Our New President—Nicholas F. LaRusso, MD
Article Outline
- The Formative Years
- The Accidental Gastroenterologist
- The Rockefeller Experience
- Writing the PSC Textbook
- Defining Cholangiocyte Biology and Pathobiology
- Legendary Mentorship
- The Mayo Chief
- The National Leader
- Defining Characteristics
- Family and Recreation
- Summary
- Authors’ Disclosure and Unabashed Bias
- References
- Copyright
Nicholas F. LaRusso, MD
In May 2007, Nicholas LaRusso will become the 102nd president of the AGA during the Digestive Disease Week in Washington, DC. His outstanding talents and accomplishments as a physician-scientist, clinician, mentor, and administrator coupled with his relentless energy and vision have prepared him for the position of the president of our prestigious association. Based on his personal and leadership qualities, he will serve and guide the AGA with effective strategic planning and creativity despite increasing external challenges during the current era in medicine. To appreciate his pathway of ascent to the leading position of the AGA, we had to trace his upbringing, education, and medical training as well as his academic and personal life. In this effort, we brought together our own impressions of his personality and qualities along with the experiences from other colleagues whose careers have been inspired by this outstanding person.
The Formative Years
Nicholas was born and raised in Brooklyn, New York. His father worked a variety of jobs including owning a restaurant and working as a production engineer; his mother raised the family. He was the eldest of one brother (John) and 3 sisters (Dorothy, Kathy, and Connie). He attended high school at Brooklyn Preparatory School. Nicholas’ leadership skills were apparent early in life, as he excelled as the captain and quarterback of the football team in high school (Figure 2). One of our favorite LaRusso quotes comes from this era, from his high school newsletter, which reads as follows: “…
The quarterback must be the hardest worker on the team, but the greatest asset he can have is the confidence and respect of his teammates. Without this, the team is dead…!” His approach to leadership teamwork and acknowledging others crystallized at an early age.
Figure 2.
At Brooklyn Prep, he learned how to pass the ball and delegate for success.
After graduating from Brooklyn Preparatory School, he attended Boston College and graduated magna cum laude with a BS degree in biology. Although he attempted to make the football team as a “walk on” during his freshman year, he quickly realized that courage, determination, and commitment could not make up for size at this level of athletic competition.
The Accidental Gastroenterologist
Nicholas completed medical school at New York Medical College in 1969. As a medical student, he pursued a clerkship at Mayo Clinic, Rochester, Minnesota on the advice of a chief resident. Although cultural changes were challenging for the young New Yorker transplanted to the rural Midwest, he was impressed by the institution and returned for his medicine residency (1970–1972) following an internship year at Metropolitan Hospital Medical Center, New York. He was an exceptional medicine resident and received an Outstanding Achievement Award, an honor of high distinction in the large Mayo residency program. However, he was undecided as to his ultimate career plan well into the end of his medicine residency. In fact, he had planned to pursue locum tenens in the region. At this time, an “accidental” opportunity emerged. Dr Albert Czaja, now a world-renowned hepatologist, was scheduled to enter a GI fellowship at Mayo Clinic Rochester. However, he was drafted into the medical service. Nicholas was asked if he wanted to fill this vacancy, and he accepted, as he had no other concrete career plans. (By the way, Dr Czaja later returned to a Mayo GI fellowship after his tour of duty was finished.) One of us (G. J. G.) often recalls this story when asking potential GI fellow applicants for their long-term career development plans; thereby, wondering why he is asking the question.
During his fellowship, he was ultimately encouraged by Dr William H. J. Summerskill, the founder of the GI Research Unit at Mayo Clinic, Rochester and former president of the American Association for the Study of Liver Diseases (AASLD), to work with Dr Alan F. Hofmann, at that time, a future AASLD president. Although entry into a research laboratory was challenging, he ultimately focused his rich intellectual prowess on becoming a physician-scientist and ultimately exceeded admirably. However, he still shudders when talking about his first experience with thin-layer chromatography. Nicholas was contemplating his initial experimental results at the bench, when a very busy Dr Hofmann walked past and remarked, “…this is the ugliest thin-layer chromatography I have ever seen….” and then ran off to catch an airplane. Despite this disheartening occurrence, they became a productive duo. His first article with Alan was published in the Lancet and his second article appeared in the New England Journal of Medicine, the latter entitled, “Dynamics of the Enterohepatic Circulation of Bile Acids. Postprandial Serum Concentrations of Conjugates of Cholic Acid in Health, Cholecystectomized Patients, and Patients with Bile Acid Malabsorption.”1 What next for such an audacious beginning in academic gastroenterology?
