Digestion Center for Digestive Health

Inside this Issue Studying ocular radiation exposure Collaboration with Esophageal and Lung Institute Latest treatments for pelvic floor disorders Fecal microbiota transplant

Digestion Allegheny Health Network Center for Digestive Health Volume 2, Issue 1

Inside this Issue Medical Director’s Message

Page 1

Effectively Diagnosing and Treating Pelvic Floor Disorders

Page 2

Innovative Treatment for Liver Cancer

Page 4

AHN Digestive Health Specialists Dot the Region’s Landscape

Page 6

Collaboration with Esophageal and Lung Institute

Page 8

Multidisciplinary Collaboration for Groundbreaking Research

Page 10

Writer Dana Allwein

Fecal Microbiota Transplant to Treat Clostridium Difficile

Page 12

Graphic Designer Keith Little

In the News

Page 13

Our Locations

Page 13

Publisher Kofi Clarke, MD, FACP, FRCP (Lond) Division Chief, AHN Center for Digestive Health Editorial Board Michael Babich, MD Nitin Sardana, MD Payal Thakkar, PharmD Director, Production Services Cathy Deverts

Photographers Alex Jones Kristin Petersen

Digestion is published by the Allegheny Health Network Center for Digestive Health in cooperation with the Department of Marketing and Communications. It is produced once a year for physicians and patients interested in the latest diagnostics, treatments and research at the AHN Center for Digestive Health.

©2015 Allegheny Health Network An equal opportunity employer. All rights reserved. AHN35092

Medical Director’s Message “Alone we can do so little; together we can do so much.”

– Helen Keller

Since the formation of Allegheny Health Network (AHN), the Center for Digestive Health has continued to build the breadth of our advanced diagnostics and innovative treatments. As part of this endeavor, we have expanded in every direction from Pittsburgh’s city center to reach suburbs and rural areas, most recently at the Wexford Health + Wellness Pavilion and at Saint Vincent Hospital in Erie. This continued progress allows us to extend our specialized services – from liver transplant and endoscopic ultrasound to IBD and pelvic floor disorders – to people in numerous communities while we maintain our core value of providing personalized and compassionate care to each individual. In the pages ahead, you will read about our collaboration with the AHN Esophageal and Lung Institute (ELI), a team of highly accomplished physicians whose groundbreaking research and advanced treatments for esophageal and lung diseases have helped to revolutionize the field. You will also discover the innovative technology we use to diagnose pelvic disorders, how our fecal microbiota transplant program is successfully treating patients with clostridium difficile, and the progressive approach that AHN liver specialists are utilizing to combat liver cancer. Our research initiatives are vast and incorporate many GI-related conditions. The Center for Digestive Health physicians are studying, for instance, the amount of ocular radiation exposure to endoscopists’ eye lenses during endoscopic retrograde cholangiopancreatography (ERCP) procedures in a typical endoscopy suite and measuring the dose against the cataract threshold in order to determine appropriate ocular protection guidelines. Also, in collaboration with Carnegie Mellon University, our researchers are developing a software program and video analytics that will optimize colonoscopies by providing high-quality, real-time images to the endoscopist, improving detection of colon polyps and other lesions. In addition, our center has set up an inflammatory bowel disease (IBD) electronic research registry that will give us insight into factors that impact the natural course of the disease and could help lead to the development of more effective therapies and preventative measures. These are exciting times in the field of digestive health as we explore new methods of detection and treatment to further advance our approaches. We look forward to continuing our partnership with you and providing patients with effective, positive outcomes. Sincerely,

Kofi Clarke, MD, FACP, FRCP (Lond) Associate Professor, Temple University School of Medicine Division Chief, Allegheny Health Network Center for Digestive Health

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Effectively Diagnosing and Treating Pelvic Floor Disorders become depressed. But we have to let these patients – both men and women – know that there are things we can offer to improve the quality of their lives.” The Pelvic Floor Management Program has a comprehensive team that uses innovative diagnostic tools to accurately and quickly determine a patient’s condition. Endoanal ultrasound, for example, allows a physician to evaluate the anal sphincter muscles and rectal wall in order to identify abnormalities, such as tears, fistulas, tumors and scar tissue. The group also works closely with specialists throughout Allegheny Health Network, including urogynecology and the Women’s Pelvic Health Program. Sandra El-Hachem, MD

