Publications by authors named "F Habr"

18 Publications

  • Page 1 of 1

RE: Validation of a Machine Learning Model That Outperforms Clinical Risk Scoring Systems for Upper Gastrointestinal Bleeding.

Gastroenterology 2020 06 19;158(8):2307-2308. Epub 2020 Mar 19.

Division of Gastroenterology, Alpert Medical School of Brown University, Providence, Rhode Island.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.gastro.2020.02.061DOI Listing
June 2020

Effect of Proton Pump Inhibitor Therapy on NOX5, mPGES1 and iNOS expression in Barrett's Esophagus.

Sci Rep 2019 11 7;9(1):16242. Epub 2019 Nov 7.

Department of Medicine, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA.

Acid reflux may contribute to the progression from Barrett's esophagus (BE) to esophageal adenocarcinoma (EA). However, it is not clear whether the molecular changes present in BE patients are reversible after proton pump inhibitor (PPI) treatment. In this study we examined whether PPI treatment affects NOX5, microsomal prostaglandin E synthase (mPGES)-1 and inducible nitric oxide synthase (iNOS) expression. We found that NADPH oxidase 5 (NOX5), mPGES-1 and iNOS were significantly increased in BE mucosa. One-month PPI treatment significantly decreased NOX5, mPGES1 and iNOS. In BAR-T cells, NOX5 mRNA and p16 promoter methylation increased after pulsed acid treatment in a time-dependent manner. Four or eight-week-acid induced increase in NOX5 mRNA, NOX5 protein and p16 methylation may be reversible. Twelve-week acid treatment also significantly increased NOX5, mPGES1 and iNOS mRNA expression. However, twelve-week-acid-induced changes only partially restored or did not recover at all after the cells were cultured at pH 7.2 for 8 weeks. We conclude that NOX5, mPGES1 and iNOS may be reversible after PPI treatment. Short-term acid-induced increase in NOX5 expression and p16 methylation might be reversible, whereas long-term acid-induced changes only partially recovered 8 weeks after removal of acid treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-019-52800-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6838155PMC
November 2019

Successful Treatment of Bleeding Rectal Varices with Balloon-Occluded Antegrade Transvenous Obliteration.

ACG Case Rep J 2018 14;5:e20. Epub 2018 Mar 14.

Alpert Medical School, Brown University, Providence, RI.

We report the first described case in the United States of balloon-occluded antegrade transvenous obliteration (BATO) performed in a cirrhotic patient with recurrent bleeding from large rectal varices. This is a novel interventional radiology approach to treat bleeding rectal varices. Our patient was a poor candidate for transjugular intrahepatic portosystemic shunt and endoscopic band ligation. Successful BATO produced complete resolution of rectal varices and no further rectal bleeding. There are no established guidelines for the management of rectal varices. We demonstrate that the BATO technique is a viable option to treat recurrent bleeding due to rectal varices.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14309/crj.2018.20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852303PMC
March 2018

Safety and efficacy of endoscopic spray cryotherapy for esophageal cancer.

Dis Esophagus 2017 Nov;30(11):1-7

Scripps Clinic, La Jolla, California.

Although surgery is traditionally the standard of care for esophageal cancer, esophagectomy carries significant morbidity. Alternative endoscopic therapies are needed for patients who are not candidates for conventional treatment. The objective of this study is to assess the safety, efficacy, and tolerability of spray cryotherapy of esophageal adenocarcinoma. This study includes patients with esophageal adenocarcinoma who had failed or were not candidates for conventional therapy enrolled retrospectively and prospectively in an open-label registry and patients in a retrospective cohort from 11 academic and community practices. Endoscopic spray cryotherapy was performed until biopsy proven local tumor eradication or until treatment was halted due to progression of disease, patient withdrawal or comorbidities. Eighty-eight patients with esophageal adenocarcinoma (median age 76, 80.7% male, mean length 5.1 cm) underwent 359 treatments (mean 4.4 per patient). Tumor stages included 39 with T1a, 25 with T1b, 9 with unspecified T1, and 15 with T2. Eighty-six patients completed treatment with complete response of intraluminal disease in 55.8%, including complete response in 76.3% for T1a, 45.8% for T1b, 66.2% for all T1, and 6.7% for T2. Mean follow-up was 18.4 months. There were no deaths or perforations related to spray cryotherapy. Strictures developed in 12 of 88 patients (13.6%) but were present before spray cryotherapy in 3 of 12. This study suggests that endoscopic spray cryotherapy is a safe, well-tolerated, and effective treatment option for early esophageal adenocarcinoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/dote/dox087DOI Listing
November 2017

Safety and efficacy of endoscopic spray cryotherapy for Barrett's dysplasia: results of the National Cryospray Registry.

