Dr. Glen Lehman is currently a Professor of Medicine and Radiology at Indiana University, where he attended medical school. He has served as a research consultant to a wide variety of corporations, and is the author or co-author of over two hundred articles. In 1985, he was the first researcher in the world to inject collagen into the lower esophagus in order to treat GERD, a treatment that eventually led to a promising new intervention known as Enteryx®. In this interview, Dr. Lehman discusses the evolution of polymer-based interventions over the last twenty years, as well as the evolution of gastroenterology as a field.
Reflux1: At what point in your life did you know you wanted to be a gastroenterologist?
Dr. Lehman: During my internship at Duke University, I had a couple of favorable rotations, and one was in gastroenterology. I was exposed to some thought leaders there, and that carried over in subsequent decision-making.
Reflux1: Currently, you serve as a consultant for a number of corporations. Can you tell us about your involvement as a corporate consultant? What do your patients gain from these consultantships?
Dr. Lehman: We have been involved with the research and development of a variety of devices for use in gastroenterology and gastrointestinal endoscopy, and we have been consulting with the endoscope makers for many years, continually working on the "next year" model. Endoscopy has been my largest area of interest for twenty years, and therefore we are involved with the companies that make the products for endoscopy.
My patients get the benefit of knowing that I know what’s coming down the line; and so that helps to make decisions about today’s care, and sometimes be influenced by what’s going to be available next year.
Reflux1: What is your current focus in patient care or research?
Dr. Lehman: I am focused on the new methods to endoscopically treat GERD, like Enteryx® and others, and therapeutic ERCP treatments. [Body1: Enteryx® is a new treatment for reflux, in which a polymer is injected into the esophageal sphincter.] Enteryx® appears to be a good method to improve the competence or strength of the lower esophageal sphincter, thereby controlling acid reflux. It is relatively easy to inject, and has an excellent safety track record. We are not yet sure how widely Enteryx® or other similar products should be used in GERD patients. However, patients whose heartburn is well-controlled on medication, and patients who regurgitate fluid into the mouth or lungs, appear to be good candidates. The new endoscopic treatments appearing for GERD are interesting and promising. Their more precise effectiveness will be determined with further follow-up and refinements.
Reflux1: According to some of your colleagues, Enteryx® is a very new treatment, but it had some predecessors as early as 1985. Were you involved with any of the research on these earlier procedures?
Dr. Lehman: Our team was the first in the world to come up with the idea of collagen injections to supplement the esophageal sphincter. We did the first animal research on improving the lower esophageal sphincter with Teflon and collagen, and then we performed the first LES collagen injections in the world. It was successful, but it was not adequately durable—meaning that collagen significantly improved reflux, but collagen is fairly biodegradable; so that in six to twelve months too much of it is reabsorbed, and not enough benefit remains for many patients. The first person in the world to get this has actually remained reflux-free for fifteen years, so for a few people it has lasted long-term, but for many, it has melted away too much. Hence, Enteryx®.
Between collagen and Enteryx® were several other injectable products, none of which were good enough to push forward, but were tested on animals. Also in the meantime came the initial endoscopic sewing machine, and later the Stretta radiofrequency device.
Reflux1: What do you feel is your greatest contribution to gastroenterology?
Dr. Lehman: Our team at Indiana University Medical Center has developed a large ERCP center. We’ve developed a large endoscopic team, with great expertise in ERCP and the other standard procedures.
Endoscopy allows us to make diagnoses, but then more specifically allows us to do treatment at the same time. The area of pancreas and bile duct work—that’s the ERCP area—especially allows most exams to be therapeutic. We commonly take out bile duct stones, place stents in tumors, and open up obstructed pancreatic ducts.
Reflux1: What do you see as the most important new trends in gastroenterology?
Dr. Lehman: The major advances have been in improved diagnostic testing, with improved-quality MRI, CAT scans, and quality endoscopes; improved therapeutics, as evidenced by improved endoscopes; improved surgical techniques and intensive care management; improved techniques, such as transplantation and intensive care management; and improved drug therapies, such as drugs like potent acid suppressants, chemotherapeutic agents, anti-inflammatory agents.
Reflux1: How do you expect your practice to be different in five years?
Dr. Lehman: We will continue to see improved non-invasive imaging tests, such as improved virtual colonoscopy and remote control endoscopes similar to capsule endoscopy, and improved remote control or other surgical techniques done with miniature hands, which reach inside the body through very small holes.
Reflux1: For our readers who may be looking for a gastroenterologist, how would you recommend they find a good one?
Dr. Lehman: Good methods of finding a gastroenterologist are just asking friends, neighbors, and acquaintances with whom they have had good experiences, by calling major hospitals or universities and looking at their website rosters, and by looking at published lists of best doctors of the city or best doctors of the country.