About

Carol Semrad, MD, is a gastroenterologist specializing in small bowel diseases such as celiac disease, diarrhea, and malabsorption syndromes, as well as nutrition. She is a leader in the use of small bowel endoscopy techniques, including video capsule endoscopy and double balloon enteroscopy, for managing small bowel bleeding, ulcers, and tumors. Dr. Semrad is a member of the medical leadership team at the University of Chicago Celiac Disease Center and has contributed to the field through co-authoring chapters on malabsorption and diarrheal diseases for major medical textbooks, as well as directing courses on small bowel endoscopy. She has developed educational materials on clinical nutrition and short bowel syndrome for the American Gastroenterological Association (AGA). As chairperson of the University of Chicago Medicine’s Nutrition Advisory Committee, she oversees hospital policy on nutrition. Her research and clinical work have earned her several awards, including the AGA’s Senior Research Fellow Award and Research Scholar Award, and recognition as one of the nation's top gastroenterologists by U.S. News and World Report and one of the city's top doctors by Chicago magazine.

Research topics

• Medicine
• Internal medicine
• Gastroenterology
• General surgery
• Pathology
• Intensive care medicine
• Surgery

Selected publications

• Controversies and Opportunities of a Nonbiopsy Diagnosis for Celiac Disease

  Gastrointestinal Endoscopy Clinics of North America · 2025-01-27 · 2 citations

  reviewSenior author
  PublisherDOI

• S3062 Clinico-Histologic Correlation of Small Bowel Ulcers: Differentiating NSAIDs, Crohn’s, CMUSE and CNSU

  The American Journal of Gastroenterology · 2025-10-01

  article

  Introduction: Small bowel (SB) ulcers and strictures can stem from many underlying pathologies. Crohn’s disease (CD), nonsteroidal anti-inflammatory drug (NSAID) injury, and the emerging genetic disorders of prostaglandin production (cryptogenic multifocal ulcerous stenosing enteritis [CMUSE]) or reuptake (chronic nonspecific ulcers of the small intestine [CNSU]) have significant overlapping clinical and endoscopic features. Device-assisted enteroscopy (DAE) has allowed direct visualization and tissue sampling of ulcers deep in the small bowel. We aim to assess the correlation frequency between the clinical and histologic diagnoses of CD, NSAID, and CMUSE/CNSU SB ulcers. Methods: A retrospective cohort study at The University of Chicago (04/2004–04/2024) included adults with jejunal or ileal SB ulcers/strictures identified during DAE and recorded in ProVation (Minneapolis, MN). Patients with clinical diagnoses of CD, NSAID injury, or CMUSE/CNSU based on history, labs, imaging, and endoscopy were included. Exclusions applied to those with duodenal, terminal ileal, anastomotic ulcers, ulcers from other etiologies, or missing data (n = 38). Two gastroenterologists (DM, CS) and RM assigned diagnoses; a blinded expert pathologist (JH) performed a histologic review. Cohen’s kappa (κ) assessed agreement between clinical and histologic diagnoses. Results: Among 102 patients with SB ulcers/strictures, 41 met the inclusion criteria. Based on clinical consensus, 26 (63.5%) had NSAID injury, 12 (29.5%) had CD, and 3 (7%) were CMUSE/CNSU. Of 26 patients with a clinical diagnosis of NSAID injury, blinded histology review reported 23/26 (88%) as NSAID injury. Of 12 patients with a clinical diagnosis of CD, blinded histology review reported 5/12 (41%) as CD. Of 3 patients with a clinical diagnosis of CMUSE/CNSU, blinded histology review reported 2/3 (67%) as NSAID or CMUSE/CNSU and 1/3 (33%) as NSAID enteropathy. The correlation between a clinical diagnosis and histology was 28/41 (68%), corresponding to a k of 0.45, indicating moderate agreement. Of the 13 discordant cases, 6 (46%) remained uncertain after longitudinal follow-up for a median of 7 years. Of 7 discordant CD cases, 4 (57%) required multiple biologics and surgical resections, with 2/4 (50%) developing short bowel syndrome needing parenteral nutrition (PN). Conclusion: Differentiating the underlying cause of SB ulcers/strictures is challenging due to overlapping clinical and histologic features with only moderate agreement necessitating additional diagnostic tools.

  PublisherDOI

• The Histologic Spectrum of Rituximab-Associated Common Variable Immunodeficiency-Like Enteropathy

  Modern Pathology · 2025-04-11 · 3 citations

  article
  PublisherDOI

• 611 Olmesartan-Associated GI Mucosal Injury: Insights from Pharmacogenetic Profiling

  Laboratory Investigation · 2025-03-01

  articleOpen access
  PublisherOA PDFDOI

• Common Variable Immunodeficiency-Like Enteropathy Associated with Rituximab B-Cell Depletion Therapy

  Digestive Diseases and Sciences · 2025-01-22 · 3 citations

  articleOpen accessSenior author
  PublisherOA PDFDOI

• S2228 Tissue Transglutaminase (TTG) Assay: Hurdles to a No-Biopsy Approach for Diagnosing Celiac Disease

