CCE Gastrointestinal Disorders: Cedars-Sinal Medical Center

Cedars-Sinai Medical Center
Los Angeles, California

Primary care physicians see many patients for complaints related to acid reflux disease, chronic constipation, irritable bowel syndrome, and incontinence. When first line therapy is not successful, patients referred to Cedars-Sinai Medical Center's gastrointestinal disorders program can expect to receive cutting-edge care from clinicians dedicated to the prevention, treatment, and diagnosis of some of the most complex gastrointestinal conditions.

Cedars-Sinai also has one of the few pediatric inflammatory bowel disease (IBD) centers in the country that conducts education, treatment, and research activities all at one campus. About 400 children with Crohn's disease and other inflammatory bowel diseases receive treatment from pediatric gastroenterologists.

In terms of the overall number of patients seen, Cedars-Sinai motility program is one of the two largest centers of its kind in the U.S. The program has 30 full-time physicians dedicated solely to the treatment of motility disorders.

The Cedars-Sinai motility program treats almost all GI motility problems, including chronic constipation, irritable bowel syndrome, and incontinence. Trained motility specialists conduct diagnostic procedures and tests.

With three dedicated GI motility testing rooms, the center is equipped to handle a large volume of referrals with little or no delay. The average turnaround time for test results is less than 48 hours. One of the program's most innovative research and treatment areas is centered on irritable bowel syndrome. Most treatments focus on reducing symptoms, by either speeding up or slowing down the digestive process.

Mark Pimentel, MD, director the motility program at Cedars-Sinai is treating IBS patients in a relatively simple way – a routine round of antibiotics that eliminates excess bacteria in the small intestine.

Pimentel's developed a lactulose breath test to monitor the level of hydrogen and methane on the breath, which indicates a high level of small intestinal bacterial overgrowth (SIBO). His research has shown that an abnormal breath methane profile was 100 percent predictive of constipation-predominant IBS.

His research found that eliminating bacteria significantly improves IBS symptoms and targeted antibiotics is an effective long-term treatment for IBS. "We believe that methane gas is actually causing the constipation and by getting rid of that makes the constipation significantly improved," he says.

"Seventy to 80 percent of IBS patients seem to test positive on the lactulose breath test, which is used to determine if bacteria has moved into the small intestine," says Pimentel. "We have done multiple double blind studies that show antibiotics make IBS better and we are expanding this research to linking IBS to food poisoning."

Research and advanced technology

State- of-the-art technology is a strength of the GI program at Cedars-Sinai. High-resolution manometry, considered the gold standard in imaging evaluation of gastrointestinal motor function, is a standard diagnostic tool.

Pimentel and Jeffrey Conklin, MD, medical director, Esophageal Center, and Edy Soffer, MD, co-director, GI Motility Program at Cedars-Sinai, co-authored the first published work on high resolution manometry – Color Atlas of High Resolution Manometry, which was released this past June.

"We are ahead of the curve, not just in the tests that we do, but in the machinery we use," says Pimentel.

Patients with Barrett's esophagus are often referred to Cedars-Sinai for radio-frequency ablation of precancerous tissues in the esophagus.

Cedars-Sinai's GI program has 27 varied research protocols currently in progress. Cedars-Sinai was the first in the western part of the country to perform gastric pacemaker procedures and receives referrals for the procedure from all parts of the U.S., says Pimentel.

For patients with short bowel syndrome, research at Cedars-Sinai has found that the incretin mimetic, exenatide, slows the digestive process and as a result, many patients previously receiving intravenous feeding are able to eat.

"That is a pretty substantial discovery and we are trying to expand on that discovery over the next year and a half," says Pimentel.

Additional research into to the cause of IBS focuses on the relationship between food poisoning, bacterial overgrowth and IBS.

"What we have done is connect the dots between the development of IBS and the development of bacterial overgrowth after food poisoning," Pimentel says. "We think we may be able to connect all of the dots on how IBS develops and if that is true than we may find targets that cure it hopefully in the next five to 10 years."

Collaboration is an integral part of the GI program, with gastroenterologists regularly working with obstetrics and gynecology, ear nose and throat physicians, colon surgeons, and laparoscopic surgeons.

"We have a multidisciplinary approach to all of our patients," Pimentel says.

Most of the center's research is investigator initiated and funded through foundations."We come up with our own projects," says Pimentel. "We are very selective in choosing things that have the highest level of fruitfulness."