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A Biannual Publication of theGeorgia Regents Digestive Health CenterDIGESTIVEMATTERSJENNIE MONTGOMERY:HOW THE DIGESTIVEHEALTH CENTERCHANGED HER LIFEP7SPRING 2015INAUGURAL ISSUE
MESSAGE FROM THE DIRECTORWe have all experienced gas andbloating, bellyaches, constipation,heartburn, or runs to the restroomand gut wrenching nausea, and thankfully formany of us, these symptoms don’t stick aroundtoo long. But for a staggering 30 percent ofthe global population, digestive problems suchas these persist and may be a sign of chronic,serious, or even life-threatening conditions thatneed evaluation and treatment.At the Georgia Regents Digestive HealthCenter, we are ready to tackle the mostchallenging problems. Our faculty specialize intopics from diagnostic endoscopy to advancedendoscopic treatments; from pioneering3-D manometry tests to neuromodulationtherapies; from novel cures for hepatitis C tothe immunomodulator biologics for IBD; andfrom advanced robotic GI surgery to holisticand comprehensive bariatric care.“One cannot think well, love well, sleep well, if one has not dined well.”Virginia WoolfHow did we achieve this? To meet theseunique needs of 21st-century digestive healthpatients and their families, we designed astate-of-the-art, 43,000-square-foot DigestiveHealth Center (DHC) - the first one ofits kind in the state of Georgia. From ourwelcoming reception area and waiting room toour high-tech diagnostic and treatment rooms,we are dedicated to offering comprehensive,patient-centered care for a broad range ofdigestive health conditions. We not onlyhave the latest technology, but we also prideourselves in providing a multidisciplinary teamapproach that finds the root cause for digestiveailments and uses this knowledge to developthe best treatment plan specific for each patient- all under one roof.The DHC includes a spacious nine-room,modern endoscopy suite with three advancedendoscopy and hi-tech fluoroscopy suites; afive-room neurogastroenterology and motilitysuite, all equipped with the most sophisticatedtechnology, a 22-room preparation andrecovery suite, and adjacent to this, a 15-roomclinic consultation suite. Our design team paidparticular attention to ensuring patient comfortthroughout our facility, creating spacious2consultation rooms, clinic and procedure roomsthat are only steps apart; dedicated parkingspaces and convenient restrooms; large openplan nurses stations; and a warm, hospitablepatient lounge, all with dedicated staff. Inthis way, the DHC fulfills GRU’s mission ofpatient-centered care.The DHC’s specialty care services, includethe nation’s largest and most advanced motilityclinic, the region’s only neurogastroenterologist,bariatric medicine and surgery, hepatology,inflammatory bowel disease, cancer, pancreaticand biliary medicine, advanced endoscopy andminimally invasive digestive surgery.Not only will the DHC provide world-classcare, but its research team is also pioneeringand conducting cutting-edge research in manyareas to improve digestive health so that wepractice tomorrow’s medicine today. Soon,we hope to complete a dedicated clinical andtranslational research unit. To learn more visitour web site at grhealth.org/digestivehealth.This inaugural volume will introduce ourhighly specialized health care team, providean overview of our state-of-the–art DigestiveHealth Center, and highlight many of theunique features and services we offer, alongsideexpert commentary from the leadership ofGeorgia Regents Medical Center. We willalso feature stories from a few patients withchallenging clinical problems that werediagnosed and effectively treated by our expertsin the DHC.It is with great pride and humility thatI invite you to read this first volume of ournewsletter. I also invite you - whether you area patient with a digestive complaint, a healthcare colleague who wishes to join our missionof providing world-class health care, or aresearcher who wishes to unravel and conquerdigestive diseases - to come and visit us at theDHC and partner in our passion for excellencein digestive health care, education, training,and research. I am confident that at GRU weare poised for a millennial leap in digestivesciences and together we will remedy manyailments and restore digestive health.Respectfully,Satish SC Rao, MD, PhD, FRCPProfessor of MedicineChief, Gastroenterology/HepatologyDirector, Georgia RegentsDigestive Health Centergrhealth.org/digestivehealth
