Since its beginning in the early 1940s, the Division of Gastroenterology at the University of Michigan has been at the forefront of digestive and liver research.
The Pollard Era (1947-1972)
Under the leadership of Dr. H. Marvin Pollard, the Division of Gastroenterology was founded in 1947, long before gastroenterology was a subspecialty recognized by ABIM. Dr. Pollard was not formally trained as a gastroenterologist, simply having attended a number of post-graduate courses, but he deserved credit for introducing the Schindler scope, which was a semi-rigid endoscope. Dr. Pollard was a visionary leader, a man of great charm and leadership abilities. He presided over every organization he joined which included the American Gastroenterology Association, the American College of Physicians, and the American Cancer Society. He was one of the founders of the World Organization of Gastroenterology and became its President.
Dr. Pollard believed strongly that every self-respecting academic entity should have a research laboratory. Unfortunately at the time, there were no funds, but Dr. Pollard was not deterred. Through philanthropy, he cobbled enough funding to develop the first GI research unit at the University of Michigan. Under his tenure, he trained a number of notable gastroenterologists who became academic leaders in their own rights. These include Dr. Basil Hirschowitz, Dr. Keith Henley, Dr. R. J. Bolt, Dr. W. H. Bachrach, Dr. Arthur B. French, Dr. Ludovic Standaert, Dr. Jorge Gumucio, Dr. Milton Weiser and Dr. D. W. Watson. Perhaps the most important development during the Pollard era was the invention of the first fiber optic endoscope, the first of its kind to exam the upper gut. Much of the work was performed by Dr. Basil Hirschowitz. Working together with Dr. Hopkins and Dr. Kapany, and subsequently with Mr. Curtis and Dr. Peters from the Physics Department at the University of Michigan, and with the financial support of Dr. Pollard, Dr. Hirschowitz completed the construction of the first model of the fiber scope. This became the prototype for the gastroduodenal scope that we now use in our Medical Procedures Unit. For this achievement, Dr. Hirschowitz was awarded the Julius Friedenwald Medal, which is the highest distinction bestowed by the American Gastroenterological Association upon its member.
Other important achievement during the Pollard era includes the development of a simplified, multiple-retrieving small bowel biopsy tube. In 1962, Dr. Bolt and Dr. French performed the first intestinal biopsy in the modern era. The findings were published in American Journal of Digestive Diseases in 1962. Using this instrument, Dr. French and Dr. Bolt performed a number of pioneering studies correlating morphology and malabsorption in celiac disease. Subsequently, Dr. French was appointed to be the first Director of the Clinical Research Unit at the University of Michigan.
The Pollard era was marked by successful academicians and innovations. Dr. Pollard was a man of astute insight into individuals, whether they are colleagues or patients, and a master in demonstrating the care of private patients. He was able to generate support for salary of faculty and technical personnel through philanthropy. The research unit was among the first of its kind to receive NIH research funding and career development awards. He had one of the earliest NIH research training grants. Dr. Pollard’s foremost contribution to the University of Michigan Medical School is the development of the H. Marvin Pollard Research Institute. The endowment that he collected has grown over the last 30 years and now supports 7 endowed professorships within the Division of Gastroenterology.
The Henley Era (1972-1981)
Dr. Pollard retired in Fall 1972 and Dr. Keith S. Henley, a hepatologist interested in alcoholic liver disease, was appointed as the second Chief of the division under Department Chair Dr. William D. Robinson. Appointed in 1959, he earned an enviable reputation for integrity, accessibility, scrupulous fairness, and a deep moral conscience. He was the ideal choice at the time when there was exponential growth of the academic environment of US medical schools, fueled by generous funding opportunities from the NIH. However, the demands on the Department Chair increased during the late 1960s with the need for higher faculty salaries and at the same time, need to maintain academic momentum. During this period, growth stagnated as resources dwindled. Dr. Henley took over the Division with the laudable objective to create a community of scholars in gastroenterology. He tried to recruit faculty capable of generating NIH grants, but these were now harder to obtain, but still within the reach of two investigators. In 1973, the return of Jorge Gumucio from Chile helped to rejuvenate the Division. Together with Dr. Milton Mutchnik and Dr. Gumucio, Dr. Henley developed a hepatology research group devoted to the study of basic and translational hepatology. At this time, Dr. Henley turned his attention to develop a good GI presence at the previously neglected VA hospital. Dr. Henley was able to attract some very good GI fellows including Dr. Timothy Nostrant, now Professor Emeritus, Dr. Joel Weinstock and Dr. Jean Pierre Rauffmann, both of whom are now Division Chiefs, Dr. John Schaffner, who enjoys a distinguished career as physician educator at the Mayo Clinic, Dr. Stan Strasius, who is a leading physician educator at St. Joseph Mercy Hospital. The NIH training grant, which was lost in the late 1960s, was restored in the early 1980s and has been in place for the subsequent decades.
