Dr. James Aisenberg is an Assistant Clinical Professor at Mt. Sinai Hospital in New York, where he also completed his gastroenterology fellowship. His articles have been published in several leading gastroenterology journals, and he has been invited to present and publish his findings both nationally and internationally. Recently, he has been traveling and teaching around the country in order to instruct other physicians in the use of new reflux treatments that he has helped develop. In this interview, he tells us more about his teaching, his research, and his views on gastroenterology as a whole.
Reflux1: At what point in your life did you know you wanted to be a gastroenterologist?
Dr. Aisenberg: One of my mentors as a resident was a gastroenterologist, and that had a lot to do with it. In the middle of my residency I decided on the specialty. I liked the mixture of using your hands and using your brain. And, it’s a diverse patient population: young and old, sick and not sick, lot of different organ systems. So there’s lots of diversity in your day.
Reflux1: What do you feel is your greatest contribution to gastroenterology?
Dr. Aisenberg: The clinical care that I provide to my patients, the work that I do in the day-to-day practice, and also my teaching. I teach the fellows both endoscopy and clinical gastroenterology. For years I was the director of the gastroenterology elective, so I taught in that capacity, and I teach the internal medicine residents, also, during their training. And I do some teaching around the country in various capacities; I train other gastroenterologists in some special techniques that I have expertise in. I’ve done some teaching for a new technology called capsule endoscopy, and for Enteryx®. But at the end of the day, I’m a doctor.
Reflux1: Can you tell us more about the new technologies you mentioned?
Dr. Aisenberg: The Enteryx® technology is one of the latest developments in the management of GERD. It’s a minimally invasive technique to straighten out the problem of reflux, to spare patients lifelong medication therapy or help patients that are not adequately helped by medication. We modify the barrier between the stomach and esophagus, using a polymer injection. We only have results for one to two years after treatment, but what they show is that about two-thirds of patients feel much better or take much less medication, so they’re much healthier in that regard.
Capsule endoscopy is a minimally invasive technology for studying the small intestine. A camera travels through their gut, takes snapshots and transmits them electronically to a small computer. It takes two frames per second and enables us to make a diagnosis where it was almost impossible to do so, so patients who have gone for years without a diagnosis can return to good health. It enables us to fix the problem and make them feel well again.
Reflux1: What is your current focus in patient care or research?
Dr. Aisenberg: I have a practice of clinical gastroenterology, principally consulting and endoscopic procedures; various advanced procedures. We do a lot of work in colon cancer prevention, management of reflux disease, and common gastrointestinal disorders.
My publications have principally been in the area of reflux disease management and various endoscopic techniques. We’ve done some recent work on endoscopic sedation, which is very exciting. It enables us to safely and effectively put patients in a very comfortable sedation, so that they don’t have any discomfort, but wake up very briskly and are able to go back to work within a half hour. It’s quick, efficient, and effective; and, I think, is actually safer than the standard. It uses different drugs, which are metabolized within minutes. They’re out of the system within minutes. You wake up lucid, you don’t have a hangover, you don’t have to go home and sleep. You can go to lunch with your spouse.
Reflux1: You work closely with a colleague, Dr. Cohen, who was also been featured as a Hero on our site. Would you highlight one of the clinical trials that you and Dr. Cohen are working on together?
Dr. Aisenberg: The research we’re doing on the Enteryx® technology is ongoing. We’ll be involved in a major trial to further demonstrate its effectiveness. We’re doing a number of further trials of endoscopic sedations, to further demonstrate the added benefit of the technology. We are doing some trials looking at the capsule, which we discussed a little, to look at the injury caused to the small intestine by various pain relievers.
Many people have noticed that, when you take those drugs, your belly hurts. One thing the new pill-sized camera is to figure out why it hurts and where the problem is so we can figure out ways of making you feel better. There are a couple of trials we’re doing currently. We’re doing some other trials, using a new technology to actually measure how much reflux occurs over the course of 48 hours. For the first time ever, we’re about to evaluate how good our treatments are safely and comfortably.
Reflux1: What do you see as the most important new trends in gastroenterology?
Dr. Aisenberg: I think, from a technological standpoint, the advent of wireless endoscopy is very important, and something that I want to continue to be very involved in. I think it’s huge. In terms of therapeutics, I think that endoscopy therapy for reflux is going to be very important, and I don’t know which technology is going to emerge victorious. The cost of medication for reflux is a huge economic burden for the country. Over time, if a minimally invasive therapy can emerge to be effective, it will be extremely exciting.
Reflux1: So these new technologies really are very new.
Dr. Aisenberg: Well, it’s an old field in the sense that it’s been under consideration for a long time, but it’s only recently that viable technologies have emerged. There was some work done in the eighties where collagen was injected into the esophagus, but it didn’t catch on. That research lay fallow for ten or twenty years of so, until recently, when a lot of people have gotten involved in it.
Reflux1: How do you expect your practice to be different in five years?
Dr. Aisenberg: Hopefully, I won’t be working quite so hard! I think there’ll be some new drugs for irritated bowel syndrome, and there’ll be new drugs for bowel disease. Modifiers, smart drugs for Crohn’s disease, colitis, and irritated bowel syndrome, are coming. Hopefully, we’ll have some of those within the next five or ten years. There will be wireless endoscopy within the next five or ten years; different and new therapies we can offer through the scope without having to do surgery. It’s a very exciting time to be involved in this field: there’s a lot of change, and it’s fun to be involved in it.
Reflux1: For our readers who may be looking for a gastroenterologist, how would you recommend they find a good one?
Dr. Aisenberg: My recommendation would be to seek out the premier organizations in our field: the American Gastroenterology Association, the American Society for Gastrointestinal Endoscopy, and the American College for Gastroenterology. I would go to their websites and do a physician search, based on education, location and interest.
Reflux1: Is there anything you’d like to tell our readers in closing?
Dr. Aisenberg: I think there are a lot of new exciting treatments for reflux coming along. It’s important for each individual to weigh the choices carefully with their physician, since the treatment right for one patient is not right for the next, and the success of a lot of the newer treatments depends on selecting the right patient for the right treatment. It’s a "the educated consumer is our best customer" kind of thing. We’re very careful in our patient selection, something we want to continue to stress.
Patients are very concerned about the cancer risk of reflux. Having a good relationship with a good gastroenterologist is the best thing a patient can do to prevent the complications of reflux. It’s always an annoying disease, although if properly managed, it doesn’t even have to be that. But it should almost never be life-threatening, or have serious complications. It should be taken seriously and handled with a professional: that will give patients the peace of mind they want and need.