IN THIS ISSUESPRING 2015Welcome, huan ying, bienvenida,swagath to this inaugural editionof “Digestive Matters” a biannualpublication of our world-class DigestiveHealth Center that will bring you the latestnews and authoritative facts about digestivehealth and disease. Here you will read succinctdiscussions on what’s new and controversial,learn about the latest research and discoveriesin gastroenterology, hepatology, and digestivesurgery, both at GRU and elsewhere, andreceive tips from our internationally renownedexperts and health care team about how tomaintain a healthy gut.NEW DIGESTIVE HEALTH CENTER 4PATIENT TESTIMONIALS 6THE GLUTEN CRAZE 8A WORD FROM OUR LEADERS 9ABOUT THE COVERAfter visiting the Digestive Health Center,Jennie Montgomery’s life was changed.Read more on page 7.Digestive Matters, Spring 2015MEET OUR TEAM 10GRATEFUL PATIENT GIVES BACK 123
The 43,000-square-foot location is theonly center of its kind in the country,combining multidisciplinary care forevery type of digestive disorder into asingle location, including: Colonoscopy and Colorectal Care Neurogastroenterology/Motility Advanced Endoscopy Bariatric and Weight Loss Center Minimally Invasive DigestiveDiseases Surgery Inflammatory Bowel Disorders Pancreatic Care Hepatology and Liver Care Center General Gastroenterology Clinical Trials4grhealth.orgLobby of the new Digestive Health Center
THE NEW DIGESTIVE HEALTH CENTERFrom the high-tech equipment to patient-friendly touches, every single detail in thenew GRHealth Digestive Health Center is part of center director Dr. Satish Rao’svision, years in the making.The center specializes in care and treatments for complex digestive health disordersas well as general gastroenterology problems that affect 25 percent of the population.Rao, for example, leads the Neurogastroenterology/Motility clinic, one of only 10 in thenation designated as a Center of Excellence by the American Neurogastroenterology andMotility Society. The clinic offers novel diagnostic tests and specialized treatments, notfound anywhere else in Georgia, for disorders that affect the movement and digestion offood from the esophagus to the colon.But Rao is perhaps most proud of the many patient-friendly features that were designedinto the new space. For example, restrooms are located next to colonoscopy prep rooms forpatient comfort, and prep and recovery rooms both feature TVs for entertainment.What patients won’t necessarily notice but will benefit as much from is high-techequipment from Philips that ensures continuous monitoring from prep through recovery,as well as piped-in CO2 and water irrigation/immersion, an important new advance thatmakes a huge difference in patient comfort andprocedure time during colonoscopies and wheninflating the bowel.“Our vision was to create a beautiful newregional care facility and a national center ofexcellence that caters to the specialized needsof patients with digestive health disordersand brings together our many services intoone convenient location,” said Rao. “Our newDigestive Health Center achieves that, and weare very proud to offer this facility to patientshere in the CSRA and beyond.” Digestive Matters, Spring 2015Advanced Endoscopy with Dr. Daram5Dr. Bogorad, first patient seen in the DHC clinic.
PATIENT TESTIMONIALSGastric SleeveStuck. That’s just how Pam Williams was feeling a few months ago. Not only was she unableto join her family for evening meals because her food became stuck and indigestible, but shewas stuck living with painful arthritis, severe reflux, and fatigue. This breast cancer survivoryearned for a normal and more active life, which led her to Dr. Brian Lane at GRHealth.As a result of lap band surgery, Pam spent almost four years eating “slider” foods with littleconsistency. These foods may have gone down more easily, but they were also causing Pam damageand additional weight gain. The lap band, which had become twisted, made it very difficult for Pamto eat foods with any consistency and often led to vomiting. Most days, Pam found herself exhaustedafter getting home from work, with little energy to do anything but sit and watch TV.Pam soon realized how vital it was that she have the lap band removed, not only for healthreasons, but to regain a normal and active lifestyle. Pam decided to make an appointment withLane at the Georgia Regents Center for Obesity and Metabolism. “During the first meeting I hadwith him, I knew and felt very comfortable,” she said. “Dr. Lane is a very knowledgeable and caringdoctor. He explained the gastric sleeve and exactly what would be done.”“Thanks to these caring nurses, physician assistant, andDr. Lane, I have a new lease on life!”Pam is now one month post-surgery, andshe is already seeing results. Within twoweeks, she began feeling the positive effects ofher gastric sleeve surgery. With 20 lbs. gone,she is noticing her clothes fitting more looselyand feeling much relief from the painfulpressure on her knees and joints. She is alsoexperiencing more energy and enjoying takingher new puppy on walks every day.When asked if she has advice for othersstruggling with weight issues, Pam said, “Itell them that the struggle is real, but there isa way to be helped. The gastric sleeve surgeryis a tool to help me reach my goals, and I amanxious to see where my journey takes me. Iam very pleased with the results so far!”“Dr. Lane, physician assistant, Amy, andall of the nursing staff have been amazing!”Pam continued, “They are a wonderful group,and words cannot express how grateful Iam. I could not have dreamed of a moreexperienced staff. Thanks to these caringnurses, physician assistant, and Dr. Lane, Ihave a new lease on life!” For more informationon the Center for Obesityand Metabolism, visitgrhealth.org/weightloss.Pam Williams6grhealth.org/digestivehealth
