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Medical Gastroenterology

Head of Division:  Professor SR Thomson

The division Gastroenterology was formed in 1959 by Dr. I.N. (Solly) Marks and was the first to establish a Gastrointestinal Clinic in South Africa. He developed a GI Clinic that would provide a scientific basis to Gastroenterology in Cape Town and beyond with the emphasis on clinical, para-clinical and basic research.  In 1983 Professor Marks was appointed as the newly created chair in Gastroenterology.  Excellent Medico-surgical liaison remains one of the research strengths on the unit with combined research into Inflammatory bowel disease, abdominal tuberculosis, pancreatic function and pancreatic, and interventional endoscopy became the dominant foci for clinical and research development. 

We offer a wide range of endoscopic procedures:

Upper GI endoscopy - this comprises an emergency 24 hour service for GI bleeding, routine and double balloon endoscopy, oesophageal dilatations and eradication of oesophageal varices.

Colonoscopies - we have one dedicated colonoscopy suite with video scopes and a magnetic scope guide.

Interventional ERCP

The unit also has a fully equipped motility laboratory run by a part-time medical technologist who performs oesophageal and anal Manometry, pH studies and breath tests.

We also see a wide range of both upper and lower gastrointestinal pathologies.  The bulk of our clinical work, however, involves the management of Inflammatory Bowel Disease.  We have the largest clinic in Africa, servicing ±1500 patients coordinated by a full time nursing sister.

I have two basic science projects which have initiated and are ongoing.  One relates to laser Doppler blood flow measurement as a longitudinal temporal assessment of blood flow in the stomach after oesophageal variceal eradication.  The second is in relation to the HIV Vaccine initiative to assess if broadly neutralising antibodies can prevent HIV infection in human colonic cells.

Teaching

Our consultants are involved in:

3rd / 4th / 5th and 6th year student teaching and registrar teaching.

Research

Professor SR Thomson:

His research into pancreatic disease remains a focus.

He is currently supervising a PhD on “A critical analysis of HIV Pancreatitis” for UKZN, which aims at looking at the prediction models for severity and the immune response in those with severe disease.  Data collection is almost complete.  In the clinical area we are pioneering the use of endoscopic ultrasound to manage pancreatic fluid collections (as an alternative to surgery) and have published this experience in abstract form.  The pancreas also harbours neuroendocrine cells which can become gastrin secreting tumours and produced intractable ulcers and diarrhoea.  The clinic has the largest single centre experience with over 50 patients with the condition.  The outcome of their surgical therapy has been presented and is currently being prepared as a manuscript.  The clinic also has a large cohort of patients with chronic pancreatitis treated surgically who are being prospectively followed up with Quality of Life studies research funded by unconditional grant from industry sponsors. 

His interest in tuberculosis links in one of the senior IBD clinicians for her PhD in collaboration with the molecular GI laboratory at the Massachusetts General Hospital. I will be her co-supervisor. She will be investigating the molecular diagnosis of tuberculosis in patients with inflammatory bowel disease.

As the Head of the Division I also have a research oversight role for all medical staff.  One of my senior staff who has just completed his dissertation for an MPH on the therapy of the oesophageal motility disorder Achalasia and has just had ethical approval for a major project on Coeliac Disease. I am also supervisor of two MPhil projects detailed in postgraduate students supervised. One is a test for H Pylori infection and treat policy versus a routine endoscopy. One is a randomised trial comparing a test for H Pylori and treat policy versus routine endoscopy for patients with dyspepsia.  The other is a comparative study of two technically different colonoscopes using key performance indicators as the end points for efficacy.  My own two focus areas of research and publication continue to be active. I do however have an expanding role in supervising beyond these themes in terms of mentoring and research support for postgraduate students

Dr G Watermeyer:

She has recently completed her MPH and it has given an added dimension to her research interests are related to several aspects of Inflammatory Bowel Disease in the local community and its epidemiology, predicting its natural history and its relationship to tuberculosis.

Dr D Levin:

His research Interests are in peptic ulcer disease and H pylori infection where he is responsible for co-supervising an MPhil on managing H Pylori infection. He has gone to great lengths to develop his interventional endoscopy skills in particular in endoscopic ultrasound which he has co-developed with the surgical gastroenterologists

Dr S Hlatswayo:

Interests are in oesophageal motility and celiac disease. He has completed all the elements of his MPH and is awaiting assessment of mini dissertation on the outcome of Achalasia. He has funding to look into the epidemiology and clinical spectrum of celiac as a PhD project