CCE Gastrointestinal disorders: Mount Sinai Hospital

July 10, 2009

Mount Sinai Hospital's Division of Gastroenterology has been at the forefront of research, identification, and treatment of gastrointestinal illnesses for nearly a century.

Mount Sinai Hospital
New York, New York

Mount Sinai Hospital's Division of Gastroenterology has been at the forefront of research, identification, and treatment of gastrointestinal illnesses for nearly a century. It is a legacy that includes Burrill B. Crohn, MD. As a clinical investigator at Mount Sinai, Crohn, with his colleagues Leon Ginzburg, MD, and Gordon Oppenheimer, MD, published Regional ileitis in the Journal of the American Medical Association in 1932, which defined for the first time the disease that would eventually bear Crohn's name.

Today, Mount Sinai emphasizes the study of inflammatory bowel disease, and the division's research focuses on Crohn's disease and ulcerative colitis, says Lloyd Mayer, MD, chief of the Division of Gastroenterology.

Patients with IBDs have peaks and valleys, Mayer says. The disorder will go into remission and then re-emerge with little warning.

At Mount Sinai, patient care begins with research. Physicians are working to develop a blood test for an IBD biomarker. They are also studying the activation of cells that regulate intestinal immune response. "Crohn's and ulcerative colitis require a genetic disposition, but the clinical disease is manifested by an abnormal immune response," Mayer says.

The production of inflammatory cytokines and chemokines in both human tissues and mouse models of colitis is another area of research as is the identification of genes predisposing to IBD development, Mayer adds.

Recent research successes include demonstrating that a new noninvasive test accurately detects 86 percent of colon cancers, and that chronic bowel inflammation is a risk factor for colorectal cancer in patients with ulcerative colitis.

To help with future research, the division has accumulated an IBD biobank of more than 1,000 patients (with the goal of enrolling more than 2,000 patients) that provides tissue and DNA samples, Mayer says. The GI division has four full-time attending pathologists.

Integrated Patient Care

The division takes an integrated approach to patient care. After patients answer a series of questions about their symptoms, a GI-centric nurse practitioner explains the process before treatment begins and a nutritionist details dietary guidelines because many GI problems have some root in food intake.

In 2006, all endoscopic procedures at Mount Sinai were moved to a state-of-the-art endoscopy suite that incorporates the latest technology, Mayer says.

Mount Sinai physicians have turned to several novel therapies for the treatment of Crohn's disease and ulcerative colitis. Some of the basic scientific research leading to the use of infliximab for treatment of IBD came from Mount Sinai researchers, Mayer says."It has been life-altering for many patients," he stresses.

Other IBD therapies include 6-mercaptopurine and cyclosporine. "Patients who do not respond to IV steroids and are heading to the operating room for colectomy are often transferred to Mount Sinai to get cyclosporine," Mayer says.

Because of the potential complexity of IBD therapy, Mount Sinai employs a psychologist social worker, whose responsibilities include helping patients file insurance claims, which can be difficult because of the price of the biologic or higher biologic dose prescribed by a physician, Mayer says. Often, claims are initially denied, he adds.

"We've generated a series of form letters to help patients get the medication they need without interference from insurance companies," he says. "That becomes a large issue with many patients, especially when an individual in an insurance company argues about the requirement for a certain medication. We petition for the patient, and it has been very successful."

The Division of Gastroenterology established an open-access service for screening colonoscopies through which patients are referred by their primary care physicians. Assistance with scheduling, preparation, and transportation is provided to underinsured patients. Thanks to funding by the American Cancer Society and the Department of Medicine Advisory Board, the GI division is able to provide free colonoscopies for uninsured New York state residents. The program has reduced the waiting time for screening colonoscopy from more than three months to less than one month.

The multidisciplinary approach taken by physicians and researchers shows the full depth of their expertise across the GI disease spectrum, says Stephen Sigworth, MD, an internist in Mount Sinai's Division of General Medicine in New York. "It's comforting to know that when I refer a patient to a Mount Sinai gastroenterologist, I know that it comes with [that] depth," he says. "They perform complete and thorough evaluations, utilizing the latest technologies, to correctly diagnose and treat the patient. The patient is in particularly good hands, as some of the leading physicians and researchers in IBD are at Mount Sinai."

According to Mayer, the storied history of Mount Sinai is not lost on him or his colleagues. They know they have a legacy to live up to as they research and treat GI patients. "Mount Sinai has been known for specialty care through the years," Mayer says. "That tradition has attracted [GI] patients to Mount Sinai. It's also attracted physicians who wanted to study GI disorders. It becomes a self-fulfilling prophesy. Once you attract patients and good physicians, others who want to become expert in that area will migrate to that institution."