Fructose IntoleranceAs Jennie Montgomery made thewalk from her bathroom to thebedroom early one morning, it tookeverything in her to call out to her husband.That’s the last thing she remembered beforeblacking out from extreme pain.She had been dealing with unexplainedpain for over a month. “It hurt to walk. Iwould have to steel myself to walk frommy desk into the studio. I would listen toairchecks and noticed my shallow breathingbecause it hurt to inhale deeply,” she said. “Ieven wrote down on a little yellow Post-itnote three little symptoms I was feeling,knowing that if something happened thatKimberly, who sits two desks across from me,would know what was wrong.”After blacking out in her home thatweekend, Montgomery was rushed tothe hospital. After a weeklong stay, thedoctors and surgeons were unable to make adiagnosis. She left with questions unansweredand still in extreme pain. After discharge,Montgomery felt she was out of options.Taking her doctor’s advice, she made thedecision to undergo exploratory surgery.On the short drive from the hospital toTelevision Park, Montgomery received a call.Beth, a friend, fellow church member, andemployee at Children’s Hospital of Georgia,encouraged her to postpone the surgery. Shewanted her to see the doctors at GRHealthfirst. Beth arranged for an initial consult withDr. Todd Merchen. Merchen referred herto Dr. Satish Rao, Director of the GeorgiaRegents Digestive Health Center. “My firstvisit with Dr. Rao was wonderful, because he’sjust so compassionate and an extraordinarylistener. He is so relatable, and you knowthat he cares,” Montgomery said. Rao wasoptimistic and wanted to do a few more testsbefore considering surgery. Jennie called thesurgeon’s office that day and canceled hersurgery.Rao recommended the SmartPill and thatMontgomery take a hydrogen breath test. Asthe testing took place, Jennie rocked, doubledover in excruciating pain.When the test results came back, it wasdetermined she was suffering from fructoseand lactose intolerance. Montgomery wasrelieved to have answers. She never associatedDigestive Matters, Spring 2015For more information on Food Intoleranceand Neurogastroenterology/Motility, visitgrhealth.org/digestivehealth. To schedulean appointment, please call 706-446-GUTS(4887).Dr. Rao and Jennie Montgomeryher pain with the food she ate. After following strict dietary direction from Rao, she felt like herselfagain in a matter of days. “I felt like I was in a new body. It was amazing to realize that what we eatcan affect our whole system,” she said.The whole experience has had a lasting impact on Montgomery and her family. “It was lifechanging for me. And the benefit for my family, my kids, especially: I know that they will forever beconscious of what they put in their bodies,” she said. “My experience was just great. Knowledge ispower, and I have the power to control my health and well-being because of Dr. Rao.” “Knowledge is power, and I have the power to control myhealth and well-being because of Dr. Rao.”7
THE GLUTEN CRAZEAre you gluten phobic or friendly?Gluten is a popular topic among selfproclaimed health gurus. Gluten isa protein composed of the prolamingliadin. Prolamins are storage proteins foundin the endosperm of grains. Some health“experts” or celebrities claim eating gluten is“not healthy.” Many new books and diet planshave been developed due to this craze. (SeePaleo Diet and Wheat Belly).Types of foods that contain gluten are:wheat (emmer, spelt, einkorn, karmut), wheatstarch (wheat bran, cracked wheat, wheatgerm, hydrolyzed wheat protein), barley, andrye. Alternatives to gluten are millet, rice,amaranth, buckwheat, sorghum, quinoa, andcorn.Celiac disease is an autoimmune disorderthat is caused by eating gluten. Approximately1 in 133 people in the United States hasceliac disease. Only people with celiac diseaseneed to avoid gluten. Their bodies treat glutenas a foreign substance, and this causes damageto the lining of the small intestine. Hence,gluten needs to be excluded from their diet.The damage caused by the immune responseto