Steve Goldschmid

Interests

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Courses

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Scholarly Contributions

Books

• Goldschmid, S. (1993). American College of Gastroenterology 1993 Self Assessment Examination. Distributed in conjunction with the Annual Meeting

Chapters

• Goldschmid, S. (2006). Hepatology. In Critical Evaluation of the Specificity and Sensitivity of Biliary Imaging. In: Zakim and Boyer’s Hepatology A Textbook of Liver Diseases. 5th ed. Philadelphia:: WB Saunders.
• Goldschmid, S. (2001). “Chest Pain”. In “Chest Pain” in Patients with Gallstone Colic.. Armonk, NY: Futura Publishing.
• Goldschmid, S. (2001). “Chest Pain”.. In “Chest Pain” in Patients with Acute Cholecytitis. In: Hurst JW, Morris DC (Ed).. Armonk, NY: Futura Publishing.
• Goldschmid, S. (2001). “Chest Pain”.. In “Chest Pain” in Patients with Peptic Ulcer Disease. In: Hurst JW, Morris DC (Ed). Armonk, NY: Futura Publishing.
• Kim, S., & Goldschmid, S. (1995). Medical Management of the Surgical Patient. In Inflammatory Bowel Disease. Philadelphia: Lippincott.
• Zuckerman, A. M., Goldschmid, S., Hunter, J. G., & Kaufman, S. L. (1995). Hepatobiliary and Pancreatic Disease: A Team Approach. In Biliary Fistulae. In: Pitt HA, Carr-Locke D, Ferrucci J (Ed). Little, Brown and Company.
• Goldschmid, S., & Goldschmid, M. (1992). Medicine for the Practicing Physician. In Hematemesis/Melena. Boston, MA: Butterworths.
• Goldschmid, S., & Hersh, T. (1992). Medicine for the Practicing Physician. In Dysphagia. Boston, MA: Butterworths.

