailed demographic and clinical data, as well as information on the use of antioxidants (vitamin C and E), multivitamins, and herbal medications. RESULTS: Use of vitamin C (34.8% vs. 19.6%, P < 0.001), vitamin E (25.8% vs. 13.2%, P < 0.001), multivitamins (43.6% vs. 28.0%, P < 0.001), and herbal therapies (21.0% vs. 10.4%, P < 0.001) was significantly higher in the 500 patients with hepatitis C compared with the 250 healthy controls. The most common herbal medications taken by hepatitis C patients were milk thistle (12.2%), ginseng (4.6%), and echinacea (3.0%). After adjusting for age and gender, multivariate logistic regression identified 12 or more years of education (OR 2.7; 95% CI 1.6-4.3; P < 0.001) and annual income of at least 20,000 US dollars (OR 2.0; 95% CI 1.3-3.2; P = 0.004) as the only significant predictors of herbal medication use in patients with hepatitis C. CONCLUSIONS: The use of herbal preparations is prevalent among veterans with chronic hepatitis C, especially those with higher levels of education and higher incomes. Obtaining a detailed medical history and documentation of the use of these supplements is critical to determine the potential for herbal-drug interactions and hepatotoxicity
— id: 47855, year: 2004, vol: 38, page: 605, stat: Journal Article,

Systematic evaluation of complications related to endoscopy in a training setting: A prospective 30-day outcomes study
Bini, Edmund J; Firoozi, Babak; Choung, Rosa J; Ali, Eyad M; Osman, Mohamed; Weinshel, Elizabeth H
2003 Jan;57(1):8-16, Gastrointestinal endoscopy
BACKGROUND: The 30-day frequency of negative outcomes after outpatient endoscopy performed by gastroenterology fellows is unknown. METHODS: Questionnaires were mailed to 1000 consecutive patients 30 days after endoscopy to evaluate procedure-related negative outcomes (serious and minor adverse events) and patient satisfaction. Serious adverse events were defined as follows: oversedation requiring administration of a reversal agent, and those that resulted in a physician visit, emergency department visit, admission to the hospital, or death. Minor adverse events were defined as all problems other than serious adverse events that patients related to their endoscopic procedure. RESULTS: The 30-day frequency of negative outcomes in the 869 patients who responded was 14.3%, of which 0.6% were serious and 13.7% were minor adverse events. The frequency of negative outcomes was 17.1% for EGD, 15.0% for colonoscopy, 24.4% for combined EGD and colonoscopy, and 7.8% for flexible sigmoidoscopy. One hundred percent of the serious adverse events were known to us, but only 16.0% of minor adverse events (p < 0.001). Multiple logistic regression identified midazolam dose (OR for each 1 mg increase in dose 4.5; 95% CI [2.7, 7.3]; p < 0.001), treatment with warfarin (OR 3.0; 95% CI [1.4, 6.2]; p = 0.003), comorbid disease (OR 2.1; 95% CI [1.3, 3.4]; p = 0.001), endoscopy performed in July or August (OR 2.0; 95% CI [1.1,3.7]; p = 0.02), and age (OR for each 1 year increase in age 1.03; 95% CI [1.01, 1.05]; p = 0.01) as independent predictors of negative outcomes. There was a significant association between negative outcomes and decreased patient satisfaction, and patients who reported negative outcomes were less likely to agree to endoscopy in the future. CONCLUSIONS: Serious adverse events were rare after endoscopy performed by gastroenterology fellows. Contacting patients 30 days after outpatient endoscopy significantly improved the detection of negative outcomes. Although the majority of negative outcomes were minor, these adverse events were associated with decreased patient satisfaction
— id: 33782, year: 2003, vol: 57, page: 8, stat: Journal Article,

Endoscopic training: Looking past the surface
Francois, F; Weinshel, EH; Perez-Perez, GI; Yee, HT; Blazer, MJ; Bini, EJ
2003 ;57(5):AB109-AB109, Gastrointestinal endoscopy
— id: 108236, year: 2003, vol: 57, page: AB109, stat: Journal Article,

Radiologic assessment of the upper GI tract: Does it play a role in determining bariatric surgical approach?
Sharaf, RN; Weinshel, EH; Bini, EJ; Rosenberg, J; Ren, C
2003 ;124(4):A557-A557, Gastroenterology
— id: 108242, year: 2003, vol: 124, page: A557, stat: Journal Article,

Endoscopy plays an important role in determining bariatric surgical approach
Sharaf, RN; Weinshel, EH; Bini, EJ; Rosenberg, J; Sherman, A; Ren, CJ
2003 ;57(5):AB120-AB120, Gastrointestinal endoscopy
— id: 108241, year: 2003, vol: 57, page: AB120, stat: Journal Article,

