Affiliated WithCOLUMBIA UNIVERSITY COLLEGE OF .

New PhysicianAppointments 2003NewYork-Presbyterian Hospitalhas recruited the followingphysicians to its DigestiveDiseases Service Line:illiam Barlow Inabnet, III, MD,FACS, was named Chief of EndocrineSurgery at NewYork-PresbyterianHospital/Columbia University MedicalCenter, and Assistant Professor of Surgery atColumbia University College of Physicians& Surgeons. His interests include minimallyinvasive thyroid, parathyroid, adrenal, andpancreatic surgery, as well as laparoscopicbariatric surgery.E-mail: wbi2102@columbia.edu.Wracey D. Arnell, MD, was namedAssistant Professor of Surgery in theDivision of General Surgery at NewYorkPresbyterian Hospital/Columbia UniversityMedical Center. She is also AssistantProfessor of Surgery at Columbia UniversityCollege of Physicians & Surgeons. Herinterests include inflammatory bowel disease,colo-rectal cancer, and evidence-basedmedicine.E-mail: ta2107@columbia.edu.Tohn D. Allendorf, MD, was namedAssistant Attending Surgeon at NewYorkPresbyterian Hospital/Columbia UniversityMedical Center, and Instructor of ClinicalSurgery at Columbia University College ofPhysicians & Surgeons. He completed hisfellowship in liver transplantation and hepatobiliary surgery in July 2002.E-mail: jda13@columbia.edu.Jichel Gagner, MD, was namedDirector of the Bariatric SurgeryProgram at NewYork-PresbyterianHospital/Weill Cornell Medical Center. Heis also Assistant Professor of Surgery atWeill Medical College of Cornell University.His interests include studying the surgicaltreatment of morbid obesity.E-mail: mig2016@med.cornell.edu.Merond V. Lake-Bakaar, MD, wasnamed Assistant Attending Physician atNewYork-Presbyterian Hospital/WeillCornell Medical Center, and AssociateProfessor of Clinical Medicine at WeillMedical College of Cornell University. Hislaboratory is currently focused on viralGNewYork-Presbyterian Digestive Diseases is a publication of the Digestive DiseasesCenter of NewYork-Presbyterian Hospital. The Digestive Diseases Center is at theforefront of research and practice in the areas of gastroenterology; GI surgery; andliver, bile duct, and pancreatic disorders. NewYork-Presbyterian Hospital/ColumbiaUniversity Medical Center and NewYork-Presbyterian Hospital/Weill CornellMedical Center are respectively affiliated with Columbia University College ofPhysicians & Surgeons and the Weill Medical College of Cornell University.NewYork-Presbyterian Digestive Diseases Editorial BoardJohn Chabot, MDJeff Milsom, MDChief, Division of General SurgeryMedical Director, Operating Rooms,NewYork-Presbyterian/ColumbiaAssociate Professor of Surgery,Columbia University College ofPhysicians & Surgeonsjac4@columbia.eduChief, Division of Colorectal Surgery,NewYork-Presbyterian/Weill CornellProfessor of Surgery, Colon and RectalSurgery Section, Weill Medical College ofCornell Universityjwm2001@med.cornell.eduKenneth Forde, MDVice-Chairman for External Affairs,Department of Surgery,NewYork-Presbyterian/Weill CornellJosé M. Ferrer Professor of Clinical Surgery,Columbia University College ofPhysicians & SurgeonsAdjunct Professor of Clinical Surgery,Weill Medical College of Cornell Universitykaf2@columbia.eduDennis Fowler, MDDirector of the Minimal AccessSurgery Program,NewYork-Presbyterian/ColumbiaProfessor of Clinical Surgery, ColumbiaUniversity College of Physicians & Surgeonsdlf2001@med.cornell.eduIra Jacobson, MDChief of the Gastroenterology ServiceNewYork-Presbyterian/Weill CornellChief, Division of Gastroenterology andHepatology, and Vincent Astor Professor ofClinical Medicine, Weill Medical College ofCornell Universityimj2001@mail.med.cornell.eduArthur Magun, MDInterim Chief, Division of Digestiveand Liver Diseases,NewYork-Presbyterian/ColumbiaClinical Professor of Medicine,Columbia University College ofPhysicians & Surgeonsamm3@columbia.eduPaul Miskovitz, MDAttending Physician,NewYork-Presbyterian/Weill CornellClinical Professor of Medicine,Division of Gastroenterology and Hepatology,Weill Medical College of Cornell Universitypaulmiskovitz@pol.netMark Pochapin, MDDirector, Jay Monahan Center forGastrointestinal Health,NewYork-Presbyterian/Weill CornellDirector, GI Endoscopy, Division ofGastroenterology and Hepatology, andAssociate Professor of Clinical Medicine,Weill Medical College of Cornell Universitymbpocha@mail.med.cornell.eduLewis Schneider, MDAssistant Attending Physician,NewYork-Presbyterian/ColumbiaAssistant Professor of Clinical Medicine,Columbia University College ofPhysicians & Surgeons(212) 326-8426Peter D. Stevens, MDDirector, Gastrointestinal EndoscopyDepartment, Clinical Director, Divisionof Digestive and Liver Diseases,NewYork-Presbyterian/ColumbiaAssistant Professor, Clinical Medicine,Columbia University College ofPhysicians & Surgeonspds5@columbia.eduRichard L. Whelan, MDSite Director, Minimal Access SurgeryCenter, and Chief, Section of Colon andRectal Surgery,NewYork-Presbyterian/ColumbiaAssociate Professor of Surgery,Columbia University College ofPhysicians & Surgeonsrlw3@columbia.eduwww.nypdigestive.orgsee Appointments, page 43