The Rockefeller Experience
Upon finishing his GI fellowship, during one of the weekly Friday afternoon Bile Acid Research Fellowship meetings, Nicholas was approached by Alan Hofmann to consider further training, in research. Alan, a bile acid chemist and physiologist extraordinaire, had the vision to see the emerging importance of cell and molecular biology for the future physician-scientist. Having worked at the Rockefeller University in New York, Alan counseled his mentee to pursue additional scientific training at this prestigious institution. Nicholas was a Guest Investigator in the Department of Biochemical Cytology, at Rockefeller University from 1975 to 1977; he worked within the program of Dr Christian de Duve, a Nobel Laureate for his work on identifying the lysosome. de Duve’s motto “…as scientists, we do not simply read the book of nature, we write it….” continues to serve as an inspiration for Nicholas. His principle article from this experience was entitled “Coordinate Secretion of Acid Hydrolases in Rat Bile: Hepatocyte Exocytosis of Lysosomal Protein?” and was published in the Journal of Clinical Investigation.2 Obviously, this rewarding experience set the stage for a highly productive and insightful career as a scientist investigator.
Writing the PSC Textbook
In 1977, following his 2-year stint at Rockefeller University, Nicholas returned to the Mayo Clinic in Rochester to begin his faculty appointment in the Division of Gastroenterology and Hepatology. The focus of his research program was on the biliary excretion of lysosomal protein. The lysosome-to-bile hepatic excretory pathway was thought to be a final common pathway through which the hepatocyte degrades macromolecules and eliminates some products of partial or complete lysosomal hydrolysis.
To balance his research goals, he sought a clinical shtick. However, as always the case with junior faculty, he had to find his own niche among already established colleagues at Mayo Clinic. At that time, Albert Cjaza was already working on autoimmune hepatitis, John Thistle was studying gallstone dissolution, and Rolland Dickson was performing therapeutic trials for primary biliary cirrhosis (PBC). Nicholas had to focus on something different. Over the years, he had seen a few cases of the other adult cholestatic liver disease, the syndrome of primary sclerosing cholangitis (PSC); however, was this disease entity sufficiently prevalent enough for him to develop a clinical focus and expertise? To this end, he also had to overcome the opinion of a prominent pathologist and colleague, at the time, Jurgen Ludwig, who clearly stated to him once, “…this disease simply does not exist….” Ludwig argued that he had never seen a case of PSC among the hundreds of autopsies performed over the years.
Despite these odds, Nicholas reviewed all patients diagnosed with PSC at the Mayo Clinic from 1970 to 1977, and with the contribution of an enthusiastic trainee, Russell Wiesner (a current leader in liver transplantation and past president of United Network for Organ Sharing), they published the landmark paper in gastroenterology, entitled “Clinicopathologic Features of the Syndrome of Primary Sclerosing Cholangitis.”3 This was the first comprehensive case series of 54 PSC patients in the medical literature. The report indicated that the disease was not as rare as it was initially thought. Indeed, with the advent of endoscopic retrograde cholangiopancreatography, the frequency of PSC diagnosis at Mayo Clinic was doubled in the second half of this retrospective study. This article defined the clinical and laboratory features of the disease (eg, male predominance, progressive biochemical cholestasis, increased hepatic copper overload, failure of steroids as a treatment modality, and premature death of patients due to liver failure). As Nicholas had stated later in his career, “…we had very little to offer to those patients with advanced-stage PSC, except holding their hands….”
Something more effective had to be done for the treatment of patients with late-stage PSC. Liver transplantation was an option but was at an embryonic stage. In the early 1980s, Nicholas and Rolland Dickson, as they struggled with patients dying from end-stage liver disease, organized an intramural conference to discuss the status of liver transplantation; the conclusions of this meeting were disappointing. However, a year later, Dr Thomas E. Starlz introduced cyclosporine in the immunosuppression regimen, and a successful era in liver transplantation was about to start. The long treatment of patients with PSC became possible. At the time Starlz moved to the University of Pittsburgh to develop the transplant program, Nicholas, Rolland, and Russell visited Pittsburgh to learn from his experience. This interaction resulted in collaboration between the 2 institutions with ultimate benefit for their patients. One year, 15% of all patients who received liver transplants at the University of Pittsburgh were referred from Mayo Clinic. Nicholas, Rolland, and Russell realized that it was about time to develop a liver transplant center at Mayo Clinic in Rochester, and they were instrumental in developing this program.
