Gastroenterology involves the study and management of problems occurring in the whole gastrointestinal tract from mouth to anus, and includes the liver, biliary tree and pancreas. Surprisingly for such a substantial component of the body, gastroenterology was a relative newcomer as a medical specialty, emerging in the 1960s, but has developed rapidly to become one of the major medical subspecialties.
Gastroenterology has evolved in a multidisciplinary fashion with close collaboration with surgery, radiology, pathology and dietetic services.
The substantial developmentsin endoscopy and cross-sectional radiology have allowed all areas to become accessible to direct study, and often treatable with minimally invasive therapy.
At the outset of this period, there were very few Gastroenterologists in Scotland but by 2010 there were 26 Consultant Gastroenterologists in Glasgow and 108 in Scotland. The British Society of Gastroenterology was founded in 1937 with 36 members attending the first meeting; but this had grown to 2600 attendees in 2010. The frequency of patient problems, the large number of young patients, potential for research studies, increasingly effective therapies and the development of endoscopic skills attracted many of the most able clinicians into the specialty.
The University of Glasgow never established a University Department of Gastroenterology, unlike many British Universities, but academic development was strongly encouraged through the University Departments of Medicine and Surgery.
In the early days, the University Departments of Surgery at the Western Infirmary, under the guidance of Professors Sir Charles Illingworth and Sir Andrew Watt Kay, and at the Royal Infirmary, under Professor Leslie Blumgart, were the key players.
However, they encouraged the appointment of NHS Consultants in Gastroenterology in each of the Glasgow hospitals (Dr Geoffrey Watkinson, Western Infirmary; Dr Robin Russell, Royal Infirmary; Dr Gerard Crean, Southern General Hospital; Dr Thomas Thomson, Stobhill Hospital and Dr Kenneth Cochran, Victoria Infirmary) who all provided the essential core to initiate rapid development of the specialty.
Each of the hospitals quickly developed research programmes that led to the formation of the Glasgow Gastroenterology Club, the Caledonian Society of Gastroenterology, and the British Association for the Study of the Liver at which to present these new findings.
Glasgow clinicians were major contributors at these meetings and three (Illingworth, Watkinson and Crean) served as Presidents of the British Society of Gastroenterology. Professor Kenneth McColl (upper GI tract) and Professor Peter Mills (liver disease) were appointed at the Western Infirmary in recognition of their contributions to research, the former having supervised over 50 research theses.
Dr Robin Russell established academic and research activities at the Royal Infirmary, particularly in the areas of inflammatory bowel disease, coeliac disease and nutrition.
Diagnostic and Therapeutic Endoscopy
Flexible endoscopes first became readily available in the early 1960s and were rapidly adopted by all the Glasgow hospitals because they allowed access to parts of the body which were only indirectly seen previously.
Many of the early endoscopists were self-trained, but formal training soon became widespread and instruments were refined from fibreoptic to videofluoroscopic.
Access to the whole gastrointestinal tract was obtained and many therapeutic procedures developed through the scope, especially at the Royal Infirmary (Professor Sir David Carter, Professor Clement Imrie, Mr Ross Carter, Dr John Morris, Dr Adrian Stanley) such that it has become a major training unit for the whole of the UK.
The advent of laparoscopic surgery, interventional radiology (Dr Ramsay Vallance, Professor Jon Moss and Dr Richard Edwards at Gartnavel General Hospital), together with therapeutic endoscopy, substantially improved recovery times after procedures for patients. National bowel cancer screening for patients aged 50-74 years with positive faecal occult blood has become a major colonoscopy workload for all the hospitals.
Glaswegians have long been fond of a ‘wee refreshment’, which has resulted in one of the highest prevalences of cirrhosis from alcoholic liver disease in the UK. Additional contributions in Glasgow have been chronic hepatitis C related to drug abuse, obesity leading to fatty liver (and steatohepatitis), and genetic haemochromatosis (a genetic disorder causing excess iron storage in the liver).
The prevalence of chronic liver disease in Glasgow hospitals has mushroomed, such that it has become the commonest condition seen in the Gastroenterology in-patient wards. These patients require specialist intensive care and heroic procedures to control variceal bleeding, and have substantial mortality. Many of the conditions leading to cirrhosis are amenable to treatment to prevent progression of disease. Specialised units for liver patients were established at the Western Infirmary/Gartnavel General Hospital (Professor Peter Mills, Dr Matthew Priest) and Royal Infirmary (Dr Adrian Stanley, Dr Ewan Forrest) to support these patients, and coordinate with the Scottish Liver Transplant Unit at the Royal Infirmary in Edinburgh.
Inflammatory Bowel Disease
Ulcerative colitis and Crohn’s disease both provide a significant workload of young patients to all gastroenterologists. Interestingly, Crohn’s disease was first identified in 1913 by Sir Kennedy Dalziel, a surgeon at the Western Infirmary, and should have been named Dalziel’s disease in recognition. These conditions often require lifetime care and cause major morbidity to those who suffer their consequences. Dr Geoffrey Watkinson (Western Infirmary) and Dr Robin Russell (Royal Infirmary) both established specialist care for these patients and trained many of the local consultants. These patients exemplify the need for multidisciplinary teams involving surgeons, radiologists, pathologists and dietitians. Nutritional support, both enteral and parenteral, is required for many patients. While the aetiology of these conditions remains unknown, the recent use of biological agents has reduced the inflammation and severity of relapses.
Professor Peter R Mills
Images unless otherwise noted provided by Professor Mills
Consultant Gastroenterologists 1948-2010 (chronologically by year of appointment)
Western Infirmary/Gartnavel General Hospital
Dr Geoffrey Watkinson (died 1996)
Dr Gordon Allan
Professor Kenneth McColl
Professor Peter Mills
Dr Simon Dover
Dr Derek Gillen (died 2013)
Dr Matthew Priest
Dr John McKenzie
Dr John Morris
Dr Adrian Stanley
Dr Ewan Forrest
Dr Ruth Gillespie
Dr Jack Winter
Southern General Hospital
Dr Andrew Melrose (died 1967)
Dr Gerard Crean (died 2005)
Dr Alastair Beattie
Dr Richard Park
Dr Stewart Campbell
Dr Hisaharu Suzuki
Dr Dan Lassman
Dr Jude Morris
Sir Thomas Thomson (died 2013)
Dr John Forrest (died 2010)
Dr Booth Danesh
Dr Aidan Cahill
Dr Neil Jamieson
Professor Kenneth Cochran
Dr Christine Penney
Dr Robert Boulton-Jones
Dr Alan Clarke
Dr Saeed Sarwar
Dr Shouren Datta
Royal Alexandra Hospital, Paisley
Dr Stuart Hislop
Dr James McPeake
Dr Mathis Heydtmann
Dr Graham Naismith