gluten reduces the absorptive capacity,resulting in malabsorption of nutrients;calcium, vitamin D, iron, and folate levelsmay each be reduced. This leads to symptomssuch as diarrhea, fatigue, weight loss, anemia,and skin rash. If you have any of theseunexplained symptoms, you should consultyour physician or seek a gastroenterologistreferral rather than experiment with a glutenfree diet.The United States does a great job atmarketing health “cures,” and unfortunately,gluten suffers because of this. Foods labeled“gluten free” mislead consumers into believingan item is healthier. Gluten free can bestamped on food labels that do not containgluten to begin with! Gluten-free labels aremarketed extensively in the food supply,ranging from eggs to mint candies. Thislabeling serves two purposes, which is toincrease the price of the product and give afalse sense of security to the consumer.Foods containing gluten, such as wholewheat bread or pasta, also contain fiber, whichis beneficial to digestive health. Fiber helpsprevent constipation by providing bulk tostool. Certain types of fiber act as a prebiotic,8“Only people with celiac disease need to avoid gluten.Their bodies treat gluten as a foreign substance.”which helps to feed the healthy bacteria in the colon. Fiber also promotes satiety, which can help aidweight loss.Some people may have wheat or fructan intolerance. Fructans are complex carbohydrates thatare present in wheat, onions, garlic, and artichokes. These individuals do not have celiac diseaseor an allergy to wheat but cannot digest these food items because of a lack of enzymes that breakdown these foods. This condition, like celiac disease, can be diagnosed from proper testing. Pleaseconsult your physician or seek a referral to a gastroenterologist who can order appropriate testing todiagnose this condition.Let’s set the record straight. Gluten is a type of protein in wheat that only needs to be restrictedin the case of celiac disease or gluten malabsorption. This requires definitive diagnosis by agastroenterologist. The rest of the population does not need to be concerned with restricting gluten.Restricting food items without supplementation may also lead to nutritional deficiencies, and hence,one should exercise caution.Andy Yurechko, RD Clinical Nutrition and Dietary Servicesand Food Intolerancesgrhealth.org/digestivehealth
A WORD FROM OUR LEADERSThree years ago, we set forth the mission of our university and health system: “To provide leadershipand excellence in teaching, discovery, clinical care, and service” to our patients, students, community,and region. Since that time, Georgia Regents Health System has led the way in Georgia to delivercutting-edge and patient-centered clinical expertise across a wide range of medical specialties. It is withpride and pleasure that we welcome our newest facility, the Georgia Regents Digestive Health Center,to our family of specialty care. For the first time, those who suffer from chronic and often debilitatingdigestive health conditions will have access to the most current diagnostic tools and clinical care froma team of world-class experts — all under one roof. Congratulations and thanks to Dr. Satish Rao andhis team for their hard work and leadership in making this state-of-the-art facility a reality.Ricardo AzzizPresident, Georgia Regents UniversityCEO, Georgia Regents Health SystemThe Digestive Health Center enables optimally efficient and effective care for our patients with awide range of digestive health disorders by bringing together the medical and surgical specialiststhey may need in facilities designed to support their state-of-the art care today and into the future.We applaud Dr. Satish Rao and his team for their leadership in defining a new level of care for thesepatients in our region and nation.Peter F. Buckley, MDDean, Medical College of GeorgiaInterim Executive Vice President for Health Affairs, Georgia Regents UniversityInterim Chief Executive Officer, Georgia Regents Medical Center & Medical AssociatesThe Department of Surgery is pleased to have been a part of the development of the GeorgiaRegents Digestive Health Center. Surgeons from our department have partnered with our GeorgiaRegents gastroenterologists to offer bariatric, complex gastrointestinal surgery, and colorectal surgeryto patients throughout our region. We are very proud of this establishment and proud of Dr. Raoand the team he leads. Our talented surgeons and gastroenterologists are working together toprovide a state-of-the-art structure where medical and surgical physicians can work side by side tooffer our patients the best possible care. Please join me in welcoming this new milestone to GeorgiaRegents Medical Center.Dr. Charles G. HowellChairman, Department of SurgeryChief, Section