The Division of Gastroenterology is among the very best academic training programs in the country with a long and distinguished legacy of training future academic leaders in digestive and liver disease.
The Division of Gastroenterology was established over 50 years ago as a subspecialty division of the Department of Medicine. Under Dr. Nicholas Davidson’s leadership, the division successfully nurtures broad academic interests in teaching, research, and clinical excellence and has attracted both national and international recognition for its contributions to the fields of digestive and liver disease. Dr. Davidson was instrumental in guiding us into the 21st century and made key recruitments to expand both the division’s clinical and investigational repertoire. We currently provide state-of-the-art clinical care, cutting-edge molecular and translational research, and basic as well as advanced training for managing digestive and liver diseases. The division is distinguished in being awarded a Silvio Conte Digestive Disease Research Core Center, which provides access to core services to complement research in digestive and liver disease at Washington University School of Medicine in St. Louis. In addition, the division is home to a longstanding T32 training grant that supports career development and mentoring for trainees interested in academic careers.
Located in St. Louis, Missouri, Washington University School of Medicine lies in the heart of the Midwest. Washington University Medical Center is one of the nation’s largest clinical and biomedical research facilities. The division utilizes 27,039 square feet for its research, clinical, and education mission. Research space includes 13 labs totaling 15,218 square feet. Faculty and staff have 8,029 square feet of wet lab space (53%) and 2,393 square feet of shared research equipment and cold storage space (30%). The remaining is utilized for research faculty and administrative offices. Clinical faculty, fellows, support staff and administrative space are housed in an 11,128 square feet area on campus. Clinicians perform procedures in five, hospital-managed endoscopy centers on four different campuses. Outpatient clinics are occupied by gastrointestinal clinicians in nine different sites across eastern Missouri.
At the Forefront of Patient Care and Research
There are several clinical sections (operating at multiple locations), including:
- General Luminal Gastroenterology (Barnes-Jewish Hospital (BJH), St. Louis Veterans Affairs Medical Center (VAMC) and Barnes-Jewish West County Hospital (BJWCH), Center for Advanced Medicine – South County)
- Interventional Endoscopy (BJH, BJWCH, Missouri Baptist Medical Center)
- Inflammatory Bowel Disease (BJH, Center for Advanced Medicine – South County, BJWCH)
- Neurogastroenterology (BJH, Missouri Baptist Medical Center)
- General and Transplant Hepatology (BJH, BJWCH, Cape Girardeau)
Areas of special emphasis include bariatric endoscopy, third space endoscopy, endohepatology, inflammatory bowel disease, transplant and general hepatology, and foregut disorders and neurogastroenterology.
Clinical Programs
The division has maintained robust growth of all clinical activities.
The clinical practice for inpatient services is almost exclusively located at Barnes-Jewish Hospital (BJH). We have a small inpatient practice at Barnes-Jewish West County Hospital, predominantly for inflammatory bowel disease patients requiring a brief hospital stay and who do not require 24/7 imaging or ICU monitoring.
Our outpatient practice includes BJH, BJWCH, MoBap, and South County locations as well as offsite locations at Cape Girardeau (1429 N Mount Auburn Rd, Cape Girardeau, MO 63701) for hepatology. We offer comprehensive services at BJH and BJWCH for the entire range of digestive and liver disorders including interventional endoscopy (pancreatico-biliary disorders), bariatric endoscopic procedures and clinic, Inflammatory Bowel Disease, hepatology, and general gastroenterology. The South county location offers clinics in inflammatory bowel disease, hepatology, general gastroenterology. The MoBap location is confined to services focusing on neurogastroenterology and esophageal dysfunction.
Among the key clinical programs is liver transplantation, directed by Kevin Korenblat, MD. The liver transplant program was co-organized by Jeffrey Crippin, MD in conjunction with Will Chapman, MD as a jointly run medical-surgical service. Following Dr. Crippin’s tenure, Dr. Korenblat was appointed and currently serves as medical director. The liver transplant program has enjoyed robust growth over the last decade. We have seen enormous growth in our Inflammatory Bowel Disease (IBD) program under the leadership of Matthew Ciorba, MD who was appointed Inflammatory Bowel Diseases Program Director in 2016. Over the last several years, the division has recruited several new clinical faculty, with a major impact in reducing wait times for new IBD patients from six months to 14 days. Within the IBD program, we established a new adolescent-to-adult transition program in conjunction with the Pediatric Inflammatory Bowel Disease Center at St. Louis Children’s Hospital. We also established an Advanced IBD Fellowship training program, initiated an annual CME course along with a quarterly IBD speaker series, and successfully attracted new philanthropic support. Our Interventional Endoscopy (IE) section has enjoyed great success as a Program of Excellence. The IE section has eight full-time faculty and has enjoyed steady growth with clinical volumes now exceeding 2000 EUS and 2000 ERCP procedures annually. Among the major successful programs in the IE section, is our bariatric endoscopy program whose activities have grown exponentially and is the only regional center to offer three FDA approved intragastric balloon systems along with Aspire, endoscopic sleeve gastroplasty and is an active site for three industry-sponsored studies of weight loss devices.
