Nikki Duong

All Publications

• Racial disparities in COVID-19 and gastrointestinal diseases-related mortality: analysis from CDC-WONDER databases, 2020-2022. Proceedings (Baylor University. Medical Center) Alsakarneh, S., Duong, N., Hashash, J. G. 2024; 37 (1): 30-33

  Abstract

  The COVID-19 pandemic represents an unprecedented global health challenge. Gastrointestinal diseases (GID) have been shown to increase morbidity and mortality in COVID-19 patients, warranting a comprehensive investigation of their combined impact and racial disparities in mortality rates within the United States.Data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) mortality statistics database were analyzed for the period from January 1, 2020, to December 31, 2022. This study focused on adults, considering all deaths related to COVID-19 and GID. Age-adjusted mortality rates (AAMR) per 100,000 population were reported. Sociodemographic data, including age, sex, race/ethnicity, and region of residence, were collected.Among 9,925,729 total deaths in the US between 2020 and 2022, 3.9% were GID related only, 9.6% were COVID-19 related only, and 0.4% were attributed to both COVID-19 and GID as underlying causes of death. AAMR for COVID-19 was 121.3 per 100,000, significantly higher than the AAMR for GID (50.3 per 100,000). Age-wise, elderly individuals had the highest AAMR for both COVID-19 and GID-related deaths. Stratified by race/ethnicity, Hispanics exhibited the highest AAMR, nearly twice that of Non-Hispanic Black patients and substantially higher than Non-Hispanic White and Asian patients.Our findings reveal substantial disparities in race/ethnicity-specific AAMR associated with both COVID-19 and GID in the US. Further research is crucial to delve deeper into their root causes and develop targeted interventions to strive for health equity for all.

  View details for DOI 10.1080/08998280.2023.2264716

  View details for PubMedID 38174020

  View details for PubMedCentralID PMC10761105

• Gastroenterology fellowship application and match trends in the United States over a 12-year period, 2010 to 2022. Proceedings (Baylor University. Medical Center) Alsakarneh, S., Jaber, F., Abuheija, U., Almeqdadi, M., Duong, N., Clarkston, W. 2024; 37 (1): 90-93

  Abstract

  Gastroenterology has recently gained prominence as a competitive internal medicine subspecialty. The intense competition within the gastroenterology fellowship match (GFM) presents challenges for both applicants and programs, particularly in virtual interviews due to the COVID-19 pandemic. We analyzed the variables impacting GFM competitiveness to provide insights for prospective gastroenterologists and programs to enhance the match process.We used publicly available National Resident Matching Program (NRMP) data to examine applications and match data for internal medicine subspecialties from 2010 to 2022. We considered factors such as the number of positions, applicants, and programs, utilizing the specialty competitiveness ratio (SCR) to assess competitiveness. Annual growth rates for positions and applications and average annual growth rates were calculated. Correlation coefficients between annual salaries and SCR were computed using various compensation reports.GFM's competitiveness has increased recently, evidenced by substantial growth in positions (4.61%) and applications (3.81%) since 2010. Gastroenterology ranked as the second-fastest growing specialty in positions and applications. In 2022, GFM ranked fourth in applications (974) and positions offered (616). Among internal medicine subspecialties, gastroenterology exhibited the highest SCR (1.58). Correlation analysis highlighted a positive link between SCR and compensation across specialties.The escalating competition within GFM necessitates an expansion of positions to address potential shortages. Complex factors, such as academic interest and financial considerations, require multifaceted strategies to ensure an adequate supply of gastroenterologists. Further research is warranted to examine the long-term consequences of this trend.

  View details for DOI 10.1080/08998280.2023.2258753

  View details for PubMedID 38174007

  View details for PubMedCentralID PMC10761133

• Navigating the "First Gastroenterology Job" Search for American and International Medical Graduates. Digestive diseases and sciences Duong, N., Sleiman, J., Umar, S., Advani, R., Vinsard, D. G. 2024

  Abstract

  GI fellowships do not mandate curricula in career development. Often, fellows resort to peer mentorship for guidance. Fellows should recognize that the path to a successful career varies greatly based on how one defines and measures success. Through introspection, fellows will be able to craft their ideal post-fellowship position that balances wants versus needs. In this article, we cover the breadth of post-fellowship opportunities available with a focus on unique considerations for LGBTQ+ and IMG trainees.

  View details for DOI 10.1007/s10620-024-08555-x

  View details for PubMedID 38977521

  View details for PubMedCentralID 10936145

• Growth hormone augmentation in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis of randomized controlled trials. European journal of gastroenterology & hepatology Mohamed, I., Gautam, M., Abosheaishaa, H., Hussain, S., Kumar, K., Kotak, A., Baugh, M., Qureshi, R., Jaber, F., Dahiya, D. S., Alba, L., Duong, N. 2024

  Abstract

  Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by hepatic steatosis and metabolic dysregulation. Growth hormone (GH) augmentation has emerged as a potential therapeutic intervention for treating MASLD. This systematic review and meta-analysis aimed to evaluate the impact of GH augmentation on different parameters of MASLD. A systematic literature search identified randomized controlled trials investigating GH augmentation in MASLD patients. Search results were screened via Covidence and the Risk of Bias 2 tool was used to assess bias in randomized controlled trials. Statistical analysis utilized RevMan v5.3. We combined dichotomous outcomes employing odds ratios and continuous outcomes utilizing mean difference (MD), each with a 95% confidence interval (CI). Statistical significance was indicated by a P-value less than 0.05. Heterogeneity was evaluated using I2 tests. Our results showed that GH augmentation resulted in a significant reduction in both relative (MD: -46.26; 95% CI: -71.52, -21.00; P = 0.0003) and absolute (MD: -5.15; 95% CI: -7.93, -2.37; P = 0.0003) hepatic fat fraction. GH augmentation significantly reduced alanine aminotransferase (MD: -5.97; 95% CI: -10.31, -1.62; P = 0.007) and gamma-glutamyl transferase (MD: -16.18; 95% CI: -30.76, -1.59; P = 0.03) levels. No significant changes were observed in hemoglobin A1c, C-reactive protein, fasting serum glucose, BMI, triglycerides, and low-density lipoprotein cholesterol levels. Our meta-analysis highlights GH augmentation as a promising therapy for reducing liver steatosis and improving liver enzyme levels in MASLD patients. Further large-scale trials are warranted to examine the long-term effects, safety profiles, and potential impact on various measures.