Sandra El-Hachem, MD

Judith French, RN

One in three women suffers with a pelvic floor dysfunction, and numerous men are adversely affected by the condition as well. Yet many of these people go undiagnosed because they are embarrassed to seek help, think the condition can’t be treated and don’t realize there are options for managing their symptoms. The specialists of the Allegheny Health Network (AHN) Center for Digestive Health Pelvic Floor Management Program understand how significantly these conditions disturb people’s lives. They are experts at quickly and accurately diagnosing this dysfunction, which causes difficulty with controlling the muscles in the pelvic area and leads to symptoms, such as fecal or urinary incontinence, chronic pelvic pain, chronic constipation and pelvic organ prolapse. “Pelvic floor disorders involve problems with defecation, continence, pain, as well as prolapse of organs,” said Sandra El-Hachem, MD, gastroenterologist at the AHN Center for Digestive Health and section head of Integrative Medicine. “When people cannot defecate properly or experience incontinence or pain, they are apprehensive to interact socially, they miss work and they oftentimes

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Innovative technology for diagnosis A novel approach available at the Center for Digestive Health is a high-resolution anorectal manometry, which measures anorectal pressures so that physicians can evaluate such conditions as constipation and fecal incontinence. It involves a probe with an inflated balloon and sensors on the tip that is inserted into the rectum to see if both the rectum and anus are functioning properly. “This also allows us to determine if the anus and rectal muscles are working in a coordinated fashion,” Dr. El-Hachem explained. “It gauges the pressures of the anal sphincter

Warning signs Pelvic floor dysfunction symptoms: • Urinary or bowel incontinence • Painful urination or bowel movements • Difficulty controlling urinary or bowel urges • Constipation • Pressure in the vagina or rectum • Painful intercourse for women • Continual pain in the pelvic area, genitals or rectum • Constant feeling of needing to urinate

Accurate diagnosis and effective treatments Our advanced diagnostics include: • Endoanal ultrasound • High-resolution anorectal manometry • MRI defecography • Colonic transit study Our treatments include: • Pelvic floor physical therapy • Medications • Relaxation techniques • Surgery

muscles, the sensation in the rectum and the neural reflexes that are needed for normal bowel movements.” Physicians also use MRI defecography, which employs magnetic resonance imaging (MRI) to determine if the pelvic floor muscles are working properly. A gel substance is inserted into the rectum, and images are taken to view if the body properly dispels the gel. Dr. El-Hachem said that colonic transit studies is another diagnostic option to determine the rate that stool moves through the colon. It involves a patient ingesting two capsules with tiny opaque markers. Over the course of the next five days, physicians monitor the movement of the markers by taking X-rays of the colon. This allows for the assessment of the speed at which a patient’s colon is emptying. Treatments with lasting impact After receiving a complete evaluation and appropriate diagnostic procedures, each patient receives a physician-guided treatment plan. Pelvic floor physical therapy is the most common treatment and involves a therapist using different modalities to focus on improving patients’ symptoms, including using biofeedback to improve rectal sensation and muscle contraction and pelvic massage to treat pelvic pain, as well as helping patients optimize their body position during defecation for maximal effect.

“Patients also learn to recognize internal sensations linked to relaxation muscles and are taught home exercises for long-term maintenance,” Dr. El-Hachem said. “Studies have indicated that biofeedback provides improvement for more than 70 percent of patients with pelvic floor conditions if they are compliant with the program.” Physicians sometimes prescribe medication or recommend relaxation techniques, such as warm baths, yoga and exercises, Dr. El-Hachem added. Surgery may be required if there is an organ prolapse or incontinence amenable to surgical therapy, including sacral nerve stimulation. “Because our program is so comprehensive and crosses over various specialty areas throughout Allegheny Health Network, we are able to provide each patient with the most all-encompassing approach to care.” Pelvic Floor Management Program 412.359.8900 Women’s Pelvic Health Program 412.854.7145 or 412.578.5534 In Erie: 814.452.7867

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Innovative Medicine has Liver Transplant Patient Still Going Strong Five Years Later

Ronald Jackson retired owner of a painting business Disease: Hepatocellular carcinoma Liver transplant, June 2010