  The American Journal of Gastroenterology · 2024-10-01

  articleSenior author

  Introduction: Tissue transglutaminase (TTG) IgA antibody levels > 10 times the upper limit of normal (ULN) have a high correlation with villous atrophy (98%-100% PPV) in children (J Pediatr Gastroenterol Nutr. 2020;70:141) and adults (Gastroenterology 2024;166:620) with celiac disease, with the potential to forgo duodenal biopsy for diagnosis. In the United States, TTG assays are variable in performance and titer reporting and not standardized. We analyzed how often TTG IgA assays allowed for the interpretation of a >10 times the ULN result to forgo biopsy for diagnosis. Methods: A retrospective cohort study utilizing the University of Chicago patient database identified over 400 patients referred with a diagnosis of celiac disease to the adult clinic between 1/1/2019 and 11/1/2023. We excluded patients with IgA deficiency or TTG assay results that were unavailable upon diagnosis. We analyzed demographic data, TTG IgA titers/reference ranges, and pathology results. The primary outcome was the number of TTG IgA titers that allowed interpretation in > 10 times the ULN range. Descriptive statistics were used to analyze data. Results: To date, we analyzed data from 105 patients. The median age was 33 (IQR: 23-50) years. Seventy-four (70%) were women and 80 (76%) were White. Fifteen laboratories utilized 3 manufacturer assays to report TTG IgA levels. In 25 of 105 (24%) patients, the TTG IgA assay was not titrated to a definitive number to allow interpretation for > 10 times the ULN. For all 25 patients, the assay results were reported as >100, with the ULN < 20. Biopsies were available for review in 22 of these patients; 21/22 (95%) patients had Marsh 3 lesions and 1/22 (5%) had a Marsh 1 lesion. In the remaining 80 of 105 patients with interpretable titers, 41/80 (51%) had TTG IgA levels > 10 times the ULN. Duodenal biopsies were available for review in 31 of these patients and all (100%) had Marsh 3 lesions. Conclusion: A no-biopsy approach, when appropriate, is cost-effective and spares patients from undergoing invasive endoscopy. Our results show that a quarter of our patients had TTG assays that were not titered to allow interpretation of >10 times the ULN to forgo duodenal biopsy. To integrate a no-biopsy strategy for diagnosing celiac disease into clinical practice, it is essential to standardize the TTG IgA assays across laboratories in the United States (see Table 1). Table 1. - Demographics and Results Patient number 105 Age, Median years (IQR) 33 (23-50) Gender (%) Female Male 74 (70)31 (30) Race/Ethnicity (%) White Unknown Hispanic African American Asian/East Indian Mixed 80 (76)14 (13)4 (4)2 (2)3 (3)2 (2) Number of Laboratories 15 Number of Assays 3 TTG IgA titers x ULN 1 to 1.9 3 to 3.9 4 to 4.9 5 to 5.9 6 to 6.9 7 to 7.9 9 to 9.9 10 or greater Not interpretable Patient no. (%) 1 (1)14 (13)12 (11)6 (6)4 (4)1 (1)1 (1)41 (39)25 (24) TTG IgATiter> 10 times ULN Interpretable, 31 patients Uninterpretable, 22 patients Marsh 3 villous atrophy 31 (100%)21 (95%)

  PublisherDOI

• Outcomes of parenteral nutrition in patients with advanced cancer and malignant bowel obstruction

  Supportive Care in Cancer · 2024 · 4 citations

  • Medicine
  • Internal medicine
  • Surgery
  PublisherDOI

• Parenteral fish oil lipid emulsion use in adults: a case series and review from an intestinal failure referral center

  European Journal of Clinical Nutrition · 2024-06-17 · 4 citations

  review
  PublisherDOI

• Celiac Disease, Gluten Sensitivity, and Diet Management

  Current Gastroenterology Reports · 2024-06-12 · 4 citations

  reviewSenior authorCorresponding
  PublisherDOI

• Parenteral fish oil lipid emulsion use in adults: A case series and review from an intestinal failure referral center

  Research Square · 2024-02-15 · 1 citations

  preprintOpen access

  <title>Abstract</title> <bold>Background:</bold> Intestinal failure–associated liver disease (IFALD) is a complication of long-term PN use, attributed to use of ω-6 injectable lipid emulsions (ILE). Fish oil (FO) ILE have been successful in reversing liver injury in neonates. Evidence for pure FO ILE use in adult patients is limited. <bold>Methods:</bold> Case series of the use of FO lipid emulsions in adults with IFALD from the University of Chicago PN registry. Analysis of medical charts and PN formulations was performed. <bold>Results:</bold> Three cases of IFALD treated with FO ILE were identified. The first case was a 30 year old man with short bowel syndrome (SBS), hyperbilirubinemia, and biopsy proven IFALD. Following a change from a soy lipid emulsion to FO lipid emulsion, his liver tests rapidly improved and remained stable over 202 weeks of use. The second case was a 76 year old woman with intestinal failure (IF) due to frozen bowel. A change from a soy ILE to a composite lipid and later to a pure FO ILE did not result in improvement in her liver tests. The third case was a 28 year old man with SBS and biopsy proven IFALD. Change to a composite ILE and subsequently FO lipid emulsion resulted in a gradual improvement in liver tests. No clinical essential fatty acid deficiencies (EFA) were identified during treatment. <bold>Conclusion:</bold> FO ILE may be effective in the treatment of adult patients with cholestatic IFALD. Use is safe with no EFA deficiencies detected in up to four years of use.

  PublisherOA PDFDOI

Frequent coauthors

• Irving Waxman

  Rush University Medical Center

  82 shared

• Lauren B. Gerson

  California Pacific Medical Center

  79 shared

• Jonathan A. Leighton

  75 shared

• Kenneth F. Binmoeller

  70 shared

• Drew Schembre

  John Muir Health

  69 shared

• Simon K. Lo

  Cedars-Sinai Medical Center

  69 shared

• Richard A. Kozarek

  68 shared

• Shahab Mehdizadeh

  Cedars-Sinai Medical Center

  68 shared

Labs

• Carol Semrad LabPI

Awards & honors

• AGA’s Senior Research Fellow Award
• Research Scholar Award