  View details for DOI 10.1097/MEG.0000000000002819

  View details for PubMedID 38973533

• Utility of scores to predict alcohol use after liver transplant (lt): take them with a grain of salt. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Houston, K., Duong, N., Sterling, R. K., Asgharpour, A., Bullock, S., Weinland, S., Keller, N., Smirnova, E., Khan, H., Matherly, S., Wedd, J., Lee, H., Siddiqui, M., Patel, V., Arias, A., Kumaran, V., Lee, S., Sharma, A., Khan, A., Imai, D., Levy, M., Bruno, D. 2024

  Abstract

  The Sustained Alcohol use post-Liver Transplant (SALT) and the High-Risk Alcohol Relapse (HRAR) scores were developed to predict return to alcohol use after liver transplant (LT) for alcohol associated liver disease (ALD).A retrospective analysis of deceased donor LT 10/2018 to 4/2022 was performed. All patients (pts) underwent careful pre-LT psychosocial evaluation. Data on alcohol use, substance abuse, prior rehabilitation, and legal issues were collected. Post-LT, all were encouraged to participate in rehabilitation programs and underwent interval phosphatidylethanol (PeTH) testing. Pts with ALD were stratified by < or > 6 month sobriety prior to listing. Those with <6 month were further stratified as acute alcoholic hepatitis (AH) by NIAAA criteria and non-AH. The primary outcome was utility of the SALT (<5 vs. ≥5) and HRAR (<3 vs. ≥3) scores to predict return to alcohol use (+PeTH) within 1 year after LT.Of the 365 LT, 86 had > 6 month sobriety and 85 had <6 month sobriety; 41 with AH and 44 non-AH. In those with AH, the mean time of abstinence to LT was 58 days, and 71% failed prior rehabilitation. Following LT, return to drinking was similar in the AH (24%) compared to <6M non-AH (15%) and >6M ALD (22%). Only 4% had returned to heavy drinking. The accuracy of both the SALT and HRAR scores to predict return to alcohol was low (accuracy 61-63%) with poor sensitivity (46% and 37%), specificity (67-68%), positive predictive value (22-26%) with moderate negative predictive value (NPV) (81-83%), respectively with higher NPVs (95%) in predicting return to heavy drinking.Both SALT and HRAR scores had good NPV in identifying patients at low risk for recidivism.

  View details for DOI 10.1097/LVT.0000000000000407

  View details for PubMedID 38775570

• Promoting allyship to support and uplift the LGBTQIA+ community. Nature reviews. Gastroenterology & hepatology Huynh, D. J., Paul, S., Duong, N. 2024

  View details for DOI 10.1038/s41575-024-00928-x

  View details for PubMedID 38580787

  View details for PubMedCentralID 10159490

• Liver transplantation for people of minoritised sexual and gender identities in the USA. The lancet. Gastroenterology & hepatology Lee, T. H., Duong, N., Sutha, K., Simonetto, D. A., Paul, S. 2023

  Abstract

  The number of people who report to be of minoritised sexual or gender identities in the USA, including lesbian, gay, bisexual, transgender, queer, and other sexuality-diverse and gender-diverse identities, has been increasing in the past decade. This diverse and unique population continues to experience not only health disparities but also psychosocial, economic, and legal disparities in accessing and receiving health care, including liver transplantations. As liver transplantation is life-saving for people with end-stage liver disease, understanding the factors that can affect access to and quality of liver transplantation care in people of minoritised sexual and gender identities in the USA, including differential social supports, insurance coverage, and medical and psychiatric comorbidities, is crucial. Actions, such as collecting sexual orientation and gender identity data, implementing inclusive language, recognising implicit biases, building diverse teams, providing a safer environment, and supporting further research to understand the unique health challenges are needed to ensure equitable access to high-quality liver transplantation care for people of minoritised sexual and gender identities.

  View details for DOI 10.1016/S2468-1253(23)00238-8

  View details for PubMedID 37837981

• Current Pharmacologic Therapies for Hepatorenal Syndrome-Acute Kidney Injury. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Duong, N., Kakadiya, P., Bajaj, J. S. 2023; 21 (10S): S27-S34

  Abstract

  Hepatorenal syndrome (HRS) can occur in patients with cirrhosis and ascites due to splanchnic vasodilation, renal hypoperfusion, and vasoconstriction. HRS is a diagnosis of exclusion and portends a poor prognosis, with upward of 80% mortality at 2 weeks without treatment. This review will highlight randomized controlled trials for HRS pharmacotherapy.A PubMed review of randomized controlled trials conducted over the past 25 years was undertaken; 18 studies were included.Initial studies showed that norepinephrine is as effective as terlipressin for HRS reversal. Midodrine with octreotide and albumin is less effective than terlipressin but better than albumin alone at improving 30-day mortality. Recently, terlipressin with albumin led to significantly higher rates of HRS reversal compared to albumin alone. Non-response to terlipressin can predict 90-day mortality in acute-on-chronic-liver failure.Our current understanding of HRS treatment is improved by recent randomized clinical trials. Previous studies using varying medication doses along with the "old" definition of hepatorenal syndrome (HRS type 1) rather than HRS-AKI means that there is still a need for future multicenter prospective studies further refining the risk-benefit ratio of vasoconstrictors for HRS-AKI patients. The Food and Drug Administration has approved terlipressin for use in September 2022. Because it will take time to adapt into clinical practice, less cost-prohibitive vasoconstrictors should still be considered. Opportunities also exist to clarify the safety, timing of initiation, as well as possible discontinuation of terlipressin.