Ronald Jackson said it was sometime in the summer of 2005 that he started not feeling like himself. It didn’t take long until the 63-year-old Verona man had intolerable stomach pain that kept him from working, shooting pool, playing with his grandchildren or even drawing in his sketchbook. “It was a tough time; I wasn’t sure what was going on with me,” Ronald said. He was diagnosed with hepatocellular carcinoma, a malignant tumor in his liver. Although the diseased portion of Ronald’s liver was successfully removed and he returned to an active life, he learned four years later that the cancer had returned. This time, he had several tumors in his liver. However, Allegheny Health 4

Network doctors felt encouraged that the cancer had not spread to other parts of his body. “Ronald had recurrent liver cancer,” says Ngoc Thai, MD, PhD, director of the Allegheny Health Network Transplant Institute. “He was very lucky that his cancer hadn’t yet metastasized. That improved his prognosis tremendously. But Ronald needed a liver transplant soon; otherwise, the tumor would eventually spread beyond the liver.” Because transplant eligibility is based on the size and number of tumors, Ronald’s physicians were faced with the challenge of shrinking the tumor while causing no harm to

his liver. So they proposed a treatment plan known as “bridge-to-transplantation.” “Our goal was to eradicate his tumor while keeping liver tissue unaffected by treatment. That would buy Ronald some time while he waited for a donor liver,” said Alexander Kirichenko, MD, PhD, an Allegheny Health Network Cancer Institute radiation oncologist. Dr. Kirichenko proposed a novel alternative known as stereotactic body radiotherapy (SBRT) – a non-invasive radiation technique that precisely delivers high doses of radiation to isolated primary or metastatic liver tumors with minimal damage to surrounding healthy tissue. The Cancer Institute is one of just a few leading medical centers in the world offering the innovative therapy. Ronald needed only five SBRT treatments to shrink 90 percent of the tumors, all without harming the rest of his liver. For the next three months, he waited patiently for a donor liver to become available. Then in June 2010, Ronald received a call from Allegheny General Hospital that a compatible organ was ready for him. Dr. Thai and the transplant team performed Ronald’s surgery that day. Ronald tolerated the transplant remarkably well, Dr. Thai said, and was discharged from the hospital a week later. “In no time, I had a lot of my strength back, and now I’m doing the things I love again — walking my three dogs, going dancing on the weekends with my wife and playing pool,” said Ronald, who will need to continue taking immunosuppression medications the rest of his life to prevent rejection of his liver. Since Ronald was treated five years ago, 26 other liver cancer patients at Allegheny Health Network have successfully undergone SBRT as a bridge-to-liver transplant procedure. Just like Ronald, 18 of those patients have

already received a liver transplant. In addition, more than 178 patients with primary and metastatic liver cancer — and not in need of a transplant — have been treated with SBRT. “Liver cancer was once considered one of the most lethal and difficult forms of cancer to treat,” said Dr. Thai. “But the future for liver cancer is very promising. With new technologies and a multidisciplinary approach, we are making dramatic improvements in survival rates, and we are helping to improve the quality of life for many people.” AHN Liver Transplant Program 1.855.625.4545 5

Allegheny Health Network Digestive Health Specialists Dot the Region’s Landscape

Katie Farah, MD It’s pretty simple: Patients want convenient access to digestive health specialists who have offices close their home or work. The AHN Center for Digestive Health brings that to fruition by expanding its breadth to reach every corner of the Pittsburgh region and into Erie. Patients can now receive personalized, patientfocused care for celiac disease, functional bowel disease, inflammatory bowel disease, liver disease and transplantation, pancreas and biliary disease, and pelvic floor management, said Kofi Clarke, MD, Division Chief of the AHN Center for Digestive Health. “We have made significant strides in ensuring that patients throughout the region have direct access to these highly specialized areas,” Dr. Clarke said. “We want referring physicians to know that we are a resource near their patients, offering every aspect of diagnostic and treatments services for digestive disorders.”

