Common Ground

An old saying promises that success comes with a little luck and a lot of hard work. A chance meeting in the Greater Cincinnati/Northern Kentucky International Airport certainly supports that theory.

After nearly three years of developing plans for a comprehensive digestive health center, Richard Wright ran into Craig McClain as both were waiting for outbound flights.

The two had known each other for years: They met in Pittsburgh in medical school, and as two of the leading gastroenterologists in Kentucky they had developed a collegial relationship of mutual respect.

However, on this fall day in 1999, as the physician-researchers talked about their goals and visions, they discovered even more common ground.

Wright, chief of the Division of Gastroenterology/Hepatology at the University of Louisville, was beginning to make substantive progress toward his goal of establishing the digestive health center.

In fact, with the help of University Hospital president Jim Taylor and the support of others in UofL's School of Medicine -- including Dean Joel Kaplan, M.D., Hiram Polk Jr., M.D., and Richard Redinger, M.D. -- construction had already begun on the space that would house the clinical portion of the program.

"We were able to design the space exactly the way we wanted it," Wright says.

But the physical structure was only part of the equation. Wright saw in McClain an opportunity to recruit a leading researcher who would complement the liver transplant program jointly administered by UofL and Louisville's Jewish Hospital.

"I knew we needed to add several people to grow the clinic and the research agendas, so running into Craig was quite fortuitous," Wright says.

The overture to join UofL was an appealing one, McClain recalls.

"He asked me to come and talk with Dr. Kaplan to see if we could build the program together," says McClain, who at the time was heading a team of 17 clinical and research faculty at the University of Kentucky's gastroenterology division.

"It was a unique time -- I may not have come to UofL five years ago. But there was such a strong vision from the hospital presidents and the dean -- and the hospital partnerships are so strong -- that I thought this was an opportunity to be a part of something great."

The "something great" is a unique digestive health program that incorporates the latest in interdisciplinary patient-friendly care with a strong clinical and pre-clinical research agenda.

"Life is too short," McClain says. "You need to have fun doing what you're doing and work with people of common vision. The entire staff, including the administrators of UofL and Jewish Hospital, were supportive and willing to combine our visions. We were able to walk in and say, 'Let's go!' "

After initial meetings convinced McClain that a move to Louisville would be in his team's best interest, various team members weighed in with their thoughts.

Luis Marsano, M.D., a leading liver specialist, explained that "we needed to grow, and UofL was interested in developing a program with a large clinical base with lots of research. It was a good fit."

Kristine Krueger, M.D., the center's medical director, agrees.

"Insight. Progressiveness. Openness. A commonality with physicians. A true willingness to address the needs of patients. All of these things were here with the dean, the chair of medicine, the hospitals' administrators," Krueger says. "In my entire career I have never been as catered to."

In all, seven members of McClain's team came to Louisville from the University of Kentucky in the fall of 2000, and they hit the ground running. With their collective vision on the goal of developing a thriving, federally funded clinical research program, each member of the team is expanding his or her clinical and research prowess for the good of the team and its patients.

"The idea was to have a group of people to discuss and determine the best plan for each patient, to have physical proximity to related services, and to develop and participate in an increasing number of clinical trials," Marsano says.

Transplant expertise

One established group was particularly eager to discuss the care of its patients with Marsano and his colleagues. The liver transplant team, led by Frederick R. Bentley, M.D., had a thriving program at Jewish Hospital.

However, the team's members were anxious to work with other university-based specialists in the pre- and post-transplant care of patients.

"Drs. McClain and Marsano and their entire team are providing excellent medical care to our liver transplant patients," Bentley says. "We are excited about the growth in our program and the new research being conducted in Louisville that will lead to even more options for liver disease patients."

McClain echoes that enthusiasm.

"Dr. Bentley and his team are a great group to work with. We get along with the surgeons very well. The transplant center recently won an award for being 'patient-friendly.' I can tell you that it is 'doctor-friendly,' too."

