UGI HEMORRHAGE AND BARRETTS EPITHELIUM

我的主要职业目标与这个奖项是：1）在消化系统疾病专业中开展一项由倡导者发起，假设驱动，高质量的以患者为导向的研究计划，2）指导年轻的临床医生，很少或没有研究经验，在他们的职业发展中作为以患者为导向的研究人员，以及3）继续指导和合作与其他临床研究者谁是超越入门级的临床研究者。 两项NIH研究和几项新的合作研究支持这项研究和指导建议。 美国国立卫生研究院的第一个基金，“上消化道出血和内窥镜止血研究”，评价了消化性溃疡、Dieulafoy病损或马洛里韦斯撕裂引起的严重上消化道出血（UGIB）患者。 在三个连续的盲法、多中心随机试验中，我们的假设是联合治疗（肾上腺素和凝血）在初始止血、降低早期再出血率和降低住院护理费用方面明显优于热疗法。 第二个NIH资助项目“根除幽门螺杆菌预防溃疡出血”是一项多中心、双盲、随机比较两种不同药物治疗预防十二指肠溃疡（DU）和胃溃疡（GU）出血复发的研究。 待检验的总体假设是：1）根除幽门螺杆菌（H。幽门螺杆菌）感染将治愈大多数患者的慢性消化性溃疡，并且在预防复发性溃疡出血方面将基本上等同于幽门螺杆菌根除加全剂量H2RA维持，和2）阿司匹林或其它非甾体抗炎药的摄入或幽门螺杆菌感染的复发将导致长期随访期间溃疡出血的所有复发。 新的合作研究也提出了巴雷特上皮和静脉曲张和非静脉曲张出血的前瞻性试验。 在指导计划中，新的研究人员将接受培训，以进行随机前瞻性试验，内窥镜技术评估研究和以患者为导向的研究。 这种指导将通过生物统计学的教学课程、研究设计的研讨会以及数据管理、前瞻性试验的表格设计和方案编写的其他指导来补充。 重点将放在规划，设计和进行实际的前瞻性随机研究。 该奖项将提高申请人的研究生产力，并为年轻的研究人员提供熟练的指导，使他们能够成为独立的消化系统疾病患者为导向的研究人员。

My primary career goals related to this award are: 1) to pursue a program of investigator-initiated, hypothesis driven, high quality patient-oriented research in the specialty of digestive diseases, 2) to mentor young clinicians, with little or no research experience, in their career development as patient-oriented researchers, and 3) to continue to mentor and collaborate with other clinical researchers who are beyond the entry level as clinical investigators. Two NIH studies and several new collaborative studies support this research and mentoring proposal. The first NIH Grant, "Studies of UGI Hemorrhage and Endoscopic Hemostasis" evaluates patients with severe upper gastrointestinal bleeding (UGIB) from peptic ulcers, Dieulafoy's lesions, or Mallory Weiss tears. In three consecutive blinded, multicenter randomized trials, our hypothesis is that combination therapy (epinephrine and coagulation) will be significantly better than thermal therapy for initial hemostasis, reduction in early rebleeding rates, and reduction in hospital costs of care. The second NIH Grant, "Prevention of Ulcer Hemorrhage by H.pylori Eradication" is a multicenter, double-blind, randomized comparison of two different medical treatments to prevent recurrence of duodenal ulcer (DU) and gastric ulcer (GU) bleeding. The overall hypotheses to be tested are that 1) eradication of Helicobacter pylori (H. pylori) infection alone will cure most patients of their chronic peptic ulcers and will be substantially equivalent to H.pylori eradication plus full-dose H2RA maintenance in preventing recurrent ulcer hemorrhage and 2) ingestion of aspirin or other non-steroidal anti-inflammatory drugs or recurrence of H.pylori infection will account for all recurrences of ulcer hemorrhage during long-term follow-up. New collaborative studies are also proposed of Barrett's epithelium and prospective trials of variceal and non-variceal hemorrhage. In the mentoring program, new investigators will be trained to perform randomized prospective trials, endoscopic technology assessment studies, and patient-oriented research. This mentoring will be supplemented by didactic courses in biostatistics, seminars in study design, and other instruction in data management, form design for prospective trials, and protocol writing. Emphasis will be placed on planning, designing, and conducting actual prospective randomized studies. This award will enhance the applicant's research productivity and provide skilled mentoring for young investigators, so they can become independent patient-oriented investigators in digestive diseases.