NE WYO R K– PR E S B Y T E R I A NDigestive DiseasesClinical Trials UpdateThe following is a partial list ofcurrent clinical trials:Primary Investigator:Title: Randomized evaluation of thesafety, efficacy, and outcomes oflaparoscopic adjustable gastric banding(LAGB) versus laparoscopic gastricbypass (LGB) in patients with morbidobesityTitle: An open-label, randomized, controlled, phase III, multicenter, clinicaltrial of PN401 with high-dose fluorouracil (5FU) versus gemcitabine fortreatment of patients with advancedpancreatic cancerPrincipal Investigator:Principal Investigator:Marc Bessler, MDContact: Amna Daud,ad731@columbia.eduRoger S. Keresztes, MDContact: Shannon Holloway,(212) 746-3224Title: A phase II trial of oral thalidomideas an adjuvant agent following metastasectomy in patients with recurrent colorectal cancerPrimary Investigator:John Chabot, MDContact: Steven K. Libutti, MD,steven libutti@nih.govTitle: A prospective, randomized, openlabel study evaluating the viral kineticsand pharmacokinetics of pegasys pluscopegus and peg-intron plus rebetol ininterferon-naïve patients with chronichepatitisTitle: An open-label, multicenter, doseescalation study to assess the safety, tolerability, and activity of ISIS 14803 inchronic hepatitis C patients undergoingpegylated interferon alfa-2b and ribavirintreatment who have not achieved anearly virologic responsePrimary Investigator:Ira M. Jacobson, MDContact: Nova Y. West,nyw2002@med.cornell.eduTitle: An open-label phase I study toevaluate the safety and tolerability ofPanvac-VF in combination with GMCSF in patients with unresectable adenocarcinoma of the pancreasAppointmentscontinued from page 3dynamics of hepatitis C and the rapidearly evolution of the virus, whichallows it to “escape” interferonantiviral therapy.E-mail: gvl2002@med.cornell.edu.4Howard L. Kaufman, MDContact: Josie Mitcham,jm2124@columbia.eduPrimary Investigator:Gerond Lake-Bakaar, MDContact: Nova Y. West,nyw2002@med.cornell.eduTitle: A phase III, randomized, controlled study comparing the survival ofpatients with unresectable hepatocellular carcinoma (HCC) treated withthymitaq to patients treated with doxorubicinPrimary Investigator:Kyriakos Peter Papadopoulos, MDContact: Cara DeRosa,derosa@cancercenter.columbia.eduTitle: Percutaneous treatment of livertumors with acetic acidPrimary Investigator:John H. Rundback, MDlfons Pomp, MD, was namedAssistant Attending Physician atNewYork-Presbyterian Hospital/WeillCornell Medical Center and AssistantProfessor of Surgery at Weill MedicalCollege of Cornell University. His primary clinical research interest islaparoscopic bariatric surgery.E-mail: alp2014@med.cornell.edu.AContact: Leslie Schmidt,ls72@columbia.eduTitle: A multicenter, randomized,double-blind, placebo-controlled trial ofrifaximin in patients with pouchitis withprior abdominal colectomy and ilealpouch–anal anastomosis for ulcerativecolitis followed by 4 weeks of dosingwith open-label rifaximinPrimary Investigator:Ellen Scherl, MDContact: Debbie Golden,dlg2006@med.cornell.eduTitle: International cooperative pancreatic cyst (CPC) investigationPrimary Investigator:Peter Stevens, MDContact: Peter Stevens, MD,pds5@columbia.eduTitle: A randomized clinical trial comparing 2 management strategies for thetreatment of neutropenia and anemiaassociated with pegylated interferon andribavirin treatment of compensatedchronic hepatitis C in adult subjectsinfected with HIVPrimary Investigator:Andrew H. Talal, MDContact: Andrew H. Talal, MD,aht2002@med.cornell.eduTitle: Phase III randomized, controlledstudy comparing the survival of patientswith unresectable hepatocellular carcinoma treated with thymitaq to patientstreated with doxorubicinPrimary Investigator:Scott Wadler, MDContact: Shannon Holloway,212-746-3224For information on more clinical trials in DigestiveDiseases, visit: www.nypdigestive.org.ang Lee, MD, Assistant AttendingSurgeon at NewYork-PresbyterianHospital/Weill Cornell MedicalCenter, was appointed AssistantProfessor of Surgery at Weill MedicalCollege of Cornell University. Hisinterests include laparoscopic colon andrectal surgery.E-mail: sal2013@med.cornell.edu.S

