The goal of the UC San Diego Gastroenterology Fellowship Program is to teach trainees to master the basic clinical and endoscopic/procedural skills required to act as a consultant to patients with general gastroenterology and hepatology diseases and to acquire skills necessary for the critical evaluation and interpretation of basic and/or clinical research in the field.
About the Division
UC San Diego’s General Gastroenterology program is recognized as a leading program on the West Coast providing excellence in the treatment of general gastrointestinal diseases both in the outpatient and inpatient setting at multiple sites including Thornton/Jacobs, VA, Hillcrest and Kaiser. UC San Diego is a tertiary referral center for Southern California with top ranked Pulmonary and Cardiac programs providing opportunities in the care of patients with heart and lung transplants, left ventricular assist devices, those receiving pulmonary artery embolectomy, and a robust population of cystic fibrosis patients. In the hospitalized setting, GI management also includes percutaneous gastrostomy tube placement, graft versus host disease, GI manifestations of systemic diseases and infection, as well as treatment of upper and lower GI bleeding. We work closely with Interventional Radiology in patients with duodenal arterial bleeding and variceal bleeding and use advanced techniques including Ovesco clips, Hemospray, and cyanoacrylate glue injection. UC San Diego has a large population of HIV/AIDS patients who receive care through the Owens Clinic which provides opportunities for GI management of treatment side effects and opportunistic infections. UC San Diego also has leading Oncology and Surgical centers which provide opportunities for the GI care in these patients related to treatment. In the outpatient setting, patients are referred from all over Southern California for care related to conditions including irritable bowel syndrome, gastroesophageal reflux disease, small intestinal bacterial overgrowth, and chronic diarrhea and constipation. We provide innovative approaches to patient care such as hypnosis therapy in patients with functional GI diseases. We are also the referral center for patients transitioning from Rady Children’s Hospital needing gastrostomy tube care and management of GI conditions related to underlying genetic conditions and cerebral palsy. In addition, UC San Diego has a small bowel endoscopy program with capsule endoscopy, single balloon and double balloon enteroscopy available at all sites for the evaluation of suspected small bowel bleeding, small bowel Crohn’s disease, and small bowel malignancy.
Inflammatory Bowel Disease Center
The IBD Center at UC San Diego is one of the top referral centers of excellence in the US. The Center includes 5 IBD-focused physicians (Dr. Brigid Boland, Dr. Parambir Dulai, Dr. Derek Patel, Dr. William Sandborn, Dr. Siddharth Singh), 2 nurse practitioners, 2 clinical pharmacists, and 2 nurse coordinators. The IBD clinic actively manages 3500 patients with IBD, with annual IBD clinic volumes exceeding 2000, with a mix of routine patients with newly diagnosed mild IBD to complicated cases who have failed multiple biologics. Besides, UCSD hospitals also have a robust volume of inpatients hospitalized with IBD where fellows are exposed to patients with acute severe ulcerative colitis, complicated Crohn's disease, etc, as a consulting service. In addition to the GI IBD faculty, the IBD Center at UCSD has five colorectal surgeons who specialize in IBD, including Dr. Sonia Ramamoorthy, Dr. Samuel Eisenstein, Dr. Lisa Parry, Dr. Nicole Lopez, and Dr. Benjamin Abbadessa, gastrointestinal radiologists with expertise in MR and CT enterography (Dr. Cynthia Santillan), gastrointestinal pathologists (Dr. Mark Valasek) as well as IBD-focused clinical pharmacologists (Dr. Niels Vande Casteele).
