I am a UB faculty member and one of the few advanced endoscopists in the Buffalo-Niagara region. I serve as the chief of endoscopy and director of advanced endoscopic services at Roswell Park Cancer Institute. My clinical interests are in the field of endoscopic oncology, and the medical conditions I treat include cancers and polyps of the gastrointestinal tract, Barrett’s esophagus, bile duct strictures and pancreatic cysts. I perform endoscopic procedures that diagnose, stage, treat and palliate malignant and pre-malignant conditions of the gastrointestinal tract such as endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, cholangioscopy, endoscopic mucosal resection, enteral stenting, ablation of Barrett’s esophagus and double-balloon enteroscopy. I am widely regarded throughout the Western New York physician community for my excellence in patient care, especially as it relates to advanced endoscopic procedures. I teach and train gastroenterology fellows and supervise fellows and residents in clinical research. My research interests include the optimal management of submucosal masses of the gastrointestinal tract and the effectiveness of enteral stents for malignant bowel obstruction. I am also interested in health services research as it relates to providing patients with advanced endoscopic procedures, and I am investigating the effect of an interventional endoscopist on surgical volumes. My team is also analyzing the effectiveness of combined endoscopic ultrasound with fine needle aspiration and endoscopic retrograde cholangiopancreatography (ERCP) vs. ERCP alone as an initial step in diagnosing patients with pancreatic cancer and symptoms related to the biliary tract. I have also contributed instructional videos on gastric hyperplastic polyps and pancreatic lymphoepithelial cysts to the Digital Atlas of Video Education (the DAVE Project) so that professionals in the field have access to information on optimally managing these disorders. One of my roles is to help develop the Buffalo Niagara Medical Campus (BNMC) as a destination for patients needing complex, high-end endoscopic procedures not currently offered in this region. Toward that goal, I seek to expand training opportunities for fellows in advanced endoscopic procedures at the BNMC.
My goal is to provide high quality clinical care to patients with a broad range of gastroenterological disorders. I have a particular interest in the elderly: I completed a geriatrics fellowship, I have extensive experience treating and managing the care of elderly patients and I am dedicated to providing the best possible care for this growing, often vulnerable segment of our population. I view elderly patients first as individuals, and I work with them in ways that respect their autonomy. I also work with them in the context of their family, assessing the best ways to ensure successful disease and health management. I assess my elderly patients in a holistic way as well, taking into account their overall health status and myriad clinical problems instead of focusing solely on whatever gastroenterological problem they present. I work as a UBMD providing clinical services at the hospitals affiliated with UB’s division of gastroenterology: the Buffalo VA Medical Center, Erie County Medical Center and Buffalo General Medical Center, and Roswell Park Cancer Institute. I perform upper endoscopy including radio frequency ablation, colonoscopy and paracentesis. I have experience in performing endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, endoscopic stent placements and high resolution motility studies along with pH and manometry studies. I am conducting a multi-site research study in collaboration with the VA hospitals in Albany and Syracuse studying the effects of continuing vs. stopping clopidogrel during colonoscopies. This is an especially important study given the large number of patients taking this medication. I teach students, residents and fellows during patient rounds and via lectures to the house staff. My lectures concentrate on a variety of gastrointestinal topics ranging from the management of foreign bodies in the gastrointestinal system to biliary tract diseases and pancreatitis.
I chose the field of gastroenterology as my medical subspecialty because of my long-standing interest in cellular absorptive processes and the role of immunity in preventing and causing diseases. I have made the transition from basic scientist to full-time academic physician and find clinical practice in gastroenterology challenging, fast-paced and immensely satisfying. I see patients as a UBMD physician at Erie County Medical Center in both inpatient and outpatient capacities, and I see patients at the UBMD Internal Medicine on Youngs Road in Amherst, NY as well. I manage the care of adult patients of all ages and backgrounds in clinical situations that range from basic gastroenterology and liver disease to specialized hepatobiliary and pancreatic problems. I am comfortable with office-based consultation and all routine endoscopic procedures as well as complicated emergent and advanced endoscopic procedures. One of the most rewarding aspects of my career is the variety of clinical problems I evaluate on a daily basis. I also love the teaching aspect of being an academic physician, and I have been teaching and supervising medical students, residents and fellows for over 25 years. I consider academic physicians to be lifelong learners — i.e., health care practitioners who keep pace with medical advances in order to teach those who follow in our footsteps. Our constant review of the latest medical breakthroughs and the continuous and open exchange of thoughts and ideas we foster with our students allow us to stay up to date on medical knowledge and this, in turn, enhances our ability to deliver the highest quality patient care. I also mentor clinical research projects with medical residents and review manuscripts for publication in the medical literature.