Outcomes of endoscopy in patients with iron deficiency anemia after Billroth II partial gastrectomy
Bini, Edmund J; Unger, Jeffrey S; Weinshel, Elizabeth H
2002 Apr;34(4):421-426, Journal of clinical gastroenterology
GOALS: To determine the frequency of gastrointestinal lesions detected by upper endoscopy and colonoscopy in patients who developed iron deficiency anemia after Billroth II surgery. STUDY: The authors reviewed the medical records of 116 consecutive patients with a Billroth II partial gastrectomy and 232 age- and gender-matched controls without gastric surgery who were referred for endoscopy to evaluate iron deficiency anemia over a 5-year period. RESULTS: Clinically important lesions were detected in 22.4% of the patients with gastric surgery and in 59.5% of those with intact stomachs (p < 0.001). In the gastric surgery group, clinically important lesions were found more often in the upper gastrointestinal tract than in the colon (19.0% vs. 3.4%, p < 0.001). In the nonsurgical group, the diagnostic yields of upper endoscopy and colonoscopy were not significantly different (38.4% vs. 32.8%, p = 0.24). Synchronous lesions in the upper and lower gastrointestinal tract were significantly less common in the group of patients with gastric surgery compared with those without gastric surgery (0.0% vs. 11.6%, p < 0.001). Small bowel biopsies and small bowel follow-through did not identify any additional lesions. In the gastric surgery group, multivariate analysis identified abdominal symptoms (OR = 11.2, 95% CI 3.2-39.2, p < 0.001), a positive result on fecal occult blood testing (OR = 6.4, 95% CI 2.0-20.3, p = 0.002), and Billroth II surgery at least 10 years before evaluation (OR = 5.4, 95% CI 1.7-16.7, p = 0.004) as independent predictors of identifying a clinically important lesion by endoscopy. CONCLUSIONS: Upper endoscopy had a significantly higher diagnostic yield than colonoscopy in patients who developed iron deficiency anemia after Billroth II surgery. Prospective studies are necessary to determine the role and cost-effectiveness of colonoscopy in the evaluation of iron deficiency anemia in this patient population
— id: 39694, year: 2002, vol: 34, page: 421, stat: Journal Article,

Prevalence of Helicobacter pylori and characterization of genotypes among symptomatic patients from Uruguay
Cooperberg, BA; Bini, EJ; Perez-Perez, G; Weinshel, EH; Cohen, H; Dacoll, C
2002 ;122(4):T1164-T1164, Gastroenterology
— id: 108248, year: 2002, vol: 122, page: T1164, stat: Journal Article,

Endoscopic band ligation of bleeding rectal varices
Firoozi, Babak; Gamagaris, Zoi; Weinshel, Elizabeth H; Bini, Edmund J
2002 Jul;47(7):1502-1505, Digestive diseases & sciences
— id: 32475, year: 2002, vol: 47, page: 1502, stat: Journal Article,

Aspirin induced hepatitis in a lupus patient
Francois, F; Jager, D; Weinshel, E
2002 SEP ;97(9):286-285, American journal of gastroenterology
— id: 32556, year: 2002, vol: 97, page: 286, stat: Journal Article,

Patient preferences and satisfaction with virtual vs. conventional colonoscopy
Rajapaksa, R; Macari, M; Weinshel, E; Bini, EJ
2002 ;55(5):468-468, Gastrointestinal endoscopy
— id: 108250, year: 2002, vol: 55, page: 468, stat: Journal Article,

Socioeconomic status is the major determinant of herbal medication use in veterans with chronic hepatitis C
Siddiqui, U; Weinshel, EH; Bini, EJ
2002 SEP abstract #299;97(9):S98-S98, American journal of gastroenterology
— id: 32557, year: 2002, vol: 97, page: S98, stat: Journal Article,

Response
Bini EJ; Weinshel EH
2001 May;53(5):699-700, Gastrointestinal endoscopy
— id: 20702, year: 2001, vol: 53, page: 699, stat: Journal Article,

Impact of gastroenterology consultation on the outcomes of patients admitted to the hospital with decompensated cirrhosis
Bini EJ; Weinshel EH; Generoso R; Salman L; Dahr G; Pena-Sing I; Komorowski T
2001 Dec;34(6):1089-1095, Hepatology
Managed care has strongly discouraged generalists from referring patients to specialists in an effort to reduce the costs of health care. The aim of this study was to compare patient outcomes when generalists work together with gastroenterologists or alone in the management of patients admitted to the hospital with decompensated cirrhosis. Consecutive patients admitted to the hospital with decompensated cirrhosis over a 1-year period were identified. We compared the length of stay, cost of hospitalization, incidence of hospital readmission, and mortality for patients who did and those who did not have a gastroenterology (GI) consultation. A GI consultation was requested for 107 of the 197 patients (54.3%). Patients who had a GI consultation had a significantly shorter length of stay (5.6 +/- 3.5 vs. 10.1 +/- 5.8 days, P <.001) and a lower cost of hospitalization ($6,004 +/- $4,994 vs. $10,006 +/- $6,183, P <.001) than those patients who were managed by generalists alone. The 30-day incidence of readmission (13.3% vs. 27.8%, P =.01) and mortality (7.5% vs. 16.7%, P =.045) were significantly lower in the GI consultation group. During a median follow-up of 618 days (range, 2-970), patients who had a GI consultation during hospitalization had a significantly longer time to hospital readmission (P <.001) and improved survival (P =.02) compared with those who were managed by generalists alone. In conclusion, for patients admitted to the hospital with decompensated cirrhosis, individuals who were managed by generalists in conjunction with gastroenterologists had better outcomes than those who were managed by generalists alone
— id: 26558, year: 2001, vol: 34, page: 1089, stat: Journal Article,

