Medical Education: St George's University School of Medicine Grenada West Indies (2004) NY West Indies
Residency: St Mary's Medical Center (2008) CA
Internship: St Mary's Medical Center (2006) CA
Fellowship: West Virginia University School of Medicine (2011) WV
Board Certification: American Board of Internal Medicine, Gastroenterology (2011)
Board Certification: American Board of Internal Medicine, Internal Medicine (2008)
- Mellow Yellow: Diagnosis and Management of Multifactorial Postoperative Jaundice DIGESTIVE DISEASES AND SCIENCES 2016; 61 (8): 2226-2230
- An Elusive Cause of Severe Gastrointestinal Bleeding DIGESTIVE DISEASES AND SCIENCES 2014; 59 (1): 31-34
Indications and safety of proton pump inhibitor drug use in patients with cancer.
Expert opinion on drug safety
2013; 12 (5): 659-672
Introduction: Although the exact prevalence of proton pump inhibitor (PPI) use in cancer patients is not known, it is generally perceived to be widespread. PPIs are generally well tolerated and carry an excellent safety profile. However, increasing and longer term PPI use has raised concerns about the risk of pneumonia, bone fractures and enteric infections, and a possible interaction with clopidogrel that could increase the risk of cardiovascular events. Areas covered: We conducted a PubMed search of English language articles addressing the safety and adverse events associated with PPI use with particular emphasis in cancer patients. Expert opinion: PPIs, frequently used in cancer patients, are generally well tolerated and carry an excellent safety profile. PPI-induced acid suppression may increase the risk of Clostridium difficile or other enteric infections, nutritional deficiencies and community acquired pneumonia, all particularly important in cancer patients. The indications for PPI use in cancer patients should be carefully reviewed prior to use.
View details for DOI 10.1517/14740338.2013.797961
View details for PubMedID 23647006
Managing Barrett's esophagus with radiofrequency ablation.
2013; 1 (2): 95-104
Barrett's esophagus (BE) is a well-established pre-malignant lesion for esophageal adenocarcinoma, a condition that carries a dismal five-year overall survival rate of less than 15%. Among several available methods to eliminate BE, radiofrequency ablation (RFA) provides the most efficient modality, since it has been demonstrated to successfully eradicate BE with or without dysplasia with acceptable safety, efficacy and durability profiles. In conjunction with proton pump therapy, this new technology has quickly become the standard care for patients with dysplastic BE. However, several technical questions remain about how to deploy RFA therapy for maximum effectiveness and long-term favorable outcomes for all stages of the disease. These include how to select patient for therapy, what the best protocol for RFA is, when to use other modalities, such as endoscopic mucosal resection, and what should be considered for refractory BE. This review addresses these questions with the perspective of the best available evidence matched with the authors' experience with the technology.
View details for DOI 10.1093/gastro/got009
View details for PubMedID 24759814
View details for PubMedCentralID PMC3938010
Update on foreign bodies in the esophagus: diagnosis and management.
Current gastroenterology reports
2013; 15 (4): 317-?
Foreign body impaction in the esophagus is an important emergency that carries significant morbidity and potential mortality. The most common cause of esophageal foreign body obstruction in adults is meat bolus impaction above a pre-existing distal esophageal (mucosal) ring, peptic or malignant esophageal stricture, or eosinophilic esophagitis. Immediate evaluation of the airway, assessment of the urgency of removal, radiological evaluation to localize the object, endoscopic or surgical retrieval, and subsequent monitoring for complications are essential steps in the management.
