Combining holistic, patient-centered, state-of-the-art therapies with cutting-edge research and efforts to raise awareness of the causes and treatment of esophageal disease, the UCLA Robert G. Kardashian Center for Esophageal Health has been established within the Vatche & Tamar Manoukian Division of Digestive Diseases. The new center — named in memory of Robert G. Kardashian, a prominent Los Angeles attorney who died of esophageal cancer in 2003 — was celebrated during Esophageal Cancer Awareness Month in April, at a campus event attended by the family and other friends of the university. Kardashian’s family also announced it would launch fundraising efforts to provide resources for the center’s key initiatives and activities.
“For the first time at UCLA, we will have a concentrated effort and resources to provide care for patients who suffer from esophageal or motility disorders, ranging from benign conditions that impact quality of life such as gastroesophageal reflux, to devastating life-and-death conditions such as esophageal cancer,” says Eric Esrailian, MD, MPH, chief of the division and a longtime friend of the Kardashian family. “By honoring their father, the Kardashians have also helped us establish a center that will raise awareness about these conditions, the different treatment options, and the potential to improve on available therapies – to work toward preventing these diseases in the future. In addition, entrepreneur, beauty mogul and producer Kim Kardashian West, one of Robert Kardashian’s daughters, is the division’s newest ambassador.
Dr. Esrailian notes that the new center will leverage the Melvin and Bren Simon Digestive Diseases Center’s gastroenterologists and UCLA Health’s collective expertise in surgery, oncology, otolaryngology, anesthesiology, radiology, pathology and pediatrics to gain new insights into the causes of esophageal disorders and develop new prevention and treatment strategies. The center will draw patients from throughout the region and around the world for expert treatment of some of the most complex esophageal conditions, to benefit from the center’s motility expertise, and to participate in research and receive promising new therapies through clinical trials. The center also provides outstanding care for common esophageal conditions.
“This is the first multidisciplinary and collaborative effort of its kind to take care of patients across the spectrum of esophageal disorders,” says Jeffrey L. Conklin, MD, medical director of the Kardashian center. “By bringing all of these disciplines together, the center promotes interactions that ensure that patients are getting the best possible attention to their condition, in a streamlined way that allows them to see all of the appropriate experts on the same visit.”
Beyond the multidisciplinary medical and surgical expertise, the new center provides patients with a more holistic approach to treatment than medicine has traditionally offered. Working in conjunction with the division’s new Integrative Digestive Health and Wellness Program, the center brings in GI dietitians to optimize nutritional strategies, a GI health psychologist who can apply evidence-based principles to improve symptoms by influencing the brain-gut connection, and an integrative health nurse practitioner and certified mindfulness teacher who can work with patients on mind-body approaches to enhancing wellness. “There is not always one right way to treat a particular condition — each patient is different,” says Kevin Ghassemi, MD, the center’s associate director of clinical programs. “Our goal is not just to diagnose and treat disease, but to optimize health. Having all of these resources allows us to do that.”
Dr. Ghassemi notes that esophageal conditions run the gamut from gastroesophageal reflux disease (GERD) to esophageal cancer, and from rare disorders to common ones such as eosinophilic esophagitis (an allergic condition in which food can get stuck in the esophagus); achalasia (a swallowing disorder); and Barrett’s esophagus (an irritation in the esophageal lining caused by chronic reflux). Rates of esophageal cancer have increased dramatically in recent years; Dr. Ghassemi explains that this is likely due to increases in the incidence of GERD, the most common esophageal disorder and a major esophageal cancer risk factor.
With few symptoms, esophageal cancer often goes undetected but is treatable if caught early, especially with the most innovative approaches — most notably endoscopic techniques to remove the early cancer, potentially avoiding the need for surgery and/or chemotherapy. Patients with chronic GERD or other risk factors for esophageal cancer — including smokers, people who are significantly overweight and those with a family history — may benefit from having screening endoscopies for Barrett’s esophagus, which can be a precursor to esophageal cancer, Dr. Ghassemi says.
Approximately 5% of chronic GERD patients go on to develop Barrett’s esophagus, and about 10% of those patients will develop dysplasia. These patients are treated effectively through endoscopic therapy, and the field is now moving toward being able to predict which Barrett’s esophagus patients without dysplasia will develop the pre-cancerous condition so that these patients can be treated before they get to that point, notes V. Raman Muthusamy, MD, a clinical professor in the division and medical director of endoscopy for UCLA Health. This would also provide reassurance to people who are at low risk for developing dysplasia and cancer.
Interventional endoscopy has become the preferred procedure for diagnosing and treating many GI conditions that once required surgery, and the interventional endoscopy team at the Kardashian center will continue to blur the boundaries while improving on the endoscopy’s diagnostic and therapeutic capabilities, Dr. Muthusamy says. For example, peroral endoscopic myotomy (POEM), the endoscopic equivalent to surgery for esophageal motility disorders such as achalasia, achieves comparable outcomes. “With endoscopy we are increasingly able to improve both our diagnostic and therapeutic capabilities in minimally invasive ways — often combining them in a single procedure,” Dr. Muthusamy notes. “That ability will continue to improve.”
The state-of-the-art care provided at the center will be advanced by the research enterprise within the division, throughout the UCLA Health system and across the UCLA campus. In conjunction with UCLA’s new Institute for Precision Health, the center is leveraging advances in genetic studies, data science and information technology to develop personalized approaches to health promotion and treatment. The center is also an integral part of the UCLA Value-Based Care Consortium, which uses research to design strategies for improving the quality and outcomes of care while reducing cost.
Dr. Esrailian stresses that as the new center begins to recruit more staff and faculty to join the effort, more exciting developments lie ahead. “We hope the Kardashian family’s commitment inspires even more support from our community of friends — positioning the Robert G. Kardashian Center as a leader in the prevention, diagnosis and treatment of esophageal conditions,” Dr. Esrailian says. “This is just the beginning.”