Early detection of colorectal cancer in iron deficient patients: Don't wait for the anemia!
Bini, EJ; Lascarides, CE; Weinshel, EH
2001 APR ;53(5):AB178-AB178, Gastrointestinal endoscopy
— id: 55076, year: 2001, vol: 53, page: AB178, stat: Journal Article,

Does warfarin increase the rate of false positive fecal occult blood tests? A prospective endoscopic study
Bini, EJ; Rajapaksa, RC; Weinshel, EH
2001 APR ;53(5):AB58-AB58, Gastrointestinal endoscopy
— id: 55074, year: 2001, vol: 53, page: AB58, stat: Journal Article,

Synchronous gastric adenocarcinomas in a patient with meckel's diverticulum
Rieber JM; Weinshel EH; Nguyen T; Sidhu GS; Bini EJ
2001 Jul;33(1):78-79, Journal of clinical gastroenterology
Meckel's diverticulum, which is the most common congenital anomaly of the gastrointestinal tract, occurs when the vitelline duct persists past the 7th week of gestation. Although complications may occur in 8% to 22% of patients with Meckel's diverticula, adenocarcinoma is very uncommon. We describe a patient with early gastric cancer who was incidentally found to have a superficial adenocarcinoma arising from ectopic gastric mucosa within a Meckel's diverticulum. To the best of our knowledge, synchronous gastric adenocarcinoma in a patient with Meckel's diverticulum has not been previously reported
— id: 20813, year: 2001, vol: 33, page: 78, stat: Journal Article,

Outcome of AIDS-associated cytomegalovirus colitis in the era of potent antiretroviral therapy [In Process Citation]
Bini EJ; Gorelick SM; Weinshel EH
2000 Jun;30(4):414-419, Journal of clinical gastroenterology
The effect of protease inhibitors (PIs) on the outcome of AIDS-associated cytomegalovirus (CMV) colitis is unknown. The aim of this study was to determine the impact of PIs on the recurrence of CMV disease and long-term survival in a large cohort of acquired immunodeficiency syndrome (AIDS) patients with CMV colitis. We reviewed the medical records of 252 AIDS patients who were diagnosed with CMV colitis by colonoscopy between January 1992 and January 1997 at Bellevue Hospital (New York, NY, U.S.A.). Follow-up data were obtained from chart review and direct telephone contact. A complete response to ganciclovir and/or foscarnet therapy was seen in 87.0% of the patients. Recurrence of CMV colitis occurred in 53.1% of patients and was significantly less common in those who received maintenance therapy (36.1% vs. 56.7%; p = 0.03) and in those who were treated with PIs (22.8% vs. 71.9%; p < 0.001). During follow-up. 69.3% of patients died. Multivariate analysis using Cox regression showed that mortality was increased in patients with recurrent CMV colitis (relative risk [RR] of death, 1.7: 95% CI, 1.1-2.6; p = 0.02) and comorbid disease (RR, 1.5: 95% CI, 1.1-2.2; p = 0.02), and decreased in those who were treated with PIs (RR, 0.42; 95% CI, 0.3-0.7; p = 0.001). The median survival was 71 weeks and was significantly longer in patients who were treated with PIs than in those who did not receive these potent anti-retroviral medications (99 vs. 51 weeks; p < 0.001). PIs significantly improve the outcome of AIDS-associated CMV colitis
— id: 11629, year: 2000, vol: 30, page: 414, stat: Journal Article,

