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eDigest Fall 2013

Institute Mission Statement

The mission of Cleveland Clinic Digestive Disease Institute is to foster the most effective, efficient and compassionate multidisciplinary digestive health care through innovation: ‘Devise, Optimize, Economize without Compromise’.


Diabetes Ups Esophageal Cancer Risk, Study Shows

Prashanthi Thota, MD, discusses recent research presented at the American College of Gastroenterology annual meeting.

Patients who have both Barrett's esophagus and diabetes are at an elevated risk for the Barrett’s to progress to either dysplasia or cancer, according to the results of a Cleveland Clinic study presented during a poster session at the annual meeting of the American College of Gastroenterology.

Among patients with Barrett's esophagus, the risk of progression for those who also have diabetes was more than doubled (HR 2.3, 95 percent CI 1.2-4.5, p=0.01), according to Prashanthi N. Thota, MD, and colleagues. Among the same patient group, those without high blood pressure had twice the risk of progression of Barrett’s (HR 2.2, 95 percent CI 1.2-3.9, p=0.009).

“Diabetes has been linked with Barrett's esophagus, but its precise incidence in Barrett's patients and the associated elevated adenocarcinoma risk have never been quantified,” Dr. Thota says.

To examine this relationship, Dr. Thota and colleagues analyzed data from 1,623 patients with Barrett's esophagus. A total of 274 patients either had or were diagnosed with diabetes during the study period. Patients with diabetes were older (64 vs. 59.6 years, p <0.001) and were more likely to be hypertensive (81.4 percent vs. 33.8 percent, p <0.001).

No significant differences were seen for sex (p=0.13), race (p=0.099), length of the Barrett's esophagus segment (p=0.53) or size of hiatal hernia (p=0.17). However, higher rates of those without diabetes showed no evidence of dysplasia on initial endoscopy (62.3 percent vs. 55.5 percent, p=0.004).

On the biopsy with the most severe findings during approximately 16 months of follow-up, no dysplasia was found in 56.9 percent of those without diabetes and in 51.5 percent of those with diabetes. Progression to high-grade dysplasia or cancer was seen in almost twice as many patients with diabetes (17.9 percent vs. 9.7 percent, p=0.018).

Highlighting hypertension

Because high blood pressure is more common in patients with Barrett's esophagus than in the general population, Dr. Thota and colleagues also examined the potential contribution of hypertension to risk for progression. A total of 41.8 percent of patients had hypertension, and of those who were hypertensive, 32.8 percent had diabetes. Among those who were nonhypertensive, 5.4 percent had diabetes. Those who had hypertension were older, averaging 63.9 at the time of Barrett's diagnosis, compared with 57.9 among those without elevated blood pressure.

Length of the Barrett's segments was longer in those without hypertension (3.3 cm vs. 2.7 cm, p=0.003), but no differences were seen in sex (p=0.55), race (p=0.067) or hernia size (p=0.78).

During 17.6 months of follow-up, 61.9 percent of patients with hypertension had no dysplasia, compared with 56 percent of patients without hypertension throughout 14.6 months of follow-up (p=0.02). After adjusting for diabetes, age, Barrett’s length and hernia size, subjects without hypertension were found to have a two-fold higher hazard of progression than those with hypertension (p=0.005).

“The finding that hypertensive patients had a twofold lower risk for progression of Barrett’s was unexpected,” Dr. Thota says. “I suspect that this relates to the use of antihypertensive drugs rather than the condition per se, but this needs further study.”

For more information, please contact Dr. Thota at 440.878.2500 or at thotap@ccf.org


Expanding and Elevating Digestive Disease Care Abroad

Maher A. Abbas, MD, discusses his role and vision as Chair of Digestive Diseases, Cleveland Clinic Abu Dhabi.

Dr. Abbas joined Cleveland Clinic Abu Dhabi [CCAD] as Chair of the Digestive Disease Institute [DDI]. Cleveland Clinic Abu Dhabi is a 364-bed multi-specialty hospital currently under construction in the United Arab Emirates.

A recognized leader in colorectal surgery, Dr. Abbas most recently served in four concurrent roles: Director of Colorectal Surgery, Permanente National Center of Excellence; Regional Chief of Colorectal Surgery, Southern California Permanente Medical Group; Chair of the Center for Minimally Invasive and Robotic Surgery, Kaiser Permanente Los Angeles Medical Center; and Associate Clinical Professor of Surgery, University of California.

Dr. Abbas’ primary areas of practice are in tertiary complex pelvic surgery and therapeutic endoscopy. He has authored more than 100 publications and presented at more than 200 national and international conferences.

What’s your role as Chair of Digestive Disease Institute in Abu Dhabi?

“I will oversee the physician recruitment, development, implementation, delivery and growth in all the specialties under DDI at CCAD. The areas we will develop include gastroenterology, hepatology, nutrition, general surgery and its service lines [acute care surgery, foregut and esophageal surgery, oncologic surgery, and bariatric], colorectal surgery, minimally invasive and robotic abdominal surgery, and solid organ transplantation in the future.”

Why is it so important for the Cleveland Clinic Digestive Disease Institute to have a presence in Abu Dhabi?

“Gastrointestinal conditions are very common in the region. Because of that there’s a tremendous need for establishing an institute that offers coordinated and advanced multidisciplinary care. Cleveland Clinic will bring expertise in the treatment of common conditions but also complex disorders. We will provide the latest medical and surgical treatments, including advanced endoscopic treatment and minimally invasive techniques such as laparoscopy and robotics.”

How will you collaborate with Cleveland Clinic’s main campus?

“I view our program as a valuable addition to our main campus in Ohio. Our relationship will be collaborative in nature and will entail significant exchange of expertise which will undoubtedly lead to the global growth of the enterprise. The experience and current support of the Cleveland Clinic Ohio as well as Cleveland Clinic Florida will provide us with the necessary elements to grow and succeed in Abu Dhabi. I look forward to working with Dr. John Fung, chair of DDI in Ohio and Dr. Steven Wexner, chair of DDI in Florida as we move ahead. This is a great opportunity for us to take the Cleveland Clinic founders’ vision to a global level. It is an exciting time for us as an organization.”

What is your vision for Digestive Disease Institute in Abu Dhabi?

“Our short-term mission is to establish the necessary infrastructure to support an exceptional group of recruited physicians to have the best possible practices who in turn will provide the best possible care for patients. I would like to see CCAD become one of the best places to practice medicine and one of the best places to receive care in the world. The five-year vision is to become the region’s leading multidisciplinary gastrointestinal institute and offer a comprehensive approach to the treatment of patients with digestive tract conditions.”

What attracted you to this job halfway around the world?

“Cleveland Clinic Abu Dhabi will grow within a rapidly evolving healthcare environment in the United Arab Emirates. What is very exciting about this opportunity is not what CCAD looks like today but what it will become 5 and 10 years from now. The possibilities and opportunities are tremendous. Our journey is going to be a fantastic one and the legacy that the Cleveland Clinic will establish in the region will be everlasting. But more importantly the positive impact it will bring to this region will go beyond the actual care rendered to patients by elevating the level of healthcare across the region.”

For more information, please contact Dr. Abbas abbasm@clevelandclinicabudhabi.ae


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