Dis Esophagus 2016 Apr 24;29(3):241-7. Epub 2015 Feb 24.

Department of Gastroenterology, Scripps Clinic, La Jolla, CA, USA.

Retrospective series have shown the efficacy of endoscopic spray cryotherapy in eradicating high-grade dysplasia (HGD) in Barrett's esophagus (BE); however, prospective data are lacking, and efficacy for low-grade dysplasia (LGD) is unclear. The aim of this study was to assess the efficacy and safety of spray cryotherapy in patients with LGD or HGD. A multicenter, prospective open-label registry enrolled patients with dysplastic BE. Spray cryotherapy was performed every 2-3 months until there was no endoscopic evidence of BE and no histological evidence of dysplasia, followed by surveillance endoscopies up to 2 years. Primary outcome measures were complete eradication of dysplasia (CE-D) and complete eradication of all intestinal metaplasia (CE-IM). Ninety-six subjects with Barrett's dysplasia (67% HGD; 65% long-segment BE; mean length 4.5 cm) underwent 321 treatments (mean 3.3 per subject). Mean age was 67 years, 83% were male. Eighty patients (83%) completed treatment with follow-up endoscopy (mean duration 21 months). In patients with LGD, rate of CE-D was 91% (21/23) and rate of CE-IM was 61% (14/23). In HGD, CE-D rate was 81% (46/57) and CE-IM was 65% (37/57). In patients with short-segment BE (SSBE) with any dysplasia, CE-D was achieved in 97% (30/31) and CE-IM in 77% (24/31). There were no esophageal perforations or related deaths. One subject developed a stricture, which did not require dilation. One patient was hospitalized for bleeding in the setting of non-steroidal anti-inflammatory drug use. In the largest prospective cohort to date, data suggest endoscopic spray cryotherapy is a safe and effective modality for eradication of BE with LGD or HGD, particularly with SSBE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/dote.12330DOI Listing
April 2016

Continued evidence for safety of endoscopic retrograde cholangiopancreatography during pregnancy.

World J Gastrointest Endosc 2014 Aug;6(8):352-8

Sean Fine, Department of Internal Medicine, Warren Alpert School of Medicine Brown University, Providence, RI 02903, United States.

Aim: To report the safety of continued use of endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy at various maternal ages.

Methods: A retrospective chart review of pregnant patients who underwent ERCP at a tertiary academic center was undertaken between 2002 and 2012. Pertinent past medical history and initial presenting laboratory data were collected. Review of the procedure note for each ERCP performed provided documentation of lead shielding, type of sedation, fluoroscopy time, and post-procedure complications. Patients' clinical courses were reviewed until the time of delivery and pregnancy complications with fetal outcomes were examined. Data was stratified based upon the mother's age at the time of ERCP: 18-21, 22-29, and ≥ 30 years of age.

Results: Twenty pregnant patients who underwent ERCP between 2002 and 2012 were identified. The mean age at the time of ERCP was 26.4 years (18-38 years) and the average trimester was the second. The indications for ERCP were choledocholithiasis in 17 patients, gallstone pancreatitis in 2 patients, and cholangitis in 1 patient. The mean fluoroscopy time of ERCP was 3.8 min (0.3-23.6 min). Sphincterotomy was performed in 18 patients with therapeutic intent and not as a prophylactic measure to prevent recurrences. Clinical documentation of use of protective shielding was found in only 8 notes (40%). Post procedure complications were limited to two cases of post-ERCP pancreatitis (10%). Elective cholecystectomy was performed shortly after ERCP in 11 of the pregnant patients. Birth records were available for 16 patients, of which 15 had full-term pregnancies. Cesarean sections were performed in 5 (31%) patients. Term birth weight was greater than 2500 g in all cases except one in which the mother had a known hypercoagulable state.

Conclusion: ERCP during pregnancy is both safe and efficacious regardless of maternal age or trimester.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4253/wjge.v6.i8.352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4133414PMC
August 2014

Intermittent esophageal dysphagia: an intriguing diagnosis. Dysphagia lusoria.

