The gastroenterology and hepatology subspecialty residency (fellowship) program at Saint Louis University School of Medicine is designed to provide superior training in all aspects of clinical and endoscopic gastroenterology and hepatology.
We expect that graduates of our program will excel in both the cognitive and the procedural aspects of gastroenterology.
Gastroenterology and Hepatology Training
During the three-year program, subspecialty residents receive training in the cognitive aspects of consultative gastroenterology and hepatology, in gastrointestinal endoscopy and liver biopsies, and have opportunities for research activities. Subspecialty residents also have an opportunity to spend six months in laboratory-based or clinical research. An amalgamation of these clinical, procedural and research experiences provides the foundation for a future career in academic medicine, as well as in a scholarly clinical practice.
The role of the gastrointestinal specialist has been modified with the changes in healthcare delivery and the advent of managed care. We are cognizant of these changes and we have tried to design our program to be sufficiently flexible to meet the needs of our trainees and to allow for future success.
Complex problems in gastroenterology often require a team approach. We have excellent collaborative relations with GI and liver transplant surgeons, diagnostic and therapeutic radiologists and GI pathologists who interact with us regularly in the care of our patients and in our research efforts. Saint Louis University has an active abdominal transplantation program.
Subspecialty residents and faculty participate in a variety of weekly one-hour conferences including gastroenterology grand rounds, GI fellows case conferences, Journal Club, Biliary Journal Club, Pathophysiology, Pathology Conference, Radiology Conference and the Liver Cancer Conference.
You may apply for one of our four GI subspecialty residency positions through the Electronic Residency Application Service (ERAS). We accept applications July 1-31 for each interview season. We review applications in early August and invite applicants to interview from late August-October. All of our positions will be filled through the National Residency Match Program (NRMP). We sponsor both H-1B1 and J-1 visas. All application requirements are listed with ERAS.
Fellowship Clinical Services
SSM Health Saint Louis University Hospital, the VA Saint Louis Health Care System - John Cochran Division and SSM Health St. Mary's Hospital participate in the training program. A different spectrum of patients and diseases is seen at each. Subspecialty residents learn consultative gastroenterology and hepatology and patient management in the setting of a tertiary/quaternary university hospital, a public hospital and a community hospital.
During the first year of training, subspecialty residents rotate on the gastroenterology service at SSM Health Saint Louis University Hospital and VA Saint Louis Health Care System - John Cochran Division.
Subspecialty residents become proficient in basic endoscopic procedures including:
- Upper endoscopy
- Endoscopic biopsy
- Esophageal dilatation
- Endoscopic hemostasis
- Percutaneous endoscopic gastrostomy
The second and third years of training includes rotations on:
- Liver service
- Pancreaticobiliary service
- General gastroenterology service at SSM Health St. Mary's Hospital
- VA Saint Louis Health Care System - John Cochran Division
Electives are presently available in:
- Gastrointestinal radiology
- Pediatric and adolescent gastroenterology
- Gastrointestinal motility
- Liver transplantation
When working with the Liver Service, subspecialty residents receive extensive training in the outpatient evaluation and management of patients with a variety of liver diseases. The inpatient experience on the Liver Service includes the evaluation and management of acute liver disease, and pre- and post-transplant problems. Subspecialty residents gain extensive experience in performance of liver biopsy and paracentesis.
When working with the Pancreaticobiliary Service, subspecialty residents attain extensive experience in the evaluation and management of inpatient and complicated outpatient pancreatic and hepatobiliary disorders. At the completion of this rotation, subspecialty residents have generally become proficient in the basic aspects of ERCP (e.g., cannulation of the bile and pancreatic ducts). Although subspecialty residents have the opportunity to observe and assist in the more advanced aspects of biliary endoscopy (e.g., sphincterotomy, stent placement, lithotripsy, stone removal, sphincter of Oddi manometry, etc.), proficiency in these areas usually cannot be expected without additional training and/or experience.
Subspecialty residents rotating through the motility elective see outpatients in the Motility Clinic and provide subspecialty consultation for motility-related problems on the inpatient service. Subspecialty residents learn the performance and interpretation of esophageal manometry, ambulatory pH studies, antroduodenal manometry and anorectal manometry.
Subspecialty residents gain exposure to the use and interpretation of scintigraphic gastric emptying, small bowel and colonic transit studies. Subspecialty residents observe techniques used for pelvic floor retraining (constipation) and anal sphincter retraining (fecal incontinence). They are exposed to autonomic function testing and the use of behavioral techniques in the treatment of functional bowel disorders. By the end of the rotation, the subspecialty residents have an excellent grasp of the evaluation and management strategies in functional bowel disorders and motility disorders. True proficiency requires additional training.
Second-Year Subspecialty Residents
Second-year subspecialty residents will be involved in a research project under the direction of a faculty preceptor. They can be trained to use modern tools of investigation to address questions in cell and molecular biology as well as clinical research. Subspecialty residents are encouraged to interact with investigators in the basic science departments of the University according to their specific research interests and career plans.
Current research activities include:
- Investigation into the mechanisms of hepatic fibrogenesis
- Gene regulation of hepatic collagen synthesis
- Regulation of hepatic stellate cell activation
- Effects of Kupffer cell products on hepatic stellate cells
- Role of oxidative stress in hepatic injury
- Transcriptional activation in Kupffer cells
- Hepatic cytoplasmic transport of amphipathic molecules
- Role of complement in liver injury
- Ischemia-reperfusion injury in the pancreas
- Mechanisms of inflammation and fibrosis in the pancreas
- Pancreatic glutathione metabolism
- Mechanisms of regulation of iron homeostasis
- Intracellular signaling in stellate cells
- Kupffer cells
A variety of clinical projects is ongoing. These include evaluation of the efficacy of various types of interferon in chronic hepatitis C, multidrug therapy for hepatitis C, new drug therapy in hepatitis B, new therapies for alcoholic hepatitis, evaluation of medical therapy in irritable bowel syndrome and sphincter of Oddi dysfunction, evaluation of new methods for endoscopic control of gastrointestinal hemorrhage, identifying the role of the hemochromatosis gene in liver disease, and management of medical problems in the post-transplant setting.
Subspecialty residents are encouraged to present the results of their research experiences at an annual national meeting, such as the meetings sponsored by the American Gastroenterological Association, the American Association for the Study of Liver Diseases or the American College of Gastroenterology.
The goal of training in the second and third years is for subspecialty residents to develop specific skills in keeping with their career goals. Some interested in general gastroenterology practice might be involved in all clinical areas. Someone interested in a research-oriented academic career would place an emphasis on research. And subspecialty resident interested in a career in academic clinical hepatology might do extensive work in the Liver Clinic, with the Liver Transplant Service, and with several clinical research projects. The flexibility of the curriculum in the second and third years allows our subspecialty residents to tailor their training according to their career choices.
- Saint Louis University Medical Center Library
- American Gastroenterology Association (AGA)
- American College of Gastroenterology (ACG)
- American Association for the Study of Liver Diseases (AASLD)
- American Society for Gastrointestinal Endoscopy (ASGE)
- American College of Physicians (ACP)
- American Neurogastroenterology and Motility Society (ANMS)
- Crohn's Colitis Foundation of America (CCFA)
- American Board of Internal Medicine (ABIM)
- Accreditation Council for Graduate Medical Education (ACGME)
- Gastro Career Center Career Search