About

John Jay Alexander, M.D., is a board certified pediatric neurologist at Seattle Children’s Hospital and an associate professor of Neurology at the University of Washington. He practices in Seattle, Everett, and Olympia, and conducts outreach clinics in Wenatchee. Dr. Alexander has many years of experience evaluating and providing care to children with neurological disorders. He strives to create active partnerships with his patients and their families to achieve the best possible outcomes. He earned his M.D. from the University of Missouri-Columbia and completed his residency and internship in Pediatrics at Monmouth Medical Center, as well as a fellowship in Pediatric Neurology at Children’s Hospital Boston. His board certifications include Neurology/Child Neurology, obtained in 2015 from the American Board of Psychiatry & Neurology.

Research topics

• Internal medicine
• Medicine
• Computer Science
• Cardiology
• Virology
• Inorganic chemistry
• Biochemistry
• Metallurgy
• Chemistry

Selected publications

• Tu1637: DIAGNOSTIC PARACENTESIS IN HOSPITALIZED PATIENTS WITH CIRRHOSIS AND ASCITES: IS EARLY PARACENTESIS EARLY ENOUGH?

  Gastroenterology · 2025-05-01

  articleSenior author
  PublisherDOI

• S4440 An Intriguing Case of Direct Hyperbilirubinemia After Implantation of Left Ventricular Assist Device

  The American Journal of Gastroenterology · 2024

  Senior authorCorresponding
  • Medicine
  • Cardiology
  • Internal medicine
  PublisherDOI

• S3574 A Case of Mistaken Identity: Lanthanum Carbonate Tablet Mimicking Esophageal Button Battery

  The American Journal of Gastroenterology · 2024

  Senior authorCorresponding
  • Medicine
  • Internal medicine
  • Metallurgy

  Introduction: Esophageal button battery is a well-recognized indication for emergent endoscopic removal. Lanthanum carbonate is a radiopaque phosphate binder with physical dimensions similar to button batteries. We report a case of esophageal lanthanum tablet masquerading the appearance of a button battery leading to emergent endoscopic intervention. Case Description/Methods: A 69-year-old man who had previously undergone renal transplantation was hospitalized with severe hyperkalemia, fluid overload and uremic encephalopathy due to allograft rejection. He was emergently started on hemodialysis, but as the renal failure persisted, decision was made to place a tunneled dialysis catheter. While getting the dialysis catheter placed under fluoroscopic monitoring, he was noted to have a densely radiopaque discoid esophageal foreign body, 18 mm in diameter and 5 mm in width, located immediately above the gastroesophageal junction. A chest X-ray was obtained which redemonstrated the same and raised concern of esophageal button battery in this patient who was delirious. He underwent emergent upper gastrointestinal tract endoscopy which ended up revealing that the foreign body was not a button battery but a large tablet with dimensions corresponding to lanthanum carbonate that he was taking as a phosphate binder. The tablet was pushed down into the stomach and the procedure was concluded uneventfully. Discussion: Lanthanum carbonate is a phosphate binder that is more efficacious than sevelamer and calcium-based phosphate binders. There are 2 clinical effects of lanthanum that gastroenterologists might incidentally encounter. Firstly, they can show up as radiopaque foreign bodies in the GI tract. When these tablets are inadvertently swallowed without chewing, they can masquerade as button batteries as in this case. Radiological distinction between the 2 is possible if the 2 metallic disks in the button battery can be identified radiologically (“double rim sign”) distinguishing it from lanthanum which is homogeneous. Even when the tablets are swallowed after chewing, the fragments could be seen as luminal radiopaque foreign bodies. Secondly, mucosal lanthanum deposition can be encountered in endoscopies as whitish lesions predominantly in the stomach and duodenum. It has also been known to cause mucosal lesions including erythema, erosions, granularity, nodularity and lymphangiectasia. Being aware of these would help avoid unnecessary diagnostic testing in these patients (see Figure 1).Figure 1.: A) Fluoroscopy demonstrating densely radiopaque discoid esophageal foreign body from lateral view. B) Chest X-ray redemonstrating densely radiopaque discoid esophageal foreign body. C) Large tablet resembling lanthanum carbonate as seen on endoscopy after being pushed down into the stomach.