View details for DOI 10.1007/s11894-013-0317-5
View details for PubMedID 23435762
Algorithmic Approach to Patients Presenting with Heartburn and Epigastric Pain Refractory to Empiric Proton Pump Inhibitor Therapy
DIGESTIVE DISEASES AND SCIENCES
2011; 56 (10): 2871-2878
Reflux-like dyspepsia (RLD), where predominant epigastric pain is associated with heartburn and/or regurgitation, is a common clinical syndrome in both primary and specialty care. Because symptom frequency and severity vary, overlap among gastroesophageal reflux disease (GERD), non-erosive reflux disease (NERD), and RLD, is quite common. The chronic and recurrent nature of RLD and its variable response to proton pump inhibitor (PPI) therapy remain problematic.To examine the prevalence of GERD, NERD, and RLD in a community setting using an algorithmic approach and to assess the potential, reproducibility, and validity of a multi-factorial scoring system in discriminating patients with RLD from those with GERD or NERD.Using a novel algorithmic approach, we evaluated an outpatient, community-based cohort referred to a gastroenterologist because of epigastric pain and heartburn that were only partially relieved by PPI. After an initial symptom evaluation (for epigastric pain, heartburn, regurgitation, dysphagia), an endoscopy and distal esophageal biopsies were performed, followed by esophageal motility and 24-h ambulatory pH monitoring to assess esophageal function and pathological acid exposure. A scoring system based on presence of symptoms and severity of findings was devised. Data was collected in two stages: subjects in the first stage were designated as the derivation cohort; subjects in the second stage were labeled the validation cohort.The total cohort comprised 159 patients (59 males, 100 females; mean age 52). On endoscopy, 30 patients (19%) had complicated esophagitis (CE) and 11 (7%) had Barrett's esophagus (BE) and were classified collectively as patients with GERD. One-hundred and eighteen (74%) patients had normal esophagus. Of these, 94 (59%) had one or more of the following: hiatal hernia, positive biopsy, abnormal pH, and/or abnormal motility studies and were classified as patients with NERD. The remaining 24 patients (15%) had normal functional studies and were classified as patients with RLD. Utilizing the scoring system a total score was calculated for each patient and effectively distinguished patients with GERD (mean score 9), NERD (mean score 6), and RLD (mean score 3). Receiver operating characteristic (ROC) curves confirmed the optimization of the model, particularly in RLD (P = 0.0001, 95% CI: 0.91-0.98).In a community cohort of patients presenting with heartburn and epigastric pain partly refractory to empiric PPI therapy, the prevalence of CE was 19%, BE 7%, NERD 59%, and RLD 15%. An algorithmic approach coupled with a novel scoring system, effectively distinguishes GERD from NERD and RLD and facilitates further management decisions. This novel and simple scoring system is both reproducible and validated as a diagnostic aid in evaluating patients presenting with both epigastric pain and heartburn.
View details for DOI 10.1007/s10620-011-1708-9
View details for Web of Science ID 000295164600032
View details for PubMedID 21512760
- Biliary stone extraction techniques: old and new. Pract Gastroenterol 2011; XXXV: 17-46
- Recurrent hematochezia secondary to gastrointestinal stromal tumors (GISTs) in neurofibromatosis type one. WV Med J 2011; 107 (4): 16-19
Endoscopic approach to capsule endoscope retention
EXPERT REVIEW OF GASTROENTEROLOGY & HEPATOLOGY
2010; 4 (6): 713-721
In recent years, wireless capsule endoscopy has become increasingly indicated and utilized in the diagnosis and management of small bowel disorders. As such, its most common complication, capsule retention, has become a more frequently encountered clinical entity. Historically, when medical management of capsule retention has failed, patients have been sent directly to surgery. However, recent advances in small bowel enteroscopy have demonstrated a high success rate and safety profile in retrieving retained capsules. These approaches appear to be a viable alternative to surgery in many clinical scenarios. This article discusses both standard and advanced endoscopic approaches to capsule retention, and presents an algorithmic approach to their utilization.
View details for DOI 10.1586/EGH.10.80
View details for Web of Science ID 000297984200011
View details for PubMedID 21108591
- A fellow’s guide to generating the endoscopy procedure report. Gastrointest Endosc 2010; 72: 803-805
- Radiofrequency ablation of Barrett's esophagus EUROPEAN SURGERY-ACTA CHIRURGICA AUSTRIACA 2009; 41 (1): 19-25
- Introduction to a new series. Endoscopy: opening new eyes. Pract Gastroenterol 2009; XXXIII: 13-4
- I spy biliary and pancreatic ducts: the spyglass single-operator peroral cholangiopancreatoscopy system. Pract Gastroenterol 2009; XXXIII: 15-32
Circumferential and focal radiofrequency ablation for the treatment of Barrett's esophagus.
Expert review of gastroenterology & hepatology
2008; 2 (5): 627-634
This invited profile summarizes the technical aspects and clinical trial results related to the use of circumferential and focal radiofrequency ablation in the management algorithm for Barrett's esophagus. What makes this relatively new endoscopic intervention unique is its promising safety and efficacy profile reported in published clinical trials. This technology appears to have overcome many of the limitations of prior endoscopic ablative modalities, and is thus garnering a role in the management of this disease state.