The IBD faculty at UC San Diego has a very robust and diverse research program focusing on: clinical trial design, targets and outcome measures, biomarker development, performance and evaluation for disease assessment, comparative effectiveness research, population health management and outcomes research in IBD using large administrative datasets, electronic medical record-based cohorts and/or secondary analyses of clinical trials, identifying biomarkers and prognostic markers for response to different therapeutic agents for personalized medicine in IBD, as well as clinical pharmacology of biologic agents in IBD. To support the clinical and translational research enterprise in IBD, the IBD team is well-supported and funded (through NIH, Foundations, Industry, etc.) with 5 study coordinators, a data analyst in the Division of Biomedical Informatics, biostatisticians and a well-characterized comprehensive longitudinal biobank of serum, stool and tissue from >800 patients with IBD. There is also a large basic science research faculty focused on IBD-related mucosal immunology within the Gastroenterology Division including Dr. John Chang, Dr. Jesus Rivera-Nieves, Dr. Peter Ernst, Dr. Lars Eckmann, Dr. Kim Barrett, and Dr. Vipin Kumar. Additionally, there is a 12-month postgraduate training program in Inflammatory Bowel Disease available at UCSD to applicants who have completed a three-year ACGME accredited gastroenterology training program - the preceptorship is comprised of seeing inpatients and outpatients with IBD under the supervision of GI faculty in the UCSD IBD center.
The Liver Center at UC San Diego is the region's leader in complex, multi-disciplinary care for patients with acute and chronic liver diseases. Hepatology care is provided at both the Hillcrest and La Jolla campuses, along with outreach clinics across southern California. Led by the Director of Hepatology, Dr. Rohit Loomba, the Center includes eight hepatologists (Dr. Veeral Ajmera, Dr. Pranab Barman, Dr. Shravan Dave, Dr. Yuko Kono, Dr. Rohit Loomba, Dr. Michel Mendler, Dr. Irine Vodkin, Dr. Suzanne Sharpton), five nurse practitioners, and a dedicated team of nurses, schedulers and medical assistants. Diagnostic and treatment services are provided for viral hepatitis, alcohol-related liver disease, autoimmune liver diseases, inheritable liver diseases, decompensated cirrhosis, liver cancer, liver disease secondary to congenital heart disease, and non-alcoholic fatty liver disease (NAFLD). The NAFLD Research Center, led by clinician-researcher Dr. Rohit Loomba, is one of the nation's largest translational research programs that investigates all aspects of NAFLD spanning genetics, the microbiome, biomarkers and therapeutics. The NAFLD Research Center faculty (Dr. Loomba, Dr. Ajmera, Dr. Sharpton) are well-supported by funding from the NIH, foundations and industry and lead a team of research coordinators, biostatisticians and visiting scholars to conduct cutting-edge research in fatty liver disease. UCSD also provides comprehensive liver cancer care through a dedicated multidisciplinary clinic and tumor board under the leadership of Dr. Kono.
Liver transplantation at UC San Diego is undergoing a period of unprecedented growth with a recent doubling in transplant volume. Transplant Hepatology services are concentrated at the UCSD Center for Abdominal Transplant in La Jolla, comprised of four abdominal transplant surgeons and the aforementioned eight transplant hepatologists, led by the medical director of liver transplantation, Dr. Veeral Ajmera. Transplant hepatologists collaborate with transplant surgeons, nurse coordinators, pharmacists, social workers, dieticians, and financial coordinators to provide multidisciplinary inpatient and outpatient care. Gastroenterology fellows will work closely with the general and transplant hepatology team during dedicated hepatology inpatient rotations and as part of rotating clinics. UCSD also offers a dedicated ACGME-accredited Transplant Hepatology fellowship, led by Dr. Irine Vodkin who serves as the fellowship program director.