  View details for DOI 10.1016/j.cgh.2023.06.006

  View details for PubMedID 37625864

• Prevalence and dynamics of NAFLD-associated fibrosis in people living with HIV in Vienna from first presentation to last follow-up. Wiener klinische Wochenschrift Schwarz, C., Chromy, D., Bauer, D., Duong, N., Schmidbauer, V. U., Schwarz, M., Mandorfer, M., Rieger, A., Trauner, M., Gschwantler, M., Reiberger, T. 2023; 135 (15-16): 420-428

  Abstract

  Non-alcoholic fatty liver disease (NAFLD) is frequent in people living with HIV (PLWH) and may be aggravated by metabolic comorbidities and antiretroviral therapy (ART)-associated adverse effects.We retrospectively assessed epidemiological, clinical and laboratory parameters and ART regimens at HIV diagnosis (BL) and at last follow-up (FU) in 1458 PLWH without viral hepatitis coinfection attending our HIV clinic in 2014-2016. Fibrosis was non-invasively assessed by the NAFLD fibrosis score (NFS).The median age of subjects was 37.8 years, 77.4% were male and 67.2% on ART, median CD4+ count was 356.0 cells/µL. At BL, 503 (34.5%) and 20 (1.4%) PLWH had dyslipidemia and diabetes, respectively. According to the NFS 16 (1.3%) showed advanced fibrosis (NFS ≥ 0.676), among which 1 (6.3%) had diabetes, 7 (43.8%) had dyslipidemia, and 5 (31.3%) were on HIV-protease inhibitors (PI). In addition, 191(15.1%) had intermediate NFS results, while fibrosis was ruled out (NFS ≤ 1.455) in 1065 (83.7%) PLWH. After a median follow-up of 6.3 years, 590 (42.8%) had dyslipidemia and 61 (4.4%) had diabetes. Also, 21 (1.6%) showed advanced fibrosis, of which 10 (47.6%) had diabetes, 4 (19.0%) had dyslipidemia, and 9 (42.9%) were on PI-based ART, 223 (17.4%) had intermediate NFS results, while 1039 (81.0%) showed no fibrosis.During FU, advanced NAFLD fibrosis occurred in 1.3-1.6% of PLWH. Dyslipidemia, diabetes, and PI-based ART were associated with advanced NAFLD fibrosis. Prospective investigations of NAFLD severity and risk factors in PLWH are warranted.

  View details for DOI 10.1007/s00508-022-02133-9

  View details for PubMedID 36576556

  View details for PubMedCentralID PMC10444631

• Overcoming disparities for sexual and gender minority patients and providers in gastroenterology and hepatology: introduction to Rainbows in Gastro. The lancet. Gastroenterology & hepatology Duong, N., Lee, T. H., Newman, K. L., Goldowsky, A., Jencks, K. J., Chedid, V., Barrow, J., Burbridge, R., Chiang, A., Targownik, L., Simonetto, D. A., Paul, S. 2023; 8 (4): 299-301

  View details for DOI 10.1016/S2468-1253(23)00005-5

  View details for PubMedID 36796399

• QuickStroop, a Shortened Version of EncephalApp, Detects Covert Hepatic Encephalopathy With Similar Accuracy Within One Minute. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Acharya, C., Shaw, J., Duong, N., Fagan, A., McGeorge, S., Wade, J. B., Thacker, L. R., Bajaj, J. S. 2023; 21 (1): 136-142

  Abstract

  Covert hepatic encephalopathy (CHE) is associated with poor outcomes but is often not diagnosed because of the time requirement. Psychometric hepatic encephalopathy score (PHES) is the gold standard against which EncephalApp Stroop has been validated. However, EncephalApp (5 runs each in "Off" and "On" state) can take up to 10 minutes. This study sought to define the smallest number of EncephalApp runs needed for comparable accuracy to the total EncephalApp using CHE on PHES as gold standard.A derivation and a validation cohort of outpatients with cirrhosis who underwent PHES (gold standard) and total EncephalApp was recruited. Data were analyzed for individual runs versus total EncephalApp time versus PHES-CHE. The derivation cohort (n = 398) was split into training (n = 299) and test (n = 99) sets. From the training data set a regression model was created with age, gender, education, and various sums of the "Off" settings. After this, a K-fold cross-validation on the test dataset was performed for both total EncephalApp time and individual Off runs and for the validation cohort.In both cohorts, Off runs 1 + 2 had statistically similar area under the receiver operating curve and P value to the total EncephalApp for PHES-CHE prediction. The adjusted (age, gender, education) regression formula from the derivation cohort showed an accuracy of 84% to diagnose PHES-CHE in the validation cohort. Time for CHE diagnosis decreased from 203.7 (67.82) to 36.8 (11.25) seconds in the derivation and from 178.2 (46.19) to 32.9 (9.94) seconds in the validation cohort.QuickStroop, which is completed within 1 minute, gives an equivalent ability to predict CHE on the gold standard compared with the entire EncephalApp time.

