UCSF GASTROENTEROLOGY -- A BRIEF HISTORY

The UCSF School of Medicine, founded in 1864, was the first school of graduate medical education in the western United States. Although it appointed a full-time chair of Medicine in 1927 (William J. Kerr, M.D.), clinical subspecialty teaching continued to be performed by physicians who had their base in community practice and were only part-time at the University. This system continued into the early 1960's, when a gastrointestinal group began to form around the leadership of John V. Carbone, M.D. (1922-1990), who was the first full-time gastroenterologist at UCSF. Dr. Carbone was a graduate of UC Berkeley (1945) and UCSF School of Medicine (1948), receiving the gold-headed cane. In his area of particular interest, inflammatory bowel disease, he was revered for his clinical acumen and teaching prowess. Harrison Sadler, M.D., a colleague in Psychosomatic Medicine in the 1970's, is known to have said, "All of the medications given to colitis patients were irrelevant compared to the impact of John Carbone, the man, at the bedside of these patients."

In the mid-1960's, two events led directly to the modern UCSF Division of Gastroenterology. The first was the arrival in 1964 of L. Hollingsworth (Holly) Smith, Jr., M.D. as chair of the Department of Medicine. Dr. Smith recruited Rudi Schmid, M.D., Ph.D., in 1966 to create an academic program in Gastroenterology. At that time, Lloyd L. Brandborg, M.D., was Director of Gastroenterology at the Veterans Affairs Medical Center. Marvin H. Sleisenger, M.D., would arrive shortly as Chief of Medicine, adding to the focus on gastroenterology.

Dr. Schmid was born in 1922 to a medical family in Glarus, a village in the mountains of eastern Switzerland. He received his baccalaureate from the Zurich Kantonschule and his M.D. (1947) from the University of Zurich. He was an intern at UCSF (1948-49), then resident, clinical fellow and Instructor in Medicine at the University of Minnesota, receiving his Ph.D. from the latter institution in 1954. In Minneapolis, he worked with Cecil Watson, M.D., who introduced him to the field of porphyrins and bile pigments. His seminal contributions included the development of experimental. models of porphyria and identification of bilirubin diglucuronide as "direct-reacting" bilirubin. Together with Harvey S. Marver, Ph.D., he elucidated the enzymatic breakdown of heme to bile pigment. In 1974, Dr. Schmid was elected to membership in the National Academy of Sciences. In 1983, he became Dean of the UCSF School of Medicine.

Together with Drs. Sleisenger and Brandborg, Dr. Schmid integrated teaching and training across the major UCSF clinical facilities, which at that time included Moffitt Hospital on the Parnassus campus, the Veterans Affairs Medical Center and the San Francisco General Hospital. Research in the Gastrointestinal Unit (as it was then known) expanded rapidly. Robert K. Ockner, M.D., joined the Division in 1968, bringing a focus on hepatic and intestinal lipid metabolism. In 1975, UCSF won funding from the National Institutes of Health to create a Liver Center, an inter-disciplinary consortium of basic and clinical scientists for advancing knowledge in the biology and diseases of the liver. Dr. Schmid led the Center until 1983, to be followed by Dr. Ockner. In 1998, D. Montgomery Bissell, M.D., was appointed Center director. In 1980, the Division was awarded an institutional training grant from the National Institutes of Health, funding for which has been continuous to the present.

Clinical activities at the Moffitt-Parnassus site grew along with research. In 1969, Howard Shapiro, M.D., who was an early trainee of Dr. Carbone, became chief of Endoscopy, a position he held until 1985; Dr. Shapiro died in July, 1995. James W. Ostroff, M.D., became UCSF chief of Endoscopy in 1990. In 1999, the endoscopy units at Moffitt-Long and Mt Zion were linked administratively and electronically. Currently, they handle ~10,000 procedures annually.

In 1988, UCSF established its Liver Transplantation Program under the leadership of Nancy L. Ascher, M.D., Ph.D. The Division of Gastroenterology partnered this activity, and the first Medical Director of Liver Transplantation was John R. Lake, M.D. In 1998, he was succeeded by Nathan M. Bass, M.D., Ph.D.

Department of Veterans Affairs Medical Center. In 1968, shortly after an affiliation agreement was signed between UCSF and the Veterans Administration, Holly Smith recruited Marvin H. Sleisenger, M.D., to head the Medical Service. Dr. Sleisenger worked with Lloyd L. Brandborg, M.D. (1924-95), who was chief of Gastroenterology, to develop a program, recruiting Young S. Kim, M.D., to head a research laboratory in digestion and nutrient metabolism. Dr. Kim's group became distinguished for its contributions to intestinal glycoprotein metabolism and colon cancer. In 1981, Thomas D. Boyer, M.D., became Division chief at the VAMC, succeeded in 1990 by James H. Grendell, M.D. In 1992, Dr. Sleisenger was designated a Distinguished Physician of the Department of Veterans Affairs. In 1994, Teresa L. Wright, M.D., assumed leadership of the Division, building a nationally recognized program in viral hepatitis. A new Endoscopy Center opened in 2000 under the direction of Kenneth R. McQuaid, M.D., and in 2006, Dr. McQuaid became chief of the Division at the VAMC.

San Francisco General Hospital Medical Center. For much of the first half of the 20th century, both UCSF and Stanford maintained teaching services at SFGH. In 1960, Stanford moved its San Francisco-based clinical programs to Palo Alto, leaving UCSF as the sole academic affiliate of SFGH. In 1976, a new inpatient facility opened, which left the previous patient-care structures available for expansion of clinical and research activities. The Gastroenterology service acquired an integrated suite of interview rooms, procedure rooms and offices. The service was directed by John P. Cello, M.D. until 1998. Research activities also grew. In 1977, the University received a bequest from the estate of William and Mary Ann Rice for support of research in liver disease, and it was decided that the proceeds would be devoted to a new laboratory at SFGH. Under the direction of D. Montgomery Bissell, M.D., from 1981 to 1997, the Rice-Liver Center Laboratory pioneered research on mechanisms of liver injury and repair. The director of the Rice Liver Center Laboratory since 1997 has been Jacquelyn Maher, M.D. The current Chief of the integrated Division of Gastroenterology and Hepatology at SFGH is Hal F. Yee, Jr., M.D., Ph.D.