The Nostrant Era (1981-1983)
The nature of gastroenterology was rapidly changing. With the advancement of endoscopy, the financial aspect became very attractive. In 1981 when Dr. Henley stepped down as Division Chief, Dr. William Kelley, the Chair of the Department of Internal Medicine, appointed Dr. Nostrant to be acting chief while searching for permanent chief who could take the division to new heights. At the time, Dr. Nostrant was an Assistant Professor, and who recently completed his GI fellowship training at University of Michigan. He was the first person at Michigan to emphasize the importance of endoscopy and was instrumental in establishing one of the world’s most sophisticated and well equipped medical procedure unit. The MPU remains one of the most successful clinical units in UMHS. There are over 25,000 procedures performed in the last year. Dr. Nostrant has trained many of the key clinical faculty members in the division. He had also been the lead physician of the Faculty Diagnostic Unit, which was designed to serve as a national model for the development of the clinician scholar track. Within a short period of time, he successfully built the unit into the most productive and sought after consultative service in the Department of Internal Medicine. Its multi-subspecialty approach to consultation served as the blueprint for other departments within the UMHS. In addition, he also developed the curriculum for the GI fellowship program. Much of it is still being used today.
The Yamada Era (1983-1990)
The long search for a permanent division chief ended in June 1983 when Dr. Tadataka (Tachi) Yamada joined the University of Michigan from UCLA. Dr. William Kelley recognized the potential, vision, drive and talent in Dr. Yamada, who at the time, was a relatively young researcher. Dr. Yamada approached his new position with enthusiasm and fervor. Before his actual move, he made multiple trips to Ann Arbor to develop his blueprint for the future of the division. In the early 1970s transitional leadership in the Department of Internal Medicine caused the GI Division to fall on tough times. By the time of Dr. Yamada’s arrival, the Division only had 7 full-time faculty members, and one NIH research grant. Dr. Yamada did not see this as a disadvantage, but rather, an opportunity to implement his vision and direct his efforts toward rebuilding the Division from the ground up. One of his first initiatives was to respond to an RFA from the NIH for a Digestive Diseases Center grant. This was made possible through Dr. Yamada’s ability to recruit collaborators and forge alliances with faculty members from outside the Division. The Center grant was crucial to the development of the Michigan Gastrointestinal Peptide Research Center, the first of its kind in the country. Today, the Center has enjoyed 29 years of continuous funding.
The Center provided the infrastructure for Dr. Yamada to build one of the strongest GI research programs in the country. Annual research funding increased from approximately $200,000 to $4 million during Dr. Yamada’s tenure and set the foundation for the present level of $15 million dollars. The Center played a key role in the University recruitment of Dr. John Williams, former Chair of the Department of Physiology, Dr. Bishr Omary, the current Chair of the Department of Physiology, and Dr. Jack Dixon, former Chair of Biological Chemistry. Dr. Yamada has always demonstrated a knack for recognizing opportunities for synergistic relationships and an ability to bring together scientists for collaborations that would never had been dreamed of if not for his imagination and creativity.
As part of the rebuilding process, Dr. Yamada recruited a number of promising young physician scientists to join the Division. These include Dr. Richard Boland, Dr. Richard Moseley, Dr. Paul Watkins and Dr. Rebecca Van Dyke. Dr. Boland has served admirably as the Section Chief of the VA, and subsequently, as Division Chief of University of California, San Diego. Dr. Moseley succeeded Dr. Boland as the Section Chief of the VA and subsequently was appointed Chief of Medicine of the Ann Arbor VA Hospital. Dr. Watkins is an expert in liver drug toxicity and served as director of the clinical research center at the University of Michigan. He is now Director of the Hamner-UNC Institute for Drug Safety Sciences. Dr. Van Dyke moved through the ranks to become Professor of Medicine. She has contributed much to our medical education mission. She received many distinguished teaching awards from the Medical School and Department of Internal Medicine. Dr. Yamada will also be long remembered for helping junior faculty to launch their careers and realize their potentials. Many of the faculty members he recruited or trained have gone on to become academic leaders in gastroenterology. Dr. Peter Traber became Chair of Department of Internal Medicine and subsequent Dean of Medicine at the University of Pennsylvania. In the recent past, he served as the President of the Baylor College of Medicine. Dr. Chris Dickinson has been the Chief of the Pediatric Gastroenterology division at the University of Michigan for many years. Dr. John Del Valle, a former Robert Wood Johnson trainee, is now Associate Chair of Medicine at the University of Michigan. Dr. Grace Elta, Director of the UM Medical Procedures Unit, became the first woman on the governing board of the AGA and was the president of the ASGE. Dr. Michael Lucey, is currently chief of gastroenterology at University of Wisconsin and is a well-recognized expert in liver transplant. Dr. Juanita Merchant, endowed professor of medicine, directs her own research program project. Dr. Jim Scheiman, another GI fellow under Yamada tutelage, is now Professor of Medicine and director of Advanced Endoscopy program at Michigan. His foreign fellows from Japan have also achieved significant academic success. Dr. Kentaro Sugano is Chair of Medicine at Jichi University in Japan. Dr. Tsutomo Chiba is now Chair of Medicine at Kyoto University in Japan.
