Current trends in the health care delivery system and their impact on the gastroenterology research community have resulted in a shortage of basic, clinical and translational science investigators in this field. Fortunately, this negative circumstance has begun to lessen in the past few years due to the following significant developments: 1. higher quality applicants in larger numbers are applying to Gastroenterology Fellowship programs, for example the Gastroenterology Division at the Medical College of Wisconsin received over 294 applications for the academic year 2013-14, and more importantly, 2. the rollout of the NIH roadmap initiative aimed at re-engineering the clinical and translationa research that in turn has resulted in significant institutional commitment to further develop this distinct discipline across the country including MCW which received a CTSA grant along with its 7 academic and healthcare system partners in 2010, directly benefiting this training program. These encouraging changes, combined with the need for increasing the limited pool of physician scientists and the track record of the Division of Gastroenterology and Hepatology in training academic gastroenterologists provides the impetus for submission of this competitive renewal proposal. The objective of this proposed training grant is to rigorously train and prepare 10 postdoctoral fellows for a research career in academic gastroenterology. The program offers training in two understudied areas of gastrointestinal research with paramount clinical significance in terms of human suffering and health care resource utilization: 1. upper GI and aerodigestive tract sensory motor function and their physiologic and pathophysiologic relationships such as most notably seen in dysphagia and airway complications of reflux disease and 2. neurogastroenterology and brain-gut interactions in health and disease such as functional GI disorders. To achieve this goal, we have designed a rigorous, multidisciplinary program based on a long history of interdisciplinary collaboration between faculty investigators from Gastroenterology (adult and pediatrics), Biophysics, Neurology, Otolaryngology, Pulmonary Medicine, and Radiology. We are also making three modifications to the existing program: (1) increasing training opportunities by engaging more pediatric gastroenterology faculty as preceptors and one as Co-Director, (2) increasing the involvement of Neurology faculty to enhance the neurogastroenterology and brain gut interaction research that is ongoing, and (3) putting an external advisory committee in place to review the program annually and make recommendations to the PI
Diseases of swallowing and gastroesophageal reflux are common and prevalent among pediatric and adult populations; incidence of feeding disorders is estimated to range between 25-45% of typically developing children and up to 80% of children with developmental disabilities. Abnormalities of swallowing, prevalent among geriatrics patients, with its associated complications such as aspiration pneumonia, malnutrition as well as esophageal and supraesophageal complications of reflux disease involving the airway pose a significant increased burden to the healthcare system. Training of physician scientists with investigative expertise in the pathophysiological mechanisms of these disorders and their timely diagnosis and management is needed to improve public health.
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