Journals/Publications

• Brady, P. G., Peebles, M., & Goldschmid, S. (2016). Role of laparoscopy in the evaluation of patients with suspected hepatic or peritoneal malignancy. Gastrointestinal endoscopy, 37(1), 27-30.
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  The purpose of this study was to determine the role of laparoscopy in patients with suspected hepatic or peritoneal malignancy and a normal computerized tomograph (CT). Twenty-five consecutive patients with a normal liver and no peritoneal lesions on CT were evaluated. Patients with a documented primary neoplasm or a positive ascitic fluid cytology were excluded. At laparoscopy, malignancy was documented by biopsy in 12 patients for an incidence of 48%. Of the patients with exudative ascites, 75% had peritoneal metastases. In addition seven patients had benign liver disease documented by laparoscopic biopsy. Liver enzymes were not helpful in distinguishing benign and malignant disease in this group of patients. This study indicates that a negative CT does not exclude liver or peritoneal malignancy. Laparoscopy has a significant yield in patients with a negative CT suspected of having hepatic or peritoneal malignancy and is the procedure of choice in evaluating these patients.
• Mixon, T., Goldschmid, S., Brady, P. G., & Boulay, J. (2016). Endoscopic management of expandable metallic biliary stent occlusion. Gastrointestinal endoscopy, 39(1), 82-4.
• Martin, D. R., Kalb, B., Sauer, C. G., Alazraki, A., & Goldschmid, S. (2015). Magnetic resonance enterography in Crohn's disease: techniques, interpretation, and utilization for clinical management. Diagnostic and interventional radiology (Ankara, Turkey), 18(4), 374-86.
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  Crohn's disease treatment has improved significantly with the development of immunosuppressive and immunomodulatory agents, while surgery remains an important option in selected patients. However, a relative lag in diagnostics has become apparent with a growing need for the capacity to noninvasively and safely evaluate the tissue changes of Crohn's disease within the bowel wall and deeper tissues. We have noted marked technical improvements in magnetic resonance enterography (MRE) and in our understanding of the different facets of Crohn's disease that can be elucidated by optimized MRE, in contrast to other diagnostics. This review will provide an integrated understanding of MRE related to other available tests and recommendations for the optimal use of MRE for the clinical management of Crohn's disease. We will review the relative strengths and limitations of MRE as applied to clinical evaluation and therapeutic decisions, including the use of the unique capacity to delineate active inflammation and fibrosis in the submucosal and deeper enteric tissues, which is beyond the diagnostic reach of endoscopy and biopsy.
• Bernstein, C., Facista, A., Nguyen, H., Zaitlin, B., Hassounah, N., Loustaunau, C., Payne, C. M., Banerjee, B., Goldschmid, S., Tsikitis, V. L., Krouse, R., & Bernstein, H. (2010). Cancer and age related colonic crypt deficiencies in cytochrome c oxidase I. World journal of gastrointestinal oncology, 2(12), 429-42.
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  To investigate whether deficiency of expression of cytochrome c oxidase I (CcOI) in colonic crypts is associated with colon cancer.
• Nguyen, H., Loustaunau, C., Facista, A., Ramsey, L., Hassounah, N., Taylor, H., Krouse, R., Payne, C. M., Tsikitis, V. L., Goldschmid, S., Banerjee, B., Perini, R. F., & Bernstein, C. (2010). Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer. Journal of visualized experiments : JoVE.
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  In carcinogenesis, the "field defect" is recognized clinically because of the high propensity of survivors of certain cancers to develop other malignancies of the same tissue type, often in a nearby location. Such field defects have been indicated in colon cancer. The molecular abnormalities that are responsible for a field defect in the colon should be detectable at high frequency in the histologically normal tissue surrounding a colonic adenocarcinoma or surrounding an adenoma with advanced neoplasia (well on the way to a colon cancer), but at low frequency in the colonic mucosa from patients without colonic neoplasia. Using immunohistochemistry, entire crypts within 10 cm on each side of colonic adenocarcinomas or advanced colonic neoplasias were found to be frequently reduced or absent in expression for two DNA repair proteins, Pms2 and/or ERCC1. Pms2 is a dual role protein, active in DNA mismatch repair as well as needed in apoptosis of cells with excess DNA damage. ERCC1 is active in DNA nucleotide excision repair. The reduced or absent expression of both ERCC1 and Pms2 would create cells with both increased ability to survive (apoptosis resistance) and increased level of mutability. The reduced or absent expression of both ERCC1 and Pms2 is likely an early step in progression to colon cancer. DNA repair gene Ku86 (active in DNA non-homologous end joining) and Cytochrome c Oxidase Subunit I (involved in apoptosis) had each been reported to be decreased in expression in mucosal areas close to colon cancers. However, immunohistochemical evaluation of their levels of expression showed only low to modest frequencies of crypts to be deficient in their expression in a field defect surrounding colon cancer or surrounding advanced colonic neoplasia. We show, here, our method of evaluation of crypts for expression of ERCC1, Pms2, Ku86 and CcOI. We show that frequency of entire crypts deficient for Pms2 and ERCC1 is often as great as 70% to 95% in 20 cm long areas surrounding a colonic neoplasia, while frequency of crypts deficient in Ku86 has a median value of 2% and frequency of crypts deficient in CcOI has a median value of 16% in these areas. The entire colon is 150 cm long (about 5 feet) and has about 10 million crypts in its mucosal layer. The defect in Pms2 and ERCC1 surrounding a colon cancer thus may include 1 million crypts. It is from a defective crypt that colon cancer arises.
