Geriatric Gastroenterology

C.S. Pitchumoni � T.S. DharmarajanEditors

Geriatric Gastroenterology

EditorsC.S. Pitchumoni, MD, MPH, FRCP(C), MACP

MACG, AGAFClinical Professor of MedicineRobert Wood Johnson School of MedicineDrexel University School of MedicineAdjunct Professor of MedicineNew York Medical College, Valhalla, NY

Chief, Gastroenterology, Hepatology and Nutrition

Saint Peter’s University Hospital New Brunswick, NJ, USA

T.S. Dharmarajan, MD, FACP, AGSFProfessor of MedicineAssociate DeanNew York Medical College, Valhalla, NYVice Chairman, Department of MedicineClinical Director, Division of GeriatricsProgram Director, Geriatric Medicine

Fellowship ProgramMontefiore Medical Center (North Division)Bronx, New York, USA

Please note that additional material for this book can be downloaded from http://extras.springer.com

ISBN 978-1-4419-1622-8 ISBN 978-1-4419-1623-5 (eBook)DOI 10.1007/978-1-4419-1623-5Springer New York Heidelberg Dordrecht London

Library of Congress Control Number: 2012938546

© Springer Science+Business Media, LLC 2012This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on micro fi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied speci fi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law.The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

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Dedicated to my parents,My wife, PremaAnd children Sheila, Shoba and Suresh For love, encouragement and understanding!

CSPDedicated to my mother,My wife, Lekshmi,And, Kumar and Kavita,With love and gratitude,

TSD

vii

The de fi nition of old age is not a clear one; most societies use arbitrary language to de fi ne ‘the older adult.’ One hundred years ago, old age was de fi ned as ‘any age after fi fty.’ Later, criteria such as pension schemes evolved to de fi ne the older adult, and ages 60 to 65 are numbers still accepted today. The term ‘geriatrics’ means ‘related to the aged’ and geriatric medicine deals with ‘medical problems of old age.’ Aging is associated with a gradual decline in physiologic processes, along with susceptibility to disease. The needs of the old differ from those of the young. Geriatric patients often present atypically. Both evaluation and care differ. Decision-making is in fl uenced not only by the disease process itself, but also by life expectancy, quality of life issues and patient choices. This book deals with both the physiologic and pathologic changes in the gastrointestinal system as the aging process advances, and with the evaluation and care appropriate to the older age group.

The gastroenterology and geriatric medicine disciplines are fortunate to have two experi-enced editors in Dr. Pitchumoni and Dr. Dharmarajan: they have conceived this book and have brought it to fruition. They are distinguished educators and clinicians who have achieved national and international respect in the fi elds of gastroenterology, internal medicine and geri-atrics. As authors and editors, they have been collaborating for over three decades. Having co-authored a series of articles in geriatric gastroenterology in peer-reviewed journals, they have now taken a step further in the design and execution of this work. The diverse back-grounds of the two editors bring strength and breadth to this ambitious text.

Both editors have spent the majority of their professional careers in academic gastroenterol-ogy and geriatric medicine respectively. They have published extensively and have served on the editorial boards of prestigious journals. Dr. Pitchumoni, a recognized master teacher, is a Master of both the American College of Physicians and the American College of Gastroenterology. He has advanced degrees and board certi fi cation in the fi elds of internal medicine, gastroenterology, clinical nutrition and public health. Although he considers this author to be his mentor, I have certainly reaped equal bene fi t from our personal and profes-sional relationship over the years.

Dr. Dharmarajan, a dedicated geriatrician, developed one of the largest known acute care hospital geriatric programs and associated geriatric medicine fellowships. He also serves as Associate Dean of his af fi liated medical school. In 1998, he published “Launching a Geriatric Unit” in Health Progress . The two continued their academic alliance in 2002 with the publica-tion “Geriatric Medicine Programs in India: Has the Time Arrived?” in the Journal of Association of Physicians India . The present book joins several other textbooks previously edited by this fi ne team of scholars.

This is not just another gastroenterology textbook. The design is unique in providing con-temporary information in the fi eld of gastroenterology pertinent to the older adult.

