UGI HEMORRHAGE AND BARRETTS EPITHELIUM

与此奖项相关，我的主要职业目标是：1)在消化系统疾病专业中开展由研究者发起、假设驱动、高质量的以患者为导向的研究项目；2)指导缺乏或没有研究经验的年轻临床医生作为以患者为导向的研究人员的职业发展；3)继续指导并与其他临床研究人员合作，这些临床研究人员超过了临床研究的入门水平。两项美国国立卫生研究院的研究和几项新的合作研究支持这项研究和指导建议。第一项美国国立卫生研究院拨款“UGI出血和内窥镜止血研究”评估由消化性溃疡、Dieulafoy病变或Mallory Weiss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，在初始止血、降低早期再出血率和降低医院护理费用方面，联合治疗（肾上腺素和凝血）将明显优于热疗法。第二项NIH拨款“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。需要验证的总体假设是：1)单独根除幽门螺杆菌感染可以治愈大多数慢性消化性溃疡患者，其效果与根除幽门螺杆菌加全剂量H2RA维持预防溃疡出血复发的效果基本相当；2)长期随访期间，服用阿司匹林或其他非甾体抗炎药或幽门螺杆菌感染复发是溃疡出血复发的原因。新的合作研究也提出巴雷特上皮和前瞻性试验的静脉曲张和非静脉曲张出血。在指导项目中，新的研究人员将接受培训，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。这种指导将辅以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方面的其他指导。重点将放在计划、设计和实施实际的前瞻性随机研究上。该奖项将提高申请人的研究效率，并为年轻的研究者提供技术指导，使他们能够成为独立的消化疾病患者导向的研究者。

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.