Adult Gastroenterology Training Program

Research Activity

Research Training

BASIC RESEARCH ACTIVITY (FARNCOMBE FAMILY DIGESTIVE HEALTH RESEARCH INSTITUTE)

The Farncombe Family Digestive Health Research Institute is an integrated group of clinical and basic scientists dedicated to understanding the impact of digestive health and nutrition on disease across the life span. The institute is focused on developing new strategies for the diagnosis, treatment and prevention of intestinal diseases such as Crohn’s disease and ulcerative colitis. However, the focus of research in the institute is not limited to digestive disease; rather, it includes diseases of many other organ systems that may be caused and/or profoundly influenced by digestive health.

Facilitated by an extraordinary $15 million donation from the Farncombe family, the institute was established as an outgrowth of McMaster University’s Intestinal Diseases Research Program (IDRP), originally founded in 1983. The Farncombe Family’s generous contribution has allowed by the establishment of endowed chairs and infrastructure capital, which will ensure the long-term success of the institute and enhance its role as an innovative training environment.

For more than 20 years, McMaster’s Intestinal Diseases Research Program has garnered an international reputation as one of the top 10 gastrointestinal research groups in the world. The growth in research funding, faculty awards and the expansion into a Research Institute is a testament to the critical role McMaster researchers are playing in the study of digestive disorders.

Mission

The mandate of Farncombe Family Digestive Health Research Institute encompasses its leadership role in research, innovation and training as it relates to intestinal diseases. The mission of the Farncombe Family Digestive Health Research Institute:

  1. Understand the causes of chronic gastrointestinal diseases that are prevalent in society, and to develop new strategies for their diagnosis, treatment and prevention.
  2. Provide a productive and innovative training environment.
  3. Maintain excellence in research at an international level.

There are 14 full members of the Farncombe Family Digestive Health Research Institute. These members conduct their primary research within the Institute’s facilities. There are 13 associate members who conduct collaborative research with the institute’s members. The Farncombe Institute includes Canada’s only gnotobiotic laboratory and houses a metagenomics platform that includes a Roche 454 rapid DNA sequencer. There is a clinical research center within the institute that conducts clinical trials, meta-analyses, epidemiological studies in affiliated hospitals as well as on a national and international basis. The institute has a large complement of technical staff, graduate students and research fellows as well as administrative staff.

Research Themes

The Farncombe Family Digestive Health Research Institute conducts research under the following themes:

  • Inflammation, infection and mucosal immunology (including the pharmacology of inflammation)
  • Molecular microbiology
  • Gut-Brain Interactions and the relationship of gastrointestinal diseases with emotional stress, anxiety and depression, including the exploitation of models of behavioral illness
  • Gastrointestinal physiology (including motility, pain perception, entero-endocrine cell function and mucosal barrier function)
  • Abnormal responses to food (including gliadin sensitivity and other food intolerances)
  • Developmental neurobiology
  • Hepatic blood flow and vascular adhesion molecule expression in sepsis and multi-organ failure
  • Clinical, Epidemiological and Health Services Research

The above-described themes represent overlapping areas of research interests, with most institute researchers working in more than one area. This forms the basis of the institute’s integrated research program on gut function in health and disease.

Specific Areas of Research

  • The role of resident bacteria in the development of the immune system and its reactivity; allergic and autoimmune disease; hygiene hypothesis of diseases of developed countries.
  • Pathogenesis of chronic inflammatory disorders including celiac disease
  • Role of pathogenic bacteria in functional gastrointestinal disorders (post-infective IBS) including epidemiological studies and patient phenotyping and genotyping (e.g. in Walkerton residents).
  • The role of resident bacteria in inflammatory and functional gastrointestinal diseases and the accompanying psychiatric co-morbidity; rationalization of probiotic use in these and other disorders
  • Assessments of brain-gut interactions including established models of primary behavioural disorders and behavioral phenotyping.
  • Immuno-physiology and host defense in the context of intestinal infection/inflammation
  • Physiology of enteroendocrine cells
  • Myogenic and neural control of intestinal smooth muscle, in particular the electrophysiology of smooth muscle cells and interstitial cells of Cajal (ICC)
  • Pathophysiology of gut motor abnormalities
  • Interaction between immune cells, in particular resident immune cells, ICC smooth muscle and enteric nerves
  • Sensory and autonomic neuroscience and information processing in enteric neuronal networks
  • Leukocyte recruitment to bring inflammatory cells to the site of infection or injury in the liver
  • Adhesion molecules for leucocytes in the liver

Full Members

The membership of the Farncombe Institute can be reviewed on the website, where in depth profiles of the individual faculty members’ research interests (and recent publication citations) are available. The following list gives only a briefest introduction to the members’ research expertise.