Gastroenterology; Ion channel kinetics and structure; Membrane Transport (Ion Transport); Molecular and Cellular Biology
Research in my laboratory concerns neurotransmitter and hormone-mediated anion secretion by gastrointestinal secretory tissues like intestinal crypts and liver ducts. I am determining the mechanisms that regulate the basolateral membrane K+ channel, KCNQ1, in anion secretion because these channels play a critical role in secretion by maintaining membrane potential as a driving force for anion exit across the apical cell membrane. Characterization of KCNQ1 K+ channels will help us to understand and remedy defects in anion secretion, especially in diseases like cystic fibrosis. I use electrophysiological techniques, including Ussing chamber, patch-clamp, and Fura-2 fluorescence techniques. I am also studying the mechanisms by which K+ channel antagonists (e.g., Zn2+) block KCNQ1 channels so that anti-secretory, anti-diarrheal drugs can be developed. I have past experience determining the mechanisms by which neurotransmitters regulate K+ channels via inositol 1,4,5-trisphosphate (IP3)-mediated Ca2+ release transduction pathways. I am also collaborating with Dr. John Crane to define the mechanisms by which Zn2+ inhibits the effects of Enteropathogenic E. coli (EPEC) on epithelial cell death and EPEC-stimulated phosphorylation and activation of the CFTR Cl- channel. There is considerable controversy concerning the role and basis of GI disorders associated with autism. In collaboration with Drs. Randall Rasmusson and Glenna Bett, I am investigating the mechanistic link between autism susceptibility and abnormal GI function. I propose that disorders of cellular Ca2+ homeostasis play a key role in the GI disorders of autism. Using mouse models derived from Cav1.2 Ca2+ channel defect that produces the human disorder, Timothy Syndrome, I am characterizing muscle tension and electrophysiological properties of the Ca2+ channel in intestinal smooth muscle. This information will lead to new approaches to identify therapeutic targets and treatments for autistic spectrum GI disorders and symptoms.
I direct the UB Behavioral Medicine Clinic (BMC), an internationally known clinic and research facility that provides short-term, state-of-the-art treatment for patients with painful medical disorders. These disorders include irritable bowel syndrome (IBS), low back pain, fibromyalgia, non-cardiac chest pain, temporomandibular disorder (TMD) and benign headaches such as migraine and tension headaches. A unique feature of our care is the use of evidence-based treatment protocols to help patients gain control of symptoms that have not adequately responded to standard medical treatments. Because our clinicians are active researchers, patients treated at the BMC receive cutting-edge treatments. My research, which is focused on developing and testing novel treatments for functional gastrointestinal (GI) disease, has been funded by the National Institutes of Health (NIH) since 1999. My research responsibilities include designing and conducting outcome clinical trials of novel treatments, which provide valuable research experiences for the medical, public health and psychology students I mentor. Students who work at my lab learn to design, write, conduct and analyze quality research projects with the goal of authoring at least one empirical study for publication in a first-tier journal. The academic skills my students learn at the BMC help them grow into independent researchers or academically oriented clinicians who value critical thinking and a scholarly approach to medicine. In addition, I routinely assist faculty and mentor GI fellows in research design and analysis. I lecture in several UB academic departments such as psychiatry, orthopedic surgery, neurosurgery and psychology with the aim of familiarizing trainees with the psychosocial aspects of chronic disease and ways to promote symptom self-management skills in patients coping with chronic illness. I present at the GI research conference on brain-gut interactions, outcome research, research methods and behavioral aspects of GI disease.