Mucosal abnormalities of the colon in patients with portal hypertension: an endoscopic study
Bini EJ; Lascarides CE; Micale PL; Weinshel EH
2000 Oct;52(4):511-516, Gastrointestinal endoscopy
BACKGROUND: Controversy still exists regarding colonic mucosal abnormalities in patients with portal hypertension (portal colopathy). The aims of this study were to better define portal colopathy and to identify risk factors for these colonic mucosal abnormalities. METHODS: We reviewed the medical records of 437 patients with cirrhosis and portal hypertension and 224 with irritable bowel syndrome (control patients) who underwent colonoscopy over a 6-year period. RESULTS: Individuals with portal hypertension were significantly more likely than control patients to have colitis-like abnormalities (38% vs. 3%, p < 0.001) and vascular lesions (13% vs. 3%, p < 0.001). In the multivariate model, portal hypertensive gastropathy (odds ratio 5.64: 95% CI [3.39, 9.41]; p < 0.001), 2+ or larger esophageal varices (odds ratio 4.76: 95% CI [2. 78, 8.15]; p < 0.001), and Child-Pugh class C cirrhosis (odds ratio 2.64: 95% CI [1.40, 4.97]; p = 0.003) were independently associated with an increased risk of having portal colopathy, whereas the use of beta-blockers independently decreased the risk of having these findings (odds ratio 0.23: 95% CI [0.13, 0.40]; p < 0.001). Mucosal biopsies of the colon in patients with colitis-like abnormalities revealed a mild, nonspecific inflammatory infiltrate with edema and vascular ectasias in the majority of cases. CONCLUSIONS: Mucosal abnormalities in portal colopathy include edema, erythema, granularity, friability, and vascular lesions, findings that may be confused with colitis. A standardized grading system to classify the endoscopic appearance and severity of portal colopathy should be adopted
— id: 17556, year: 2000, vol: 52, page: 511, stat: Journal Article,

Natural history of HIV-associated esophageal disease in the era of protease inhibitor therapy
Bini EJ; Micale PL; Weinshel EH
2000 Jul;45(7):1301-1307, Digestive diseases & sciences
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 inhibitors have had a positive impact on the outcome of HIV-associated esophageal disease
— id: 11528, year: 2000, vol: 45, page: 1301, stat: Journal Article,

Prospective, randomized, single-blind comparison of two preparations for screening flexible sigmoidoscopy
Bini EJ; Unger JS; Rieber JM; Rosenberg J; Trujillo K; Weinshel EH
2000 Aug;52(2):218-222, Gastrointestinal endoscopy
BACKGROUND: The best and most cost-effective bowel cleansing regimen for patients undergoing flexible sigmoidoscopy is not known. The aim of this study was to compare patient tolerance, quality of preparation, and cost of 2 bowel cleansing regimens for flexible sigmoidoscopy. METHODS: Two hundred fifty consecutive patients referred for screening flexible sigmoidoscopy were randomized to receive an oral preparation (45 mL oral sodium phosphate and 10 mg bisacodyl) or an enema preparation (2 Fleet enemas and 10 mg bisacodyl). Tolerance of the preparation was graded as easy, tolerable, slightly difficult, extremely difficult, or intolerable. The endoscopist was blinded to which preparation the patient received and graded the quality of the preparation as poor, fair, good, or excellent. Cost was calculated by adding the cost of the medications and the cost for the nursing time required to prepare the patient for endoscopy. RESULTS: Patients in the oral preparation group were more likely to grade the preparation as easy or tolerable when compared with the enema group (96.8% vs. 56.4%, p < 0.001). The endoscopist graded the quality of the preparation as good or excellent in 86.5% of the patients in the oral preparation group compared with 57.3% in the enema group (p < 0.001). In the oral preparation group, the mean nursing time (34.6 vs. 65.3 minutes, p < 0.001) and cost ($16.39 vs. $31.13, p < 0.001) were significantly less than in the enema group. CONCLUSIONS: An oral sodium phosphate preparation results in a superior quality endoscopic examination that is better tolerated and more cost-effective than enemas in patients undergoing screening flexible sigmoidoscopy
— id: 17557, year: 2000, vol: 52, page: 218, stat: Journal Article,

Incidence of complications within 30 days of outpatient endoscopy: What you don't know can hurt you
Bini, EJ; Ali, EM; Choung, RJ; Firoozi, B; Osman, M; Weinshel, EH
2000 APR ;51(4):AB67-AB67, Gastrointestinal endoscopy
— id: 54565, year: 2000, vol: 51, page: AB67, stat: Journal Article,

Chronic hepatitis C infection is associated with a significant reduction in health-related quality of life: A cross-sectional survey of US veterans
Bini, EJ; Baskies, MA; Mannix, RA; Reid, M; Weinshel, EH
2000 OCT ;32(4):283A-283A, Hepatology
— id: 55262, year: 2000, vol: 32, page: 283A, stat: Journal Article,

Marked reduction in health-related quality of life in US veterans with chronic hepatitis C
Bini, EJ; Baskies, MA; Mannix, RA; Weinshel, EH
2000 APR ;118(4):A1426-A1426, Gastroenterology
— id: 54573, year: 2000, vol: 118, page: A1426, stat: Journal Article,

Should liver biopsy be performed in all HCV-infected patients with persistently normal ALT levels? A prospective comparison of clinical characteristics, liver histology, and health-related quality of life
Bini, EJ; Reid, M; Mannix, RA; Weinshel, EH
2000 OCT ;32(4):282A-282A, Hepatology
— id: 55260, year: 2000, vol: 32, page: 282A, stat: Journal Article,