In an effort to alleviate the suffering of patients with PSC, Nicholas carried out the first randomized, prospective, double-blind, clinical trial of D-penicillamine to assess its therapeutic potential in these patients. D-penicillamine was thought to be a promising agent for the treatment of PSC because of its cupruretic, antifibrogenic, and immunosuppressive effects. Despite high anticipation, it was concluded that use of penicillamine in PSC was not associated with a beneficial effect on disease progression or survival; in addition, penicillamine caused considerable toxicity in 20% of the patients.
Nicholas’ clinical research on PSC along with productive collaborations with Russell Wiesner, Jurgen Ludwig, and Keith Lindor made this clinical entity visible in the medical community and Mayo Clinic referral center for PSC over the past 25 years. This effort led him to write his own chapter in the book of nature as de Duve had stated years before. His focus on PSC became the basis for a number of seminal studies including the description of the progressive natural history of the disease, the Mayo PSC risk score, and several therapeutic trials for the disease under the direction of Keith Lindor. Moreover, because of the availability of these patients, Jurgen Ludwig became an international expert by defining the stages of liver histopathology for both PSC and PBC.
Defining Cholangiocyte Biology and Pathobiology
Despite making progress in his initial research direction on the biliary excretion of lysosomal protein, Nicholas was always keen to apply innovative approaches in his research program and to take the chances of uncharted paths of scientific investigation. To this extent, he had and continues to have the custom to keep on his desk a folder named “novel ideas,” which functions as a starting point of future projects. Many of these ideas may never materialize, but in the late 1980s, he realized that in order to understand the pathogenesis of cholestatic liver diseases, he would have to focus on the biology of biliary epithelia. This was an important concept, nonetheless, he had to develop methods to isolate these cells. The task was challenging, but working with a serene fellow from Sendai Japan, Motoyasu Ishii, his laboratory was the first to isolate highly purified rat bile duct cells by using immunomagnetic approaches. Subsequently, Nicholas coined the term cholangiocyte, to define the specialized epithelial cells that line the intrahepatic bile ducts, and a new field emerged for the study of biliary epithelia.
Additionally, he was aware that in order to make progress in the physiology and pathophysiology of cholangiocytes, he had to develop innovative and feasible experimental techniques and models. With this in mind, Nicholas spent a number of years in the early 1990s developing methodologies to investigate biliary epithelia. He established a spontaneous cell line of normal rat cholangiocytes and improved methods to isolate apical from basolateral domains of biliary epithelia. These preparations were key for subsequent studies to define the transport properties of bile duct cells. Moreover, his lab was the first to isolate, characterize, and employ the use of “bile duct units” as a model to study transport phenomena in cholangiocytes.
Following the development of these experimental models, Nicholas published a plethora of seminal articles describing the concept of heterogeneity of biliary epithelia across the bile ducts and studying the secretion and reabsorption of solutes in the formation of ductal bile. More specifically, he extensively investigated the function of the water channels, aquaporins, and other solute transporters of cholangiocytes. In addition, he used Cryptosporidium parvum, a parasite, to study the interaction of this microorganism with the biliary tract. This work produced several novel articles that describe the mechanisms of attachments, invasion, and cytopathic effects of C parvum in biliary epithelia. In the more recent years, Nicholas’ work has moved to the study of cilia in cholangiocytes. Cilia are extracellular organelles, which likely provide mechano- and osmosensor signals to biliary cells as a result of changes in biliary bile flow. Based on his current data, cholangiocyte cilia are also involved in the generation of cysts within the liver. To this extent, he collaborates with Drs Vicente Torres and Peter Harris to study the underlying mechanisms of cilia dysfunction in polycystic liver disease.
There is no question that Nicholas has opened and sustains the cholangiocyte biology field. To boost the field of biliary epithelia and to bring investigators together, he organized 2 single-topics symposia (1994, 2001) at Airlee House in Virginia under the auspices of AASLD. Moreover, his work inspired others to study the bile duct cells. To this end, the publications that focus on cholangiocytes had an exponential growth over the past 15 years. Also, during the annual AASLD meeting, there is now a parallel scientific session and a poster session devoted specifically on cholangiocyte biology. In a broad sense, he introduced the concept of cholangiopathies, a spectrum of biliary disease in which the cholangiocyte is the cell target.