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Allegheny General Hospital/Federal North Heitham Abdul-Baki, MD Elie Aoun, MD Michael Babich, MD (Hepatology) Kofi Clarke, MD Manish Dhawan, MD Katie Farah, MD Abhijit Kulkarni, MD Paul Lebovitz, MD Robin Midian, MD (Hepatology) Marcia Mitre, MD Ricardo Mitre, MD Suzanne Morrissey, MD Jose Oliva, MD (Hepatology) Christina Strahotin, MD (Hepatology) Shyam Thakkar, MD Jorge Vazquez, MD (Nutrition) Barbara Nagrant, PhD (Psychology) Melanie Shuster, CRNP Stephanie Sossong, PA-C Jennifer Whiteside, MAc (Acupuncture) Meredith Wisiniewski, PA-C Allegheny Valley Hospital Kenneth Glick, MD H. David Lipsitz, MD Canonsburg Hospital Shyam Thakkar, MD Peters Township Health + Wellness Pavilion Jennifer Hadam, MD Jose Oliva, MD (Hepatology) Forbes Hospital Hossam Kandil, MD (Director in the East) Irving Gottfried, MD Paul Lebovitz, MD Rene Rivera, MD

Jefferson Hospital Renee Flannagan, MD Jose Oliva, MD (Hepatology) Pikul Patel, MD Christina Strahotin, MD (Hepatology) Mon Valley Hospital (affiliated hospital) Michael Babich, MD (Hepatology) Deepti Dhavaleshwar, MD Jennifer Hadam, MD John Hauser, MD Robin Midian, MD (Hepatology) Meredith Wisiniewski, PA-C Saint Vincent Hospital Segun Abogunde, MD Vladislava Buntic, MD Yasser Jamal, MD Dinesh Khera, MD Jose Oliva, MD (Hepatology) Christina Strahotin, MD (Hepatology)

Wexford Health + Wellness Pavilion

West Penn Hospital Heitham Abdul-Baki, MD Elie Aoun, MD Michael Babich, MD (Hepatology) Kofi Clarke, MD Manish Dhawan, MD Robert Kania, MD Suzanne Morrissey, MD Wexford Health + Wellness Pavilion Sandra El-Hachem, MD Katie Farah, MD Robin Midian, MD (Hepatology) Christina Strahotin, MD (Hepatology) Shyam Thakkar, MD

Demonstration kitchen at Wexford Health + Wellness Pavilion for specialized and healthy diets.

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Allegheny Health Network Esophageal and Lung Institute Nationally Dynamic Clinical and Research Powerhouse approaches in these highly specialized fields,” said Abhijit Kulkarni, MD, an AHN gastroenterologist who collaborates with ELI specialists at weekly interdisciplinary conferences to develop evidence-based treatment plans. “They are experts with diagnostic and therapeutic modalities that have proven to detect conditions at their earliest stages and achieve exceptional outcomes through advanced treatments.”

Rodney Landreneau, MD (l) and Blair Jobe, MD (r).

Enormous strides have been made in the last decade to detect esophageal and lung diseases sooner and to treat them more effectively. Patients are being freed of the acid pains of reflux, learning how to swallow again, and even living longer and healthier with esophageal or lung cancers. Experts at the AHN Esophageal and Lung Institute (ELI) have been significant contributors to this trend through their pioneering medical and clinical research and use of cutting-edge diagnostic and treatment options for the complete spectrum of thoracic and esophageal diseases. Led by Blair Jobe, MD, and Rodney Landreneau, MD, the ELI is one of the country’s foremost centers for innovative, patient-centered care. The team specializes in minimally invasive surgery and endoscopic therapies and delivers unique prevention strategies, early diagnosis and innovative treatments for conditions, such as gastroesophageal reflux disease (GERD), Barrett’s esophagus, dysplasia, esophageal and gastric cancers, lung cancer, mesothelioma, mediastinal tumors and tracheal diseases. “Having these nationally renowned surgeons available to all of our patients truly allows us to provide comprehensive, multidisciplinary 8

The ELI’s diagnostic technology includes endoscopy, pH acid monitoring and highresolution manometry, and their treatments are unique and varied. Dr. Jobe explained how he and the ELI team treat GERD with a minimally invasive procedure called the LINX Management System, which studies have shown can greatly reduce the symptoms and associated risks of this common digestive disorder. Performed laparoscopically on an outpatient basis, it is designed to prevent reflux by reinforcing the faulty lower esophageal sphincter (LES). LINX uses a small, flexible band of magnets enclosed in titanium beads to regulate a weak LES and mimic a natural barrier to reflux. The bracelet is placed around the base of the esophagus. When food or liquid passes through, the band expands. The magnetic bond then allows the beads to close after swallowing, preventing gastric juices from refluxing back into the esophagus. “Effectively treating GERD with a surgical repair of the LES can not only improve patients’ quality of life by eliminating symptoms, but it may also help to prevent or stop serious associated conditions, including adult onset asthma, chronic cough, and esophageal inflammation and scar formation. After undergoing the LINX procedure, patients will be able to eliminate the use of GERD medications,” Dr. Jobe said. Dr. Jobe and other ELI surgeons also perform per-oral endoscopic myotomy (POEM), a novel endoscopic treatment for esophageal motility disorders and achalasia, and he has developed