Monahan Center Incorporates GastrointestinalCancer Research and Treatmenthe Jay Monahan Center forGastrointestinal Health, acollaboration of NewYorkPresbyterian Hospital and WeillMedical College of Cornell University,provides seamless, multidisciplinarycare through a core team made up ofgastroenterologists, surgeons, oncologists, and a nurse coordinator. Patientswill also have access to genetic counselors, social workers, psychologists,nutritionists, and home care services.“This place is going to be unique,”said Mark Pochapin, MD. “It’s notTgoing to be a place where patients justget shuttled in and out of rooms.”The Monahan Center is named forJay Monahan—the late husband ofNBC Today show co-anchor KatieCouric. Monahan was diagnosed withadvanced colon cancer at the age of 41.He and his family were troubled by theexhausting effort needed to collectinformation and identify treatmentoptions. Monahan battled the diseasefor several months. He died in 1998.In 2000, Couric brought attention tothe need for further research in the“[The Monahan Center] is going to be unique. The peoplewho were chosen to work here are very caring, responsible,and compassionate. It’s not going to be a place where patientsjust get shuttled in and out of rooms.”—Mark Pochapin, MDAt the Monahan Center, GI cancer patients will have access to genetic counselors, socialworkers, psychologists, nutritionists, and home care services.area of gastrointestinal cancers with a5-part series of broadcasts entitled,“Confronting Colon Cancer,” duringwhich she underwent a televised colonoscopy performed by Kenneth Forde,MD, at NewYork-PresbyterianHospital and Columbia UniversityCollege of Physicians & Surgeons. Dr.Pochapin, who was Monahan’s gastroenterologist, took part in the series.A year later, a follow-up series won theprestigious Peabody Award for broadcast journalism.“After that segment aired, investigatorslooked at the rates of colonoscopy, andthey had jumped by almost 20%,” saidDr. Pochapin. This phenomenon, dubbedthe “Couric Effect” by researchers at theUniversity of Michigan and the University of Iowa, was the subject of an articlein Archives of Internal Medicine last year(2003 Jul 14;163(13):1601-1605).After Monahan’s death, his familypledged to find a better way to treat GIcancers. With the support of theEntertainment Industry Foundation’sNational Colorectal Cancer ResearchAlliance, the Center was established.Physicians at the Center will have theresources to evaluate and offer newapproaches to prevention and treatmentof gastrointestinal cancers, from the latestdiagnostic equipment to alternative andholistic options.The Center will also provide a universal referral service for information onclinical outcomes, research protocols,prevention, and treatment. Research willfocus on the most promising clinical trials, ensuring the latest and most effectivepatient care options.Mark Pochapin, MD, is Director, JayMonahan Center for GastrointestinalHealth, and Director, GI Endoscopy,Division of Gastroenterology andHepatology at NewYork-Presbyterian/WeillCornell. He is also Associate Professor ofClinical Medicine at Weill Medical Collegeof Cornell University.E-mail: mbpocha@mail.med.cornell.edu.5

NE WYO R K– PR E S B Y T E R I A NDigestive DiseasesDavid A. Brenner, MD: New Chair of MedicineSees Breakthroughs in GI ResearchHopes to Bring New Research Focus to GI Divisionavid A. Brenner, MD, says hisprimary goal as the newDirector of Medical Service atNewYork-Presbyterian Hospital/Columbia University Medical Centerand Chairman of the Department ofMedicine at Columbia UniversityCollege of Physicians & Surgeons is to“bridge the gap between the terrificbasic research and devoted patient care”through translational research.“This is one of the unique roles ofacademic medical centers,” explainedDr. Brenner. “Basic science can be donein many places. But translating thoseseminal observations into asking clinically relevant questions can really onlybe done at academic medical centers.That’s going to be one of our uniqueniches in the next 20 years.”Dr. Brenner is editor-in-chief ofGastroenterology, the field’s premierjournal. He arrived at NewYorkPresbyterian/Columbia from theUniversity of North Carolina, where heserved as the university’s Chief of theDivision of Digestive Diseases andNutrition.He received his medical degree fromYale University. After serving as a resident at Yale, he worked at the NationalInstitutes of Health, then joined theDepartment of Medicine at theUniversity of California, San Diego. In1992, he was appointed the Nina andJohn Sessions Distinguished