Outcome of fecal occult blood testing obtained the time of hospital admission
Bini, EJ; Weinshel, EH; Generoso, R; Salman, L; Dahr, G; Pena-Sing, I; Komorowski, T
2000 APR ;118(4):A256-A256, Gastroenterology
— id: 54591, year: 2000, vol: 118, page: A256, stat: Journal Article,

Gastrointestinal endoscopy in premenopausal women with iron deficiency anemia: determination of the best diagnostic approach
Bini EJ; Micale PL; Weinshel EH
1999 Jun;94(6):1715-1715, American journal of gastroenterology
— id: 17559, year: 1999, vol: 94, page: 1715, stat: Journal Article,

Risk factors for rebleeding and mortality from acute upper gastrointestinal hemorrhage in human immunodeficiency virus infection
Bini EJ; Micale PL; Weinshel EH
1999 Feb;94(2):358-363, American journal of gastroenterology
OBJECTIVES: 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. METHODS: 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. RESULTS: 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 hemorrhage, and lymphoma. The 30-day mortality from UGIH was 11.4% and a hemoglobin of <8 g/dl, a platelet count of <100,000/mm3, major stigmata of hemorrhage, rebleeding within 30 days, and lymphoma were independent predictors of mortality. The introduction of protease inhibitors in December 1995 resulted in a reduction in 30-day mortality from 13.5% to 4.4% (p = 0.04) without affecting the etiology of UGIH or the incidence of rebleeding. CONCLUSIONS: Acute UGIH in HIV-infected patients is most commonly due to gastroduodenal ulcers, esophageal ulcers, and Kaposi's sarcoma. In this patient population, the introduction of protease inhibitors has had a positive impact on the outcome of UGIH
— id: 7302, year: 1999, vol: 94, page: 358, stat: Journal Article,

Is upper gastrointestinal endoscopy indicated in asymptomatic patients with a positive fecal occult blood test and negative colonoscopy?
Bini EJ; Rajapaksa RC; Valdes MT; Weinshel EH
1999 Jun;106(6):613-618, American journal of medicine
PURPOSE: There are no recommendations as to whether endoscopic evaluation of the upper gastrointestinal tract is indicated in asymptomatic patients who have a positive fecal occult blood test and a negative colonoscopy. SUBJECTS AND METHODS: All asymptomatic patients with a positive fecal occult blood test who were referred for diagnostic endoscopy were identified. Patient charts, endoscopy records, and pathology reports were reviewed. RESULTS: During the 5-year study period, 498 asymptomatic patients with a positive fecal occult blood test and negative colonoscopy were evaluated. An upper gastrointestinal source of occult bleeding was detected in 67 patients (13%), with peptic ulcer disease being the most common lesion identified (8%). Four patients were diagnosed with gastric cancer and 1 had esophageal carcinoma. In addition, 74 patients (15%) had lesions that were not considered a source of occult bleeding; these findings prompted a change in management in 56 patients (11%). Anemia was the only variable significantly associated with having a clinically important lesion identified (multivariate odds ratio = 5.0; 95% confidence interval 2.9 to 8.5; P <0.001). CONCLUSIONS: Upper gastrointestinal endoscopy yields important findings in asymptomatic patients with a positive fecal occult blood test and negative colonoscopy. Our data suggest that endoscopic evaluation of the upper gastrointestinal tract should be considered, especially in patients with anemia
— id: 6142, year: 1999, vol: 106, page: 613, stat: Journal Article,

The findings and impact of nonrehydrated guaiac examination of the rectum (FINGER) study: a comparison of 2 methods of screening for colorectal cancer in asymptomatic average-risk patients
Bini EJ; Rajapaksa RC; Weinshel EH
1999 Sep 27;159(17):2022-2026, Archives of internal medicine
BACKGROUND: Testing stool for occult blood at the time of digital rectal examination (DRE) has been discouraged because it is thought to increase the number of false-positive test results. OBJECTIVE: To compare the diagnostic yield of colonoscopy and the cost per cancer detected in asymptomatic patients with a positive fecal occult blood test result obtained by DRE with that obtained from spontaneously passed stool (SPS) samples. METHODS: We reviewed the medical records of consecutive asymptomatic patients at average risk for colorectal cancer who were referred for colonoscopy to evaluate a positive fecal occult blood test result obtained by DRE (n = 282) or SPS samples (n = 390). The cost of colonoscopy was estimated by adding the physician fee under Medicaid reimbursement, the facility fee for endoscopy, and the pathology fee for the biopsy specimens. RESULTS: During the 5-year study period, 672 patients were evaluated and a colonic source of occult bleeding was identified in 145 patients (21.6%). The predictive value of a positive fecal occult blood test result (22.0% vs 21.3%, P = .85) and the cost per cancer detected ($7604.80 vs $7814.54) were no different in the DRE and SPS groups, with carcinomas being detected in 11.7% and 11.3% of patients, respectively. CONCLUSIONS: Testing stool for occult blood at the time of DRE does not increase the number of false-positive test results or the cost per cancer detected in asymptomatic patients at average risk for colorectal cancer. In this patient population, all individuals should be evaluated by full colonoscopy regardless of the method of stool collection
— id: 6216, year: 1999, vol: 159, page: 2022, stat: Journal Article,