For thoracic disease, Dr. Landreneau and other ELI thoracic surgeons have expertise in lung cancer, airway and esophageal obstruction, as well as mesothelioma. Dr. Landreneau is particularly noted for his expertise in the use of advanced, minimally invasive surgical techniques and is also one of only a few doctors nationwide performing a breakthrough mesothelioma therapy known as hyperthermic intraperitoneal chemoperfusion (HIPEC). The procedure involves surgically removing all visible signs of cancer before heated chemotherapy drugs are introduced directly into the chest cavity. ELI thoracic surgeons also utilize low-dose computed tomography (LDCT) scans for screening those at high-risk for lung cancer even when asymptomatic. The screening is offered in hopes of catching the disease in as many patients as possible at its earliest and most curable stages.

“Unfortunately, most patients are not treated for lung cancer until they become symptomatic, and the disease is well advanced,” Dr. Landreneau said. “With preventative screening, we can detect cancer at an early, more treatable stage and potentially cure the cancer.” Patients who qualify for the screening program are contacted by a lung cancer nurse navigator who educates them about

Toshitaka Hoppo, MD, PhD

Esophageal and Lung Institute Physicians

“Esophageal cancer patients often have few options available to fight this disease, and five-year survival rates are extremely low at about 15 percent,” said Dr. Jobe. “We’ve made progress in treating and monitoring patients with conditions that can progress to esophageal cancer, such as GERD, Barrett’s esophagus and high-grade dysplasia. Yet, only a small minority of these patients develops life-threatening esophageal cancer. Better detection techniques are needed to identify the patients who will likely progress from these precursor lesions to cancer.”

The U.S. Preventative Services Task Force recommends annual LDCT screening for lung cancer in adults age 55 to 74 who have a 30 pack-year history of smoking (a pack a day for 30 years, or two packs a day for 15 years), and either currently smoke or have quit within the past 15 years. The National Lung Screening Trials showed that LDCT scans saved lives, reducing lung cancer mortality by 20 percent.

Blair Jobe, MD

Rodney Landreneau, MD

Lana Schumacher, MD

Lana Schumacher, MD Mathew Van Deusen, MD

the screening process and implications of test results. The test requires no preparation or contrast injections. The navigator also guides patients through follow-up care and about critical disease prevention measures, such as smoking cessation. Allegheny Health Network has developed a database that tracks participants – their demographics, smoking history, test results and follow-up recommendations – to demonstrate the value of this program. Esophageal and Lung Institute 724.260.7300 Lung Screening Program 1.844.246.5864

Center for Digestive Health Physicians

a biomarker for both early detection and management of esophageal cancer. The serum and tissue biomarkers predict the likelihood of disease progression in patients with Barrett’s esophagus as well as on novel agents for preventing and treating esophageal cancer.

Manish Dhawan, MD

Abhijit Kulkarni, MD

9 Shyam Thakkar, MD

Multidisciplinary Collaboration for Groundbreaking Research The AHN Center for Digestive Health is committed to the highest standards of academic excellence and research innovation. With a total of 24 faculty and 12 fellows in training in the division, the center continually raises the bar and pushes boundaries to improve the quality of patient care. Physicians work in partnership not only with colleagues from various AHN disciplines, but also with researchers from other prominent institutions. Most recently, the Center for Digestive Health had numerous abstracts accepted to the annual 2015 Digestive Disease Week meeting, a highly recognized event where the world’s leading academicians, clinicians, researchers, students and trainees in the field of gastroenterology and hepatology come together.