Interventional and Advanced Endoscopy
UC San Diego’s Interventional and Advanced Endoscopy practice is an internationally recognized program which provides world class care for the treatment of complex gastroenterological diseases utilizing cutting edge endoscopic techniques. Led by Thomas Savides, an internationally recognized expert, who was recently awarded the Master Endoscopist Award by the American Society of Gastrointestinal Endoscopy, our group includes 5 additional physicians who have all obtained additional training in advanced endoscopy (Dr. Abbas Fehmi, Dr. Mary Lee Krinsky, Dr. Wilson Kwong, Dr. Michael Chang, Dr. Gobind Anand). Interventional and advanced endoscopic procedures which are performed include:
- Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Endoscopic Ultrasound (EUS)
- Endoluminal Stenting
- Endoscopic mucosal resection, endoscopic full thickness resection
- Endoscopic submucosal dissection
- Ablation of Barrett’s esophagus
- Intramural endoscopy including per-oral endoscopic myotomy
- Interventional endoscopic ultrasound including drainage of peripancreatic fluid collections
- Endoscopic closure (including endoscopic suturing, over the scope clip closure)
- Balloon enteroscopy
UC San Diego is also a National Pancreas Foundation Center of Excellence for Pancreatitis and Pancreas Cancer and the advanced endoscopy team works closely with surgeons, oncologists, Interventional Radiologists to provide care for patients with complex pancreatitis and a variety of cancers.
General Gastroenterology Fellows have the opportunity to work closely with the Advanced Endoscopy team while caring for inpatients during their consult rotations, including performing endoscopic procedures. They also rotate through clinics including the recently developed Pancreas Cancer Prevention Clinic, which is a multidisciplinary clinic involving Surgical Oncologists, Gastroenterologists, Genetic counselors to manage patients with pancreas cystic lesions, significant family histories of pancreas cancer and genetic mutations which increase their risk of pancreas cancer. UCSD also offers an Advanced Endoscopy Preceptorship for fellows interested in pursuing a 4th year of additional training to gain expertise in advanced endoscopy.
Esophageal Diseases and Motility
The Center for Esophageal Diseases is a leading multi-disciplinary center of excellence for patients with esophageal diseases such as achalasia, reflux syndromes, esophageal cancer, eosinophilic esophagitis, and functional esophageal conditions. The Center includes Dr. David Kunkel, Dr. Ravinder Mittal, Dr. Rena Yadlapati, one nurse practitioner, three motility nurses, and two nurse coordinators. State-of-the-art infrastructure within the esophageal motility lab includes high-resolution impedance esophageal manometry, ambulatory reflux monitoring (impedance-pH and wireless pH), and functional lumen imaging planimetry (FLIP). The center collaborates closely with minimally invasive surgery, advanced therapeutic GI, laryngology, pulmonary, and pediatric GI, and offers integrative therapies such as gut-directed hypnotherapy. In addition to esophageal disease, the GI Motility program offers the most advanced diagnostic technologies and innovative clinical therapies for gastric, intestinal, and pelvic floor motility conditions. The motility lab provides breath testing, ano-rectal manometry, and a pelvic floor biofeedback therapy program.
The motility faculty are comprised of national and international leading experts in the field and have robust research programs. Dr. Yadlapati, director of the esophageal diseases & motility program, is an actively funded investigator with a clinical-translational research program focused on identifying mechanisms of injury and nociception in reflux disorders, developing and testing novel diagnostic and therapeutic strategies for GERD, and implementing practice guidelines for esophageal diseases. Dr. Yadlapati is the principal investigator of several clinical trials studying the efficacy for novel treatments for laryngopharyngeal reflux, GERD, and eosinophilic esophagitis. Dr. Yadlapati's overarching research objective is to define phenotype guided care paradigms for esophageal conditions. Dr. Mittal's novel research program focuses on the sensory and motor function of esophagus using the state of art techniques, some of which were developed in his own laboratory. He worked extensively on the role of crural diaphragm as an external lower esophageal sphincter in health and disease, studying its control mechanisms. His recent studies have focused on the role of longitudinal muscles of the esophagus in the physiology and pathophysiology of esophageal motor function. His esophageal research has been funded by NIH continuously since 1988 and VA MERIT grants for the last 12 years. For the last 15 years, he has also focused on the pelvic floor and external anal sphincter in the context of fecal continence and incontinence.