Marsano, McClain and Stephen McClave, M.D., bring a wide range of liver disease diagnosis and treatment expertise to the table. Each has a particular interest in nutrition and metabolic disorders. According to Marsano, "Nutritional disorders and viral diseases are the two most common liver diagnoses."

McClain, past president of the American College of Nutrition and UofL's distinguished professor of hepatology, says it is "important for these patients to be diagnosed and treated at the earliest possible stages to avoid further damage to the liver and other organs. Our research shows that even a slight improvement of nutrition, including weight loss for obese patients, can result in improved liver function."

To support this research, McClain is seeking additional funding from the National Institutes of Health.

"The NIH is funding six centers to study this further," he says. "We would like to be one of them."

In addition to liver diseases, the physician-researchers of the Digestive Health Center diagnose and treat a variety of digestive disorders. Krueger is especially proud of the center's minimally invasive options for both diagnosis and treatment.

"Less invasive techniques need to be developed and refined so that patients have a stepping stone before major surgery is performed," she says.

"It is fulfilling to be involved in new technology and procedures," Krueger continues. "We have the opportunity to work with manufacturers on prototyping equipment. All of this is to the benefit of our patients."

For example, Krueger is trained in performing the endocinch procedure, an endoscopic way to treat severe heartburn. Unlike with the traditional surgery, called Nissen fundiplication, patients who are candidates for endocinch experience little pain and generally go home the same day as the procedure.

Other center faculty are pioneering endoscopic surgical treatments for obesity and weight loss, new drug therapies for inflammatory bowel disease, and new high-tech diagnostic procedures.

Broad range of care

The mix of experts in different sub-specialties is the very thing that makes the center so positive for patients and the physicians themselves, Marsano says.

"Everyone has an area of emphasis," he explains, "but each person can handle a range of diagnoses. We work as a group. We share ideas and opinions, and depend on each other's expertise for different procedures."

The Digestive Health Center team now includes gastroenterologists, surgeons, radiologists, hepatologists, endoscopists and pathologists who regularly collaborate in patient care and research.

Based in newly constructed facilities in University Hospital, the team treats all types of gastrointestinal disorders, including pancreatobiliary diseases, swallowing and motility disorders, inflammatory bowel disease, nutritional and metabolic disorders, and liver disease.

The center's physicians unanimously agree that the physical proximity to support services is key to their patient-friendly service.

"We are a true multidisciplinary clinic," Krueger says. "Our patients can see all of their doctors on the same day in one office visit.

"Radiology is across the hall, the lab is right here. We do our own endoscopy. Sometimes a patient needs all of these services in the same day, and we can provide that with little inconvenience to the patients or our collaborating doctors."

Even with the success of the program after its initial year, no one is ready to say that the original mission has been accomplished. Wright, who says he is always working within the context of a five-year plan, would like to triple the program's research funding over the next five years.

"Considering that we've doubled our funding since the team's arrival, I think that's an achievable goal," Wright says.

Krueger is hoping to create a one-of-a-kind system for facilitating clinical trials.

"My hope for the future is to smoothly integrate enrollment of interested patients in clinical trials right here in the clinic," she says.

"I'd like to make the trials as patient-friendly as our other services and create space on-site for research associates to consult patients and clinicians."

Marsano agrees that perfecting systems for the successful implementation of clinical studies is vital. Entering a clinical trial can benefit patients by giving them access to treatments not yet widely available. In addition, Marsano sees studies as crucial to treating traditionally underserved populations.

"Even after a drug or a treatment is approved, studies need to be conducted on their long-term affects or on their effectiveness in treating related disorders," Marsano notes.

"Conducting these studies allows us to offer advanced treatments to patients who otherwise may not be able to afford them."

For McClain, the hard work continues. In addition to the research he personally conducts or oversees for the digestive health program, he is looking at ways to foster the growth of clinical research at the university as a whole.

By appointing McClain director of UofL's new General Clinical Research Center, the dean of the School of Medicine is supporting that role.

"UofL is doing all the right things to become a national leader in many areas of research," McClain says, "and I'd like to be a part of that."

With a lot of hard work and a little luck, surely he can.