From Bench (to Post-graduate Practitioners) to Bedside
Translational research brings new findings from bench to bedside to expedite improvement in patient outcomes. Baylor Scott & White Research Institute (BSWRI) also brings these findings to lecture halls and conferences to ensure postgraduates are well-informed of the latest findings and “best clinical practices” in their disease specialty.
Stuart Spechler, MD, AGAF, FACG—Co-Director of the Center for Esophageal Research at BSWRI—is a prominent researcher in his field and a prolific educator. As a recipient of many research grants, he is widely renowned as an expert in diseases of the esophagus. Dr. Spechler has treated, researched, and published extensively on gastroesophageal reflux disease (GERD), Barrett’s esophagus, eosinophilic esophagitis, and esophageal motility disorders such as achalasia. His latest research and educational efforts have been around the accurate evaluation and management of Proton Pump Inhibitor (PPI)-refractory GERD.
As the Chief of Gastroenterology and Co-Director of the Center for Esophageal Diseases at Baylor University Medical Center at Dallas, Dr. Spechler led a pioneering study published two years ago in The New England Journal of Medicine. In the randomized trial, he and his colleagues discovered that PPI-refractory and reflux-related heartburn was present in only a minority of cases after an extensive, systematic workup. In other words, most patients with PPI-refractory heartburn did not have GERD. In the minority of patients for whom the workup established that PPI-refractory heartburn was reflux-related, however, anti-reflux surgery was superior to medical therapy (67% versus 28% success rate, respectively).
“Many people assume that if you have heartburn that means you have GERD, but that is just not true,” says Dr. Spechler. “Physicians considering recommending an operation to treat GERD should be sure that their patients really have GERD causing their heartburn, and that heartburn isn’t being caused by something completely different.”
According to Dr. Spechler, being sure requires a systematic evaluation with tests that include endoscopy, esophageal manometry, and esophageal impedance-pH monitoring. “These tests are necessary before resorting to surgery because if the heartburn isn’t caused by GERD, then the surgery won’t help and can only make things worse,” says Dr. Spechler. “A systematic workup will reveal that GERD is not the cause of PPI-refractory heartburn in the large majority of cases.”
Shortly after these findings were reported in the literature, Dr. Spechler presented the data and new clinical approaches to postgraduate practitioners at conference, including the American College of Gastroenterology’s Midwest Regional Postgraduate Course. He aims to educate the next generation of gastroenterologists on the criteria for differential diagnosis in this setting. Specifically, identifying the five primary potential mechanisms in PPI-refractory heartburn, recognizing the relationship between PPI withdrawal and rebound acid hypersecretion, and clinically appreciating the pros and cons of lifelong PPI therapy versus laparoscopic anti-reflux surgery in reflux-related PPI-refractory heartburn.
Along with fellow Co-Director of the Center for Esophageal Research, Rhonda Souza, MD, AGAF, FASGE, the team has helped shift paradigms in esophageal diseases—from identifying cytokines as the causative agent in reflux damage (and not acid burn) to investigating the source of esophageal cancer. The team recently published a review of their findings in PPI-refractory heartburn in a definitive paper entitled “Evaluation and Management of Patients with PPI-Refractory Heartburn” in Current Treatment Options in Gastroenterology.2
Last year, the NIH awarded $1.5M to Dr. Spechler and Dr. Souza to study the molecular mechanisms that link GERD to Barrett’s esophagus and cancer. As these findings unfold, the data will not only help transform patient diagnosis and care but inform the clinical approaches of their up-and-coming practitioners as well.
“Our research is translational and patient-oriented, focusing on fundamental mechanisms that underlie common disease processes,” says Dr. Spechler. “These are the kinds of studies needed to develop novel, effective treatments for our patients.” Moreover, these clinical studies—and the resulting postgraduate conferences—will inform the next generation of GI practitioners.
Extending investigational expertise across more than 50 specialties areas, Baylor Scott & White Research Institute provides the business and regulatory infrastructure to accelerate medical breakthroughs and innovative new treatment models through clinical and translational activities. Baylor Scott & White Research Institute is present at sites and centers across Baylor Scott & White Health and maintains nearly 2,000 active trials each year.