Gastroenterology 2014 Apr 25;146(4):e3-4. Epub 2014 Feb 25.

Rhode Island Hospital Division of Gastroenterology, Alpert Medical School, Brown University, Providence, Rhode Island.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.gastro.2013.10.067DOI Listing
April 2014

Successful percutaneous endobiliary radiofrequency ablation for unresectable malignant biliary obstruction: a case report and review of the literature.

J Gastrointest Cancer 2014 Dec;45 Suppl 1:55-7

Department of Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA,

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12029-013-9538-yDOI Listing
December 2014

Now you see it, endo you don't: case of the disappearing knife.

Gastroenterology 2013 Jun 26;144(7):e6-7. Epub 2013 Apr 26.

Department of Internal Medicine, Warren Alpert School of Medicine Brown University, Providence, Rhode Island, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.gastro.2013.01.059DOI Listing
June 2013

Predictors of gastroesophageal reflux symptoms in pregnant women screened for sleep disordered breathing: a secondary analysis.

Clin Res Hepatol Gastroenterol 2013 Feb 7;37(1):93-9. Epub 2012 May 7.

Warren Alpert Medical School of Brown University, Rhode Island Hospital, Gastroenterology, 593, Eddy Street, APC 414, Providence, RI 02903, United States.

Background: Gastroesophageal reflux disease (GERD) is common in pregnancy. The cause is multifactorial, including a decreased or transient lower esophageal sphincter relaxation, increased intra-abdominal pressure, and gastrointestinal motility disturbances.

Aims: Evaluate the incidence of GERD in pregnancy and assess predictors and predisposing factors.

Method: This is a secondary analysis of a survey of postpartum women regarding symptoms of sleep disordered breathing (SDB) and GERD performed at a large tertiary care center. Patients rated heartburn frequency during pregnancy as either never, occasionally/sometimes, or frequently/always. Pregnancy outcomes and newborn information was collected. Categorical variables were compared by Fisher's exact test and continuous variables were compared by Anova or Kruskal-Wallis test. Multinominal logistic regression was also performed.

Results: Information regarding 1000 mothers and 1025 newborns was reviewed. The majority of mothers were Caucasian (68.8%) with mean age 29 ± 6.1 years. A total of 56.7% had GERD frequently/always; and 25.5% had none. GERD symptoms correlated with pre-pregnancy body mass index (BMI), BMI at delivery, maternal age, smoking and symptoms of SDB. There was no significant correlation between fetal weight and maternal weight gain with GERD symptoms. Symptoms were more frequent in white non-Hispanic women than in other racial groups.

Conclusions: This study suggests that GERD symptoms correlate with pre-pregnancy BMI and BMI at delivery, but not with the amount of weight gain during pregnancy. Maternal age, smoking, race, and SDB are also associated with GERD. Interestingly, fetal weight/uterine size did not seem predictive of developing GERD in pregnancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clinre.2012.03.036DOI Listing
February 2013

Current state of endoscopic therapies in Barrett's esophagus and esophageal cancer.

Hosp Pract (1995) 2011 Feb;39(1):170-80

Department of Internal Medicine, Warren Alpert School of Medicine of Brown University, Providence, RI, USA.

Barrett's esophagus (BE) is a premalignant condition that predisposes patients to esophageal adenocarcinoma. This risk increases with increasing dysplasia, especially in patients with BE and high-grade dysplasia. Radical esophagectomy had long been the only option for these patients; however, it has been associated with significant morbidity and mortality. Endoscopic therapies have been increasingly used as an alternative to radical esophagectomy given the minimally invasive nature and tolerability of the procedure relative to surgery. Currently, the most widely used endoscopic therapies include endoscopic mucosal resection, photodynamic therapy, CryoSpray ablation, and radiofrequency ablation. Retrospective and prospective studies on the use of each of these modalities in patients with nondysplastic BE, dysplastic BE, and early esophageal cancer have demonstrated their effectiveness in eradication of dysplasia with or without reversion of Barrett's epithelium to normal squamous epithelium of the esophagus. These modalities are well tolerated, safe, and have few side effects. Ultimately, more research is needed regarding their ability to fully displace surgical intervention as the gold standard, although at this point their role in poor operative candidates or patients seeking conservative approaches remains promising.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3810/hp.2011.02.388DOI Listing
February 2011

Removable self-expandable plastic stent to treat postphotodynamic therapy esophageal stricture.