of Pediatric SurgeryProfessor of Surgery and PediatricsThe multidisciplinary Digestive Health Center represents a major resource for Georgia and the region.Dr. Satish Rao and his team of physicians, scientists, health care workers, and patients, have put together acomprehensive and phenomenal program that will serve patients’ needs now and in the future. Thoughtfuland meticulous attention to patients’ needs is apparent as you enter the facility, and it is carried forththroughout every area. The Augusta community is fortunate to have this group of caregivers, in thisfacility, to provide the highest quality of care. As importantly, the Digestive Health Center will lead theway to improving the health of the people in the region and beyond.Dr. Michael MadaioSydenstricker Professor and ChairmanDepartment of Medicine, Medical College of Georgia at Georgia Regents UniversityDigestive Matters, Spring 20159
MEET OUR TEAMIf you have a digestive health disorder, big or small, we can help. As part of the region’s only comprehensive digestive health center, our physiciansare specially trained and experienced in virtually every subspecialty of gastroenterology — from advanced endoscopy to hepatology to IBD andneurogastroenterology and motility.Our center director, Satish Rao, MD, is an international leader in digestive health disorders. He is past president of the AmericanNeurogastroenterology and Motility Society, a recipient of the three highest honors from the American Gastroenterological Association, and a federallyfunded investigator.Satish Rao, MDDirector, Digestive HealthCenter & Professor ofMedicine & ProgramDirectorSpecialties: Neurogastroenterology & GIMotility, Nutrition, GastroenterologyResearch: Brain-Gut Interactions, Constipation,Biofeedback Therapy, Fecal Incontinence, IBS,Gastroparesis, Dietary Fructose Intolerance, 3-DAnorectal Evaluation, Magnetic Therapy, NovelDiagnostic Tools for GI MotilitySumanth ReddyDaram, MDInterventionalGastroenterologist,Advanced Endoscopy,Associate Professor ofMedicineSpecialties: ERCP, Endoscopic Ultrasound,Gastroenterology, Digestive HealthResearch: Clinical Outcomes, Therapeutic EUS,Endoscopic Videos in Education, EUS TissueSamplingHumbertoSifuentes, MDAssistant Professorof MedicineSpecialties: Crohn’s Disease, Ulcerative Colitis,Microscopic Colitis, Pouchitis, Novel Treatmentof IBD, Postoperative Crohn’s Disease,Constipation and General GastroenterologyResearch: Inflammatory Bowel Disease,Nutrition, Quality Measures, Colon CancerPreventionJohn Affronti, MDDirector of AdvancedEndoscopy, Pancreas& Bile Duct Group &Professor of MedicineSpecialties: Advanced Endoscopy,Gastroenterology, Digestive HealthResearch: Pancreas and Bile Duct Disorders,Endoscopic Ultrasound (EUS), EndoscopicRetrograde Cholangiopancreatography (ERCP)Advanced Endoscopy Technology, EndoscopyTraining, Quality and Clinical Outcome MetricsSherman M.Chamberlain, MDMedical Director,Endoscopy & Professorof MedicineSpecialties: Gastroenterology, Digestive HealthResearch: Colonoscopy Preparation, VideoCapsule EndoscopySubbaramiah Sridhar, MDSandeep Khurana, MDDirector, Hepatology andAssociate Professor ofMedicineSpecialties: Hepatology, Gastroenterology,Digestive HealthResearch: Cholinergic Mechanisms of LiverInjury, Portal Hypertension, Hepatitis CNon-Alcoholic Fatty Liver DiseaseBrian Francis Lane, MDAssociate Director,Digestive Health Center,Associate Professor ofSurgerySpecialties: Bariatric, Weight Loss, BariatricSurgery, Minimally Invasive and DigestiveDisease Surgery, General Surgery,Research: Mechanisms of Diabetes and NASHImprovement after Bariatric Surgery, RevisionBariatric Surgery, Total Endoscopic Approachesto Bariatric Surgery, the Application of MIS toComplex Gastrointestinal ProceduresProfessor of Medicine& Associate Director,GastroenterologyFellowship ProgramAdvanced &Interventional EndoscopyPancreas & Biliary GroupSpecialties: ERCP, Endoscopic Ultrasound, andAdvanced EndoscopyResearch: Translational Research, IschemicColitis, Interventions in GastrointestinalBleeding, Clinical Trials, and Clinical OutcomesSean Michael Lee, MDAssistant Professorof SurgerySpecialties: Minimally Invasive and DigestiveDisease Surgery, Bariatric Surgery, Weight Loss,General SurgeryResearch: Clinical Outcomes of BariatricSurgery, Metabolic Effects of Bariatric SurgeryOur team is pioneering and conducting cutting-edge research in many areas to uncover new solutions forchallenging diseases and to improve digestive health so that we practice tomorrow’s medicine today. Some ofour current and upcoming clinical trials include: Advanced Endoscopy, Colon, Hepatology Inflammatory BowelDisease,Motility and Neurogastroenterology. For more information, contact Amanda Schmeltz at 706-721-196810or Meagan Gibbs at 706-721-1968.