David Armstrong, MD – upper gastrointestinal diseases including gastroesophageal reflux, Barrett’s esophagus, Helicobacter pylori-related diseases and dyspepsia; nutrition, including home parenteral nutrition; practice audit and education in endoscopy

Premysl Bercik, MD –functional gastrointestinal diseases, gastrointestinal motility, visceral sensitivity, gut-brain axis

Stephen Collins, MD – immune modulation of enteric nerve and muscle function

Alison Fox-Robichaud, MD – adhesion molecules, pro-inflammatory mediators and endogeneous anti-inflammatory molecules in systemic inflammation

Jan Huizinga, PhD – physiology and pharmacology of gastrointestinal motility, cellular and molecular basis of peristalsis and mixing motor patterns, effects of inflammation and gut bacteria on motility

Richard Hunt, MD – pathophysiology of acid related disorders, clinical pharmacology of treatment of gastrointestinal disease

Robert Issenman, MD – pediatric Gastroenterology

Waliul Khan, PhD –Mucosal immunology, immuno-physiology and host defense in the context of intestinal infection/inflammation.

John Marshall, MD – clinical studies in inflammatory bowel disease and post-infectious IBS, clinical epidemiology, gastrointestinal bleeding, health economics and outcomes research, technology assessment

Paul Moayyedi, MD – clinical epidemiology, health economics and outcomes research

Elyanne Ratcliffe, MD – normal and abnormal development of the extrinsic innervation of the gut

Michael Surette, PhD – normal flora-pathogen interactions in health and disease

Elena Verdu, MD –the pathogenesis of chronic inflammatory disorders such as celiac disease, host-bacterial interactions in particular in the context of probiotics and functional gastrointestinal diseases

CLINICAL RESEARCH ACTIVITY

McMaster is also the home of a world-renowned expertise in health research methodology and clinical epidemiology. Gastroenterology trainees can obtain formal education in the design and execution of clinical research, both within the Training Program and by participating in the M.Sc. program in Health Research Methodology.

Drs. Moayyedi, Leontiadis, Marshall, Ganguli, and Tse are all trained in clinical epidemiology. Dr. Marshall conducts clinical research, with interests in IBD, post-infectious IBS, gastrointestinal bleeding, technology assessment and health economics. Drs. Hunt, Armstrong and Morgan have international reputations in the area of the pathophysiology and treatment of peptic ulcer disease and gastroesophageal reflux, which provide excellent opportunities for education in research. Gastrointestinal motility has traditionally been a strong presence at McMaster, both at the bench and bedside, and several fellows have worked successfully in this arena of research under the mentorship of Drs. Collins and Bercik. Dr. Moayyedi brings a wealth of experience in clinical epidemiology, systematic review, health outcomes and health economics research in the areas of dyspepsia and colorectal cancer screening. Dr. Leontiadis has an established interest in the role of acid suppression in managing gastrointestinal bleeding. Dr. Tse has an interest in the role of ERCP in gallstone pancreatitis and the prevention of post-ERCP pancreatitis.

The Division of Gastroenterology conducts clinical research at all three training sites, with clinical Research Nurses and clinical Research Assistants. The McMaster Site offers a clinical investigation unit fully equipped for human phase I to III trials, including pharmacokinetics, pharmacodynamic and endoscopy studies. Members of the Division also participate in Phase III and Phase IV single- and multi-centre controlled trials of medical therapy for inflammatory bowel disease, functional gut disorders, acid-peptic disorders and viral hepatitis.

