Category Archives: Education

Structured Transition from Pediatric to Adult IBD Care Increases Patient Retention, May Improve Outcomes

For adolescent patients with inflammatory bowel disease (IBD) at Penn State Hershey Medical Center, a quarterly pediatric-to-adult care transition clinic has dramatically improved follow-up rates in the adult clinic, reducing no-shows to less than one percent.

“The structured transition program makes the process smoother and addresses the biggest problems that patients and parents encounter when the patient reaches 18 years-of-age,” says Emmanuelle Williams, M.D., assistant professor, Penn State Hershey Gastroenterology and Hepatology, and associate director, Penn State Hershey IBD Center. Together with Tolulope Falaiye, M.D., Penn State Hershey Pediatric Gastroenterology, Penn State Hershey Children’s Hospital, Williams has led the development of the successful program.

The process of transition begins around the age of 12. Transfer to adult care occurs at age 18. A specialized IBD nurse navigator is assigned to follow patients throughout the multi-year transition process. Older adolescents with IBD, under the care of pediatric gastroenterology, complete the Transition Readiness Assessment Questionnaire (TRAQ). At age 18, patients identified as ‘transition-ready’ are presented at a transition conference and have their first adult care visit held in the pediatric clinic location. Their former gastroenterologist performs introductions and is present the day of transfer. Continue reading

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Fecal Microbiome Transplant (FMT) for Clostridium Difficile (C. diff): Drawing Upon Wisdom of the Ancients

The successful use of fecal matter to treat severe diarrhea was first recorded more than 1,800 years ago in China. Flash forward to 2014, and the publication of controlled clinical trial evidence demonstrating the effectiveness of “fecal microbiota transplant” (FMT) to treat C. diff infection (CDI).¹ Thomas J. McGarrity, M.D., chief, Penn State Hershey Gastroenterology and Hepatology, has drawn on this evidence to treat twelve patients with recurrent or severe CDI. McGarrity explains, “We’ve administered FMT via a colonoscopic approach to patients with either three or more recurrences of CDI, or severe CDI unresponsive to conventional antibiotic treatment. Some of the patients were critically ill and faced the risk of renal failure. Within forty-eight hours of receiving FMT, clinical improvement was seen and a full recovery was eventually made in all twelve patients. None have experienced any further CDI occurrences.” Continue reading

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Expanding the Role of Medical Simulation Technology in Medical Digestive Health Student Training

Long before they are admitted to medical school, students have well-honed studying and testtaking skills. But they often lack the skills needed to apply what they’ve learned in the classroom to the clinical setting. Emmanuelle D. Williams, M.D., director of gastroenterology training for second-year medical students for Penn State Milton S. Hershey Medical Center’s Division of Gastroenterology and Hepatology, is working to change that.

“At Penn State Hershey, all of our second-year medical students (currently more than 140) are required to participate in handling initial intake of a simulated ‘patient’ who presents to the emergency department with a gastrointestinal bleed,” said Williams. The case builds directly on classroom lectures about obtaining a medical history, monitoring vital signs and differential diagnosis.

“It’s usually a very emotional experience for the students,” said Williams. “The clinical routine begins to fall apart; they don’t get a proper history, they struggle with differential diagnosis, and professionalism is lacking. It opens their eyes to the difference between book learning and applying that knowledge in the clinic.” Continue reading

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Digestive Health Update: Thomas J. McGarrity, M.D.

The Division of Gastroenterology and Hepatology recently welcomed Karen Krok, M.D. Dr. Krok earned her medical degree and completed internal medicine training at the University of Pennsylvania. She completed a gastroenterology fellowship at Johns Hopkins University which included an additional year of transplant hepatology training. Dr. Krok returned to the Hospital of the University of Pennsylvania as a fulfilled hepatologist for the past five years. At Penn State Hershey, she serves as director of the live donor liver transplant program.

Award presentation photo

Dr. Harold L. Paz, Chief Executive Officer, Senior Vice President for Health Affairs, and Dean, Penn State College of Medicine presented the 2013 Penn State Hershey Medical Center and Penn State College of Medicine Community Service Award for Faculty to Dr. Ian Schreibman.

Transplant hepatologist Ian Schreibman, M.D., recently received the 2013 Penn State Hershey Medical Center and Penn State College of Medicine Community Service Award for Faculty. He was recognized for his ongoing contributions at the Bethesda Mission free medical clinic in Harrisburg, PA. Dr. Schreibman has volunteered many hours of service and has mentored many medical students and internal medicine residents at the Bethesda Mission.

Nurse practitioner Marjorie Lebo, C.R.N.P., received a staff community service Award for organizing the annual Colon Cancer Prevention 5K Run and Fun Walk. This event—held in June for the last seven years—has rapidly become a focal point for the racing community in central Pennsylvania. Proceeds from this event in part support colorectal cancer genetics counseling for individuals without health insurance.