Legendary Mentorship
Throughout his academic career, Nicholas has been an outstanding and a tireless mentor to both trainees and faculty alike. Under his tutelage and role model, he has guided and inspired the academic and professional careers of many, including the authors of this article. Over the last 30 years, more than 50 research fellows have been trained in his laboratory on the cellular biology and pathobiology of hepatic epithelia. But Nicholas’ mentorship goes beyond the scientific inquiry, the design/execution of experiments, and data analysis. He is ardent in teaching manuscript writing and editing, grantsmanship, and fostering other attributes relevant to career development. Mentorship in his own terms is a long-lasting, committed effort that requires time and genuine interest in advancing the academic career of the trainee. He practices what he preaches. Despite his many responsibilities, he always finds the time to give guidance to students about experiments and to promptly review their manuscripts. Nicholas is always proactive and urges you to contemplate the big picture of a scientific project. Even before the experiments are completed, he asks you to envision the structure and content of the manuscript. He aims high and expects to bring out the best of his students. Our favorite quotes of his come out as he counsels trainees: “…it takes the same effort to study an important biological question as it does for a mediocre one, so seek for the first and avoid the latter…” “…you have to explain your results to the audience as if you had to talk to a sixth-grade student….”
In his mentoring approach, he is always supportive, inspires, and advises with foresight. Nicholas has the ability to transmit his well-structured manner of thinking to postdoctoral fellows, ultimately teaching them how to ponder important biological questions. He is also the most serious judge for his trainees whether they interpret experiments, write a manuscript, or present their work at a national conference—but he does so with strong encouragement and a sense of personal pride. However, these learning processes can at times be agonizing. In fact, one of us (K. N. L.) still recalls working on the slides for a plenary session presentation for weeks and Nicholas grilling him with potential questions that the audience might ask; and the other (G. J. G.) remembers his 30 revisions/rehearsals for his first oral presentation. At the last oral rehearsal, Nicholas looked somewhat satisfied and stated, “…it takes work, but the work has finally paid off!”
Many of his former trainees are now at different stages of their own National Institutes of Health (NIH)-funded research careers including Gregory Gores (currently president of AASLD), Gene LeSage, Gianfranco Alpini, Xian–Ming Chen, and Kostas Lazaridis. Other trainees have returned to their country of origin where they have established academic careers including Stuart Roberts (Victoria, Australia), Motoyasu Ishii and Yoshi Ueno (Sendai, Japan), and Raul Marinelli (Rosario, Argentina).
The Mayo Chief
Chief of Gastroenterology and Hepatology. Nicholas became Chief of the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester in 1990. As is the tradition at Mayo, his appointment involved a competitive, internal selection process. Although like all serious physician-scientists, he approached this new challenge with concerns about its potential impact on his scientific productivity, he quickly assumed this position with energy and full dedication. The division underwent enormous change and growth during his 9-year tenure as chief. It not only grew in size from 46 to 64 faculty members, but he also restructured the division. Recognizing the need for an academic health center to distinguish its care and provide patients with high quality and expert medical attention, he restructured the division into focused interest groups, and it now comprises 9 separate interest groups (such as advanced endoscopy, esophagus, hepatobiliary, and inflammatory bowel disease, etc), each with its own clinics, members, and academic vision. The creation of one of these groups illustrates his support of education in an otherwise high clinical demand, research-intensive enterprise. He established the Comprehensive Gastroenterology Interest Group with the raison d’être to educate residents and fellows. To further support their efforts, he developed “Education Clinics” with reduced patient volumes to create time for educational opportunities. More impressively, this group was rapidly assembled by recruitment of clinician educators from other institutions. Recruitment from the fellowship program and/or changing the career focus of established faculty was viewed as too slow a response to accomplish this vision. Finally, using creative approaches, he was able to establish mechanisms to promote clinical and translational research initiatives. The developmental endoscopy unit was established with Chris Gostout, former President of the American Society of Endoscopy, to foster technical advances in endoscopy. An outcomes/epidemiology group of investigators was organized. Translational bench research was expanded by sending trainees recruited to staff to other institutions (at the division’s expense) for 1 to 3 years to learn new technologies and disciplines; the aggressive use of this program termed “The Mayo Scholar Program” has ensured a new generation of physician-investigators within the division. One of us (K. N. L.) is a direct beneficiary of this approach and program under Nicholas’ tenure as division chief. All of this was accomplished despite maintaining a vibrant, NIH-funded research program, serving as President of the American Association for the Study of Liver Diseases (1996–1997), and Editor of gastroenterology (1991–1996). Clearly, his energy, enthusiasm, administrative skills and multitasking abilities were honed to a sharp edge during these 9 years.
