Fifty years of Australian gastroenterology and hepatology: A golden era of contributions to the region
Year: 2009
Type: editorial
Abstract: This issue of the Journal of Gastroenterology and Hepatology (JGH) is accompanied by a Supplement that celebrates the 50th Anniversary of the Gastroenterological Society of Australia (GESA). GESA also incorporates the Australian Liver Association (ALA), the Australian Gastroenterological Endoscopy Association (AGEA), and the Australian Association for Inflammatory Bowel Disease. GESA has always been committed to the Asia–Pacific region. It was a founding member of the Asia–Pacific Associations of Gastroenterology (APAGE), for Study of the Liver (APASL) and for Digestive Endoscopy (APSDE). It has successfully convened a World Congress of Gastroenterology (Sydney 1990), the inaugural Asia–Pacific Digestive Week (APDW, Sydney 2001) and two APASL meetings (Surfers Paradise 1991, Perth 1998). Australian gastroenterologists have much to celebrate but even more to share with our colleagues in neighboring Asian–Pacific countries. The traditions of Australian gastroenterology are firmly rooted in the United Kingdom tradition of clinical excellence, and the Founding Fathers of GESA had little training in what could be regarded as research skills or training credentials. These have been garnered from international exchange, including with Asia, and from the increasingly strong Australian Research Institutes. Yet, from the start, Australian investigators, for the most part working in Australia but also studying abroad, have made substantial contributions to a host of important gastrointestinal and liver disorders, in adults and in children;1–3 the latter include discovery of the rotavirus and subsequent vaccine development.4 In the early years, a focus was on autoimmune liver disease, to which Ian Mackay has made numerous outstanding contributions. Then, during the 1970s to the present, Lawrie Powell, June Halliday and many other members of their Brisbane group have led the world in characterizing iron-storage disorders.2 More recently, Australian researchers have contributed substantially to knowledge about hepatitis C and its treatment (reviewed by Geoff McCaughan),5 mutations of the hepatitis B virus (Stephen Locarnini is the world guru) and to non-alcoholic fatty liver disease (many leading investigators).6 Another interest of Australian gastroenterologists in the 1950s and 1960s was inflammatory bowel disease (IBD), until recently a condition not thought to be important elsewhere in our region. Subsequently, many developments in the science and practice of IBD have been strengthened by Australian research and practice, as reviewed by Peter Gibson,7 and Michael Grimm.8 In foregut disease, Australians were first to recognize the two most common causes of peptic ulcer, first aspirin (by careful observational and epidemiological studies), then Helicobacter pylori, the latter by Robin Warren and Barry Marshall from Perth.1 The latter Nobel-prize-winning research (for Medicine or Physiology 2005) has been translated into therapies that have saved innumerable lives and greatly improved the health of all populations, including those in Asia. In gastroesophageal reflux disease (GERD), John Dent not only invented the sleeve device which allows reliable determination of lower esophageal sphincter (LES) function, he then discovered transient LES relaxations that are a key aspect of the pathogenesis of GERD.9 Following the unsuccessful attempts to treat GERD with H2 receptor blockers, Dent and other Australian colleagues were the first to try, then successfully trial proton pump inhibitors, the current standard-of-care in reflux disease. Meanwhile, Nicholas Talley, now at the Mayo Clinic, has effectively become the world doyen of indigestion, or dyspepsia as he calls it;10 symptoms and their relief have always been a high priority for gastroenterologists worldwide. In other aspects, too, Australian gastroenterologists, endoscopists and surgeons have made substantial efforts to improving understanding and to implementing standards of better clinical practice. Liver transplantation is another area in which Asia–Pacific cooperation has been particularly strong. Russell Strong pioneered this field in Australia (and more recently in Malaysia) and made several major advances,11 including split-liver transplantation that has made living-related transplantation the safe, life-saving operation that it now is in Japan, Korea, China including Hong Kong, Singapore, Malaysia and India. In this Supplement, Strong reviews the hurdles (particularly medico-political) that had to be surmounted for all this to be achieved.2,11,12 Meanwhile, current and future challenges in liver transplantation are reviewed by Elwyn Elias from Birmingham, UK, and this will be of great interest to colleagues in the region,13 while Geoffrey Cleghorn has reviewed the important advances made in