  View details for DOI 10.1016/j.cgh.2021.12.047

  View details for PubMedID 34998992

  View details for PubMedCentralID PMC9256863

• On a Need to Know Basis: Being "Out" in Medical Training. The American journal of gastroenterology Duong, N., Barrow, J. 2022; 117 (6): 827-830

  View details for DOI 10.14309/ajg.0000000000001817

  View details for PubMedID 35505516

• An Overview of the GI Fellowship Interview: Part I-Tips for the Interviewee. Digestive diseases and sciences Advani, R., Duong, N., Bilal, M., Grover, S. C., Siau, K., Bollipo, S., Charabaty, A. 2022; 67 (5): 1707-1711

  View details for DOI 10.1007/s10620-022-07408-9

  View details for PubMedID 35122591

  View details for PubMedCentralID 6948692

• Patient- and provider-level factors that underlie alcohol use disorder treatment offer and acceptance in veterans with cirrhosis. Alcoholism, clinical and experimental research Chaudhari, R. B., Duong, N., Shrestha, S., Badal, B., Dharia, N., Robalino Gonzaga, E., Spoutz, P., Chia, L., Wade, J. B., Rogal, S., Bajaj, J. S. 2022; 46 (5): 809-814

  Abstract

  Untreated alcohol use disorder (AUD) is associated with poor cirrhosis outcomes. We evaluated factors associated with AUD treatment discussions and initiation in the Veterans Health Administration.Chart reviews were conducted for veterans with International Classification of Diseases codes for both cirrhosis and AUD who were receiving care at one of three large medical centers in 2020. Factors associated with a 1-year offer of AUD treatment and its acceptance were assessed using regression models, which included as covariates demographic characteristics, comorbidities, and depression, as measured by the patient health questionnaire (PHQ-2) from the electronic health record.The cohort included 654 veterans, 68 of whom were engaged in AUD treatment at baseline and 174 who were documented as being in AUD remission. Treatment was offered to 264 (64%) of the 412 veterans with opportunities to initiate it. AUD treatment discussions were most often documented by practitioners in primary care (n = 162), hepatology (n = 45), or both (n = 41). Multivariable logistic regression modeling revealed that treatment was significantly more likely to be offered to patients with co-occurring bipolar disorder (OR 2.94, p = 0.03) or depression (1.50, p = 0.05) or who were younger (0.97, p = 0.01). Of the 264 patients offered AUD treatment, 107 (40%) agreed to initiate it. Acceptance of an offer of treatment was significantly associated with hospitalization in the prior year (OR 1.74, p = 0.05), prior AUD treatment (9.92, p < 0.0001), and a higher PHQ-2 depression score (2.85, p = 0.004).We identified factors associated with an offer of AUD treatment and its initiation among veterans with cirrhosis. Application of these findings could increase the likelihood that veterans with alcoholic cirrhosis initiate AUD treatment.

  View details for DOI 10.1111/acer.14809

  View details for PubMedID 35312086

• Bristol Stool Scale as a Determinant of Hepatic Encephalopathy Management in Patients With Cirrhosis. The American journal of gastroenterology Duong, N. K., Shrestha, S., Park, D., Shahab, O., Fagan, A., Malpaya, Z., Gallagher, M. L., Morris, A., Davis, B. C., Bajaj, J. S. 2022; 117 (2): 295-300

  Abstract

  Bowel movement (BM) frequency is used to titrate lactulose for hepatic encephalopathy (HE). However, stool consistency using the Bristol stool scale (BSS, 0-7) is often ignored.The study included pre-BSS and post-BSS cohorts. BSS was incorporated into decision-making after training in outpatients with cirrhosis. Two to 3 BMs/d and BSS 3-4 were considered normal, whereas the rest were considered high or low; concordance between the metrics was evaluated. Medication changes and 6-month admissions were compared between this group (post-BSS) and a comparable previous group (pre-BSS). Concordance and regression analyses for all-cause admissions and HE-related admissions were performed, and comparisons were made for HE-related medication stability. In the longitudinal analysis, an outpatient group seen twice was analyzed for BSS and BMs.In the post-BSS cohort, 112 patients were included with only 46% BSS and BMs concordance and modest BSS/BMs correlation (r = 0.27, P = 0.005). Compared with a pre-BSS cohort (N = 114), there was a lower 6-month total (4% vs 0.36%, P < 0.001) or HE-related admission (1% vs 0.12%, P = 0.002). Regression showed model for end-stage liver disease (odds ratio [OR]: 1.10, P = 0.003) and pre-BSS/post-BSS (OR: 0.04, P < 0.001) for all-cause admissions and HE (OR: 3.59, P = 0.04) and preera/postera (OR: 0.16, P = 0.02) for HE-related admissions as significant. HE medication regimens were more stable post-BSS vs pre-BSS (32% vs 20%, P = 0.04), which was due to patients with BSS > BMs (P = 0.02). In the longitudinal analysis, 33 patients without medication changes or underlying clinical status changes were tested 36 ± 24 days apart. No changes in BSS (P = 0.73) or BMs (P = 0.19) were found.BSS is complementary and additive to BM frequency, can modulate the risk of readmissions and stabilize HE-related therapy changes in outpatients with cirrhosis, and could help personalize HE management.