My clinical focus is providing excellent clinical care to patients with a broad range of gastroenterological disorders--particularly those with liver diseases such as hepatitis, alcoholic and non-alcoholic liver disease, cirrhosis, ascites and portosystemic encephalopathy. I work exclusively at the Buffalo VA Medical Center where I serve as chief of gastroenterology. I perform upper endoscopy, colonoscopy and paracentesis on inpatients and outpatients at that facility. My patient-care efforts include digital outreach: I co-authored an article for the inaugural issue of the patient-oriented online magazine “HCV Next.” Since the Buffalo VA Medical Center serves veterans from a broad geographic area, I also provide telehealth—i.e, telephone and secure messaging consultation and follow up to patients in need of this type of long-distance care. This provides more accessible health care to patients who reside a distance from Buffalo, saving them the time and expense of traveling, or to patients for whom travel is inconvenient. I teach the medical students at the University at Buffalo in the classroom, on the wards and in the clinic, how to diagnose and treat liver disease. I have been recognized for my educational skills and have received several awards for teaching. My current research focuses on the delivery of care to patients with liver disease who have limited access to specialists. I conduct studies evaluating tele-gastroenterology, tele-hepatology, telephone medicine and palliative care in patients with advanced liver disease, and I routinely involve and mentor UB fellows, internal medicine residents and medical students in these ongoing studies. The aim of this research is to help provide more accessible health care to patients with physical challenges, those patients who have trouble traveling and those patients whose remote geographic location prevents them from otherwise receiving high-quality health care.
Addictions; Gastroenterology; Internal Medicine; Liver (Hepatology); Infectious Disease
I care for patients with liver disease and addiction disorders, including opiate dependency, viral hepatitis, alcoholic and fatty liver disease, in an outpatient setting at Erie County Medical Center where I am the medical director of hepatology. In collaboration with the division of infectious diseases, I also evaluate and treat patients with hepatitis C virus (HCV) and HIV co-infection. I also treat veterans with opiate dependency at the Buffalo VA Medical Center, in the addiction medicine unit. My patient-care efforts include digital outreach: I co-authored an article for the inaugural issue of the patient-oriented online magazine “HCV Next.” My research involves improving hepatitis C treatments in populations disproportionately affected by HCV but with limited access to health care (including many American veterans, ethnic minority groups, injection drug users, and patients with psychological disorders) as well as developing novel modalities to deliver care. The goal of my research is to expand HCV treatment services to a wide-ranging group of patients, especially those without immediate access to care, in an effort to reduce global disease burden. This may include training primary care or other providers to treat HCV and using telemedicine and co-localization as a way to increase treatment uptake in areas such as rural primary care clinics and methadone clinics. My team is also investigating barriers to hepatitis C screening and treatment. Using the data we collect (e.g., patients’ knowledge of the disease, their perceptions regarding treatment, their willingness to be treated), we can design initiatives to improve patient-based HCV education and work toward the goal of increasing treatment uptake. This component of my research also looks at the same issues on the provider side: provider HCV knowledge and screening, referral and treatment practices. These data will help us understand what the provider-level barriers are to disease control, and we can design provider-based HCV educational initiatives to improve screening and referral for care. I am also a co-investigator on numerous clinical trials related to new therapeutic agents for hepatitis C and fatty liver disease, including a study funded by the Centers for Disease Control and Prevention (CDC) to evaluate the use of telemedicine to treat HCV in methadone maintenance clinics. I present and lecture nationally about hepatitis C with an emphasis on opiate dependence and special populations. I am a member of the New York State Hepatitis C Demonstration Project expert panel. I teach medical students in small group settings in the area of gastroenterology and hepatology. I also precept internal medicine residents and gastroenterology fellows in the outpatient clinics.
I was the first chief of gastroenterology at the Buffalo VA Medical Center, and I have been an attending physician and have cared for patients there for more than 30 years. I am also an attending physician at Erie County Medical Center (ECMC), and I see patients at UBMD Internal Medicine at Amherst as part of the UBMD practice plan. I am a board certified gastroenterologist, and my specialty interest in clinical care is treating patients with inflammatory bowel disease (IBD), specifically patients with Crohn’s disease and ulcerative colitis. I focus my practice exclusively on individuals with these disorders. My primary interest in IBD is treating the disease and understanding and treating its complications. I am also interested in identifying and understanding genetic predispositions to the disease, i.e., why the disease runs in some families, and why IBD may sometimes occur or get worse after a patient sustains an infection. I follow more than 100 patients with IBD, including many in families that have multiple generations affected by the disease. I take a holistic, multidisciplinary approach to the care of my IBD patients, and their welfare and recovery are my primary concern. In treating them, I work in close collaboration with surgeons and nutritionists whose skills and knowledge are frequently needed to help treat and support patients with IBD. I enjoy teaching medical students residents and gastroenterology fellows and contribute to the division’s teaching activities through several case studies that are used to demonstrate important principles in clinical gastroenterology and hepatology. I lecture extensively on IBD, its complications and its manifestations.