Although not the fi rst book in geriatric gastroenterology, this fi rst edition is conceptually bold and novel. The text is a state of the art, comprehensive and practical approach to the clini-cal practice of internal medicine, geriatrics and gastroenterology. The references are updated

Foreword

viii Foreword

and current clinical practice guidelines are appropriately presented. The book impresses me as one meant for the practicing physician as well as the resident in training and the fellow in geriatric medicine or gastroenterology. Key points at the end of every chapter summarize the highlights. Every chapter is amply supplemented with easy- to-understand tables and fi gures. Two chapters are devoted to radiologic images of gastrointestinal disorders in the aged. A chapter dealing with gastrointestinal pathology is rich in photographs of virtually every common gastrointestinal disorder in the elderly. The book as a whole is liberally illustrated with high quality images and clear captions.

The editors have done an excellent job in their plan and execution of the contents. Seventy-two chapters are presented in fourteen sections. Introductory chapters present the perspectives of the editors as geriatrician and gastroenterologist. These are followed by a chapter on future trends in health care, and enable clinicians become knowledgeable on management of gastro-intestinal disorders in the aged population, a view supported by the American College of Gastroenterology. Chapters follow on the basic sciences and principles of gastroenterology in the context of the older adult and the aging process. Subsequent chapters deal with the impor-tant topics of pharmacology and drug interactions. The next few focus on geriatric nutrition, with topics ranging from healthy diet to enteral feeding to ethical issues in end-of-life care. The chapters which follow deal with luminal disorders, malignancies of the gastrointestinal tract, the liver, gallbladder and pancreas, palliative care, systemic disorders, and psychiatric disease. Each chapter focuses on evaluation, differential diagnosis and management of gastro-intestinal problems relevant to the older adult.

Over eighty authors have contributed to the writing of this book. Many are of national and international repute, and ably supported by junior faculty members. In addition to their role as editors, Dr. Pitchumoni and Dr. Dharmarajan have also contributed a signi fi cant share of book chapters.

In summary, this fi rst edition of Geriatric Gastroenterology is a major attempt to be all-inclusive in the fi eld of gastroenterology pertinent to the geriatric patient. The information therein is contemporary and basic to the practice of medicine. It is a privilege and honor to write this Foreword. The Editors are world-renowned educators and scholars who have designed and delivered a masterful textbook for clinicians of internal medicine, geriatrics and gastroenterology. They are to be congratulated for this effort.

Clinical Professor of Medicine Martin H. Floch, M.D. Yale University School of Medicine

ix

Over the past several decades, trends in global aging have focused attention on the manner in which we care for older adults. How can we be best prepared to meet the demands of medical illness in our aging population? Many of the medical societies have increasingly promoted the blending of medical sub-specialty training with expertise in the care of the older adult. In this regard, the American Gastroenterologic Association Future Trends Committee Report recently highlighted several areas for improvement in health care delivery, including the need to iden-tify ‘best evidence-based care’ for the older adult; to develop guidelines for care of speci fi c gastrointestinal issues in geriatrics; to modify current practices in order to meet the complex needs of older individuals; and to adapt the healthcare workforce to meet the demands of spe-cialized treatments in gastroenterology for older people. Until there are suf fi cient trained per-sonnel in both geriatrics and gastroenterology, providers must handle the daunting task with knowledge gained in other ways.

As editors specialized in gastroenterologiy and geriatric medicine, we see the need for a textbook to address the physiology, pathology, evaluation and management of digestive disor-ders in the elderly. Too often, clinical complaints are attributed to ‘old age’ by patient and provider alike. Physicians must be better trained to discern physiological from pathological processes and normal aging from disease. Disorders such as constipation and diverticular dis-ease are common in the old, but are they pathological, or the result of aging? As age is associ-ated withimmune dysfunction, the role of the gut in the elderly has become a subject of increasing importance. How should the age-related decline in homestatic mechanisms, known as homeostenosis, alter medical care in the elderly? Added to the complex situation is the impact of polypharmacy and adverse drug events which often mimic gastrointestinal disorders, with increasing health care costs. How can we learn to be more focused and sensitive to these issues? This book attempts to clarity these challenging and controversial issues in the diagno-sis and care of the geriatric individual.