  View details for DOI 10.14309/ajg.0000000000001550

  View details for PubMedID 34738545

  View details for PubMedCentralID PMC8816826

• The Impact of Frailty, Sarcopenia, and Malnutrition on Liver Transplant Outcomes. Clinical liver disease Duong, N., Sadowski, B., Rangnekar, A. S. 2021; 17 (4): 271-276

  View details for DOI 10.1002/cld.1043

  View details for PubMedID 33968388

  View details for PubMedCentralID PMC8087926

• How to Become a Competitive Applicant for Gastroenterology Fellowship: Tips and Tricks for Success Part I. Digestive diseases and sciences Duong, N., Aby, E. S., Hathorn, K. E., Simons-Linares, C. R., Bilal, M. 2020; 65 (7): 1895-1898

  Abstract

  In recent years, gastroenterology has become one of the most competitive subspecialties included in the internal medicine fellowship match, which increases the stressful nature of an already potentially nerve-wracking process for the trainee. Though each applicant has unique strengths and thus the process is somewhat individualized, there are some basic principles that can render an applicant more competitive for a gastroenterology fellowship. These include establishing mentorship, achieving scholarly work, building your resume, honing interpersonal and networking skills, and a writing a well-planned application. The goal of this article is to outline some basic principles that will help improve the competitiveness of an applicant, and also highlight some practical tips and tricks for applicants with diverse backgrounds, such as international medical graduates, minority applicants, and women in medicine.

  View details for DOI 10.1007/s10620-020-06292-5

  View details for PubMedID 32350721

• Correction to: Navigating the "First Gastroenterology Job" Search for American and International Medical Graduates. Digestive diseases and sciences Duong, N., Sleiman, J., Umar, S., Advani, R., Vinsard, D. G. 2025

  View details for DOI 10.1007/s10620-025-08904-4

  View details for PubMedID 39966291

• A comparison of career plans of gastroenterology fellows compared to fellows in other internal medicine subspecialties. Proceedings (Baylor University. Medical Center) Alsakarneh, S., Almeqdadi, M., Jaber, F., Beran, A., Aldiabat, M., Kilani, Y., Reid, A. M., Zulqarnain, M., Abughazaleh, S., Duong, N., Clarkston, W. 2024; 37 (1): 96-100

  Abstract

  The career trajectory of medical professionals, particularly in specialized fields like gastroenterology, can significantly impact healthcare and research. This study aimed to analyze career choices among gastroenterology fellows in the US and investigate the factors influencing these choices.We utilized data from the American Medical Association on internal medicine subspecialty fellows. The study examined career plans of gastroenterology fellows and compared them with those of other subspecialties. A chi-square test was performed to assess differences in career choices and practice settings.Among gastroenterology fellows, 46% opted for private practice, 28% pursued further training, and 26% chose academia. Notably, gastroenterology fellows were more inclined toward private practice than their counterparts in other subspecialties (46.3% vs 38.4%) and were less likely to pursue academic careers (25.6% vs 30.7%).This study highlights a concerning trend among recent gastroenterology fellowship graduates favoring private practice over academic careers or additional training. To sustain and strengthen academic medicine in gastroenterology, interventions such as scholarships, mentorship programs, and loan repayment initiatives tailored to academic pursuits could play a crucial role.

  View details for DOI 10.1080/08998280.2023.2282819

  View details for PubMedID 38173997

  View details for PubMedCentralID PMC10761130

• Autoimmune Hepatitis and Vitamin D Deficiency: A Nationwide Perspective. Alimentary pharmacology & therapeutics Kilani, Y., Alsakarneh, S., Madi, M. Y., Mosquera, D. A., Ferreira, M. N., Jaber, F., Helzberg, J., Duong, N., Syn, W. K. 2024

  Abstract

  Vitamin D deficiency is linked to worse outcomes in patients with chronic liver diseases (CLD). However, data in patients with autoimmune hepatitis (AIH) remain limited.We aimed to assess the impact of vitamin D deficiency on the outcomes of individuals with AIH.This retrospective cohort study used the TriNetX research network to identify patients with AIH. Patients were matched using propensity score matching and stratified to sufficient vitamin D levels (e.g., 25 (OH) D3 ≥ 30 ng/mL), vitamin D insufficiency (25 (OH) D3: 20-29.9 ng/mL) and vitamin D deficiency (e.g., 25 (OH) D3 < 20 ng/mL). The primary outcome was the all-cause mortality among adult patients with AIH. Secondary outcomes included decompensated liver cirrhosis, acute hepatic failure, liver transplantation (LT), all-cause hospitalizations and all-cause critical care admissions.A total of 1288 AIH patients with vitamin D deficiency were identified and propensity matched with 1288 patients with normal vitamin D levels. Patients with vitamin D deficiency had significantly increased odds for all-cause mortality compared to those with normal levels (adjusted odds ratio (aOR) = 3.2, 95%CI: 2.3-4.48). Patients with vitamin D deficiency were at increased odds of all-cause hospitalizations (aOR = 2.37, 95%CI: 1.97-2.84), critical care unit admissions (aOR = 2.8, 95%CI: 2.21-3.71), decompensated liver cirrhosis (aOR = 2.74, 95%CI: 2.13-3.54), acute hepatic failure (aOR = 3.11, 95%CI: 2.09-4.62) and LT (aOR = 3.47, 95%CI: 1.71-7.04), as compared to those with normal vitamin D levels.This cohort study showed significantly increased odds for all-cause mortality in AIH patients with vitamin D deficiency. Vitamin D deficiency in patients with AIH was associated with increased likelihood of hospitalisation, decompensated liver cirrhosis, acute liver failure and LT.