Dr. Yamada was a pioneer in gut endocrinology. He was among the first to apply molecular biology techniques to the study of biochemistry and physiology of gut hormones. He has made a number of novel contributions vital to our understanding of the synthesis, release and actions of gut hormones. His scientific achievements have been recognized by many awards received throughout his career. These include the 1991 American Physiological Award for Outstanding Contributions in Gastroenterology Research, the 1992 University of Michigan Distinguished Scientific Achievement Award, the 1996 Distinguished Scientist Award from the Medical College of Virginia, and the 1998 Morton I. Grossman Distinguished Lectureship. His contributions have also been recognized through his elections as member of a number of societies as well. He is a member of the Institute of Medicine National Academy of Sciences, Master of the American College of Physicians, Fellow of the Imperial College of Medicine (UK), member of the Academy of Medical Sciences (UK). Aside from more than 160 manuscripts of original research, he has contributed book chapters in all of the major textbooks in the field. His crowning literary achievement, however, is as Editor of the Textbook of Gastroenterology, perhaps the most widely used textbook by gastroenterologists in this county.
The Owyang Era (1990-present)
In 1990, Dr. Yamada assumed the role of Chair of the Department of Internal Medicine, succeeding Dr. William Kelley. Dr. Owyang was then selected to be the next Chief of Gastroenterology, a position that he still holds today. Dr. Yamada set the strong foundation to which Dr. Owyang brought his energy and vision, strengthening the depth and breadth of the division. One of his first initiatives was to establish a clinical Hepatology unit. He recruited Dr. Anna Lok, a well-recognized hepatologist in viral hepatitis to lead this initiative. The Division then began to train fellows interested in liver disorders. These included Drs. Robert Fontana, Jorge Marrero, Hari Conjeevaram, Fred Askari, and Grace Su. All these individuals have emerged as leaders in Hepatology in their own right. Dr. Fontana is currently our Director of Liver Transplant at the University of Michigan and directs our liver transplant fellowship. Dr. Jorge Marrero led our liver cancer program at UM, a nationally designated program and is now the Hepatology Program Director at UT Southwestern. Dr. Hari Conjeevaram is an expert in NAFLD and is the GI Fellowship Director at the UM. Dr. Askari directs the University of Michigan Wilson Disease Program, one of three Centers of Excellence in Wilson’s Disease in the country. Dr. Grace Su has become the Section Chief of Gastroenterology at the Ann Arbor VA Hospital. The Hepatology Unit continues to grow at the UM and has become the largest in the US with 14 faculty members. Some of our more recent recruits include Drs. Michael Volk (chronic liver failure), Liz Speliotes (genetics of fatty liver disease), Andrew Tai (Hepatitis C research), Pratima Sharma (liver transplant). All these individuals are funded through NIH and have thriving research endeavors.
Recognizing the importance of health services research, Dr. Owyang cemented the division’s strength in this area with the recruitment of Drs. Phillip Schoenfeld and John Inadomi. Under their leadership, the Division obtained a second T32 NIH Training Grant dedicated to the training of physicians interested in clinical outcome research. This is one of only three programs funded by the NIH in the U.S. for this mission and remains essential for the development of GI fellows interested in this field. Many of the GI fellows participating in this program go on to receive Master’s degrees in Clinical Epidemiology and Outcome Research. The Outcome Research Program encompasses subspecialties in colon cancer, inflammatory bowel disease, functional bowel disease, and liver transplantation.