A standard format has been adopted for this text, whereby most chapters conclude with key summary points. Numerous tables and fi gures are included to emphasize content. There are abundant pictures focusing on endoscopy, radiography and pathology. Several relevant gastro-intestinal topics unique to the older person are included. We anticipate the book will be a valu-able resource for residents, fellows, and practicing physicians alike. A section providing Questions with multiple choice Answers and brief discussions relating to the chapters is hosted in an electronic platform (Springer Extras); this may be an additional benefi t particularly to residents and fellows in training.

This work is by no means all-inclusive, but does offer solid grounding in geriatric gastroen-terology. It is also not the fi rst text on the subject: the fi rst comprehensive book was written in 1984 by Lawrence J. Brandt MD, Emeritus Chairman of Gastroenterology at Albert Einstein College of Medicine, entitled “Gastrointestinal Disorders of the Elderly.” Tremendous credit is due to Peter R. Holt MD of Saint Luke’s Hospital of New York-Presbyterian Medical Center

Preface

x Preface

for pioneering the concept of ‘Aging and the Gastrointestinal Tract’. These two provided the initial motivation for our efforts. We salute as well many pioneers in the fi eld of Geriatrics: William R. Hazzard, Christine K. Cassel, Joseph G. Ouslander, Mary E. Tinetti, Laurence Z. Rubenstein, John E. Morley, and others; and the fi eld of Gastroenterology: Howard M. Spiro, Henry L. Bockus, Sir Francis Avery Jones, Dame Sheila Sherlock, Marvin H. Sleisenger, John S. Fordtran, Edward J. Berk, and others. All of these scholar-mentors in medicine paved the path for us to follow.

Special thanks are due to Martin H. Floch MD of Yale University, who has graciously pro-vided the Foreword for the book. We are grateful to the many contributors who responded to our call and gave generously of their time to provide chapters for the book. Springer has been supportive from the start of this venture and throughout the editing process. Both of us wrote a series of articles over the past fi fteen years on the theme of geriatric gastroenterology, and Springer has been instrumental in bringing to fruition our dream of a textbook of geriatric gastroenterology.

Support and encouragement from our family was ever present, and for this we are eternally grateful. Our families were a source of strength and inspiration; their patience, understanding and sacri fi ces commendable. As teachers and mentors, we acknowledge our students, resi-dents, fellows and professional colleagues for providing the opportunity to enrich our knowl-edge and clinical skills. And above all, we pay tribute to our older adult patients in community, hospital and nursing home settings, from whom we have learned so much.

It is our hope that this textbook serves as a resource towards ful fi llment of a goal so aptly stated by Abraham Lincoln: “And in the end, it’s not the years in your life that count. It’s the life in your years.”

C.S. Pitchumoni MD T.S. Dharmarajan MD

xi

Part I Perspectives and Trends

1 Geriatric Gastroenterology: The Geriatrician’s Perspective ............................... 3T.S. Dharmarajan

2 Geriatric Gastroenterology: The Gastroenterologist’s Perspective .................... 7C.S. Pitchumoni

3 Geriatric Gastroenterology: Future Trends .......................................................... 11Karen E. Hall

Part II Basic Sciences, Principles and Epidemiology

4 The Physiology of Aging .......................................................................................... 17T.S. Dharmarajan

5 The Gastrointestinal System and Aging ................................................................ 33T.S. Dharmarajan, Amit Sohagia, and C.S. Pitchumoni

6 Epidemiology of Gastrointestinal Disease ............................................................. 49Julia B. Greer, Haq Nawaz, and Dhiraj Yadav

7 Comprehensive Geriatric Assessment .................................................................... 55T.S. Dharmarajan

Part III Pharmacology

8 Drug Effects on the Gastrointestinal Tract ............................................................ 73Vishal Jain, T.S. Dharmarajan, and C.S. Pitchumoni