Shyam Thakkar, MD 2015 Research Highlights Ocular Radiation Study Endoscopic retrograde cholangiopancreatography (ERCP) is considered the gold standard procedure in the evaluation of pancreaticobiliary disorders and to treat problems of the bile and pancreatic ducts, as well as other conditions. However, ERCP requires fluoroscopic exposure, with radiation risk, specifically to endoscopy staff who perform the procedure in high-workload circumstances. Parts of the body that are at risk are those not protected by the lead apron, such as the skin, hands and eye lens. Although the radiation dose is very low, it can have a cumulative effect over time, leading to skin changes and cataracts. Pikul Patel, MD, and Shyam Thakkar, MD, designed the Ocular Radiation Study to determine the amount of ocular radiation exposure to endoscopists’ eye lenses during ERCP procedures in a typical endoscopy suite setup and measure the dose against the cataract threshold. The data collected from these projects can be used to suggest guidelines for ocular radiation protection for endoscopy suite personnel.

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Video Analytics Colonoscopy has the ability to prevent colon cancer and reduce its incidence; however, interval cancers may develop as a result of limited exam quality. Shyam Thakkar, MD, is leading the development of a software program with researchers at Carnegie Mellon University that can measure the quality of the colonoscopy from a video of a live exam with the intent to provide real-time feedback to the endoscopist during the exam. This technology could help to prevent interval colon cancers related to low-quality exams.

Recent Publications 1. Agrawal S, Aoun E. The physiology of the pancreas. Practical Gastroenterology. 2014. 2. Agrawal S, O’Connor R, Aoun E, Babich M. Intense pruritus in Epstein-Barr virus (EBV) hepatitis treated with naloxone drip. BMJ Case Rep. 2015. doi: 10.1136/ bcr-2014-207037 3. Garg M, Schuerle T, Liu Y, Thakkar S. Intraductal oncocytic papillary neoplasm of the pancreas: a case of a second neoplasm in a pancreas cancer survivor. JOP. 2015;16:63-65. 4. Gurram K, Czapla A, Thakkar S. Acute pancreatitis: pancreas divisum with ventral duct intraductal papillary mucinous neoplasms. BMJ Case Rep. 2014. doi: 10.1136/bcr-2014-205322 5. Khosa K, Clarke K. Management of ulcerative colitis pre- and post-liver transplant for primary sclerosing cholangitis: two case reports and review of literature. Int J Colerectal Dis. 2014;29:1313-1320. 6. Moussaide G, Kazemi A, Mitre R, Mitre M. Mantle cell lymphoma: a rare cause of a solitary duodenal mass. BMJ Case Rep. 2014. doi: 10.1136/bcr-2014-203823. 7. Sherman S, Freeman M, Tarnasky PR, Wilcox CM, Kulkarni A, Aisen A, Jacoby D, Kozarek R. Administration of secretin (RG1068) increases the sensitivity of detection of duct abnormalities by magnetic resonance cholangiopancreatography in patients with pancreatitis. Gastroenterology. 2014;147:646-654.

Inflammatory Bowel Disease (IBD) Registry Kofi Clarke, MD, director of the AHN Center for Digestive Health, has initiated an IBD electronic research registry that allows patients to voluntarily enter their IBD-related medical information directly into a computer while they are in the waiting room. Data received on the registry will give us more insight into factors that impact the natural course of the disease and could successively lead to the development of more effective therapies and preventative measures. End-Tidal Carbon Dioxide (ET CO2) Study Recent studies have shown that ET CO2 levels have an inverse correlation with serum lactate levels in trauma patients. They may be an earlier indicator of the switch from aerobic to anaerobic metabolism as a result of hypoperfusion to vital organs secondary to hemorrhagic shock. These studies also suggest that ET CO2 levels (< 35 mm Hg) were associated with acute blood loss and the need for operative intervention. Elie Aoun, MD, in collaboration with the physicians from the Allegheny General Hospital Emergency Department (ED), have initiated a pilot study to evaluate if patients with a significant acute GI bleed may also show lower ET CO2 readings by a similar mechanism in comparison to those with occult GI blood loss. This would suggest its value as a prognostic marker in assessing patients with ED presentations of this condition.

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8. Singh S, Purohit T, Aoun E, Patel Y, Carleton N, Mitre M, Morrissey S, Dhawan M, Thakkar S. Comparison of outcomes of endoscopic ultrasound based on community versus tertiary academic center settings. Dig Dis Sci. 2014;59:1925-1930. 9. Thakkar S, Awad M, Gurram K, Tully S, Wright C, Sanan S, Choset H. A novel, new robotic platform for natural orifice distal pancreatectomy. Surg Innov. 2014. pii: 1553350614554232. 10. Yergiyev O, Krishnamurti U, Mohanty A, Thakkar S, Gurram K, Silverman JF. Fine needle aspiration cytology of acinar cell cystadenoma of the pancreas. Acta Cytol. 2014;58(3):297-302.