The Penn State Hershey Inflammatory Bowel Disease (IBD) Center works with the Crohn’s and Colitis Foundation of America (CCFA). The IBD Center continues to serves as a major sponsor of the CCFA’s Take Steps for Crohn’s and Colitis contribution to patient awareness efforts throughout Pennsylvania.

Emmanuelle D. Williams, M.D., a member of the IBD Center, also serves on the Advisory Board for the Gluten Intolerance Group of South Central Pennsylvania. Dr. Williams is the recipient of the 2013 American Gastroenterological Association Bridges to Excellence “Recognition for Excellence in the Delivery of Quality Inflammatory Bowel Disease Care”—the only one awarded in Pennsylvania and one of eighteen in the country.

Penn State Hershey physician demonstrating endoscopy techniques to medical students

Dr. McGarrity shares endoscopy techniques as part of the 2013 Ghana Endoscopy Training Program at Korle Bu teaching hospital in Accra, Ghana.

Thomas J. McGarrity, M.D., Professor of Medicine, recently returned from an endoscopy training program at Korle Bu Hospital in Accra, Ghana. With collaborators from Mayo Clinic and Oslo, Norway, a hands-on endoscopy training is provided annually for physicians from Ghana and West Africa. The Ghana College of Medicine has also approved funding for a first-ever gastroenterology fellowship program. The first gastroenterology fellow began training in January 2013.

Finally, Abraham Mathew, Professor of Medicine, was recognized at the annual Penn State Hershey Innovation Ceremony. Dr. Mathew, in collaboration with members of the mechanical engineering department at Penn State University, was awarded two patents for endoscopic devices which will be useful in the development of new endoscopic surgical procedures including NOTES (Natural Orifice Transluminal Endoscopic Surgery).

To learn more about Penn State Hershey Gastroenterology and Hepatology, and to watch a video featuring Dr. McGarrity, please visit http://www.pennstatehershey.org/web/gi/home/aboutus .

photo of Thomas J. McGarrity, M.D.

Thomas J. McGarrity, M.D.

Thomas J. McGarrity, M.D.

  • Professor of Medicine
  • Chief, Division of Gastroenterology and Hepatology
  • Penn State Hershey Gastroenterology
  • Phone: 717-531-1441
  • Fellowship: Gastroenterology, Penn State Milton S. Hershey Medical Center
  • Residency: Medicine, Penn State Milton S. Hershey Medical Center
  • Internship: Medicine, University of Pittsburgh – University Health Center of Pittsburgh; University of Virginia, School of Medicine

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Treatment-resistant Chronic Constipation: Sign of an Underlying Motility Disorder

Deborah Bethards, M.D.

Deborah Bethards, M.D.

Most gastroenterologists have encountered patients who complain of chronic constipation. Colonoscopy shows no anatomical abnormalities. Nonetheless, conservative treatment with laxatives and bulking agents brings only temporary, minor relief. After several failed treatment attempts, the patient is distressed, uncomfortable and anxious; the gastroenterologist is frustrated. Deborah Bethards, M.D., a gastroenterologist at Penn State Hershey Medical Center’s Neurogastroenterology and Motility Clinic explains, “Failure of conservative treatment to resolve constipation should be a red flag. With no other detectable abnormality, the possibility of a chronic pelvic floor disorder that primarily affects women—known as dyssynergic defecation—should be considered.”

With this disorder, the rectosigmoid area does not function properly so that during attempted defecation, paradoxical anal contraction occurs, and pelvic floor muscles fail to relax. The result is that stool is retained in the rectum. If left untreated, complications such as fecal impaction, rectocele, megacolon, and fecal incontinence may occur. Continue reading

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Cancer Genetics Program Expands as Universal Screening for Lynch Syndrome Considered

The Penn State Hershey Cancer Genetics Program was developed in 1998 to provide genetic counseling services to individuals concerned about a personal or family history of cancer. New patient appointments typically involve the development of a three- or four-generation family pedigree, education about various risk factors for developing cancer, and discussion regarding risks, benefits, and limitations of genetic testing, if appropriate. Options to manage one’s increased risk for cancer are reviewed, including dietary and lifestyle changes, as well as enhanced surveillance, chemoprevention, and prophylactic surgery.

Over the past fourteen years, nearly 300 patients have been identified to carry a genetic predisposition to cancer. Hereditary gastrointestinal cancer syndromes identified include not only the more common ones such as Lynch syndrome, FAP, and MYH-Associated Polyposis (MAP), but also the more rare conditions such as Cowden syndrome (or PTEN Hamartoma Tumor syndrome), Peutz-Jeghers syndrome, and Hereditary Diffuse Gastric Cancer syndrome. Continue reading

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