9 Pharmacokinetics of Aging ..................................................................................... 83Ryan J. Haumschild

10 Drug–Nutrient Interactions .................................................................................... 89Srinivas Guptha Gunturu and T.S. Dharmarajan

11 Probiotics .................................................................................................................. 99Martin H. Floch

Part IV Nutrition

12 Geriatric Nutritional Assessment ........................................................................... 107Kumar Dharmarajan and Kenneth L. Minaker

13 Tube Feeding: Techniques and Procedure ............................................................. 119Amit Sohagia and Hilary I. Hertan

Contents

xii Contents

14 Enteral and Parenteral Nutrition ........................................................................... 127Manie Juneja and Stephen J.D. O’Keefe

15 Ethical Aspects, Expectations, and Outcomes Associated with PEG in Dementia ............................................................................................. 137T.S. Dharmarajan, Krishna P. Aparanji, and C.S. Pitchumoni

16 Water, Potassium, Sodium, and Chloride in Nutrition ......................................... 145Kumar Dharmarajan and Kenneth L. Minaker

17 Intravenous Fluid Administration .......................................................................... 153Eugene C. Corbett, Jr.

18 B12 and Folic Acid ................................................................................................... 161T.S. Dharmarajan and Srinivas Guptha Gunturu

19 Iron, Copper, and Zinc ............................................................................................ 177T.S. Dharmarajan, Srinivas Guptha Gunturu, and C.S. Pitchumoni

20 Vitamin D and Calcium ........................................................................................... 185T.S. Dharmarajan and Amit Sohagia

21 Dietary Fiber in Health and Disease ...................................................................... 197C.S. Pitchumoni and Fisseha Y. Ghidey

22 Healthy Diet for the Older Adult ............................................................................ 205Sirakarn Tejavanija and Sunil S. Jhangiani

Part V Imaging

23 Endoscopy in Older Adults: Risks, Benefits, Considerations .............................. 215Noelle O’Shea and Frank J. Lukens

24 Wireless Capsule Endoscopy ................................................................................... 221C.S. Pitchumoni and Neelam G. Gidwaney

25 GastroIntestinal Radiology ..................................................................................... 227Judith K. Amorosa and C.S. Pitchumoni

26 Advanced Imaging of Geriatric Gastrointestinal Pathology ................................ 249Fernanda Samara Mazzariol

Part VI Pathology

27 Laboratory Tests in Older Adults: Indications, Interpretation, Issues ............... 261T.S. Dharmarajan and C.S. Pitchumoni

28 Gastrointestinal Pathology in the Older Adult...................................................... 271Noam Harpaz, Hongfa Zhu, and Mohammad Raoufi

Part VII Motility Disorders

29 Dysphagia.................................................................................................................. 293James C. Reynolds and Bassem R. George

30 Gastroparesis in Older Adults ................................................................................ 301Richard W. McCallum and Ashish Malhotra

31 Esophageal Reflux Disease and Its Complications ................................................ 311Missale Solomon and James C. Reynolds

Part VIII Signs and Symptoms

32 Abdominal Pain ........................................................................................................ 323C.S. Pitchumoni and T.S. Dharmarajan

xiiiContents

33 Intestinal Gas ............................................................................................................ 329Debra R. Goldstein and C.S. Pitchumoni

34 Constipation.............................................................................................................. 337T.S. Dharmarajan, David Widjaja, and C.S. Pitchumoni

35 Diarrhea .................................................................................................................... 351Sita Chokhavatia and Arvind J. Trindade

36 Upper and Lower Gastrointestinal Bleeding ......................................................... 363C.S. Pitchumoni and Alexander Brun

Part IX Hepato Biliary System and Pancreas

37 Liver Function Tests and Interpretation ................................................................ 375Jacob Alexander and Kris V. Kowdley

38 Viral Liver Diseases ................................................................................................. 383Satheesh Nair and Jihad O. Arteh

39 Tumors of the Liver ................................................................................................. 391Satheesh Nair and Jihad O. Arteh

40 Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH)............................................................................................ 399C.S. Pitchumoni