• Meyskens, F. L., McLaren, C. E., Pelot, D., Fujikawa-Brooks, S., Carpenter, P. M., Hawk, E., Kelloff, G., Lawson, M. J., Kidao, J., McCracken, J., Albers, C. G., Ahnen, D. J., Turgeon, D. K., Goldschmid, S., Lance, P., Hagedorn, C. H., Gillen, D. L., & Gerner, E. W. (2008). Difluoromethylornithine plus sulindac for the prevention of sporadic colorectal adenomas: a randomized placebo-controlled, double-blind trial. Cancer prevention research (Philadelphia, Pa.), 1(1), 32-8.
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  Preclinical studies of chemoprevention drugs given in combination at low doses show remarkable efficacy in preventing adenomas with little additional toxicities, suggesting a strategy to improve risk to benefit ratios for preventing recurrent adenomas. Three hundred seventy-five patients with history of resected (> or =3 mm) adenomas were randomly assigned to receive oral difluoromethylornithine (DFMO) 500 mg and sulindac 150 mg once daily or matched placebos for 36 months, stratified by use of low-dose aspirin (81 mg) at baseline and clinical site. Follow-up colonoscopy was done 3 years after randomization or off-study. Colorectal adenoma recurrence was compared among the groups with log-binomial regression. Comparing the outcome in patients receiving placebos to those receiving active intervention, (a) the recurrence of one or more adenomas was 41.1% and 12.3% (risk ratio, 0.30; 95% confidence interval, 0.18-0.49; P < 0.001); (b) 8.5% had one or more advanced adenomas, compared with 0.7% of patients (risk ratio, 0.085; 95% confidence interval, 0.011-0.65; P < 0.001); and (c) 17 (13.2%) patients had multiple adenomas (>1) at the final colonoscopy, compared with 1 (0.7%; risk ratio, 0.055; 0.0074-0.41; P < 0.001). Serious adverse events (grade > or =3) occurred in 8.2% of patients in the placebo group, compared with 11% in the active intervention group (P = 0.35). There was no significant difference in the proportion of patients reporting hearing changes from baseline. Recurrent adenomatous polyps can be markedly reduced by a combination of low oral doses of DFMO and sulindac and with few side effects.
• Alberts, D. S., Einspahr, J. G., Krouse, R. S., Prasad, A., Ranger-Moore, J., Hamilton, P., Ismail, A., Lance, P., Goldschmid, S., Hess, L. M., Yozwiak, M., Bartels, H. G., & Bartels, P. H. (2007). Karyometry of the colonic mucosa. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 16(12), 2704-16.
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  The study summarizes results of karyometric measurements in epithelial cells of the colorectal mucosa to document evidence of a field effect of preneoplastic development among patients with colorectal adenocarcinoma or adenoma.
• Gerner, E. W., Meyskens, F. L., Goldschmid, S., Lance, P., & Pelot, D. (2007). Rationale for, and design of, a clinical trial targeting polyamine metabolism for colon cancer chemoprevention. Amino acids, 33(2), 189-95.
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  Polyamine metabolic genes are downstream targets of several genes commonly mutated in colon adenomas and cancers. Inhibitors of ornithine decarboxylase, such as difluoromethylornithine (DFMO), and agents that stimulate polyamine acetylation and export, such as non-steroidal anti-inflammatory drugs (NSAIDS), act at least additively to arrest growth in human cell models and suppress intestinal carcinogenesis in mice. These preclinical studies provided the rationale for colon cancer prevention trials in humans. A Phase IIb clinical study comparing the combination of DFMO and the NSAID sulindac versus placebo was conducted. Endpoints were colorectal tissue polyamine and prostaglandin E2 contents and overall toxicity to participants. Participants in the Phase IIb study served as a vanguard for a randomized, placebo-controlled prospective Phase III trial of the combination of DFMO and sulindac with the primary study endpoint the prevention of colon polyps. Seventy percent of participants will have completed the three years of treatment in December 2006.
• McClave, S. A., Brady, P. G., Wright, R. A., Goldschmid, S., & Minocha, A. (1996). Does fluoroscopic guidance for Maloney esophageal dilation impact on the clinical endpoint of therapy: relief of dysphagia and achievement of luminal patency. Gastrointestinal endoscopy, 43(2 Pt 1), 93-7.
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  Use of fluoroscopy for Maloney esophageal dilation is controversial. We designed this prospective, randomized, single-blinded study to determine whether fluoroscopic guidance has an impact on relief of dysphagia and achievement of luminal patency.
• Kim, S. L., & Goldschmid, S. (1995). Antibiotics in acute pancreatitis: the debate revisited. The American journal of gastroenterology, 90(4), 666-7.
• Kim, S. L., & Goldschmid, S. (1995). Palliation of malignant dysphagia: carvers versus plumbers. The American journal of gastroenterology, 90(3), 512-3.
• Goldschmid, S., & Nord, H. J. (1994). Endoscopic diagnosis and treatment of esophageal cancer. Gastrointestinal endoscopy clinics of North America, 4(4), 827-50.
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  Esophageal carcinoma is one of the deadliest malignant tumors. This article reviews its epidemiology, etiology, and clinical and endoscopic presentation, as well as methods for proper staging to identify the patients who will not benefit from surgery and require palliative therapy. The various treatment options are discussed in detail with an emphasis on the latest endoscopic palliative measures.