improving nutrition prior to successful pediatric liver transplantation.12 Other instructive Australian experiences have included the development of laparoscopic surgery of the upper gastrointestinal tract and for obesity, related in these pages by David Gotley.14 Endoscopy in Australia owes much to Asian leadership and technology, particularly by exchange with Japan, Hong Kong and India. In turn, our country is now making a contribution to considering what are the hallmarks of ‘quality endoscopy’, particularly as it applies to colonoscopic screening for colorectal cancer (CRC). Michael Bourke writes a thoughtful overview on this topic,15 which we hope may be helpful in our neighbor countries, now experiencing a surge of CRC, as they join efforts to optimize current endoscopic practice. The genetics of familial CRC (Barbara Leggett),16 the Australian experience of population-based screening (Graeme Young),17 Sphincter of Oddi dysfunction (James Toouli),18 and chronic pancreatitis and pancreatic cancer (Minoti Apte and colleagues)19 are also reviewed here. So why is a country of approximately 21 million inhabitants, less than the population of one large Asian city, important to gastroenterological and hepatological research and practice in this region of >3.5 billion persons? We believe that our tradition of marrying best standards of clinical practice with teaching and research, and including all these aspects as essential components of professional training, is what makes GESA such a vibrant and successful specialist society. Further, tendencies to form splinter groups or separate societies have generally been resisted after joint consideration of the benefits of specialty subgroups working together; there is only ONE Gastroenterological Society of Australia. For this reason, Australian Gastroenterology Week (AGW), the Annual Scientific Meeting of GESA held in conjunction with the Gastroenterological Nurses Society of Australia (GENSA, our specialist nursing colleagues) now regularly hosts 1200–1500 registrants, many visiting from New Zealand and Asia. The historic 50th Anniversary AGW in Sydney this month (October 2009) is expected to register double this number in up to eight concurrent, well-attended sessions. In the years since 1959 when GESA was born, Australia has been fortunate to be a relatively wealthy country. Thus, while research expenditure per capita remains less than most comparator countries in North America and north-western Europe, it has benefited nevertheless from a strong National Health and Medical Research Council that supports research training, projects and programs in all fields (there have been a few programs in gastroenterology and hepatology), albeit on a highly competitive basis. But as well, GESA as an organization has made conspicuous attempts to recognize and promote research, particularly among trainees. Examples include Young Investigator Awards, poster prizes and Travelling Fellowships, and there is a Distinguished Research Award for life-time achievement. Since 1990, GESA has itself directly supported, in partnership with industry sponsors, numerous Research Training Scholarships for both clinically trained and scientist investigators, as well as highly valued Post-doctoral Fellowships. This Society has also sought to foster basic science involvement in its scientific meetings and among its membership, together with physician, surgeon, pathology and imaging colleagues. In addition to unity and inclusiveness, Australia welcomes trainees from Asian countries, and interchange for training, research or collegial purposes. In the 21st century, Australia is truly becoming a EurAsian nation; approximately 25% of the population is of Asian ethnicity, and Asian Australians are conspicuous among the ‘new breed’ of gastroenterologists ‘down under’. At the same time, our English language background facilitates ready connections with US and UK institutions, and has been helpful in the rising success of the Journal of Gastroenterology and Hepatology. From the start, GESA has adopted and supported JGH. At a personal level, the authors are proud to be so strongly associated with this Journal, which is fast becoming the region's most important vehicle for communication of advances in science and practice of the specialty. If Australia has more to give back to the Asia–Pacific region, it is to share the experiences and benefits derived from fostering and valuing research, working together towards high-quality clinical practice and more effective public health strategies. We all share the ultimate goal to improve the health of our own communities and that of our region. The assistance of Betty Rooney in preparation of this Editorial and the JGH Supplement on which it is based is gratefully acknowledged.
Language: English
Subfield: History and Philosophy of Science
Field: Arts and Humanities
Domain: Social Sciences
Open Access status: bronze
OpenAlex ID: W2036011759