Gastroenterology Fellowship

The program of education as outlined above is designed to provide training and experience
for the fellow, allowing him/her the opportunity to develop competence of a specialist in
gastroenterology. This training includes clinical expertise with the development of history
and physical exam skills, consultation skills, interaction with other services in the evaluation
and management of patients, use of radiology, surgery, pathology, and related disciplines in
the assessment and management of patients with gastroenterologic disorders.

In addition, competence in endoscopy, including esophagogastroduodenoscopy, esophageal
dilation, flexible sigmoidoscopy and proctoscopy, colonoscopy with polypectomy,
percutaneous liver biopsy, percutaneous endoscopic gastrostomy, biopsies of the mucosa of
the esophagus, stomach and small bowel, and colon, treatment of bleeding, both variceal
and non-variceal are taught at KU Medical Center and at the VA Medical Center.

Competences will be determined, not only by the numbers, but also by their ability to
appropriately assess patients, understand the indications and risks, proceed with careful
evaluation during the procedure and recognize disease processes and plan appropriate
intervention. The American College of Gastroenterology has developed (with other societies)
guidelines for numbers of cases and the minimums that they require are easily met during
our training program.

During our conferences and consultation, we would expect to have formal instruction and
clinical experience and opportunities to all variety of these diseases of the gastrointestinal
tract:

1. Diseases of the esophagus including reflux inflammatory diseases, ulcerative, and
   infectious disease.
2. Acid peptic and Helicobacter related disorders of the gastrointestinal track.
3. Motility disorders including gastroesophageal reflux disease, dysphagia (its analysis
   and management), gastroparesis of all types, pseudo obstruction, and chronic
   constipation.
4. (Functional) bowel disorders including dyspepsia, Irritable bowel syndrome, chronic
   abdominal pain and non-cardiac chest pain.
5. Inflammatory bowel diseases including ulcerative colitis, ulcerative proctitis, Crohn's
   disease, and other inflammatory diseases including pseudomembranous colitis,
   colitis associated with collagen vascular disorders.
6. Malnutrition, malabsorption, and other disorders of nutrient assimilation.
7. Vascular disorders including ischemic bowel, arteria-venous malformations etc.
8. Gastrointestinal infections including Helicobacter, retroviral, "herpes, CMV, hepatitis,
   fungal and mycotic, and parasitic diseases.
9. Gastrointestinal neoplasms including esophageal cancer, gastric cancer, small bowel
   cancer, colon cancer, pancreatic cancer, and hepatocellular carcinoma, and biliary
   tract tumors.
10. Gastrointestinal diseases associated with acquired immunodeficiencies syndrome.
11. Cholelithiasis and choledocholithiasis
12. Chronic liver diseases:
    • Related to alcohol, related to chronic viral hepatitis, related to biliary tract
      disorders including primary biliary cirrhosis, primary sclerosing cholangitis.
    • Drug-induced hepatic injury
    • Management of chronic liver disease including assessment of portal
      hypertension including ascites and bleeding with utilization of paracentesis,
      TIPS, and endoscopic and surgical techniques.

In particular, during consultation and during conferences the trainee should be able to
evaluate patients who present with symptoms such as dysphagia, abdominal pain, acute
abdomen, acute and chronic nausea and vomiting, malabsorption, diarrhea, constipation,
gastrointestinal bleeding, jaundice, cirrhosis, with and without portal hypertension and
malnutrition, genetic or inherit disorders, depression, neurosis, and somatizations
syndromes The trainee should understand assessment, the use of consultative advisers to
assist and the ultimate treatment.

A gastroenterologist often works closely with gastrointestinal surgeons, and our program
emphasizes a good relationship with these colleagues. We stress the understanding of
surgical indications, management of patients pre and post operatively, and integrating care
and testing with our surgical colleagues in the management of patients.

At the conference level, and in daily clinical care, we emphasize that the trainees
understand the indications, contra indications, complications, limitations and interpretation
of a variety of diagnostic and therapeutic procedures. These include radiographic
procedures such as ultrasound of the abdomen, computed tomography, magnetic resident
imaging, vascular and nuclear medicine.

In the invasive radiographic program, we encourage the fellows to understand the
complications, limit his management of patient asses and interpret percutaneous
cholangiography, vascular intervention, TIPS, and drainage procedures as utilized by the
interventional radiologist.

Our program also maintains an active clinical and research motility program and a fully
complimentary diagnostic GI laboratory. Fellows are exposed to and understand the
indications and application of gastric, pancreatic and biliary secretory tests including gastrin
levels, gastric analysis, secretions, hydrogen breath testing, urea breath testing, pancreatic
polypeptide levels, and motility studies including esophageal manometry, gastroduodenal
manometry, anal rectal manometry, and 24-hour pH monitoring. Exposure to endoscopic
retrograde cholangiopancreatography is available.

It is our goal to expose all fellows to the appropriate indications and application of these
techniques and diagnosis and management of their patients. At certain level, a competence
is required, not only with diagnostic but also with therapeutic procedures in ERCP before the
individual can be fully certified. These include papillotomy and biliary and pancreatic stent
placement.

Competence will be measured by the expert faculty that is available supervising those
procedures.