Clinical Focus

  • Internal Medicine

Academic Appointments

  • Clinical Assistant Professor, Medicine

Professional Education

  • Board Certification: American Board of Internal Medicine, Internal Medicine (2023)
  • Residency: Stanford University Internal Medicine Residency (2023) CA
  • Medical Education: The Ohio State University College of Medicine (2020) OH

Contact

  • Academic
    lmulsh@stanford.edu
    University - Academic staff Department: Med/Hospital Medicine Position: Clinical Assistant Professor
  • Clinical (Primary)  Medicine 300 Pasteur Dr Rm JC007 Stanford, CA 94305 (650) 725-8381 (fax)

Additional Clinical Info

All Publications

  • Use of a footstool improves rectal balloon expulsion in some patients with defecatory disorders. Neurogastroenterology and motility Ulsh, L., Halawi, H., Triadafilopoulos, G., Gurland, B., Nguyen, L., Garcia, P., Sonu, I., Fernandez-Becker, N., Becker, L., Sheth, V., Neshatian, L. 2024: e14781

    Abstract

    Whether patients with defecatory disorders (DDs) with favorable response to a footstool have distinctive anorectal pressure characteristics is unknown. We aimed to identify the clinical phenotype and anorectal pressure profile of patients with DDs who benefit from a footstool.This is a retrospective review of patients with high resolution anorectal manometry (HR-ARM) and balloon expulsion test (BET) from a tertiary referral center. BET was repeated with a 7-inch-high footstool in those who failed it after 120 s. Data were compared among groups with respect to BET results.Of the 667 patients with DDs, a total of 251 (38%) had failed BET. A footstool corrected BET in 41 (16%) of those with failed BET. Gender-specific differences were noted in anorectal pressures, among patients with and without normal BET, revealing gender-based nuances in pathophysiology of DDs. Comparing patients who passed BET with footstool with those who did not, the presence of optimal stool consistency, with reduced instances of loose stools and decreased reliance on laxatives were significant. Additionally, in women who benefited from a footstool, lower anal pressures at rest and simulated defecation were observed. Independent factors associated with a successful BET with a footstool in women included age <50, Bristol 3 or 4 stool consistency, lower anal resting pressure and higher rectoanal pressure gradient.Identification of distinctive clinical and anorectal phenotype of patients who benefited from a footstool could provide insight into the factors influencing the efficacy of footstool utilization and allow for an individualized treatment approach in patients with DDs.

    View details for DOI 10.1111/nmo.14781

    View details for PubMedID 38488172

  • Delivery of Fecal Material to Terminal Ileum Is Associated with Long-Term Success of Fecal Microbiota Transplantation. Digestive diseases and sciences Weingarden, A. R., Treiger, O., Ulsh, L., Limketkai, B., Goldenberg, D., Okafor, P., Sonu, I., Stollman, N., Neshatian, L. 2022

    Abstract

    BACKGROUND: Fecal microbiota transplantation (FMT) is a highly effective treatment for recurrent Clostridioides difficile infection (CDI). However, 10-20% of patients still fail to recover following FMT. There is a need to understand why these failures occur and if there are modifiable factors that can be addressed by clinicians performing FMT.AIMS: We sought to identify factors related to the FMT procedure itself which could impact FMT outcomes. We also aimed to identify patient demographics which might be associated with FMT outcomes and whether any factors were associated with early FMT failure compared to late CDI recurrence.METHODS: We performed a retrospective multicenter cohort analysis of FMT procedures between October 2005 and November 2020. We collected data on patient demographics, details of the FMT procedure, and procedure outcomes. Using univariate and multivariate regression, we evaluated whether these factors were associated with long-term FMT success, early FMT failure (less than 60days following procedure), or late CDI recurrence (more than 60days following procedure).RESULTS: Long-term success of FMT was strongly correlated with any delivery of stool to the terminal ileum (Odds Ratio [OR] 4.83, 95% confidence interval [CI] 1.359-17.167) and underlying neurologic disease (OR 8.012, 95% CI 1.041-61.684). Lower bowel prep quality was significantly associated with both early FMT failure (p=0.034) and late CDI recurrence (p=0.050).CONCLUSIONS: Delivery of stool to the terminal ileum is significantly associated with long-term success following FMT. This is a relatively safe practice which could easily be incorporated into the standard of care for colonoscopic FMT.

    View details for DOI 10.1007/s10620-022-07761-9

    View details for PubMedID 36372864

  • Utilizing Anorectal Manometry to Predict the Phenotype of Patients Who Will Benefit From a Squatting Assist Stool Ulsh, L., Nguyen, L., Gurland, B., Neshatian, L. LIPPINCOTT WILLIAMS & WILKINS. 2021: S218

    View details for Web of Science ID 000717526100491