Professorof Digestive Diseases at the Universityof North Carolina, where he also held aprofessorship in biochemistry and biophysics.Having moved his laboratory toNewYork-Presbyterian/Columbia, Dr.Brenner is continuing his fundamentalD6research in liver fibrosis and intracellular signaling. In his first 6 monthson the job, his primary observation isthat “the students, the residents, andthe faculty here are all just outstanding,the best I’ve ever had the honor ofworking with.”In research on Barrett’s esophagus,he predicted, researchers at NewYorkPresbyterian Hospital/Columbia will“clarify what the benefits are of screening for adenocarcinoma in Barrett’spatients.” And to increase access tocolon cancer screening, he said, “virtual“Basic science can be done in many places. But translatingthose seminal observations into asking clinically relevantquestions can really only be done at academic medicalcenters. That’s going to be one of our unique niches in thenext 20 years.”—David A. Brenner, MDIn GI research, he foresees excitingnew advances. “Irritable bowel disease isan area where there are incrediblebreakthroughs in biologics and newtherapies,” he said. “The opportunitiesto offer improved patient care and newdiagnostic tests are going to be enormous over the next 10 years.”The study of obesity and nonalcoholic fatty liver disease offers anotheropportunity for making importantobservations, according to Dr. Brenner.“It’s become an area of particularlyintense research because of the largenumber of patients undergoing surgeryfor obesity,” he said. “This is an opportunity to not only provide better clinicalcare, but also to learn more about thedisease and its treatment. There will beclinical trials to assess what the effect ofgastric surgery is on obesity and on theliver disease associated with it.”colonoscopy done by CT scans—aswell as new tests in the blood and stoolfor cancer cells and cancer markers—will make for much more efficientscreening. Only those patients whohave positive findings will get acolonoscopy.”To lead the GI division, Dr. Brenneris in the process of recruiting a newdivision chief, whose primary focuswill be on basic research.“I want someone to be a leader inthe molecular pathophysiology of GIdiseases, someone who does fundamental research,” he said. “We hope toreinvigorate that field.”David A. Brenner, MD, is Director,Medical Service at NewYorkPresbyterian/Columbia, and Chairman,Department of Medicine at ColumbiaUniversity College of Physicians &Surgeons. E-mail: dab2106@columbia.edu.

Hypertensioncontinued from page 1group, with far fewer interventions andbetter uninterrupted maintenance ofportosystemic decompression.”Most patients with TIPS require theprocedure because worsening liver disease and resultant portal hypertensionlead to recurrent variceal bleeding orrefractory ascites. But Dr. Haskal’s teamof interventional radiologists uses TIPSin other, more unusual ways, in patientswhose portal hypertension is not causedby liver disease. They work closely withtransplant specialists Robert Brown,MD, and Jean C. Emond, MD, toemploy a multidisciplinary approach forpatients with portal hypertension andother liver-related conditions.“Our approach is to look at the portalpressure and blood flow, as well as theunderlying condition,” said Dr. Brown.One example is Budd-Chiari syndrome. This occurs in patients whoselivers may be healthy but, because of avariety of hypercoagulation disorders,their blood tends to clot, causing blockages in veins flowing out of the liver.“These patients have an essentially normal liver with an outflow problem,” Dr.Haskal said. “The liver becomesswollen, congested, and painful. Thepatients develop ascites. These arepatients in whom pressure-loweringprocedures like TIPS can actually prevent development of liver disease.”IBScontinued from page 1system in the brain and the enteric nervous system in the intestine. By breakingthe brain–gut connection, we can makepatients more comfortable and less visceralized—less focused on their intestineand more focused on their life.”According to Dr. Frissora, approximately 96% of serotonin is located inthe GI tract, compared to just 2% in thecentral nervous system. The serotoninLeft, a patient treated with a conventional TIPSbare stent at 3-month follow-up, and (right)another treated with a stent-graft TIPS at 6month follow up. The graft-lined shunt (arrow)remains widely patent compared with the shuntlined with the conventional stent, which hasnarrowed despite repeated interventions(arrow). Inset: The Viatorr endoprosthesis usedin the US Randomized TIPS Trial.Dr. Haskal and his team recentlylooked at a series of patients with BuddChiari syndrome, who were treated withTIPS. Over a follow-up period of morethan 2 years, “we have seen that everypatient has had improvement or regression of their hepatic congestion, improvement of liver function, and resolution of their ascites,” he reported.