Digestive Health 

The management of digestive diseases, which has improved enormously over the last two to three decades, has also become more complex as the number of treatments has rapidly grown.

The majority of patients are managed with medical, endoscopic, and non-operative therapies; but, when these treatments are ineffective, patients are referred for surgical management. This has made it essential for specialists of different expertise to work together to provide the most effective and efficient treatment for their patients.

Our challenge is to combine the most newer and more effective treatments with genuine caring, advice, and guidance.

The DDC's specialized faculty has particular expertise in a variety of approaches to digestive health, including:

• Advanced diagnostic and therapeutic endoscopy
• Esophageal diseases and general motility disorders
• Liver disease (and transplantation)
• Complex pancreatic and biliary diseases
• Interventional radiology
• Nutritional disorders
• Ano-rectal and colonic problems
• Laparoscopic surgery
• Pediatric gastroenterology and surgery
• GI oncology (in association with the MUSC Hollings Cancer Center)

The DDC also offers services at the Ralph H. Johnson Department of Veteran Affairs Medical Center (VAMC).

The Hospital recognized the importance of the multi-disciplinary vision of MUSC Digestive Health (formerly known as the Digestive Disease Center), and reorganized into Integrated Centers of Clinical Excellence (ICCE). Dr. Brenda Hoffman now leads the Digestive Disease, Endocrine & Metabolism ICCE, with its Administrator, April Reeder. 

The MUSC Health Digestive Disease Center has developed an Endoscopy Learning Center, pulling together the talent of faculty, trainees and staff from the Divisions of Gastroenterology & Hepatology, Surgery, and Radiology, as well as other specialists dealing with patient care, research and education in digestive diseases.

These multidisciplinary resources provide a broad education perspective. We offer a standard three-year fellowship program, focused advanced training fourth-year programs, and short-term attachments (for observation).

A clinical trial is a research study involving human volunteers to help answer specific health questions. Carefully conducted clinical trials are the fastest and safest way to find treatments that work and improve health.

Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research.

DDC Research efforts are managed by the Digestive Disease Research Center and is supported by the DDC/GI clinic, endoscopy staff and physicians.

New studies in sphincter of Oddi dysfunction

MUSC faculty continue to address important issues in biliary and pancreatic medicine. Joe Elmunzer and team have NIH funding to establish the best method to prevent pancreatitis after ERCP procedures. The SVI study is designed to establish whether medical intervention (Indomethacin) is as effective as the combination of Indomethacin and a pancreatic Stent. It is being carried out in 14 centers across USA and has already enrolled in excess of 600 subjects judged to be at increased risk of pancreatitis. Many of these subjects have post-cholecystectomy biliary pain, or unexplained idiopathic recurrent pancreatitis (IRAP), and are suspected to have "sphincter of Oddi dysfunction (SOD)".

The earlier NIH-funded EPISOD study, led by Peter Cotton, was an iconoclastic contribution to the field of gastroenterology. In addition to setting a new standard for sham-controlled trials in endoscopy, EPISOD established that patients diagnosed with SOD based on the presence of biliary- or pancreatic-type abdominal pain alone – previously called "SOD type III," fared no better after a sphincterotomy than a sham intervention. Given the substantial short- and long-term risks of ERCP, including post-ERCP pancreatitis, bleeding, perforation, and post-sphincterotomy re-stenosis (scarring), EPISOD has changed clinical practice: fewer patients are now offered ERCP for biliary- or pancreatic-type pain alone.

What remains controversial is the role of ERCP and sphincterotomy in two other groups of patients still classified as SOD: first, those who have biliary-type abdominal pain with a dilated bile duct or abnormal liver chemistries; second, those who have pancreatic-type abdominal pain with a dilated pancreatic duct, abnormal pancreas chemistries, or simply unexplained episodes of acute pancreatitis. Based on limited evidence, many patients are offered ERCP and sphincterotomy when the symptoms are severe enough to warrant the risks of the procedure. The SVI study includes many of those patients, but follows them for only a month after sphincterotomy to measure the incidence of post-ERCP pancreatitis.

Greg Cote and team have received NIH funding to perform the RESPOnD (Results of ERCP in SPhincter of Oddi Dysfunction) study, which will follow patients who undergo ERCP for SOD for a full year. The goal is to establish the precise characteristics of patients who benefit, and of those who do not, to better inform future practice. One of the reasons this study is important is because the treatment (ERCP and sphincterotomy) has substantial risks as detailed above. Patients with suspected SOD who are not in the SVI trial may also be enrolled in RESPOnD. In addition to studying the impact of ERCP on biliary- and pancreatic-type pain, RESPOnD also evaluates the role of sphincterotomy in reducing the risk of recurrent idiopathic pancreatitis. It will be by far the largest study of this problem, and should produce definitive results.

Details of these, and other ongoing studies, can be found at SCResearch.org.

First, let us thank you for considering the Medical University of South Carolina as your health care provider. It is our intention to provide you with the information that you and your family need to feel comfortable with this decision. We consider you as partners and decision-makers in your health care journey, whether you are with us for outpatient services or inpatient care.

Ask your primary care doctor about MUSC! Speaking with your doctor about where you want to be seen for treatment or procedures is not as hard as you think. MUSC has an outstanding reputation for delivering quality healthcare. Our specialty practices are mentioned frequently in many national and international magazines and journals.

MUSC is a teaching hospital, where physicians are trained in the latest advances in medical care.

MUSC is in the heart of downtown Charleston, and is easy to get to from an international airport.

MUSC is a state-of-the-art facility, with the most up-to-date equipment and rooms.

Write down the following information to bring with you to your appointment:

• What medications are you taking? Include all supplements and vitamins.
• When did you first notice your condition?
• If you are in pain, when did your pain first begin?
• Have there been any personal traumatic events or experiences that have occurred recently?
• Have there been changes in diet or regularity?
• Has there been any increase in the use of alcohol or drugs?

During your appointment, be prepared to answer the following questions:

• When did you first begin experiencing symptoms?
• Have your symptoms ever included fever?
• Have your symptoms been continuous or occasional?
• On a scale of 1–10, with ten being the most severe, what is your level of pain?
• About how long do your symptoms last?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

A few simple questions may help you feel better about any upcoming procedure, such as:

• How long will my condition last?
• What happens if my condition is left untreated?
• What tests should I be given?
• Why is this test performed?
• Why do I need this procedure?
• How many times do you perform this procedure every year?
• What are the possible complications?
• Are there any side effects?
• Are there any alternatives?
• Do you have any brochures on this condition?
• When will I get the results?
• What number can I call with questions?
• What number can I call for prescriptions?
• How do you spell the name of that drug?
• Will this medicine interact with medicines that I’m already taking?