  View details for DOI 10.1111/apt.18438

  View details for PubMedID 39660607

• Low Body Mass Index is Associated With Higher Mortality in Patients Undergoing Liver Transplantation: A Population-Based Study Alsakarneh, S., Abuassi, M., Jaber, F., Duong, N. LIPPINCOTT WILLIAMS & WILKINS. 2024: S1364

  View details for DOI 10.14309/01.ajg.0001036972.85015.33

  View details for Web of Science ID 001360387400010

• THE IMPACT OF POMEGRANATE CONSUMPTION ON CLINICAL PARAMETERS IN MASLD: A META-ANALYSIS AND A SYSTEMATIC REVIEW Mohamed, I., Abosheaishaa, H., George, S., Bhatia, M., Baetje, L., Manek, S., Henry, N., Parekh, K., Abboud, Y., Salem, A., Jaber, F., Dahiya, D., Duong, N. LIPPINCOTT WILLIAMS & WILKINS. 2024: S1953-S1954

  View details for Web of Science ID 001366004005167

• AUTOIMMUNE HEPATITIS AND VITAMIN D DEFICIENCY: A NATIONWIDE PERSPECTIVE Kilani, Y., Alsakarneh, S., Madi, M., Mosquera, D., Ferreira, M., Jaber, F., Helzberg, J., Duong, N., Syn, W. LIPPINCOTT WILLIAMS & WILKINS. 2024: S1839-S1840

  View details for Web of Science ID 001366004005013

• A SYSTEMATIC REVIEW AND META- ANALYSIS ASSESSING THE SAFETY AND EFFICACY OF HEPATITIS E VIRUS VACCINE Mohamed, I., Abosheaishaa, H., Boda, A., Yang, F., Kamali, E., Scott, R., Huntress, K., Saravanan, T., Salem, A., Jaber, F., Abboud, Y., Dahiya, D., Alba, L., Duong, N. LIPPINCOTT WILLIAMS & WILKINS. 2024: S139

  View details for Web of Science ID 001366004000200

• THE HISTOLOGIC FEATURES OF SEVERE ALCOHOL-ASSOCIATED HEPATITIS UNDERGOING LIVER TRANSPLANTATION: AN EXPLANT STUDY Spencer, C., Idowu, M., Houston, K., Chadha, N., Duong, N., Bruno, D., Wedd, J., Sterling, R. LIPPINCOTT WILLIAMS & WILKINS. 2024

  View details for Web of Science ID 001366004003016

• PRE-TRANSPLANT ORAL MIDODRINE EXPOSURE DOES NOT AFFECT MORTALITY AMONG LIVER TRANSPLANT RECIPIENTS Achalu, S., Manikat, R., Gedallovich, S., Sedki, M., Duong, N., Gougol, A., Jalil, S., Masuoka, H., Sands, R., Singal, A., Kwo, P. LIPPINCOTT WILLIAMS & WILKINS. 2024: S1049

  View details for Web of Science ID 001366004002431

• Fibroblast Growth Factor Analogues in Metabolic Dysfunction Associated Steatotic Liver Disease: A Network Meta-Analysis Elnaggar, M., Imran, M., Mohamed, I., Abuelazm, M., Najah, Q., Mahmoud, A., Amin, A., Rezq, H., Khan, U., Abdelazeem, B., Duong, N. LIPPINCOTT WILLIAMS & WILKINS. 2024: S1356

  View details for DOI 10.14309/01.ajg.0001036912.89796.12

  View details for Web of Science ID 001359535300001

• Alcohol-Related Liver Disease Among Sexual and Gender Minority Patients: Analysis From a Large Multicenter Database Alsakarneh, S., Nikzad, N., Paul, S., Duong, N. LIPPINCOTT WILLIAMS & WILKINS. 2024: S1364-S1365

  View details for DOI 10.14309/01.ajg.0001036976.26425.d2

  View details for Web of Science ID 001360387400011

• Part II: Contract Negotiation and Job Preparation-The Gastroenterology Perspective. Digestive diseases and sciences Sleiman, J., Umar, S., Vinsard, D. G., Duong, N., Advani, R. 2024

  Abstract

  GI fellowships do not mandate curricula in career development. Often, fellows resort to peer mentorship for guidance. Fellows should recognize that the path to a successful career varies greatly based on how one defines and measures success. Keywords are preferr Through introspection, fellows will be able to craft their ideal post-fellowship position that balances wants versus needs. In this article, we cover four practical tips for trainees entering the job negotiation process.

  View details for DOI 10.1007/s10620-024-08556-w

  View details for PubMedID 38977520

• Transgender health care in the United States: legal, ethical and practical concerns for gastroenterologists in a changing landscape. Nature reviews. Gastroenterology & hepatology Singh, S., Duong, N., Targownik, L., Paul, S., Vélez, C., Feld, L. D. 2024

  View details for DOI 10.1038/s41575-024-00933-0

  View details for PubMedID 38693299

  View details for PubMedCentralID 7455854

• Improving culturally safe engagement with sexual and gender minority populations. Nature reviews. Gastroenterology & hepatology Nikzad, N., Duong, N., Paul, S. 2024

  View details for DOI 10.1038/s41575-024-00927-y

  View details for PubMedID 38565649

  View details for PubMedCentralID 7766835

• Gastrointestinal Variant of Lemierre's Syndrome: A Systematic Review and Comprehensive Analysis of 36 Case Reports. Journal of clinical and experimental hepatology Jaber, F., Alsakarneh, S., Alsharaeh, T., Salahat, A., Elfert, K., Beran, A., Gangwani, M. K., Abboud, Y., Al-Sayyed, L., Madi, M. Y., Jaber, M., Dahiya, D. S., Numan, L., Duong, N. 2024; 14 (2): 101319

  View details for DOI 10.1016/j.jceh.2023.101319

  View details for PubMedID 38250215

• Predictors of clinical outcomes of hospitalized patients with primary sclerosing cholangitis in the United States. Proceedings (Baylor University. Medical Center) Alsakarneh, S., Duong, N. 2023; 36 (6): 705