Gastrointest Endosc 2009 Apr;69(4):e27-30

Department of Gastroenterology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gie.2008.08.037DOI Listing
April 2009

Docetaxel, capecitabine and carboplatin in metastatic esophagogastric cancer: a phase II study.

Cancer Invest 2007 Sep;25(6):445-8

The Brown University Oncology Group, Providence, Rhode Island 02906, USA.

Purpose: A Phase I investigation of docetaxel, carboplatin, and capecitabine at our institution demonstrated the safety and tolerability of this regimen in patients with metastatic esophagogastric cancer. The objectives of this Phase II study were to determine the response rate, toxicity, and survival for patients with metastatic esophagogastric cancer treated with this regimen.

Materials And Methods: Chemotherapy naïve patients with metastatic esophageal or gastric cancer received a regimen comprised of docetaxel 40 mg/m(2), days 1 and 8, carboplatin AUC = 2, Days 1 and 8, and capecitabine 2000 mg/m(2), Days 1-10 in 21-Day cycles. Patients were treated until disease progression or unacceptable toxicity.

Results: Twenty-five patients were treated with a median of 4 cycles of chemotherapy. Twelve of 25 patients (48 percent) had a Grade 3/4 toxicity. There were no Grade 4 nonhematologic toxicities, and 1 patient (4 percent) had neutropenic fever. There were 3 complete responses, and 9 partial responses, for an overall response rate of 48 percent. The median survival was 8 months (95% confidence interval, 5.5-13 months), and the 1-year survival was 36 percent.

Conclusions: Weekly docetaxel and carboplatin with capecitabine was an easily administered outpatient regimen. The response rate and 1-year survival were similar to more complex regimens. Future trials may investigate the substitution of carboplatin with more active agents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/07357900701358025DOI Listing
September 2007

An unusual complication: postcolonoscopy appendicitis.

Endoscopy 2007 Feb 4;39 Suppl 1:E138. Epub 2007 Jul 4.

Department of Medicine, Division of Gastroenterology, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-2007-966288DOI Listing
February 2007

Brunner's gland hamartoma.

Clin Gastroenterol Hepatol 2006 Jul;4(7):A26

Division of Gastroenterology, Rhode Island Hospital and Brown Medical School, Providence, Rhode Island, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cgh.2005.12.018DOI Listing
July 2006

Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer.

Authors:
F Habr P Akerman

Front Biosci 2000 Apr 1;5:E30-5. Epub 2000 Apr 1.

Department of Gastroenterology, Rhode Island Hospital, Brown University School of Medicine, Providence, RI 02903, USA.

Endoscopic Ultrasound (EUS) is a relatively new modality. Its high resolution makes it possible to detect tumors of 5mm in diameter otherwise missed by other imaging modalities. It is more accurate than computerized tomography (CT) scan, Transabdominal Ultrasound (US) and Magnetic Resonance Imaging (MRI) in diagnosing pancreatic lesions, especially those less than 20mm in diameter. EUS can be used to obtain pancreatic and nodal tissue using ultrasound- guided fine needle aspiration increasing the diagnostic yield and helping determining further management. It can also determine vascular involvement by pancreatic cancer with a sensitivity of more than 90%. The current indications for EUS in the diagnosis and management of pancreatic cancer will be reviewed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2741/habrDOI Listing
April 2000

Acute transverse myelitis in systemic lupus erythematosus: a case of rapid diagnosis and complete recovery.

Authors:
F Habr B Wu

Conn Med 1998 Jul;62(7):387-90

Department of Medicine, Hospital of Saint Raphael, New Haven, USA.

Acute transverse myelitis is a rare and serious complication of systemic lupus erythematosus. Delay in diagnosis and treatment is associated with significant morbidity and mortality. Earlier diagnosis is facilitated by magnetic resonance imaging. Treatment of systemic lupus erythematosus-related acute transverse myelitis remains controversial. The use of steroids alone may result in incomplete recovery. We report a patient who was promptly diagnosed with systemic lupus erythematosus-related acute transverse myelitis by magnetic resonance imaging. The patient had complete resolution of her symptoms following aggressive treatment with steroids and cyclophosphamide. Review of published treatment of systemic lupus erythematosus-related acute transverse myelitis suggests aggressive therapy with steroids and cyclophosphamide may provide the best outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 1998