41 Drug-Induced Liver Injury ..................................................................................... 409Indira Donepudi, Hatef Massoumi, T.S. Dharmarajan, and C.S. Pitchumoni

42 Gallbladder Disease ................................................................................................. 421Rad M. Agrawal, Suzanne Morrissey, and Shyam Thakkar

43 Acute Pancreatitis .................................................................................................... 429C.S. Pitchumoni

44 Chronic Pancreatitis ................................................................................................ 441Gaurav Aggarwal and Suresh T. Chari

Part X Luminal Disorders

45 Oral Health in Older Adults ................................................................................... 451Mary S. Haumschild and Barbara G. Hammaker

46 Small Intestinal Bacterial Overgrowth Syndrome ................................................ 457T.S. Dharmarajan and C.S. Pitchumoni

47 Peptic Ulcer ............................................................................................................... 463Isidor Segal

48 Irritable Bowel Syndrome ....................................................................................... 467Eamonn M.M. Quigley

49 Intestinal Ischemia ................................................................................................... 475Hazar Michael and C.S. Pitchumoni

50 Inflammatory Bowel Disease ................................................................................... 483Jeffrey Raphael Abergel and Kiron M. Das

51 Non-IBD and Noninfectious Colitis ........................................................................ 493Ole Haagen Nielson and Jakob Benedict Seidelin

52 Celiac Disease ........................................................................................................... 501C.S. Pitchumoni and Nancy Chen

xiv Contents

53 Diverticular Disease ................................................................................................. 511C.S. Pitchumoni

54 Clostridium difficile-Associated Diseases ................................................................ 519C.S. Pitchumoni and T.S. Dharmarajan

55 Gastrointestinal Infections ...................................................................................... 527David V. Alcid

56 Anal Incontinence .................................................................................................... 533Sanjiv K. Patankar and Negar M. Salehomoum

57 Rectal Prolapse ......................................................................................................... 541Sanjiv K. Patankar and Rodolfo Pigalarga

Part XI Neoplasms

58 Colorectal Cancer Screening in the Older Adult: A Case-Based Approach .......................................................................................... 549Brijen J. Shah and Sita Chokhavatia

59 Gastrointestinal Polyps ............................................................................................ 559Tamir Ben-Menachem

60 Gastric Neoplasms ................................................................................................... 565Philip Chang and Isidor Segal

61 Esophageal Cancer................................................................................................... 571Noah Kornblum

62 Pancreatic Cancer .................................................................................................... 581Gaurav Aggarwal and Suresh T. Chari

63 Colorectal Cancer .................................................................................................... 587Giridhar U. Adiga and Janice P. Dutcher

Part XII Palliative Care

64 Palliative Care of GI Issues at the End of Life ...................................................... 599John M. Heath and Elizabeth Poplin

Part XIII Surgery

65 The Surgical Abdomen ............................................................................................ 607Carlos A. Pelaez and Nanakram Agarwal

66 Colostomy and Ileostomy Care ............................................................................... 615Juan J. Omana and Nanakram Agarwal

Part XIV Systems Disorders

67 Gastrointestinal and Hepatic Manifestations of Systemic Diseases .................... 623Ellen C. Ebert

68 Abdominal Aortic Aneurysm .................................................................................. 631T.S. Dharmarajan

69 Rheumatological Manifestations of Gastrointestinal Disease .............................. 637Nayan K. Kothari and Srilatha Kothandaraman

70 Mucocutaneous Manifestations with Gastrointestinal Disease ............................ 647Robert A. Norman and Trupal Patel

xvContents

71 HIV Disease .............................................................................................................. 659C.S. Pitchumoni and Alexander Brun

72 Gastrointestinal Disorders in the Older Adult: The Psychiatrist’s Role ............................................................................................ 667Alberto Cortes-Ladino

Index .................................................................................................................................. 671

xvii

Jeffrey Raphael Abergel , MD Department of Medicine , UMDNJ-Robert Wood Johnson Medical School , New Brunswick , NJ , USA

Giridhar U. Adiga , MD, FACP Department of Medical Oncology , Ephrata Cancer Center , Ephrata , PA , USA