  View details for DOI 10.1080/08998280.2023.2257104

  View details for PubMedID 37829232

  View details for PubMedCentralID PMC10566426

• Changing the Face of Transplant Hepatology Trainees in 2023. Gastro hep advances Alsakarneh, S., Duong, N. 2023; 2 (6): 873-874

  View details for DOI 10.1016/j.gastha.2023.07.014

  View details for PubMedID 39130113

  View details for PubMedCentralID PMC11308853

• Professional Networking at Gastroenterology Scientific Meetings: A Trainee's Practical Guide. Digestive diseases and sciences Sleiman, J., Duong, N., Aby, E. S., Guerrero Vinsard, D., Advani, R., Bilal, M. 2023; 68 (1): 24-28

  View details for DOI 10.1007/s10620-022-07730-2

  View details for PubMedID 36310307

  View details for PubMedCentralID PMC9618300

• The impact of COVID-19 on liver transplantation: challenges and perspectives THERAPEUTIC ADVANCES IN GASTROENTEROLOGY Fatima, I., Duong, N. 2023; 16: 17562848231171452

  Abstract

  The coronavirus disease 2019 (COVID-19) pandemic presented unique challenges to patients with decompensated cirrhosis awaiting transplant, with respect to accessing medical facilities for routine clinic visits, imaging, laboratory workup, or endoscopies. There was a delay in organ procurement that led to a decrease in the number of liver transplants (LTs) and an increase in the morality of waitlisted patients at the beginning of the pandemic. LT numbers later equalized to pre-pandemic numbers due to combined efforts and adaptability of transplant centers as well as dynamic guidelines. Due to being immunosuppressed, the demographics of LT patients were at an increased risk of infection. Although there is a higher rate of mortality and morbidity in patients with chronic liver disease, LT itself is not a risk factor for mortality in COVID-19. There was no difference in overall mortality in LT patients compared to non-LT patients, and mortality risk factors were the same: age, hypertension, diabetes, obesity, and chronic kidney disease. The most common causes of death were respiratory complications. Liver-related deaths were reported in 1.6% of patients. The optimal timing of liver transplantation post-infection depends on various factors, such as the severity of liver injury, the presence of comorbidities, and the progression of the underlying liver disease. There is not enough data available on COVID-19 cholangiopathy and the number of cases that will be seen in the future that will require LT. There are some concerns of lower immunogenicity of COVID-19 vaccines in LT patients but available evidence suggests that the vaccines are safe and well-tolerated.

  View details for DOI 10.1177/17562848231171452

  View details for Web of Science ID 000984771600001

  View details for PubMedID 37180361

  View details for PubMedCentralID PMC10172841

• Use of doppler ultrasound to predict need for transjugular intrahepatic portosystemic shunt revision. World journal of hepatology Duong, N., Healey, M., Patel, K., Strife, B. J., Sterling, R. K. 2022; 14 (6): 1200-1209

  Abstract

  Transjugular intrahepatic portosystemic shunt (TIPS) is used to treat complications of portal hypertension, such as ascites and variceal bleeding (VB). While liver doppler ultrasound (DUS) is used to assess TIPS patency, trans-shunt venography (TSV) is the gold standard.To determine the accuracy of DUS to assess TIPS dysfunction and for need for revision.Retrospective review of patients referred for TIPS revision from 2008-2021. Demographics, DUS parameters at baseline and at the DUS preceding TIPS revision, TSV data were collected. Receiver operating characteristics curves, sensitivity, specificity, performance for doppler to predict need for revision were performed. Univariate and multivariate analyses were used to predict clinical factors associated with need for TIPS revision.The cohort consisted of 89 patients with cirrhosis (64% men, 76% white, 31% alcohol as etiology); median age 59 years. Indication for initial TIPS were VB (41%), refractory ascites (51%), and other (8%). TIPS was revised in 44%. On univariate analysis, factors associated with need for TIPS revision were male (P = 0.03), initial indication for TIPS (P = 0.05) and indication for revision (P = 0.01). Revision of TIPS was associated with lower mortality (26% vs 46%) and significantly lower rates of transplant (13% vs 24%; P = 0.1). In predicting need for TIPS revision, DUS has a 40% sensitivity, 45% specificity, PPV 78%, and NPV 14%. The most accurate location for shunt velocity measure was distal velocity (Area under the curve: 0.79; P = 0.0007).DUS has poor overall sensitivity and specificity in predicting need for TIPS revision. Non-invasive methods of predicting TIPS dysfunction are needed since those needing TIPS revision had better survival.

  View details for DOI 10.4254/wjh.v14.i6.1200

  View details for PubMedID 35978660

  View details for PubMedCentralID PMC9258261

• Reply. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Duong, N. K., Heuman, D. M., Bajaj, J. S. 2022; 20 (5): e1221

  View details for DOI 10.1016/j.cgh.2021.06.031

  View details for PubMedID 34214679

• Identifying the patient with acute-on-chronic liver failure: navigating through multiple definitions. Clinical liver disease Duong, N., Bajaj, J. S. 2022; 19 (5): 183-186

  Abstract

  Content available: Audio Recording.