Fecal Microbiota Transplant Proves Highly Successful in Treating Clostridium Difficile

Kofi Clarke, MD, FRCP

Marcia Mitre, MD

Meredith Wisniewski PA-C

Ricardo Mitre, MD

Meredith Wisniewski PA-C

Some patients with Clostridium difficile (C. diff.) colitis who don’t respond to antibiotics could find a cure through microbiome-based treatment. AHN Center for Digestive Health physicians have been performing fecal microbiota transplants (FBT) at Allegheny General and Forbes hospitals for more than two years with highly successful results. Fecal Microbiota Transplant (FMT) is a procedure where fecal matter, or stool, is collected from a tested donor, mixed with a saline or other solution, strained and placed in a patient by colonoscopy, endoscopy, sigmoidoscopy, nasojejunal tube or retention enema. The procedure is meant to replace bad bacteria that have over-populated the colon, typically from the use of antibiotics, with good bacteria. C. diff. is a serious infection that results from a change in the balance of bacterial population in the colon. The “good bacteria” in the colon are killed, over run or suppressed, resulting in often debilitating — and sometimes fatal — diarrhea, said Kofi Clarke, MD, Division Chief of the AHN Center for Digestive Health.

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FMT has been highly effective for patients who have tried multi-rounds of treatment without sustained resolution of the infection or those with relapsing C. diff. “The incidence of C. diff has risen dramatically in the last few decades among the elderly as frequent antibiotic use can destroy the good bacteria in the colon and allow an infection to affect the normal balance of the gut,” Dr. Clarke said. “The results from FMT have been exceptional with patients often seeing improvement the same day of the procedure and going from bedridden to having the infection completely eradicated.” Currently, AHN uses the donated stool from patients’ family members; however, the network is in the process of setting up a protocol with the FDA’s approved stool bank. “Utilizing the stool bank would eliminate the need to complete donor testing ourselves,” said Meredith Wisniewski, MPA, PA, coordinator of the Fecal Transplant Program. “It would also give us instant access to screened stool from an FDA-approved source to meet our patients’ needs.”

In the News

Allegheny Health Network Center for Digestive Health

Inflammatory Bowel Disease Center continues to expand As the IBD Center experienced a 9 percent growth in patient volume over the past year, it also expanded its resources and locations to ensure exceptional care and convenience for patients. Heitham Abdul-Baki, MD, and Joleen Schwartz, RN, both joined the center as full-time staff. In addition, the AHN Center for Digestive Health now offers IBD care in the southern region of Pittsburgh at the Peters Township Health + Wellness Pavilion, in the north at the Wexford Health + Wellness Pavilion, and in the East at Forbes Hospital’s medical offices. There are plans for another location to open in the next year to accommodate continued growth.

Practice Locations AHN Center for Digestive Health 1307 Federal Street Suite 301 Pittsburgh, PA 15212 412.359.8900 Allegheny Valley Office (Main) 301 First Avenue Suite C Tarentum, PA 15084 724.224.3113 Allegheny Valley Office (Satellite) 1 Nolte Drive Suite 140 Kittanning, PA 16201 724.224.3113

CME classes now streamlined to Forbes Physicians can obtain Continuing Medical Education (CME) credits at the monthly multidisciplinary IBD meeting at Allegheny General Hospital, which is streamed live to the Forbes Hospital campus. Visit www.ahn.org/specialties/ digestive-health for details.

Brighton Road Office 925 Brighton Road Pittsburgh, PA 15233 412.321.1648

Inaugural IBD Collaborative Conference in Pittsburgh Kofi Clarke, MD, co-directed the first IBD Collaborative Conference at the Rivers Club in Pittsburgh last December to discuss topics pertaining to IBD care. Fellows Helen Lee, MD, and Abhishek Gulati, MD, participated in a debate at the Rivers Club during the IBD Collaborative Conference. They discussed current controversies on the utility of thiopurines in Crohn’s Disease. The conference was well attended by physicians from the Pittsburgh area, West Virginia and Ohio. The next conference is scheduled for summer 2015. Visit www.ahn.org/specialties/digestive-health for details.