Nanakram Agarwal , MD, MPH, FRCS, FACS Department of Surgery , Monte fi ore Medical Center (North Division) , Bronx , NY , USA

Gaurav Aggarwal , MBBS Division of Gastroenterology and Hepatology , Department of Medicine, Mayo Clinic , Rochester , MN , USA

Rad M. Agrawal , MD, FACP, FACG, AGAF, FASGE Allegheny General Hospital, Drexel University College of Medicine , Division of Gastroenterology , Pittsburgh , Pennsylvania , USA

David V. Alcid , MD Department of Medicine , Saint Peter’s University Hospital , New Brunswick , NJ , USA

Jacob Alexander , MBBS, MD, DM Division of Gastroenterology , University of Washington , Seattle , WA , USA

Judith K. Amorosa , MD, FACR Department of Radiology , Robert Wood Johnson University Hospital , New Brunswick , NJ , USA

Krishna P. Aparanji , MD Division of Geriatrics , Monte fi ore Medical Center (North Division) , Bronx , NY , USA

Jihad O. Arteh , MD Department of Internal Medicine , University of Tennessee Health Science Center , Memphis , TN , USA

Alexander Brun , MD Department of Medicine, Division of Gastroenterology , North Shore-Long Island Jewish Health System , New Hyde Park , NY , USA

Philip Chang , MBBS, FRACP Gastrointestinal and Liver Unit , Prince of Wales Hospital , Sydney , NSW , Australia

Suresh T. Chari , MD Division of Gastroenterology and Hepatology , Department of Medicine, Mayo Clinic , Rochester , MN , USA

Nancy Chen , MD Department of Gastroenterology , Robert Wood Johnson University Hospital , New Brunswick , NJ , USA

Sita Chokhavatia , MD Departments of Internal Medicine and Gastroenterology , Mount Sinai Hospital , New York , NY , USA

Contributors

xviii Contributors

Eugene C. Corbett, Jr , MD, FACP General Medicine, Geriatrics and Palliative Care, Department of Internal Medicine , University of Virginia , Charlottesville , VA , USA

Alberto Cortes-Ladino , MD Department of Psychiatry , Monte fi ore Medical Center (North Division) , New York , NY , USA

Kiron M. Das , MD, PhD Division of Gastroenterology and Hepatology, Department of Medicine, Crohn’s and Colitis Center of New Jersey , UMDNJ-Robert Wood Johnson Medical School , New Brunswick , NJ , USA

Kumar Dharmarajan , MD, MBA Department of Medicine , Massachusetts General Hospital , Boston , MA , USA

T. S. Dharmarajan , MD, FACP, AGSF Professor of Medicine, Associate Dean , New York Medical College, Valhalla , NY , USA

Vice Chairman, Department of Medicine, Clinical Director, Division of Geriatrics, Program Director, Geriatric Medicine Fellowship Program, Monte fi ore Medical Center (North Division) , Bronx , NY , USA

Indira Donepudi , MD Division of Gastroenterology , Monte fi ore Medical Center (North Division) , Bronx , NY , USA

Janice P. Dutcher , MD Division of Hematology/Oncology, Department of Medicine , Continuum Cancer Centers, St. Luke’s Roosevelt Hospital Center , New York , NY , USA

Ellen C. Ebert , MD Department of Medicine , Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital , New Brunswick , NJ , USA

Martin H. Floch , MD, MS, BA Yale Digestive Diseases , Yale New Haven Hospital , New Haven , CT , USA

Bassem R. George , MD Department of Internal Medicine , Hahnemann University Hospital/Drexel University College of Medicine , Philadelphia , PA , USA

Fisseha Y. Ghidey , MD, MPH Department of Internal Medicine , Saint Peter’s University Hospital , New Brunswick , NJ , USA

Neelam G. Gidwaney , MD Department of Internal Medicine , Robert Wood Johnson School of Medicine , New Brunswick , NJ , USA

Debra R. Goldstein , MD, FACP Department of Internal Medicine , Saint Peters University , New Brunswick , NJ , USA