Chief of the Department of Medicine. In 1999, Nicholas stepped down as Division Chair to become Chair of the Department of Medicine. Again, he was selected through a vigorous and competitive internal process. If anything, he has brought even greater energy, commitment, and constructive change to the department than he did with the division. His first initiative was to grow the academic enterprise. Although the growth occurred during the doubling of the NIH budget, he actually quadrupled the NIH funds received by the Department of Medicine. The Department of Medicine’s rank improved from 37th to 12th in the magnitude of federal dollars received. This was accomplished not by hiring established investigators (eg, the New York Yankees approach to team building), but by concerted mentoring efforts, the department supported seed money investigators and a cultural emphasis. The use of seed money, an initiative, which he termed the Medicine Innovation Development Advancement System program paid off. Next, he focused his energies and attention on the Mayo outpatient practice. Recognizing the increased regulatory burden placed on physicians, he has worked on developing a team approach to the outpatient practice. This team incorporates desk assistants, nurses, mid-level providers (physician assistants and nurse practitioners), and appointment secretaries to help manage patient visits. At the time of writing this article, he has motivated the department and institution to re-examine the inpatient practice. Realizing the hospital should not be the primary source for resident and fellow education, in our current era of preventative and chronic disease management, he is restructuring the inpatient practice to take care of patients without residents/fellows. Although much of what we have described during his tenure as a “Mayo Chief” reflects details, these examples illustrate several key features of his administrative philosophy and skills. He is a phenomenal team builder, is visionary, remains consistently and intently engaged in constructive change, works via consensus, and is tireless in his efforts to improve medical care for patients and the process by which it occurs. These well-developed attributes will serve the AGA-I/AGA well as we face a period of change and uncertainty in our profession.
The National Leader
From 1991 to 1995, Nicholas was on the governing board of the AASLD and assumed its presidency in 1996. This was a time of dynamic change in hepatology. Liver transplantation was proliferating throughout the country. The cause of non-A and non-B hepatitis had been identified (hepatitis C) and a treatment (α-interferon) approach was under great study and scrutiny. The society grew rapidly, placing considerable growing pains on the organization. Nicholas and colleagues on the governing board addressed this problem by creating and establishing a central office, a fundamental change for this organization, which previously had few resources and essentially outsourced its annual meeting. The central office has ever since grown in size and mission. The creation of a central office with permanent dedicated staff was a transforming event for this organization. The AASLD Annual Meeting had also outgrown the extremely popular hotel venues of Chicago. Because of these space constraints, the AASLD governing board elected to leave Chicago and seek larger and alternative venues. This move was unpopular initially, but it has also ultimately served the AASLD well. The AASLD Annual Meeting now requires a convention center, and this initial decision to leave Chicago was simply a necessary, albeit painful, step to accommodate the growth of this well-liked meeting.
During this time period, Nicholas was also Editor of gastroenterology, the official journal of the AGA. For the duration of his tenure, the journal flourished with increased submissions, an improved impact factor, and increasing advertising revenue. Although the Managing Editor was housed at the Editor’s home institution during this era, Nicholas realized this was not in the journal’s long-term best interest and helped advocate for its permanent home office now in Bethesda, Maryland. Thus, he brings the same vision and change-oriented leadership to national organizations as he has to Mayo Clinic’s Division of Gastroenterology and Hepatology and Department of Medicine.