Severe exacerbation of asthma: a new side effect of interferon-alpha in patients with asthma and chronic hepatitis C
Bini EJ; Weinshel EH
1999 Apr;74(4):367-370, Mayo Clinic proceedings
Interferon-alpha is used by physicians to treat numerous common medical disorders; however, therapy is often limited by side effects. Pulmonary complications, such as interstitial pneumonitis and bronchiolitis obliterans organizing pneumonia, have been described in patients receiving interferon-alpha therapy. Exacerbation of asthma induced by subcutaneous administration of interferon-alpha has not been previously reported. We describe two patients with mild asthma in whom treatment with interferon-alpha for chronic hepatitis C resulted in exacerbation of the underlying asthma. The severe asthmatic symptoms resolved promptly after use of interferon-alpha was discontinued and corticosteroid therapy was initiated. Repeated treatment with interferon-alpha several months later resulted in a rapid, more severe exacerbation of asthma in both patients. Patients undergoing therapy with interferon-alpha, especially those with chronic asthma, should be monitored closely for pulmonary symptoms. If these symptoms develop, patients should be instructed to discontinue use of interferon-alpha and seek medical attention immediately
— id: 6101, year: 1999, vol: 74, page: 367, stat: Journal Article,

Risk factors for recurrent bleeding and mortality in human immunodeficiency virus infected patients with acute lower GI hemorrhage
Bini EJ; Weinshel EH; Falkenstein DB
1999 Jun;49(6):748-753, Gastrointestinal endoscopy
BACKGROUND: Little is known about lower gastrointestinal (GI) hemorrhage in the human immunodeficiency virus (HIV) infected population. Our aim was to determine the underlying causes, the clinical outcome, and the risk factors for recurrent bleeding and mortality in HIV-infected patients with acute LGIH. METHODS: We reviewed the medical records of consecutive HIV-infected patients with acute lower GI hemorrhage who were evaluated with endoscopy from January 1992 through January 1997 at Bellevue Hospital Center. RESULTS: During the 5-year study period, 312 patients with acute lower GI hemorrhage underwent colonoscopy (n = 233) or flexible sigmoidoscopy (n = 79). Cytomegalovirus colitis (25.3%), lymphoma (12.2%), and idiopathic colitis (12.2%) were the most common causes identified. Within 30 days of presentation, recurrent bleeding occurred in 17.6% of patients. Independent predictors of recurrent bleeding included the presence of at least one comorbid illness, a hemoglobin level of less than 8 gm/dL, a platelet count of less than 100,000/mm3, and major stigmata of hemorrhage. The 30-day mortality from lower GI hemorrhage was 14.4%, and the presence of comorbid disease, recurrence of bleeding, and surgical intervention were found to be the only independent predictors of mortality in this patient population. CONCLUSIONS: Acute lower GI hemorrhage in HIV-infected patients is most commonly caused by cytomegalovirus colitis and is associated with a high short-term morbidity and mortality
— id: 6123, year: 1999, vol: 49, page: 748, stat: Journal Article,

Prospective, randomized, single-blind comparison of two preparations for screening flexible sigmoidoscopy
Bini, EJ; Rosenberg, J; Weinshel, EH; Leung, J
1999 ;49(4 pt. 2):AB195-AB195 #550, Gastrointestinal endoscopy
— id: 108261, year: 1999, vol: 49, page: AB195, stat: Journal Article,

Impact of gastroenterologists on the cost and outcome of patients admitted to the hospital with decompensated liver disease
Bini, EJ; Weinshel, EH; Generoso, R; Salman, L; Dahr, G; Pena-Sing, I; Komorowski, T
1999 ;116(4):G0203-G0203, Gastroenterology
— id: 108258, year: 1999, vol: 116, page: G0203, stat: Journal Article,

Impact of a nutrition support team on the cost and outcome of patients given total parenteral nutrition
Weinshel, E; Ali, EM; Bloom, ED; Gramata, JA; Levinger, ES; Bini, EJ
1999 ;116(4):G0442-G0442, Gastroenterology
— id: 108262, year: 1999, vol: 116, page: G0442, stat: Journal Article,