Leveraging the faculty’s strength in motility disorders, Dr. Owyang established one of the most complete and versatile motility disorder groups in the United States. This group includes Drs. John Wiley (visceral hypersensitivity and IBS), William Chey (food allergy, Rome Foundation and IBS), Bill Hasler (gastroparesis), Phillip Schoenfeld (outcome research and functional bowel disease), Rick Saad (pelvic floor disorders and colonic inertia), Shanti Eswaran (FOPMAD and IBS), Joel Rubenstein (esophageal motility disorders, GERD and Barrett’s Esophagus) and Chung Owyang (intestinal pseudo obstruction, microbiome, and IBS). Many of the group’s research initiatives are NIH-funded and some of the major research accomplishments include:
The first to use octreotide and neostigmine to treat chronic, intestinal pseudo-obstruction, establish the use of dopamine antagonist to manage gastric tachyarrhythmia, and key participation in the national gastroparesis registry.
In 2000, the Michigan Peptide Center underwent a major reorganization and expansion which now includes more than 70 faculty members from across disciplines such as GI, Physiology, Cell Biology, Microbiology, Pharmacology, and Surgery. The Center has become the fulcrum of activity that galvanizes the efforts of the large and established group of investigators in gut peptides that exist at the University of Michigan. The three major thematic areas that reflect the common research interests of numerous investigators affiliated with the Center include (i) neurobiology in appetite control, motility and visceral pain; (ii) molecular and cellular mechanisms of inflammation and (iii) cell growth, differentiation and program cell death. To support these research activities, 4 major research cores were established. These include 1. Molecular Biology; 2. Protein Identification and Localization; 3. Microbiome and Host Interaction; and 4. Clinical In vivo study. Since its inception, the Center has played a major role in the academic development of individual investigators and the recruiting efforts of the Division of Gastroenterology, as well as the Department of Internal Medicine. The Center has also played a central role in the initiation of a number of program projects. For example, in early 2000s, Dr. Juanita Merchant started collaborations with a number of Center investigators including Drs. Deb Gumucio, Linda Samuelson and Andrea Todisco. With administrative and intellectual support from the Center, the group successfully competed for a P01 grant entitled “Cellular Decisions of Differentiation in the GI Tract”, now in its 11th year of funding, after 2 successful competing renewals. The Center also has played a central role in helping to develop the academic careers of Drs. Ezra Burstein, Matt DiMagno, Peter Higgins, John Kao, Michelle Anderson and Joel Rubenstein. All of these individuals were fellows in the GI division who obtained pilot feasibility awards from the Center that led to their successfully obtaining NIH grants. The Center has also played a critical role in the recruitment of Dr. Tom Wang, a high profile investigator who is a physician scientist as well as biomedical engineer. Dr. Wang’s research focuses on the rapidly developing field of molecular imaging for the study of gene and protein expression in vivo. The identification of novel peptides as markers for early dysplasia, which can be detected by microendoscopy, lies at the heart of his research efforts. With the support of the Center, and participation of other Center members, Dr. Wang was successful to compete for two U54 program projects from NCI. A few years ago, the Center was instrumental to convince the Department to dedicate sufficient resources to support the development of a microbiome facility. The venture also facilitated the recruitment of Dr. Vincent Young. Because of some of the initial success, the Medical Center has selected the Microbiome Center as one of two programs in the Fast Forward Project.
Over the last two decades, the Division continues to train the next generation of gastroenterologists and hepatologists. Currently, slightly more than half of the faculty members, completed their GI fellowship at Michigan. Many of these individuals have gone on to become academic leaders in gastroenterology. Notables include John Carethers, who is now Chair of Department of Internal Medicine at University of Michigan; Joe Kolars, Senior Associate Dean of Medicine at University of Michigan; Ellen Zimmermann, Associate Chair of Medicine at University of Florida; Bill Chey, Professor of Internal Medicine and Director of the GI Physiology Lab; Uri Ladabaum, Acting Chief of Gastroenterology at Stanford; both Gary Wu and Michael Kochman are endowed professors at University of Pennsylvania; Gary Falk is full professor at University of Pennsylvania.
Under the leadership of Dr. Owyang, the Gastroenterology division at University of Michigan has expanded rapidly in both its clinical services and its outreach programs. With a clinical practice encompassing 70 full time faculty, the Division is the second largest digestive and liver health group in the nation and offers a broad range of expertise as well as a tremendous depth of knowledge, in a variety of gastrointestinal and hepatic disorders. The MPU continues to serve as the hub for all major endoscopy procedures. In 2005, because of space limitation, the Division established a 2nd procedure unit at the East Ann Arbor Health Campus. Under the direction of Dr. Leslie Aldrich, the MPC is now doing more than 9,000 procedures per year. The Division’s clinical services now extend to 14 separate locations and 4 endoscopy centers. As of 2013, there were more than 30,000 outpatient clinic visits and we performed 25,000 procedures.