Julia B. Greer , MD, MPH Division of Gastroenterology, Hepatology & Nutrition , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA

Srinivas Guptha Gunturu , MD Department of Medicine , Monte fi ore Medical Center (North Division) , Bronx , NY , USA

Karen E. Hall , MD, PhD Department of Internal Medicine , University of Michigan Healthcare System, East Ann Arbor Health and Geriatric Center , Geriatric Clinic, Ann Arbor , MI , USA

Barbara G. Hammaker , RDH, BASDH, MHS Department of Dental Hygiene , Broward College , Davie , FL , USA

Noam Harpaz , MD, PhD Departments of Pathology and Medicine, Division of Gastroenterology , Mount Sinai School of Medicine , New York , NY , USA

Mary Snider Haumschild , RDH, RN, MHSc, DrHS Department of Health Sciences , St. Petersburg College , Seminole , FL , USA

xixContributors

Ryan J. Haumschild , MBA, BS University of Florida College of Pharmacy, Shands Hospital , Gainesville , FL , USA

John M. Heath , MD, AGSF Geriatric Services Director , Summit Medical Group , Berkeley Heights , NJ , USA

Hilary I. Hertan , MD Department of Medicine , Division of Gastroenterology and Clinical Nutrition, Monte fi ore Medical Center (North Division) , Bronx , NY , USA

Vishal Jain , MD Department of Gastroenterology and Hepatology , Penn State Hershey Medical Center , Hershey , PA , USA

Sunil S. Jhangiani , MD, MBA, FACP, AGAF Division of Clinical Nutrition, and Gastroenterology & Department of Internal Medicine , Monte fi ore Medical Center (North Division) , Bronx , NY , USA

Manie Juneja , MD Department of Internal Medicine , Georgetown University Hospital , Washington , DC , USA

Noah Kornblum , MD Department of Oncology , Monte fi ore Medical Center (North Division) , Bronx , NY , USA

Srilatha Kothandaraman , MD Department of Medicine , Saint Peter’s University Hospital; Drexel University College of Medicine , New Brunswick , NJ , USA

Nayan K. Kothari , MD, FACP Department of Medicine , Saint Peter’s University Hospital; Drexel University College of Medicine , New Brunswick , NJ , USA

Kris V. Kowdley , MD, FACP, FACG, FASGE, AGAF Department of Gastroenterology , Virginia Mason Medical Center , Seattle , WA , USA

Frank J. Lukens , MD Health Science Center at Houston , The University of Texas , Houston , TX , USA

Ashish Malhotra , MD Department of Gastroenterology and Hepatology , Seton Hall University of Health and Medical Sciences , Paterson , NJ , USA

Hatef Massoumi , MD Department of Medicine, Division of Hepatology , Monte fi ore Medical Center , Bronx , NY , USA

Fernanda Samara Mazzariol , MD Department of Radiology , Monte fi ore Medical Center , Bronx , NY , USA

Richard W. McCallum , MD, FACP, FRACP, (AUST), FACC Department of Internal Medicine , Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine , El Paso , TX , USA

Tamir Ben-Menachem , MD, MS Department of Gastroenterology , Robert Wood Johnson Medical School, Summit Medical Group , Berkeley Heights , NJ , USA

Hazar Michael , MD Department of Medicine , UMDNJ-RWJMS , New Brunswick , NJ , USA

Kenneth L. Minaker, MD Department of Medicine , Massachusetts General Hospital , Boston , MA , USA

Suzanne Morrissey , MD Department of Gastroenterology , Allegheny General Hospital, West Penn Health System , Pittsburgh , PA , USA

Satheesh Nair , MD, MBBS Transplant Department , Methodist University Hospital , Memphis , TN , USA

Haq Nawaz , MD Department of Internal Medicine , University of Pittsburgh Medical Center , Pittsburgh , PA , USA

xx Contributors

Ole Haagen Nielson , MD, DMSc Department of Gastroenterology D112 , Herlev Hospital , Herlev , Denmark