  PublisherDOI

• S2360 A Case of Gastrointestinal Bleeding From the Excluded Stomach 22 Years After Roux-en-Y Gastric Bypass

  The American Journal of Gastroenterology · 2021-10-01

  articleSenior author

  Introduction: Roux-en-Y gastric bypass (RYGB) is an effective weight loss surgery. Ulcers and bleeding from the excluded stomach are reported but diagnosis is challenging due to difficulty accessing the excluded stomach with standard endoscopy. We present a rare case of perforation of a marginal ulcer in the excluded stomach. Case Description/Methods: A 55-year-old man with Roux-en-Y gastric bypass surgery 22 years ago, perforated marginal ulcer with surgical repair, and anastomotic stricture requiring dilation, was hospitalized with abdominal pain and new CT finding of ascites of uncertain etiology. Surgery was consulted for possible perforated marginal ulcer but upper GI series was negative and no surgical intervention was recommended. He continued to endorse abdominal pain for which he underwent endoscopy showing a clean-based ulcer. Over the course of admission, patient's pain improved and he was discharged. The patient returned after developing a fever with recurrent pain. CT was concerning for perforation of the greater curvature of the stomach with frank pneumoperitoneum and peripheral enhancement of a large fluid collection concerning for an abscess. CT guided drainage of the abscess was done and he was started on antibiotics. Repeat CT abdomen showed retroperitoneal collection despite drain being in position. TPA was administered through the drain with improvement in output. The patient then had an episode of maroon stools and sanguinous drain output, became hypotensive, and had a decreased in hemoglobin. He was taken to the OR emergently and underwent EGD which was unremarkable, followed by exploratory laparotomy with partial gastrectomy of the excluded gastric remnant. He had no further bleeding post-operatively. Discussion: Delayed upper GI bleeding after RYGB has been reported in the setting of marginal ulcers, peptic ulcer disease including H. pylori, ischemia, tumors, gastrogastric fistula, variceal bleeding, and rarely perforation. Often, bleeding can be diagnosed and treated endoscopically but due to the altered anatomy, standard endoscopy is not always effective. Other options include CT angiography, tagged RBC scanning, celiac angiography, double balloon enteroscopy, or laparoscopic gastroduodenoscopy. Surgery remains the ultimate treatment for unstable gastric remnant bleeding with perforation. GI bleeding after RYGB presents a unique diagnostic challenge. Clinicians should have a high index of suspicion for a bleeding source in the excluded stomach, even years after the procedure.

  PublisherDOI

• S2592 Misleading Hepatitis C Viral Counts During COVID-19 Infection: A Case Report and Discussion

  The American Journal of Gastroenterology · 2021-10-01

  articleSenior author

  Introduction: COVID-19 infection is associated with liver injury that increases in severity in sicker patients. This is thought to be due to the cytokine storm phenomenon which can paradoxically suppress other underlying chronic viral infections. We report the 1st case of suppressed HCV viral load and undetectable HCV genotype in the setting of COVID-19. Case Description/Methods: A 77-year-old man with chronic hepatitis C (HCV) secondary to intravenous drug use was seen at the gastroenterology clinic for initiation of HCV treatment. Four months prior to presentation, HCV screening showed a positive HCV antibody and HCV viral load of 127330 IU/mL. Further testing for initiation of HCV therapy was remarkable for a markedly decreased HCV viral load of 31 IU/mL. Genotype could not be evaluated as the test requires a viral load of ≥1000 IU/mL. FibroSure revealed F1 fibrosis. Around that time, the patient reported body aches, fevers, and an exposure to a person with upper respiratory tract symptoms. Four days later, he tested positive for COVID-19, then quarantined and recovered. As the marked drop in HCV viral load was felt to be secondary to cytokine response in COVID-19 infection, a decision was made to repeat HCV viral load and genotyping 3 months later. The results revealed a viral load of 9010000 IU/ml and genotype 2b. The patient’s liver function tests and INR remained normal and he was initiated on glecaprevir/pibrentasvir. Discussion: While liver injury from cytokine storm in COVID-19 is well recognized, there is paucity of data on its effect on chronic viral infections. This is the first report of documented transient reduction in HCV viral load in COVID-19, presumably secondary to the cytokine response. It is notable that the HCV viral load reduction in this case was to such an extent that genotyping was not possible. Therefore, we believe that reductions to below the lower limit of detection are possible resulting in false negative HCV PCR results. Since it is standard practice to interpret a one-time negative HCV viral load to be indicative spontaneous viral clearance, such a result could lead to a mistaken diagnosis. Clinicians need to be mindful of the coexistent clinical conditions while interpreting HCV PCR results. Additionally, there may be a role for repeating HCV PCR after an interval if a negative result was obtained during a period of widespread community transmission of COVID-19 or other viral epidemics. Further research is required to validate the appropriateness of such a testing strategy.

  PublisherDOI

• EXISTENCE OF COVID-19 A RECONDITE STATE BUT A CATALYST FOR TRANSITION

  International Journal of Advanced Research · 2020

  1st authorCorresponding
  • Computer Science
  • Virology
  • Medicine
  PublisherDOI

• A rare systemic etiology of heart failure and liver dysfunction

  Clinical Case Reports · 2019-06-03 · 1 citations

  articleOpen access

  Systemic amyloidosis is a rare condition that can manifest with cardiomyopathy, hepatic dysfunction, and renal disease. Diagnosis is often missed and/or delayed due to chronic multi-system involvement and indeterminate signs and symptoms. Treatment generally involves systemic therapy and autologous stem-cell transplantation.