I am a board-certified gastroenterologist with deep clinical experience. Having been a leader in interventional endoscopy in the gulf region in the U.S. for nearly a decade, I now care for patients at Buffalo General Medical Center (BGMC), Roswell Park Cancer Institute (RPCI) and Erie County Medical Center (ECMC). I also care for patients at the UBMD Internal Medicine office at 1020 Youngs Rd. in Amherst. Patient-focused care is a hallmark of my medical practice; I often collaborate with other gastroenterologists and primary care physicians to help ensure the best possible coordinated care for my patients. I have advanced training in therapeutic endoscopic procedures, and I have vast experience in all aspects of therapeutic endoscopy. This includes endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasounds (EUS), endoscopic mucosal resection (EMR), radio frequency ablation (RFA), cryoablation, balloon-assisted ERCP in postsurgical anatomy, cholangioscopy, biliary and pancreatic EUS rendezvous, post-liver-transplant ERCP in deceased and live-donor anatomy and minimally invasive hybrid endoscopic surgery. My research interests span the field of interventional endoscopy, with a special focus on genetic and environmental risk factors of pancreas disease as well as interventional endoscopic ultrasound (EUS). I am active in training and mentoring the next generation of physicians. I believe it’s critical that trainees understand the disease process. I encourage them to question the intricacies of each case in order to foster their knowledge and growth as clinicians. I believe that expecting trainees to conceptualize each case in this manner is more valuable than simply memorizing the data. When approaching disease from this perspective, novel questions inherently arise and this, in turn, drives research questions that will fill a void in the extant literature. I teach from the perspective that while I am an expert in this field, I continue to be a student, following the literature and incorporating best practices as they arise.
Gastroenterology; Liver (Hepatology); Infectious Disease
I am a leading expert in liver disease. My work through UBMD at Erie County Medical Center’s liver clinic has tripled the clinic’s capacity to treat patients with viral hepatitis and other forms of liver disease. Colleagues and I also have established comprehensive liver clinics at Buffalo General Medical Center to evaluate patients with liver disease referred from throughout Western New York. In addition, we provide clinical support to the Buffalo VA Medical Center in order to deliver uniformly excellent clinical care to patients with liver disease cared for at hospitals and clinics affiliated with UB’s medical school. We offer trial therapies to patients with viral hepatitis and other forms of liver disease if they meet the protocol criteria of our clinical trials. Our patient-care efforts include digital outreach: my colleagues and I co-authored an article for the inaugural issue of the patient-oriented online magazine “HCV Next.” My lab has received multi-year funding for its research programs in translational and clinical research. During the course of our translational research, members of my lab and I developed techniques for animal and human liver sampling that will enable sorting of liver cells in order to understand drug distribution in the liver during treatment and to develop ways to measure liver drug concentration. These translational research techniques will enable physicians to base drug dosing on the data gathered from the site of antiviral action in the liver instead of measuring the plasma concentration that is more reflective of systemic exposure. This may be an important breakthrough because of the fine line between drug efficacy and toxicity: the techniques will help physicians pinpoint the precise amount of drug needed for maximum benefit to the patient. In the area of clinical research, we are studying care models for viral hepatitis. We are conducting a study sponsored by the Centers for Disease Control and Prevention (CDC) Foundation to assess telemedicine to treat hepatitis C (HCV) in patients who are in treatment for substance use. By creating processes that simplify testing and improve provider and patient awareness and by expanding recommendations for HCV screening, patients can receive more timely care and treatment. I teach GI fellows, residents and students in outpatient and inpatient settings. I also teach first- and second-year medical students in small groups and research seminars with pharmacology graduate students. I am very interested in mentoring, and I supervise residents and fellows in clinical research as well as in my laboratory. The enriching experience my trainees receive affords them excellent placement opportunities once their training is complete. A number of my former trainees so valued their work with my lab that they joined our division as faculty members.