View details for DOI 10.1586/17474184.108.40.2067
View details for PubMedID 19072339
Early experience with radiofrequency energy ablation therapy for Barrett's esophagus with and without dysplasia
DISEASES OF THE ESOPHAGUS
2007; 20 (6): 516-522
Radiofrequency (RF) ablation using the HALO(360) system combined with proton pump inhibitor (PPI) therapy is a new treatment for Barrett's esophagus (BE). We assessed the safety and effectiveness of this combination therapy at a community-based, BE referral center. After symptom evaluation, endoscopy and histologic assessment, esophageal motility, pH monitoring on PPI, computed tomography, endoscopic ultrasonography and mucosal resection for nodules, we performed HALO(360) ablation followed by twice daily PPI and 3-monthly surveillance for up to 12 months. If metaplasia or dysplasia were present at follow-up, the patients received a second ablation. Thirteen patients (12 male) were treated, three with high-grade dysplasia, four with low-grade and six with non-dysplastic intestinal metaplasia. The mean baseline BE length was 6 cm (range 2-12); nine patients had an hiatal hernia and two had a prior fundoplication. Esophageal pH < 4.0 for < 4% of time was achieved only in 5/13 patients. A mean of 1.4 ablation sessions were performed, without serious adverse events or strictures. Complete eradication of BE was achieved in 6/13 (46%) patients. The mean endoscopic surface regression was 84% (from a mean length of 6 +/- 1 cm to 1.2 +/- 0.5 cm, P < 0.001). Complete elimination of dysplasia was achieved in 5/7 (71%) patients. Ablation efficacy was better in those patients who had maximal pH control (P < 0.05). HALO(360) ablation of BE with or without dysplasia is safe, well-tolerated and effective in the community setting. Follow-up ablation further reverses residual BE or dysplasia.
View details for DOI 10.1111/j.1442-2050.2007.00728.x
View details for Web of Science ID 000250297400011
View details for PubMedID 17958728
Do pH and temperature play a role in gastrostomy tube deterioration?
JOURNAL OF PARENTERAL AND ENTERAL NUTRITION
2005; 29 (5): 388-391
The effects of pH and temperature over time on percutaneous endoscopic gastrostomy (PEG) tube longevity were examined in an in vitro model. Two sets of tubes were obtained from 7 major US PEG manufacturers. Using scissors, each PEG tube was cut cross-sectionally 8 cm from the bumper end of the tube. Both qualitative (photographs) and quantitative (mass) measurements were taken at baseline. Median physiologic gastric acidity was approximated by completely submerging 1 set of each cut PEG tube in a 250-mL glass jar containing a 0.050-N (pH 1.3) solution of hydrochloric acid. As a control, another set of each PEG tube was completely submerged in a 250-mL glass jar containing a buffer solution of pH 6. Each jar was then submerged in the waterbath so that the water completely covered the tube but did not enter the jar. The waterbath was covered and maintained at a constant temperature of 37 degrees C. Measurements taken at baseline were repeated at 168 days and again at 375 days. On qualitative examination, no dilations, brittleness, obstruction, nodularity, tears, loss of elasticity, color changes, tube fracturing, kinking, loss of resilience, or variation in external diameter was observed. Quantitative examination showed no change in mass. Tubes removed from the pH 1.3 solution appeared identical to the tubes removed from the pH 6 solution. In all cases, there were no apparent changes from baseline. These findings suggest that temperature and pH can be excluded as predominant factors in tube deterioration and lend further support to a microbial hypothesis of PEG tube deterioration.
View details for Web of Science ID 000248443000020
View details for PubMedID 16107603
- Male breast disease. J Am Coll Surgeons 2005; 200: 255-69
Images in clinical medicine. A bleeding Meckel's diverticulum.
New England journal of medicine
2003; 349 (9)
View details for PubMedID 12944585
Ectopic breast cancer: special treatment considerations in the postmenopausal patient.
2002; 8 (5): 286-289
A 70-year-old woman with congenital bilateral accessory nipples developed a clinical mass and pain in the left accessory breast tissue. Excision revealed a T2 invasive ductal carcinoma with an identifiable in situ component. No masses were present in the normal breast, and 9 years after surgery, radiation therapy, and tamoxifen there has been no recurrence either in the ipsilateral affected accessory or normal breast tissue.
View details for PubMedID 12199756
- PEG: A safe procedure in the elderly: including the oldest old. Pract Gastroenterol 2002; XXVI (38-44)
- Further analysis of standards for antacid simethicone defoaming properties. Curr Ther Res Clin E 1997; 58: 955-63
- An analysis of standards for antacid simethicone defoaming properties. Curr Ther Res Clin E 1995; 56: 1202-8