  PublisherOA PDFDOI

• Radiologically Undetected Hepatocellular Carcinoma in Patients Undergoing Liver Transplantation

  The American Journal of Surgical Pathology · 2017-09-14 · 1 citations

  article

  Orthotopic liver transplantation is the best option for patients with carefully selected unresectable disease because of underlying liver dysfunction. The 5-year survival rate after orthotopic liver transplantation for early detected hepatocellular carcinoma (HCC) is high, and a similar or even higher rate is reported in those with radiologically undetected HCC. This study evaluated and compared the histologic features of pretransplant radiologically undetected (14 patients, 25 tumors) versus detected (36 patients, 45 tumors) HCCs. Tumor size, tumor differentiation, number of unpaired arteries, mitotic count per 10 high-power fields, CD34 immunostain to assess microvessel density, and Ki67 immunostain were compared with the Liver Imaging Reporting and Data System score, which was retrospectively assigned to each tumor in both groups. The Liver Imaging Reporting and Data System score was significantly higher in the HCC detected group (P<0.001). The vast majority of the undetected HCCs (88%) was <2 cm in size. Only 12% of the undetected HCCs were ≥2 cm, whereas 51% of the detected HCCs were ≥2 cm in size. Higher rate of moderate to poor tumor differentiation was noted in the detected HCCs compared with the undetected group (89% vs. 60%; P=0.004). No statistically significant difference in the number and distribution of unpaired arteries, or mitotic count was observed in 2 groups (although fewer unpaired arteries were identified in the undetected group). The detected HCCs had a higher rate of 2+ CD34 staining compared with the undetected HCCs (68% vs. 27%; P=0.002), whereas the opposite was observed for 1+ CD34 staining (59% undetected HCCs vs. 17% detected HCCs; P=0.002). Ki67 proliferative index was not statistically different between the 2 groups (120.8/1000 cells detected HCCs vs. 81.8/1000 cells undetected HCCs; P=0.36). The factors associated with failing to detect HCCs pretransplant by radiologic studies include small tumor size (<2 cm), low-grade histologic differentiation, and low microvessel density (low CD34 staining). A significant association between the number and distribution of unpaired arteries and HCC detection has not been established by our study.

  PublisherDOI

• Prevalence and New Starts of Proton Pump Inhibitors (PPI) in Patients Presenting with Variceal Bleeding: A 5 Year, Multi-Center Us Experience

  Gastroenterology · 2017-04-01

  article
  PublisherDOI

• A Multicenter Evaluation of Adherence to 4 Major Elements of the Baveno Guidelines and Outcomes for Patients With Acute Variceal Hemorrhage

  Journal of Clinical Gastroenterology · 2017-06-22 · 20 citations

  article

  GOALS: To determine the rate of and outcomes associated with guideline adherence in the care of acute variceal hemorrhage (AVH). BACKGROUND: Four major elements of high-quality care for AVH defined by the Baveno consensus (VI) include timely endoscopy (≤12 h), antibiotics, and somatostatin analogs before endoscopy and band ligation as primary therapy for esophageal varices. STUDY: We retrospectively evaluated 239 consecutive admissions of 211 patients with AVH admitted to 2 centers in Massachusetts from 2010 to 2015. The primary outcome was 6-week mortality; secondary outcomes included treatment failure (shock, hemoglobin drop by 3 g/dL, hematemesis, death ≤5 d), length of stay, and 30-day readmission. RESULTS: Guideline adherence was variable: endoscopy ≤12 hours (79.9%), antibiotics (84.9%), band ligation (78.7%), and somatostatin analogs (90.8%). However, only 150 (62.8%) received care that was adherent to all indicated criteria. The 6-week mortality rate was 22.6%. Treatment failure occurred in 50 (21.0%) admissions. Among the 198 patients who survived to discharge, 41 (20.7%) were readmitted within 30 days. Octreotide before endoscopy was associated with a reduction in 30-day readmission (18.4% vs. 42.1%; P=0.03), whereas banding of esophageal varices was associated with a reduced risk of treatment failure (15.0% vs. 50.0%; P≤0.001). However, adherence to quality metrics did not significantly reduce the risk of death within 6 weeks. CONCLUSIONS: Adherence to quality metrics may not reduce the risk of mortality but could improve secondary outcomes of AVH. Variation in practice should be addressed through quality improvement interventions.

  PublisherDOI

Frequent coauthors

• Kris V. Kowdley

  11 shared

• Paul E. Swanson

  University of Washington

  5 shared

• Matthew M. Yeh

  University of Washington

  5 shared

• Zachary A. Borman

  Digestive Care (United States)

  4 shared

• Elliot B. Tapper

  Michigan United

  4 shared

• Alan Bonder

  Beth Israel Deaconess Medical Center

  4 shared

• Rony Ghaoui

  4 shared

• Sheryl Ramdass

  Baystate Medical Center

  4 shared

Labs

• UW Medicine Pediatric NeurologyPI