Dr. Gregory Sayuk joined the Division of Gastroenterology at the Washington University School of Medicine in St. Louis in 2006. He completed his medical school training at the University of Texas in Houston (1996-2000) and then came to Washington University for his Internal Medicine Residency training (2000-2003) and Gastroenterology fellowship (2003-2006). Dr. Sayuk trained under the mentorship of Dr. Ray Clouse, and has a clinical interest in irritable bowel syndrome (IBS) and related functional GI disorders.

IBS represents a condition whose pathogenesis remains incompletely understood. Dr. Sayuk collaborates with Washington University colleagues in Neuroradiology and Psychiatry to perform neuroimaging research using functional magnetic resonance imaging (fMRI) technology to identify central symptom amplification mechanisms and defective pain inhibitory pathways that may be relevant to IBS pathophysiology.

The Division of Gastroenterology at the Washington University School of Medicine represents one of the finest examples of an academic training program, dedicated to the study of digestive and liver diseases. The balance of outstanding faculty, exemplary facilities, and a cohesive philosophy ensure consistent excellence across the missions of maintaining national prominence in research, teaching and patient care.

The Division of Gastroenterology was established almost 40 years ago as a subspecialty division of the Department of Internal Medicine. Under Dr. David Alpers' visionary leadership, the Division has successfully nurtured broad academic interests in teaching, research and clinical excellence and has attracted both national and international recognition for its contributions to the field of gastroenterology. When Dr. Alpers stepped down as Division Chief in 1996 after 27 years at the helm, he had established the Division as a center for clinical excellence and a well-rounded training program steeped in rich academic tradition. Dr. Nicholas Davidson came to Washington University in 1998 to lead the Division and has continued to affirm these strong traditions of academic excellence, which are deeply embedded in the institutional philosophy. Dr. Davidson has been instrumental in guiding the Division into the 21st century, and has made key recruitments to broaden the clinical and investigational repertoire of the Division. The Division currently provides state-of-the-art clinical care, cutting-edge molecular and translational research, and basic as well as advanced training for managing diseases of the digestive tract. The Division is one of only two centers in the country to have been awarded a Digestive Disease Research Core Center and a Clinical Nutrition Research Unit, both funded by the National Institutes of Health (NIH). The Division ranks among the top training programs in the country, our NIH-funded Training Grant entering its 36th year of continuous support.

Located in St. Louis, Missouri, Washington University School of Medicine lies in the heart of the Midwest. Washington University Medical Center is one of the nation's largest clinical and biomedical research facilities. This year Washington University is again among the top five recipients of NIH Funding Awards granted to academic medical schools in the USA. The campus includes more than 60 buildings on nearly 230 acres and is located on the eastern edge of Forest Park, the second largest city park in the country. The Medical Center consists of Washington University School of Medicine, Barnes-Jewish Hospital, Barnard Free Skin and Cancer Hospital, St. Louis Children's Hospital and the Central Institute for the Deaf. The newest addition to the Medical Center is the Alvin J. Siteman Cancer Center, which received National Cancer Institute (NCI) designation as a cancer center in August 2001.

The clinical services of the Division of Gastroenterology are provided through Barnes-Jewish Hospital. Barnes-Jewish Hospital is a member of the BJC Healthcare System, the largest academically-linked health system in the country. Barnes-Jewish Hospital has a premier reputation in patient care, medical education, research and community service. With 1624 beds, it is the largest hospital in the St. Louis area. Barnes-Jewish hospital has been consistently rated as one of the top 10 hospitals in the country by U.S. News and World Report, the most recent ranking being 8th in 2006. The Division of Gastroenterology has a diverse research base with a number of physician-scientists (MD and MD, PhD) and PhD scientists conducting basic investigation into the molecular regulation of development, nutrient absorption, colon carcinogenesis, immune tolerance and inflammation and repair. In addition, there is a range of active translational research, including novel therapies for inflammatory bowel disease, obesity and energy metabolism, hepatic steatosis, hepatitis C and topographic manometric assessment of esophageal motility.

The primary purpose of the fellowship training program remains one of producing outstanding academicians and clinicians with unparalleled skills in gastroenterology. To accomplish this goal, the first fellowship year is devoted to the basics of clinical gastroenterology, exposing the trainee to a wide variety and large number of common gastrointestinal diseases. The subsequent two years complete clinical core requirements while providing opportunities to develop skills in a basic sciences laboratory or in the arenas of clinical translational research and investigation. An optional fourth year advanced fellowship provides the interested trainee with advanced interventional endoscopy skills for a career in biliary, pancreatic and interventional endoscopy. Approximately 50% of former fellows from the Division of Gastroenterology are currently making contributions to academic gastroenterology as basic scientists, clinical investigators or educators.

 The Modulation of Cerebral Pain Responses Using Desipramine in the Treatment of Irritable Bowel Syndrome (IBS)

Individuals with irritable bowel syndrome (IBS) may experience abdominal pain as a result of pain signals in the bowel and how these signals are processed in the brain. Studies using brain imaging (pictures) have shown that IBS patients with more pain diagnoses (i.e. fibromyalgia, migraines, etc.) have greater activity in the regions of the brain responsible for the emotional and thought processing of pain signals. This could possibly make bowel sensations and bowel difficulties feel abnormal or more noticeable, in turn causing more severe IBS symptoms. The purpose of this protocol is to explore the role of pain diagnoses and their affect on brain activity in IBS patients. The investigators will also examine the use of a medication, desipramine, which is known to affect these brain regions, in IBS patients.

Estimated Enrollment: 200
Study Start Date: February 2009
Estimated Primary Completion Date: February 2012 (Final data collection date for primary outcome measure)

Ages Eligible for Study: 18 Years to 90 Years
Genders Eligible for Study: Female
Accepts Healthy Volunteers: Yes