Robert A. Norman , DO, MPH, MBA Department of Dermatology , Nova Southeastern College of Medicine , Tampa , FL , USA

Stephen J.D O’Keefe , MD, MSc Department of Gastroenterology , Hepatology and Nutrition, University of Pittsburgh Medical Center , Pittsburgh , PA , USA

Juan J. Omana , MD Department of Surgery , Monte fi ore Medical Center (North Division) , Bronx , NY , USA

Noelle O’Shea , DO Division of Gastroenterology, Hepatology and Nutrition , The University of Texas Health Science Center at Houston , Houston , TX , USA

Sanjiv K. Patankar , MD, FACS, FRCS (Edinburgh), FASCRS Division of Colo-rectal Surgery, Department of Surgery , Saint Peter’s University Hospital , East Brunswick , NJ , USA

Trupal Patel , BS Dermatology Healthcare, LLC , Tampa , FL , USA

Carlos A. Pelaez , MD Department of Surgery , Monte fi ore Medical Center (North Division) , Bronx , NY , USA

Rodolfo Pigalarga , MD Department of General Surgery , Robert Wood Johnson University Hospital/UMDNJ , New Brunswick , NJ , USA

C. S. Pitchumoni , MD, MPH, FRCP(C), MACP, MACG, AGAF Clinical Professor of Medicine , Robert Wood Johnson School of Medicine, Drexel University School of Medicine, Adjunct Professor of Medicine, New York Medical College, Valhalla , NJ , USA

Chief, Gastroenterology, Hepatology and Nutrition, Saint Peter’s University Hospital, New Brunswick, NJ, USA

Elizabeth Poplin , MD The Cancer Institute of New Jersey, Robert Wood Johnson University Hospital , New Brunswick , NJ , USA

Eamonn M.M Quigley , MD, FRCP, FACP, FACG, FRCPI Department of Medicine , Alimentary Pharmabiotic Centre University College Cork , Cork University Hospital, Cork , Ireland

Mohammad Raou fi , MD Department of Pathology , Mount Sinai School of Medicine , New York , NY , USA

James C. Reynolds , MD Department of Medicine , Drexel University College of Medicinef/Hahnemann University Hospital , Philadelphia , PA , USA

Negar M. Salehomoum , MD Department of General Surgery , UMDNJ-Robert Wood Johnson Medical School , New Brunswick , NJ , USA

Isidor Segal , FRCP(UK), FRACP, PhD, AGAF, Master WGO Department of Gastroenterology and Hepatology , Prince of Wales Hospital , Randwick, Sydney , NSW , Australia

Jakob Benedict Seidelin , MD, PhD Department of Gastroenterology D112 , Herlev Hospital , Herlev , Denmark

Brijen J. Shah , MD Department of Medicine and The Brookdale Department of Gastroenterology , The Henry D. Janowitz Division of Gastroenterology, Mount Sinai Medical Center , New York , NY , USA

Amit Sohagia , MD Department of Gastroenterology , Monte fi ore Medical Center (North Division) , Bronx , NY , USA

xxiContributors

Missale Solomon , MD Department of Gastroenterology and Hepatology , Hahnemann University Hospital , Philadelphia , PA , USA

Sirakarn Tejavanija , MD, MS Department of Endocrinology and Clinical Nutrition , Phramongkutklao Army Hospital and College of Medicine , Bangkok , Thailand

Shyam Thakkar , MD Department of Gastroenterology , Allegheny General Hospital, West Penn Health System , Pittsburgh , PA , USA

Arvind J. Trindade , MD Department of Internal Medicine , Mount Sinai Hospital , New York , NY , USA

David Widjaja , MD Department of Medicine, Division of Gastroenterology, Bronx Lebanon Hospital Center , Albert Einstein College of Medicine , Bronx , NY , USA

Dhiraj Yadav , MD, MPH Division of Gastroenterology and Hepatology, Department of Internal Medicine , University of Pittsburgh Medical Center , Pittsburgh , PA , USA

Hongfa Zhu , MD, PhD Department of Pathology , Mount Sinai School of Medicine , New York , NY , USA