The Cochrane Upper Gastrointestinal and Pancreatic Diseases Review Group (Cochrane UGPD Group) also has a base at McMaster University to facilitate the synthesis and knowledge translation of primary GI research to patients and clinicians. Drs. Paul Moayyedi and Grigorios Leontiadis serve as Joint Coordinating Editors, and Dr. Frances Tse is one of the Editor for the Cochrane UGPD Group. Residents are encouraged to participate in Cochrane Systematic Reviews, and make use of the expertise of the Cochrane UGPD Review Group in the design and conduct of their research projects.

M.Sc. in Health Research Methodology (Resources: Drs. Moayyedi, Marshall, Leontiadis, Tse, Ganguli, Khan)

The Health Research Methodology Program offered by the Department of Clinical Epidemiology & Biostatistics provides M.Sc. and Ph.D. training in clinical research methodology to physicians, allied health care workers, and others interested in clinical research. The HRM Program offers an internationally-renowned faculty with extensive research experience and methodologic expertise. To complete the M.Sc. program requires 2 years after the core GI training program, depending on the trainee’s industry, choice of coursework and thesis project. Drs. Marshall, Ganguli and Tse are graduates of the Program, and serve as resources within the Division of Gastroenterology for trainees interested in formal postgraduate training in HRM. Such trainees are encouraged to identify their interest early, as entry to the HRM Program is highly competitive and not guaranteed and applications for extramural salary support are encouraged. However, coursework from the HRM Program often results in publication and/or grant submissions to peer-reviewed funding agencies.

Faculty Members with Research Interests

The faculty members of the Division of Gastroenterology can be reviewed on the website, where in depth profiles of the individual faculty members’ research interests (and recent publication citations) are available. The following list gives only a briefest introduction to the members’ research expertise.

Rebecca Anglin, MD – Psychiatry of gastrointestinal disorders, mitochondrial involvement in psychiatric illness, neuroimaging in psychiatric illness, neurobiology of women’s mental health, postgraduate OSCE evaluation

David Armstrong, MD – upper gastrointestinal diseases including gastroesophageal reflux, Barrett’s esophagus, Helicobacter pylori-related diseases and dyspepsia; nutrition, including home parenteral nutrition; practice audit and education in endoscopy

Premysl Bercik, MD –functional gastrointestinal diseases, gastrointestinal motility, visceral sensitivity, gut-brain axis

Stephen Collins, MD – immune modulation of enteric nerve and muscle function

Subash Ganguli, MD – alternative medicines in functional bowel disease and motility disorders, and the autonomic nervous system

Smita Halder, MD – epidemiology of chronic GI disorders, use of biomarkers in determining GI disease course, clinical health outcomes in women with inflammatory bowel disease

Richard Hunt, MD – pathophysiology of acid related disorders, clinical pharmacology of treatment of gastrointestinal disease

Khurram Khan, MD – outcome research, inflammatory bowel disease, bowel preparation for colonoscopy

Grigorios Leontiadis, MD – pharmacological treatment of peptic ulcer disease, pathophysiology and treatment of Helicobacter pylori infection, prevention of upper gastrointestinal side-effects of non-steroidal anti-inflammatory drugs and diagnostic utility of small bowel capsule endoscopy

John Marshall, MD – clinical studies in inflammatory bowel disease and post-infectious IBS, clinical epidemiology, gastrointestinal bleeding, health economics and outcomes research, technology assessment

Paul Moayyedi, MD – clinical epidemiology, health economics and outcomes research

David Morgan, MD – dyspepsia, particularly with regards to effects of non-steroidal anti-inflammatory drugs, colon cancer prevention with COX-2 specific inhibitors and upper GI bleeding, particularly with relation to non-steroidal anti-inflammatory drug use

Mark Puglia, MD – clinical trials in viral hepatitis

Robert Spaziani, MD – autonomic function in patients with GI disease and associated central control mechanisms

Frances Tse, MD – the role of ERCP in gallstone pancreatitis, endoscopic and pharmacologic interventions for the prevention of post-ERCP pancreatitis, use of simulation in endoscopy training, evaluation of endoscopic technologies

Keith Tsoi, MD – clinical trials in viral hepatitis

Ted Xenodemetropoulos, MD – health information technology, medical education, quality improvement and practice audit