“We’re looking at a treatment that willhave a 20- to 50-year horizon, unlike theother patients with chronic liver disease.I practice very aggressive follow-up bydoing transjugular biopsies in thesepatients to demonstrate that there is nofurther stimulus to ongoing cirrhosis orscarring because the congestion has beentreated by bypass. In 10 years of treatingsuch patients with TIPS, I’ve seen only 1require liver transplantation.”The interventional radiology teamhas explored other unusual conditionsto leverage the advantage of TIPSpatients with acute or chronic mesenteric portal and splenic vein thrombosis,for example. “They are generally healthypatients with a hypercoagulation syndrome, who come in with abdominalpain and whose symptoms worsendespite anticoagulation,” he said. “Andwe have used catheter-directed techniques, including thrombolysis,mechanical thrombectomy, and TIPStogether in the same patient to restorepatency. These patients are seen potentially by a cohort of physicians acrossspecialties. If they come to see medirectly, I involve the liver team andvice versa.”receptors most important in the GItract in general and IBS in particular,she says, are the 5-HT3 and 5-HT4receptors. Dr. Frissora was involved inthe work that led to the FDA’s approvalin July 2002 of the newest drug for IBSin women: tegaserod, a 5-HT4 partialagonist that increases intestinal motility.It remains the first and only agentshown to relieve all 3 of the so-calledABCs of IBS: abdominal pain, bloating,and constipation.Currently, Dr. Frissora is recruitingpatients for a 12-week, double-blind,placebo-controlled Phase II trial ofdextofisopam in men and women withIBS that is either diarrhea-predominantor characterized by alternating diarrheaand constipation. “The greatest efficacyfor the drug is expected in thesegroups,” she said, although it may eventually prove effective for other types ofIBS, she added. “Dextofisopam is anovel compound for which there is noequivalent drug in the United States,”Dr. Frissora continued. “The mainappeal is that it is a nonsedating, nonad-Ziv Haskal, MD, is Director of the Divisionof Vascular and Interventional Radiology,NewYork-Presbyterian/Columbia, andProfessor of Radiology and Professor ofSurgery, Columbia University College ofPhysicians & Surgeons.E-mail: zh50@columbia.edu.see IBS, page 87

IBScontinued from page 7dicting benzodiazepine. It may be usefulto treat stress and anxiety-induced GIsymptoms without the risk of sedation,addiction, or cognitive impairment.”NewYork-Presbyterian/Weill Cornell isone of the primary sites in the multicenter trial. As of January, Dr. Frissora hadenrolled 6 patients, and was looking toenroll 4 more.Another Phase II trial led by Dr.Frissora, completed last year, involved anNK3 antagonist called talnetant, a regulatory peptide that may play an important role in the pain and altered motilityassociated with IBS. Plans for additionaldose-ranging studies are under way andwill examine men and women with alltypes of IBS symptoms. The next clinical trial led by Dr. Frissora and her teamwill investigate a new probiotic,Biobalance, which patients ingest toimprove their intestinal flora. Dr.Frissora is a co-investigator on the trialwith Mark Pochapin, MD.“Biobalance is a specific strain of E.coli that has been used in Israel to treatgas and bloating,” Dr. Pochapin said.“Phase II studies will soon be conducted in the United States with NewYorkPresbyterian/Weill Cornell as a primary site.”In the future, there are also plans for aclinical trial surrounding an investigational agent that is a serotonin-1 receptor modulator. “It’s thought to workmore peripherally than centrally,” Dr.Frissora said. But any trial for the syndrome has to jump 2 high hurdles. First,the patients enrolled for such trials aretypically refractory to other treatments,meaning they’re the hardest to treat.And second, “because the symptoms ofIBS are so subjective, it’s sometimes h

Ira Jacobson, MD Chief of the Gastroenterology Service NewYork-Presbyterian/Weill Cornell Chief, Division of Gastroenterology and Hepatology, and Vincent Astor Professor of Clinical Medicine, Weill Medical College of Cornell University imj2001@mail.med.cornell.edu Arthur Magun, MD Interim Chief, Division of Digestive and Liver Diseases,