• Kim, S. L., & Goldschmid, S. (1994). Monoclonal antibody imaging in colon cancer: a transition from basic science to clinical application. The American journal of gastroenterology, 89(10), 1910-2.
• Goldschmid, S., & Brady, P. G. (1993). Approaches to the management of cholelithiasis for the medical consultant. The Medical clinics of North America, 77(2), 413-26.
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  Gallstones constitute a major medical problem in the United States. Patients who are asymptomatic require no therapy. Subsequent symptoms develop in a minority of patients, and the need for cholecystectomy is low. Symptomatic patients with reversible risk factors for gallstones, those who refuse surgery, and those who are poor surgical candidates should be considered for medical therapy. Our approach is outlined in Figure 2. Practical options include oral dissolution agents, contact dissolution agents, and shock-wave lithotripsy. Unfortunately, these therapies are successful in very select patients, and only a small percentage of patients with symptomatic gallstones will be candidates for any combination of these. If successful, the recurrence rate is high. Cholecystectomy is a safe, effective procedure that definitively treats symptomatic cholelithiasis. Patients with frequent symptoms of biliary colic, those with severe symptoms, and those who are young and do not have reversible risk factors for gallstones should be considered for cholecystectomy. If surgical expertise is available, the patient requiring an elective cholecystectomy should be educated regarding the laparoscopic approach that offers a better cosmetic result, shorter hospital stay, and faster return to normal activities. The medical consult must be aware of all the options available for managing patients with cholelithiasis. This will afford greater versatility in medical care or perioperative management.
• Kim, S. L., & Goldschmid, S. (1993). Mucin as a marker for aggressiveness of colon cancer. The American journal of gastroenterology, 88(1), 147-8.
• Kim, S. L., & Goldschmid, S. (1993). Posttransplant biliary complications: management menagerie. The American journal of gastroenterology, 88(5), 784-5.
• Brady, P. G., Straker, R. J., & Goldschmid, S. (1990). Surveillance colonoscopy after resection for colon carcinoma. Southern medical journal, 83(7), 765-8.
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  Periodic surveillance colonoscopy was used to assess 207 asymptomatic patients with a previous history of colorectal carcinoma for 2 to 8 years. Thirty-five percent of the patients had a neoplastic lesion greater than or equal to 5 mm in diameter on initial colonoscopy. Synchronous or metachronous carcinomas were found in 11 patients; and of these second carcinomas, 82% were localized. The risk of a second carcinoma developing did not correlate with a finding of neoplastic polyps on the initial colonoscopy. Six recurrent carcinomas at the anastomosis were demonstrated. The stage of the recurrence correlated well with the stage of the primary carcinoma. Two negative colonoscopies at 1-year intervals were necessary to ensure that the colon had been cleared of neoplastic lesions. This study shows that surveillance colonoscopy in patients with a history of colorectal carcinoma has a high yield and is capable of detecting localized, asymptomatic carcinoma. After two annual colonoscopies fail to show neoplasms, surveillance colonoscopy may be scheduled at 3- to 5-year intervals.
• Pascal, R. R., Hertzler, G., Hunter, S., & Goldschmid, S. (1990). Pseudoinvasion with high-grade dysplasia in a colonic adenoma. Distinction from adenocarcinoma. The American journal of surgical pathology, 14(7), 694-7.
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  High-grade dysplasia was found to extend to an area of pseudoinvasion in the submucosa of a colonic adenoma mimicking invasive carcinoma. The presence of both benign and cytologically malignant epithelium and residual foci of lamina propria among the submucosal glands distinguishes this entity from adenocarcinoma arising in an adenomatous polyp.
• Goldschmid, S., & Graham, M. (1989). Trace element deficiencies in inflammatory bowel disease. Gastroenterology clinics of North America, 18(3), 579-87.
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  Since the institution of successful parenteral nutrition, much has been learned about malnutrition and the effects and complications of nutritional therapy. A variety of patient groups suffer from malnutrition, and clinicians accept the fact that an extremely high incidence of hospitalized medical and surgical patients are malnourished. Perhaps the group we most frequently see suffering from malnutrition are patients with inflammatory bowel disease (IBD). This is especially true in Crohn's disease, in which a variety of nutritional disturbances have been described.
• Goldschmid, S., Boyce, H. W., Brown, J. I., Brady, P. G., Nord, H. J., & Lyman, G. H. (1989). A new objective measurement of esophageal lumen patency. The American journal of gastroenterology, 84(10), 1255-8.