Endoscopy StaffAdministrative StaffNEUROGASTROENTEROLOGY/MOTILITY PROCEDURESHigh-resolution esophageal andpressure topography (HREPT)3-D esophageal manometry24-hour, 48-hour, and 96-hourambulatory pH/Bravo testEsophageal balloon distension testGastric barostat studyEnterra therapy24-hour gastric-duodenal manometry studyLactose/fructose/fructan intoleranceHydrogen breath test24-hour ambulatory colonicmanometry studySmartPill or wireless motility capsule studyHigh Resolution and 3-D AnorectalmanometryTranslumbar and transsacral motor evokedpotential testBiofeedback therapy for chronic constipation,and stool leakageRepetitive translumbar/transsacral magneticstimulation therapyBotulinum toxin injections3-D anorectal and pelvic ultrasoundENDOSCOPIC PROCEDUREEndoscopy/gastroscopyEndoscopic band ligationEndoscopic stentingEnteroscopyLaser argon plasma coagulation andtumor ablation (Barryx)Percutaneous endoscopic gastrostomy/jejunostomyVideocapsule endoscopyColonoscopy with water immersion andCO2 inflationPolypectomy including complex polypectomyAchalasia/esophageal stricture dilationunder fluoroscopyDeep/device-assisted enteroscopy orsmall bowel endoscopyADVANCED ENDOSCOPY PROCEDURESEndoscopic celiac plexus block/neurolysisEndoscopic mucosal resection (EMR)Endoscopic therapy for Barrett’s esophagusEndoscopic ultrasound (EUS), FNAEndoscopic retrogradecholangiopancreatography (ERCP)Biliary/pancreatic Stone extraction, stenting,Cyst gastrostomySpyglassClinic StaffHEPATOLOGY PROCEDURESLiver biopsy (Percutaneous/Transjugular)Fibroscan of LiverNo-hassle referrals. Your time is valuable.To make an appointment for your patient, please call: 706-446-GUTS (4887)grhealth.org/digestivehealth
Communications and Marketing1120 15th Street, TR-101Augusta, Georgia 30912Non-ProfitOrganizationU.S. PostagePAIDAugusta, GAPermit No. 210CHANGE SERVICE REQUESTEDWrong address?Need to update your information?Tell us by email at updateinfo@gru.eduGo online to gru.edu/updateinfoOr call us at 706-721-4001GRATEFUL PATIENT GIVES BACKIn 2006, Allie Hoeland was diagnosedwith gastroparesis. After struggling forseveral years with the disease, Allie andher mother, Pamela, decided to get involvedin the fight for a cure. They began talkingto specialists and researchers and felt a needfor more gastroparesis funding and patientinvolvement in both activism and research. In2010, they started the GPD Foundation forthe purpose of raising funds for gastroparesis/dysmotility disease and create a network tohelp patients find better treatments and makea difference.If you would like to contributeor learn more about giving,please visit gru.edu/giving orcontact David Cantrell atdcantrell@gru.edu.Dr. Michael Diamond, Dr. Satish Rao, and Dr. Michael Madaio honoringMrs. Pam Hoeland for her generous gift to Digestive Health Center research.
Digestive Matters, Spring 2015 5 F rom the high-tech equipment to patient-friendly touches, every single detail in the new GRHealth Digestive Health Center is part of cent