Defining Characteristics
In our humble opinion, Nicholas has 4 defining characteristics. First, is his ability to break apart complex issues into their defining components. Then using unassailable logic (likely instilled by his early Jesuit education), he is able to solve the individual components, thereby solving the larger problem. To watch him do this in real time is like watching the former hockey player, Wayne Gretzky, play hockey. All of a sudden, he is in the right place with the puck, scoring the goal. In this regard, he is the consummate problem solver. Second, his approach to life is as the marathon runner. He is always thinking (analogous to the constant running of the marathoner) about what to do next. He never stops to rest; his academic mind always appears to be “on.” A quote from Lewis Carroll in Alice in Wonderland is that “It takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that.” Obviously, Nicholas has taken this concept to heart—he’s always in motion. What is more impressive is that he keeps up this activity level with aplomb. He never looks rushed or stressed; neither of us has ever heard him complain about his workload, expectations, or time constraints. He is simply indefatigable. His third leitmotif is his ability to function as a role model. He is more than willing to share his convictions and experience with colleagues. His expectations are high, but he expects no more of others than he does himself. In an era when strong clinicians are not expected to do bench research and visa versa, he is a role model in contrast. His contributions to human cholestatic liver disease and the molecular cell biology of liver pathobiology stand as examples that a simple professional career dichotomy need not exist. His passion and enthusiasm for both patients and experimental biology is evident and infectious. Finally, we would like to emphasize his sense of family. He treats colleagues as family, caring about their personal life, individual struggles, aspirations, and stressors. His approach to the family is not as patriarch but as a family member.
Family and Recreation
Nicholas was in the beginning of his medical training when he met his wife, Bobbi, a native of Ohio. Bobbi was never exposed to the culture of an Italian family until he introduced her to his family in Brooklyn. According to Nicholas, his family’s loud conversations and unedited interactions during dinner were a contrast to her quiet manner. At that point, Bobbi realized that to live with an Italian from Brooklyn builds character. Together, they raised 4 children. Elizabeth, a Harvard medical school graduate is currently a third-year resident psychiatrist in Boston; Nicholas is obtaining his MBA at the Carlson School of Management in Minneapolis; Matt currently works as a client services manager in a technology software company in Manhattan, and Michael who will graduate from college in 2007 has been accepted to law school.
Nicholas loves to run, literally. He is an avid long-distance runner and has participated in several national marathons, including the New York Marathon (Figure 3). His best time is 3:20 for those of like-minded interests who want to benchmark themselves with our new AGA President. His last participation in the New York Marathon was in 1999, when his eldest child, Elizabeth, brought him out of semiretirement to run as a father/daughter pair. He refuses to divulge who won between the pair, but rumor has it she picked up the pace at mile 18! More recently, when he cannot run in the snow of the Minnesota winter, he has taken to snowshoeing—a high calorie-burning endeavor. In different periods of his life, he has skied, golfed, and learned to bake bread. He reads voraciously, especially nonfiction books. More importantly from the perspective of 1 of the 2 authors (G. J. G.), he enjoys a good beer. He is a role model even in his ability to lead a balanced life. Does he sleep? Not much, is what we have surmised.
Figure 3.
Completing the New York Marathon with pride.
Summary
In closing, our new president Nicholas F. LaRusso, is a distinguished physician-scientist, a devoted mentor, and a talented administrator. He has contributed immensely to the field of digestive diseases from different capacities with consideration and fairness. Given Nicholas’ defining characteristics and values, it is easy to predict that his AGA/AGA-I presidency will not be a “Cult of the President” but one of “stewardship,” with adherence to the organization’s strategic plan. The governing board of the AGA/AGA-I will not only be well organized and productive but warm and cohesive under his leadership.
Authors’ Disclosure and Unabashed Bias
In all academic endeavors, there is concern about conflicts of interest. Herein, the authors (G. J. G. and K. N. L.) want to divulge their conflict of interest. We are unabashed admirers, former and current mentees, and ardent supporters of Nicholas F. LaRusso. Much of our academic success can be traced to his positive influence. Yes, we do believe he can “walk on water and tip-toe on methanol.” Therefore, we relinquish all principles of objectivity—this was never our intent! Finally, this will likely be the most-read paper either of us will ever write!
References
- . Dynamics of the enterohepatic circulation of bile acids (Postprandial serum concentrations of conjugates of cholic acid in health, cholecystectomized patients, and patients with bile acid malabsorption). N Engl J Med. 1974;291:689–692
- . Coordinate secretion of acid hydrolases in rat bile. J Clin Invest. 1979;64:948–954
- . Clinicopathologic features of the syndrome of primary sclerosing cholangitis. Gastroenterology. 1980;79:200–206
PII: S0016-5085(07)00590-2
doi:10.1053/j.gastro.2007.03.064
© 2007 AGA Institute. Published by Elsevier Inc. All rights reserved.