Research Programs
The division has three major areas of basic research interest among the 12 wet-lab based investigators, including:
- Host-microbial interactions, inflammation and mucosal immunity. We are interested in understanding how the microbiome influences inflammation (including inflammatory bowel disease) as well as how the microbiome signals to the body in obesity to regulate energy metabolism.
- Stem cells, epithelial renewal, paligenosis and cancer. We are also interested in how the various digestive organs (stomach, small and large intestine, liver, pancreas) develop normally and how we might take advantage of their regenerative capacity to engineer new tissue. We are also interested in how gastrointestinal and liver cancer arise and how these cancers can be treated. Most importantly, we are particularly excited about how advances in DNA and RNA sequencing and genome wide analysis can be transitioned to produce an effective personalized approach to cancer, particulary for recurrent or metastatic cancers.
- Metabolic homeostasis, nutrient transport, and enterohepatic signaling. We are interested in understanding the dialog between intestinal and hepatic metabolic pathways that promote obesity development, particularly childhood obesity. Our long-range goals are to develop new personalized therapies to reverse the metabolic and systemic complications of obesity, particularly the fibrogenic complications of non-alcoholic fatty liver disease (NAFLD). Among our clinical research activities, we have significant programs addressing the role of intestinal inflammation in colorectal cancer progression and response to chemotherapy, as well as understanding the role of MR enterography in predicting outcomes in inflammatory bowel disease. We are also interested in understanding the pathways linking the development and progression of non-alcoholic fatty liver disorder. (NAFLD) in patients with IBD. Our interventional endoscopy faculty is engaged in work focusing on outcomes of pancreatic cystic lesions and the utility of endoscopic ultrasound, as well as in developing educational guidelines for advanced trainees. In other work, our faculty is engaged in understanding barriers to colorectal cancer screening, advancing understanding of foregut motility disorders and the use of high-resolution manometry, clinical trials of novel biologics in intervention studies in NASH and in primary biliary cholangitis, and in clinical trials for viral hepatitis.
The division serves as the home for the Washington University Digestive Disease Research Core Center (DDRCC) (P30-DK 52574). The DDRCC provides enabling technology through four cores (Administration, Advanced Imaging and Tissue Analysis, Precision Animal Models and Organoids and Gnotobiotic; Biobank). The DDRCC has a robust membership of over 50 full and associate members who utilitize core services, supported by extramural digestive disease-related funding. The center coordinates a pilot and feasibility (PF) program, in general supporting junior faculty (track 1) with seed funding up to $30,000 annually. Over the last 15 years (2005-2020), the return on investment for the PF program has been outstanding with an ROI of 29:1. In addition, the DDRCC organizes a regular research seminar series and career development program through an enrichment program that is integrated into the overall divisional research portfolio.
The division is committed to training future academic leaders in our specialty. Dr. Davidson is the PI of the T32 in academic gastroenterology which has two slots per year for gastroenterology fellows and two slots for predocs (total 4 slots). We are also committed to enhancing diversity and promoting the careers of underrepresented minority trainees. Over the last 15 years of our T-32 award, we have trained and matriculated seven URMs (21% of the total of 33 trainees). Over the last 10 years (2010-2020) 100% of our three-year, foundational GI fellowship graduates have matriculated into academic faculty positions and 17% have returned to Washington University School of Medicine. Over the last 10 years, our advanced hepatology fellowship has matriculated six fellows, five of whom (83%) are in academic positions, while our interventional fellowship has matriculated 16 fellows, 15 of whom (94%) are in academic positions.
Training Future Leaders in Gastroenterology
Undergraduate Medical Education
The Division of Gastroenterology manages a clinical elective for undergraduate students wishing to experience inpatient and outpatient clinical gastrointestinal hepatology. This program is run by Elizabeth Blaney, MD. Dr. Blaney arranges the rotations in conjunction with the medical school office of student affairs and handles the assessments and feedback portion. In addition, the Division is responsible for 27 lectures (pathophysiology) and four small-group sessions for the annual second-year gastrointestinal pathophysiology course, which is run by Sandeep Tripathy MD, PhD. Dr. Tripathy oversees all the lectures, updates the handouts, and handles all the assessments and feedback as well as organizing the materials for the final pathophysiology examination.
Fellowship programs (ACGME and non ACGME). The division has a robust, three-year ACGME approved gastroenterology fellowship program, which currently accepts six trainees per year (18 trainees total). Four of these trainees are supported by BJH, four are supported by the T32, three are supported by a grant from the government of Saudi Arabia as part of a shared educational opportunity and five are supported by the VA. All our trainees rotate through the three major sites (BJH, BJWCH and St. Louis VA). In addition, the division manages an ACGME-approved advanced Hepatology program (Jacqueline Fleckenstein, MD Director). The division also manages an advanced interventional endoscopy fellowship program which has trained 13 fellows over the last 10 years, all of whom are in full-time academic positions. As noted above, the division has recently began an advanced IBD fellowship.