Century III Medical Office 2027 Lebanon Church Road West Mifflin, PA 15122 412.DOCTORS Crafton Medical Center One Walsh Road Pittsburgh, PA 15205 412.DOCTORS Forbes Medical Offices Professional Office Building One 2566 Haymaker Road Suite 304 & 311 Monroeville, PA 15146 412.DOCTORS

High honors for Digestive Health team Paul Lebovitz, MD, received the 2015 National Pancreas Foundation Courage Award on June 19 during a gala at Heinz Field. Susan Rushlander, RN, and Susan Spitznagel, RN, both of Allegheny Health Network, also received the Compassionate Care Award at the event.

Greentree Medical Office Five Foster Plaza 651 Holiday Drive Pittsburgh, PA 15220 412.DOCTORS Jefferson Medical Office 575 Coal Valley Road Suite 105 Jefferson Hills, PA 150255 412.469.7436

Sophisticated facility opens at Jefferson Jefferson Hospital has opened a comprehensive, stateof-the-art AHN Center for Digestive Health facility for a complete spectrum of gastroenterology and hepatology services.

Liver Transplant and Hepatology Program AHN Cancer Center, Third Floor 320 E. North Avenue Suites 481 & 261 Pittsburgh, PA 15212 412.DOCTORS

Community event for celiac The AHN Center for Digestive Health is planning a celiac education event at the Wexford Health + Wellness Pavilion this summer. Visit www.ahn.org/specialties/digestive-health for details.

McCandless Office 9335 McKnight Road Suite 240 Pittsburgh, PA 15237 412.DOCTORS

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Mon Valley Medical Office 100 Stoops Drive Suite 320 Monongahela, PA 15063 724.483.4150 Peters Township Health + Wellness Pavilion 138 Gallery Drive McMurray, PA 15317 412.DOCTORS Pine Medical Building 647 N. Broad Street Ext. Grove City, PA 16217 412.DOCTORS Pine-Richland Medical Associates 5375 William Flynn Highway Gibsonia, PA 15044 412.DOCTORS Robinson Medical Center 133 Church Hill Road Suite 2A McKees Rocks, PA 15136 412.DOCTORS West Penn Office 4815 Liberty Avenue, Suite M56 Pittsburgh, PA 15224 412.DOCTORS Wexford Health + Wellness Pavilion 12311 Perry Highway, Floor 2 Wexford, PA 15090 412.DOCTORS Wexford Medical Associates 20397 Route 19 Two Landmark North, 3rd Floor Cranberry Township, PA 16066 412.DOCTORS

Forbes Hospital 2570 Haymaker Road Monroeville, PA 15146 412.858.2000 Jefferson Hospital 565 Coal Valley Road Jefferson Hills, PA 15025 412.469.5000 Monongahela Valley Hospital 1163 Country Club Road Monongahela, PA 16063 724.258.1000 Saint Vincent Hospital 232 West 25th Street Erie, PA 16544 814.452.5000 West Penn Hospital 4800 Friendship Avenue Pittsburgh, PA 15224 412.578.5000 Surgery Center Locations McCandless Endocenter 9335 McKnight Road, Suite 200 Pittsburgh, PA 15237 412.367.1064 Monroeville Surgery Center 4121 Monroeville Boulevard Monroeville, PA 15146 412.380.5167 North Shore Endoscopy Center 1307 Federal Street, Suite 101 Pittsburgh, PA 15212 412.231.6550

Hospital Locations

Peters Surgery Center 160 Gallery Drive McMurray, PA 15317 724.942.2700

Allegheny General Hospital 320 E. North Avenue Pittsburgh, PA 15212 412.359.3131

Spartan Surgery Center 100 Stoops Drive Monongahela, PA 15063 724.483.2762

Allegheny Valley Hospital 1301 Carlisle Street Natrona Heights, PA 15065 724.224.5100

Waterfront Surgery Center 495 Waterfront Drive East #110 Homestead, PA 15120 412.325.2174

Armstrong County Memorial Hospital 1 Nolte Drive Kittanning, PA 16201 724.543.8500

Wexford Surgery Center 12311 Perry Highway Wexford, PA 15090 844.497.7968

Canonsburg Hospital 100 Medical Boulevard Canonsburg, PA 15317 724.745.6000

Center for Digestive Health 320 E. North Avenue Pittsburgh, PA 15212 412.359.3131

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