Mount Zion Hospital. This facility, dedicated in 1899, was built for the care of Jewish immigrants escaping czarist Russia but open to needy people of all creeds. By 1975, it had developed close ties to UCSF, providing research space and functioning as a teaching site. In 1990, the University acquired the Hospital, and in 1993 the Division of Gastroenterology expanded its activities to include that site under the direction of James W. Ostroff, M.D. In 1998, the UCSF Cancer Center opened at Mt. Zion, and the Division established a program in Colon Cancer Risk Assessment. In 2001, a Liver Cancer program and the UCSF Center for Inflammatory Bowel Diseases were initiated at Mt. Zion.

Other recent events:

• In 1997, the Division acquired its first endowed chair, in honor of John V. Carbone, M.D.
• In 2003, the Division created the Rainin Professorship and the UCSF Center for Colitis and Crohn's Disease, with a generous donation from Kenneth Rainin.
• in 2004, the Dean Craig estate provided funding for a chair for Health Services research in Gastroenterology.
• For each of the past five years, UCSF Gastroenterology was ranked among the nation's top ten in its subspecialty by U.S. News and World Report.

Directors, UCSF Gastroenterology

1966-1983: Rudi Schmid, M.D., Ph.D.
1983-1990: Robert K. Ockner, M.D.
1990-1996: Bruce F. Scharschmidt, M.D.
1996-1997: Nathan M. Bass, M.D., Ph.D. (interim)
1997- : D. Montgomery Bissell, M.D.

Leadership Positions of Present and Former Members of UCSF Gastroenterology

• Member, National Academy of Sciences

  Rudi Schmid, M.D., Ph.D. (elected 1974)

• Executive Committee, American Board of Internal Medicine

  Marvin H. Sleisenger, M.D. (1973-76)

• President, American Society for Clinical Investigation

  Bruce F. Scharschmidt, M.D. (1993)

• President, American Gastroenterological Association

  Marvin H. Sleisenger, M.D. (1976)

• Presidents, American Association for the Study of Liver Diseases

  Rudi Schmid, M.D., Ph.D. (1965)
  Robert K. Ockner, M.D. (1984)
  D. Montgomery Bissell, M.D. (1995)
  Thomas D. Boyer, M.D. (2002)
  Teresa L. Wright, M.D. (2005)
  John M. Vierling, M.D. (2006)
  Scott L. Friedman, M.D. (2009)

• Editors-in-Chief of Major Journals

  Marvin H. Sleisenger, M.D., Gastroenterology (1966-1971)
  Robert K. Ockner, M.D., Gastroenterology (1981-1986)
  Bruce F. Scharschmidt, M.D., Journal of Clinical Investigation (1987-1991)
  D. Montgomery Bissell, M.D., Hepatology (1997-2002)

• Editors of Major Textbooks

  Marvin H. Sleisenger, M.D., Gastrointestinal and Liver Diseases, 7th ed., W. B. Saunders Co. 2003.
  David Zakim, M.D. and Thomas D. Boyer, M.D., Hepatology, A Textbook of Liver Disease, 5th ed., W. B. Saunders Co., 2003.
  Scott L. Friedman, M.D., Kenneth R. McQuaid, M.D., and James H. Grendell, M.D. Current Diagnosis & Treatment in Gastroenterology, 2nd ed., McGraw-Hill

• Vice Chancellor

  Michael J.P. Arthur, M.D., University of Leeds, UK

• Dean

  Rudi Schmid, M.D., Ph.D., UCSF (Emeritus)
  John L. Gollan, M.D., Ph.D., University of Nebraska, Omaha

• Department Chairs

  Norbert Blanckaert, M.D., Ph.D., University of Leuven, Belgium
  Geoffrey C. Farrell, M.D., University of Sydney, Westmead, Australia
  Jacob George, M.D. University of Sydney, Westmead, Australia
  J. Gregory Fitz, M.D., University of Texas Southwestern, Dallas
  Alfred Gangl, M.D., University of Vienna, Austria

• Division Chiefs (past or present, other U S. institutions)

  Robert S. Bresalier, M.D., MD Anderson Cancer Center, Houston
  C. Richard Boland, M.D., Baylor University, Dallas
  Thomas D. Boyer, M.D., University of Arizona, Tucson
  Christopher E. Forsmark, M.D., University of Florida College of Medicine, Gainesville
  Scott L. Friedman, M.D., Mount Sinai School of Medicine, New York
  James H. Grendell, M.D., Cornell University School of Medicine, New York
  Philip S. Guzelian, M.D., University of Colorado, Denver
  Steven H. Itzkowitz, M.D., Mount Sinai School of Medicine, New York
  John R. Lake, M.D., University of Minnesota, Minneapolis
  Rodger A. Liddle, M.D., Duke University, Durham
  Denis M. McCarthy, M.D., Ph.D., University of New Mexico, Albuquerque
  Neville R. Pimstone, M.D., Ph.D., University of California, Davis
  Don C. Rockey, M.D., University of Texas Southwestern, Dallas
  John M. Vierling, M.D., Baylor College of Medicine, Houston
  C. Mel Wilcox, M.D., University of Alabama, Birmingham
  David Zakim, M.D., Cornell University School of Medicine, New York