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  This study was performed to develop a system to measure dysphagia in an objective fashion, test its correlation with subjective estimates of dysphagia, and encourage the use of a standardized measure of esophageal stenosis. Thirty-five patients with mechanical dysphagia underwent subjective estimates of dysphagia using a dysphagia scale graded from 0 to 5, as well as a diet scale. Lumen diameter was measured endoscopically, using the open or closed biopsy forceps as a measuring guide. Patients were then given barium capsules or tablets of increasing diameter under fluoroscopy, in the upright position. Pills were given sequentially until a pill failed to traverse the esophagus in less than 20 s. The diameter of the pill failing to traverse the esophagus within 20 s correlated strongly with the endoscopically measured diameter by Spearmans rank correlation (Rs = 0.85). The weakest correlation was between endoscopically measured diameter and the dysphagia scale (Rs = 0.48). The diameter of the pill failing to traverse the esophagus within 20 s is an excellent estimate of esophageal lumen diameter. Pill size correlates much better with esophageal lumen diameter than dysphagia or diet scales. This new dysphagia assessment system should simplify standardization of the grading of dysphagia.
• Goldschmid, S., Boyce, H. W., Nord, H. J., & Brady, P. G. (1988). Treatment of pharyngoesophageal stenosis by polyvinyl prosthesis. The American journal of gastroenterology, 83(5), 513-8.
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  Many authors have objected to the use of esophageal stents in the palliative management of lesions obstructing the cervical esophagus, especially when the prosthesis must lie within 2 cm of the cricopharyngeus muscle (CPM). Ten patients with stenosis of the cervical esophagus by lesions within 2 cm of or involving the CPM were considered for prosthesis placement. The prosthesis was successfully placed in eight patients, five of whom had a tracheoesophageal fistula (TEF). A prosthesis could not be placed in two patients, and two patients complained of a minimal but tolerable foreign body sensation. Six prostheses were custom-made. The necessity to place a prosthesis within 2 cm of or even immediately proximal to the CPM should not be considered an absolute contraindication to esophageal prosthesis placement in selected patients. Foreign body sensation may be absent or minimal, and stent migration is common.
• McClave, S. A., Goldschmid, S., Cunningham, J. T., & Boyd, W. P. (1988). Dieulafoy's cirsoid aneurysm of the duodenum. Digestive diseases and sciences, 33(7), 801-5.
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  Dieulafoy's lesion or cirsoid aneurysm is a rare cause of massive upper gastrointestinal hemorrhage. Historically cirsoid aneurysm most often occurs in the stomach, but has been reported to occur in the jejunum. In this paper, four cases are presented that are felt to represent the first documented cases of cirsoid aneurysm involving the duodenum. At endoscopy, the appearance of Dieulafoy's lesion may range from a pinpoint dot, clot, or tortuous vessel, to blood oozing or spurting from normal mucosa. A shallow defect may be present that can give the appearance of a partially healed peptic ulcer. Previous histologic studies have shown a wide-caliber-persistent artery with intimal thickening, sclerosis, and medial muscular hypertrophy. Once the diagnosis is made, surgical intervention utilizing simple ligation of the involved vessel results in cessation of recurrent hemorrhage. Dieulafoy's lesion is probably more common than the previous literature would suggest. The lesion needs to be considered in the clinical setting of the patient with massive upper gastrointestinal hemorrhage, a paucity of symptoms, and negative findings on barium studies, endoscopy, and exploratory laparotomy.
• Brady, P. G., Goldschmid, S., Chappel, G., Slone, F. L., & Boyd, W. P. (1987). A comparison of biopsy techniques in suspected focal liver disease. Gastrointestinal endoscopy, 33(4), 289-92.
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  This prospective study was designed to determine the most accurate method of obtaining a tissue diagnosis in patients with suspected focal liver disease. Computed tomography (CT) was performed initially in all patients. Patients with extensive right lobe disease on CT had a blind, percutaneous liver biopsy. Those with focal lesions on CT were randomized to either a CT or laparoscopic directed biopsy. Patients with no lesions on CT had laparoscopy for further evaluation. The results indicate that blind percutaneous biopsy is sufficient if extensive right lobe disease is present. There is no significant difference in the sensitivity of laparoscopy and CT directed biopsy if focal lesions are detected by CT. However, a negative CT directed biopsy does not exclude malignancy. Laparoscopy has a significant yield in patients with a negative CT and is the procedure of choice in evaluating these patients.
• Goldschmid, S., Boyce, G. A., & Boyce, H. W. (1987). Hyperalimentation: primary therapy for IBD?. Hospital practice (Office ed.), 22(5), 173, 177-80.
• Goldschmid, S., Brady, P. G., Slone, F. L., & Farber, M. S. (1986). Duodenal erosion caused by a mesocaval graft. Gastrointestinal endoscopy, 32(6), 412-4.
• Mamel, J., Goldschmid, S., Browarsky, I., Williams, C., & Andersen, P. (1986). A malignant diarrhea from the Third World. Hospital practice (Office ed.), 21(5A), 132, 135-6.

Presentations

• Goldschmid, S. (2005, January). The best of ACG and AASLD. Sierra Vista Regional Health Center. Sierra Vista, AZ: Sierra Vista Regional Health Center.
• Goldschmid, S. (2000, Spring). Scientific Evaluation of Mummies - “Mummies Unwrapped”. The Learning Channel – 2000.
• Goldschmid, S. (1990, April). Advances in Viral Hepatitis. Phoenix, Arizona. Phoenix, Arizona.
• Goldschmid, S. (1987, September). Florida Gastroenterologic Society Annual Meeting. Florida Gastroenterologic Society Annual Meeting. Tampa, Florida.
• Goldschmid, S. (1983, Spring). Contemporary Clinical Nutrition Course. Chicago, IL. Chicago, IL.