Evaluation of the gastrointestinal tract in premenopausal women with iron deficiency anemia [see comments]
Bini EJ; Micale PL; Weinshel EH
1998 Oct;105(4):281-286, American journal of medicine
PURPOSE: Iron deficiency anemia is often attributed to menstrual blood loss in premenopausal women. The aims of this study were to determine the diagnostic yield of endoscopy and to evaluate the clinical outcome in these women. METHODS: Charts, endoscopy records, and pathology reports were reviewed in consecutive premenopausal women with documented iron deficiency anemia who were referred for diagnostic endoscopy. Follow-up was obtained by telephone contact and review of medical records. RESULTS: Endoscopy revealed a clinically important lesion in 23 (12%) of 186 patients. An upper gastrointestinal source was identified in 12 patients, most commonly due to gastric cancer (3%) or peptic ulcer disease (3%). A colonic lesion was detected in 11 patients, with colon cancer in six (3%). No patient had a lesion identified in both the upper and lower gastrointestinal tract. Small bowel biopsies and radiography were normal in all patients in whom they were obtained. Independent predictors for having a gastrointestinal lesion identified by endoscopy include a positive fecal occult blood test, a hemoglobin of <10 g/dL, and abdominal symptoms. Long-term follow-up data suggested a favorable prognosis, and iron deficiency anemia resolved with appropriate therapy in nearly all patients. CONCLUSIONS: Endoscopy yields important findings in premenopausal women with iron deficiency anemia, which should not be attributed solely to menstrual blood loss
— id: 7303, year: 1998, vol: 105, page: 281, stat: Journal Article,

Endoscopic evaluation of chronic human immunodeficiency virus-related diarrhea: is colonoscopy superior to flexible sigmoidoscopy?
Bini EJ; Weinshel EH
1998 Jan;93(1):56-60, American journal of gastroenterology
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
— id: 7502, year: 1998, vol: 93, page: 56, stat: Journal Article,

Comparison of duodenal with jejunal biopsy and aspirate in chronic human immunodeficiency virus-related diarrhea
Bini EJ; Weinshel EH; Gamagaris Z
1998 Oct;93(10):1837-1840, American journal of gastroenterology
OBJECTIVES: 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. METHODS: 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. RESULTS: 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 in only 1.8% of patients evaluated, and there was no difference in the yield of duodenal and jejunal aspirates (1.3% vs 2.1%, p=0.7). Patients with a CD4 count of < 100 cells/mm3 were significantly more likely to have a pathogen identified than those with higher CD4 counts (38.8% vs 7.1%,p < 0.0001). CONCLUSIONS: Upper endoscopy with small bowel biopsy and aspirate identifies a pathogen in 27.8% of individuals with HIV-related chronic unexplained diarrhea. In this patient population, jejunal biopsies acquired by enteroscopy are superior to those obtained from the duodenum. Small bowel aspirates are of little value in the workup of chronic HIV-related diarrhea
— id: 7501, year: 1998, vol: 93, page: 1837, stat: Journal Article,

Outcome of endoscopy in patients with iron deficiency anemia and a previous history of partial gastrectomy
Bini, EJ; Unger, JS; Weinshel, EH
1998 APR ;47(4):81-18, Gastrointestinal endoscopy
— id: 98348, year: 1998, vol: 47, page: 81, stat: Journal Article,

Outcome of colorectal cancer screening by digital rectal examination in asymptomatic average-risk individuals
Bini, EJ; Valdes, MT; Weinshel, EH
1998 APR ;47(4):AB95-AB95, Gastrointestinal endoscopy
— id: 53508, year: 1998, vol: 47, page: AB95, stat: Journal Article,

Predictive value of a positive fecal occult blood test for upper gastrointestinal lesions in asymptomatic patients with a negative colonoscopy
Bini, EJ; Valdes, MT; Weinshel, EH
1998 APR ;47(4):AB80-AB80, Gastrointestinal endoscopy
— id: 53506, year: 1998, vol: 47, page: AB80, stat: Journal Article,

Colonoscopy is superior to flexible sigmoidoscopy in HIV-positive patients with chronic diarrhea
Bini, EJ; Weinshel, E
1997 ;45(4):320-320, Gastrointestinal endoscopy
— id: 108264, year: 1997, vol: 45, page: 320, stat: Journal Article,

Liver biopsy findings in 501 patients infected with human immunodeficiency virus (HIV)
Poles MA; Dieterich DT; Schwarz ED; Weinshel EH; Lew EA; Lew R; Scholes JV
1996 Feb 1;11(2):170-177, Journal of acquired immune deficiency syndromes & human retrovirology
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
— id: 6947, year: 1996, vol: 11, page: 170, stat: Journal Article,

OCCULT GASTROINTESTINAL BLOOD-LOSS MAY PREDICT HIGH HEPATIC VENOUS-PRESSURE GRADIENTS IN PATIENTS WITH CIRRHOSIS
ALPERT, DJ; ALEXANDER, RJ; WEINSHEL, EH; RAICHT, RF
1994 OCT ;20(4):A327-A327, Hepatology
— id: 52316, year: 1994, vol: 20, page: A327, stat: Journal Article,