  View details for DOI 10.1002/cld.1176

  View details for PubMedID 35662864

  View details for PubMedCentralID PMC9135153

• An Overview of the GI Fellowship Interview: Part II-Tips for Selection Committees and Interviewers. Digestive diseases and sciences Advani, R., Bollipo, S., Charabaty, A., Duong, N., Bilal, M., Siau, K., Grover, S. C. 2022; 67 (5): 1712-1717

  View details for DOI 10.1007/s10620-022-07409-8

  View details for PubMedID 35122593

  View details for PubMedCentralID PMC8817657

• Bowel Movement Frequency Is Not Linked With Cognitive Function in Cirrhosis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Duong, N., Reuter, B., Saraireh, H., Nadhem, O., Acharya, C., Fagan, A., Hassouneh, R., Bajaj, J. S. 2022; 20 (4): e897-e901

  Abstract

  The spectrum of hepatic encephalopathy (HE) ranges from overt HE (OHE) to cognitive impairment (ie, covert) HE (CHE).1 The first-line therapy is lactulose, which is titrated to achieve ~2-3 soft/loose daily bowel movements (BM). This metric is considered dogma for practitioners despite erratic results, GI adverse events, and poor tolerance in Western countries.1 There are logistic barriers for the widespread uptake of rifaximin, the second-line therapy. Moreover, although BM frequency-directed dose titration of lactulose is the usual practice, its impact on objective cognitive performance is unclear. Our aim is to determine the impact of BM frequency on cognition in patients with/without prior OHE.

  View details for DOI 10.1016/j.cgh.2021.05.014

  View details for PubMedID 33991690

  View details for PubMedCentralID PMC8589867

• The impact of the gut microbiome on liver transplantation. Current opinion in organ transplantation Duong, N., Bajaj, J. S. 2021; 26 (6): 587-594

  Abstract

  Although gut dysbiosis can hasten disease progression in end-stage liver disease and contribute to disease severity, morbidity and mortality, its impact during and after transplant needs further study.Changes in the microbiome are associated with hepatic decompensation. Immune homeostasis is further disrupted during transplant and with immunosuppressants required after transplant. There is increasing evidence of the role of microbiota in peri and posttransplant complications.Although transplant is highly successful with acceptable survival rates, infections, rejection, disease recurrence and death remain important complications. Prognostication and interventions involving the gut microbiome could be beneficial.

  View details for DOI 10.1097/MOT.0000000000000930

  View details for PubMedID 34636770

  View details for PubMedCentralID PMC8562890

• When burn-out reaches a pandemic level in gastroenterology: a call for a more sustainable work-life balance. Frontline gastroenterology Duong, N., Bollipo, S., Repaka, A., Sebastian, S., Tennyson, C., Charabaty, A. 2021; 12 (5): 440-443

  View details for DOI 10.1136/flgastro-2020-101725

  View details for PubMedID 35401964

  View details for PubMedCentralID PMC8989001

• Effects of a Resident-Led Subject Exam Review on Mean Scores of Internal Medicine Subject Exam: a Case-control Study. Medical science educator Kareff, S. A., d'Aliberti, O., Duong, N. 2021; 31 (1): 49-52

  Abstract

  The National Board of Medical Examiners (NBME) offers Subject Examinations (SE) for students completing the Internal Medicine (IM) clerkship. There is a paucity of literature in regard to the efficacy of review methods prior to rendering said examination. Our medical center's residents conducted a structured review session in preparation for SE administration. The mean SE scores prior to and after the initiation of the resident-led review session were compared. There was no statistically significant association found between the mean NBME scores in the experimental or control groups. We propose that alternative methods be further assessed for efficacy.

  View details for DOI 10.1007/s40670-020-01157-y

  View details for PubMedID 34457863

  View details for PubMedCentralID PMC8368476

• How to Become a Competitive Applicant for Gastroenterology Fellowship: Tips and Tricks for Success Part II. Digestive diseases and sciences Duong, N., Aby, E. S., Hathorn, K. E., Simons-Linares, C. R., Bilal, M. 2020; 65 (8): 2172-2175

  Abstract

  In recent years, gastroenterology has become one of the most competitive subspecialties included in the internal medicine fellowship match, which increases the stressful nature of an already potentially nerve-wracking process for the trainee. Though each applicant has unique strengths and thus the process is somewhat individualized, there are some basic principles that can render an applicant more competitive for a gastroenterology fellowship. These include establishing mentorship, achieving scholarly work, building your resume, honing interpersonal and networking skills, and writing a well-planned application. The goal of this article is to outline some basic principles that will help improve the competitiveness of an applicant, and also highlight some practical tips and tricks for applicants with diverse backgrounds, such as international medical graduates, minority applicants, and women in medicine.

  View details for DOI 10.1007/s10620-020-06293-4

  View details for PubMedID 32356262

• Case of acute mixed liver injury due to hypothyroidism. BMJ case reports Duong, N., Lee, A., Lewis, J. 2018; 2018

  Abstract

  The effects of hypothyroidism on the liver are not well understood. A 77-year-old woman with Hashimoto's thyroiditis had stopped taking levothyroxine on her own for 6 months. Her thyroid stimulating hormone (TSH) level was consistent with severe hypothyroidism. She resumed thyroid replacement therapy. The following month, her liver function tests were significantly elevated. Seven weeks after resumption of therapy, her TSH and liver tests had returned to normal. We attribute the mixed hepatocellular injury to hypothyroidism that resolved on correction of the hypothyroid state. This case reminds us that thyroid disease should be considered when evaluating acute liver injury.

  View details for DOI 10.1136/bcr-2017-222373

  View details for PubMedID 29367365

  View details for PubMedCentralID PMC5786968

• Knowledge and Attitudes of Internal Medicine Trainees' Co-Prescribing Patterns of Gastroprotective Agents in Patients Taking Long-Term Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Journal of Clinical Gastroenterology and Treatment Duong, N., Lee, A., Lewis, J. 2018; 4 (3)

  View details for DOI 10.23937/2469-584X/1510062

• ). Inflammatory bowel disease (IBD) activity and depression Gastroenterol Hepatol Open Access Duong, N., Hussain, N., Kallus, S., Mattar, M. 2018

  View details for DOI 10.15406/ghoa.2018.09.00316