Beta adrenergic stimulation and blockade in cirrhosis: effects on azygos vein blood flow and portal hemodynamics
Weinshel EH; Altszuler HM; Raicht RF; Sedlis SP
1994 Jun;307(6):396-400, American journal of the medical sciences
It is unknown whether beta adrenergic stress has adverse hepatic hemodynamic effects. Therefore, the authors studied the hemodynamic effects of beta adrenergic stimulation and subsequent blockade in 10 patients with cirrhosis (6 Childs A, 3 Childs B, and 1 Childs C) with known or suspected portal hypertension. Free and wedged hepatic vein pressures, hepatic venous pressure gradient, heart rate, mean arterial pressure, cardiac output, and azygos vein blood flow were measured at rest and after isoproterenol infusion (mean dose = 7.3 micrograms/min: target heart rate = 150% to 200% of resting heart rate). Esmolol, an ultra-short-acting beta blocker, was then infused (dose titrated to return heart rate to baseline), and all measurements were repeated. Based on the results, the authors conclude that beta adrenergic stress provoked by isoproterenol infusion significantly increases azygos vein blood flow and hepatic venous pressure gradient. Beta blockade with esmolol reduces azygos vein blood flow and hepatic venous pressure gradient significantly below baseline
— id: 17779, year: 1994, vol: 307, page: 396, stat: Journal Article,

EFFECTS OF PENTOXYFYLLINE ON HEPATIC HEMODYNAMICS
WEINSHEL, EH; LORIN, JD; SEDLIS, SP; RAICHT, RF
1994 APR ;106(4):A1006-A1006, Gastroenterology
— id: 52459, year: 1994, vol: 106, page: A1006, stat: Journal Article,

INTESTINAL PERMEABILITY IS NOT INCREASED IN HIV PLUS PATIENTS
WEINSHEL, EH; SKLAR, BF; RAICHT, RF; MA, TY; HOLLANDER, D
1994 APR ;106(4):A792-A792, Gastroenterology
— id: 52456, year: 1994, vol: 106, page: A792, stat: Journal Article,

INTESTINAL PERMEABILITY IN HIV-INFECTION - PROPER CONTROLS ARE NECESSARY
BATASH, S; WEINSHEL, E; FALKENSTEIN, D; RAICHT, R; MA, T; KATZ, K; HOLLANDER, D
1992 MAY ;87(5):680-680, American journal of gastroenterology
— id: 51954, year: 1992, vol: 87, page: 680, stat: Journal Article,

RESULTS OF 452 LIVER BIOPSIES IN PATIENTS SEROPOSITIVE FOR HUMAN-IMMUNODEFICIENCY-VIRUS (HIV)
DIETERICH, D; POLES, M; LEW, E; SCHWARTZ, E; WEINSHEL, E; LEE, M; SCHOLES, J
1992 OCT ;16(4):A69-A69, Hepatology
— id: 51856, year: 1992, vol: 16, page: A69, stat: Journal Article,

Resin residue
Abemayor EM; Weinshel EH; Falkenstein DB
1990 May-Jun;36(3):317-317, Gastrointestinal endoscopy
— id: 29037, year: 1990, vol: 36, page: 317, stat: Journal Article,

EFFECTS OF BETA-ADRENERGIC STIMULATION AND BLOCKADE ON AZYGOUS VEIN BLOOD-FLOW AND PORTAL HEMODYNAMICS IN CIRRHOSIS
Weinshel, EH; Altszuler, HM; Raicht, RF; Sedlis, SP
1990 Oct;12(4):874-874, Hepatology
— id: 32038, year: 1990, vol: 12, page: 874, stat: Journal Article,

EGD IS ESSENTIAL IN THE EVALUATION OF ESOPHAGEAL SYMPTOMS IN HIV + PATIENTS
PEARLMAN, K; WEINSHEL, E; FALKENSTEIN, D; RAICHT, R
1988 SEP ;83(9):1023-1023, American journal of gastroenterology
— id: 41761, year: 1988, vol: 83, page: 1023, stat: Journal Article,

LIVER-BIOPSY IN AIDS PATIENTS
PEARLMAN, K; WEINSHEL, E; FALKENSTEIN, D; RAICHT, R
1988 MAY ;94(5):A347-A347, Gastroenterology
— id: 41782, year: 1988, vol: 94, page: A347, stat: Journal Article,

Hemorrhoids or rectal varices: defining the cause of massive rectal hemorrhage in patients with portal hypertension
Weinshel E; Chen W; Falkenstein DB; Kessler R; Raicht RF
1986 Mar;90(3):744-747, Gastroenterology
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
— id: 17787, year: 1986, vol: 90, page: 744, stat: Journal Article,

Postgastrectomy polyps--a cause of bleeding
Weinshel E; Falkenstein DB; Raicht RF
1985 Jun;31(3):202-204, Gastrointestinal endoscopy
— id: 17788, year: 1985, vol: 31, page: 202, stat: Journal Article,

Endoscopic findings in the esophagus following the Sugiura procedure
Weinshel E; Zachary KJ; Falkenstein DB
1984 Jun;30(3):183-184, Gastrointestinal endoscopy
— id: 29038, year: 1984, vol: 30, page: 183, stat: Journal Article,