Volume 1, Issue 2 / May 2015
interviews
Professor Emeritus Guido Tytgat – A witness and moving spirit of the greatest period of gastroenterology
I met Professor Tytgat for the first time in 1991 when I had the opportunity to spend an interesting scholarship in his team. Later I could return to his institute for a longer visit to study his daily practice in gastroenterology. During these visits I saw and learnt the modern form of a Gastroenterology Unit, its all-round and perfectly organized functioning according to the latest standards of our field. I shall never forget those daily concentrated meetings and consultations at the highest level. I have always admired the Professor’s attitude to his colleagues, his approach to the patients as „whole personalities” which has unfortunately become outdated by now. His institution in Amsterdam, the “Academic Medical Center” was one of the first important places of the ultrasonic endoscopy. As it was one of the operative centers of operative endoscopy in the Netherlends I had the opportunity to study all kinds of therapies under his direction. Meeting such personalities of medicine and research contributes to new dimensions of one’s scientific career and professional perspectives.

Dear Professor Tytgat, we haven’t seen each other for a long time, so it is a special honour for me to welcome you as the main initiator and organizer of Gastro Update Europe in June 2015 on the pages of our new medical journal. Can we start with the family roots?
How did your family and personal background determine your choice of becoming a doctor? As far as I know there was also a chance for you to become a musician. Did you have music studies as well? Was it a dilemma for you which profession to choose?
The never failing drive of my parents and the idealism of the youth movement to care for and help those that suffer was probably a major altruistic drive, an inprent which was permanent throughout my life. The fact that my older brother selected medicine undoubtedly influenced my choice in line with my father's admonition to use whichever talents given for the benefit of mankind. I indeed had to make a choice between a musical carrier starting in the conservatory in Brussels or university studies in Leuven. I had passed all clarinet exams and chamber music etc. It was mainly the advice of my teacher (knowing that I was a good student) to choose university studies and keep music as my main hobby. At first I tried to combine university studies and musical performances but in the end this was almost impossible because one needs to practice several hours a day to keep up your skills which in the long run proved to be too difficult.

Who chose your university to study at?
Coming from catholic west Flanders there was only one choice, the old catholic university in Leuven (Louvain).
Which were your carrier plans: to become an active doctor „out in the field” or did you want to focus on research?
Very early in my studies it became obvious that I wanted to contribute via research although I had many opportunities to enter clinical practice including the internal medicine practice of my father-in-law.

How did gastroenterology become the field of your special interest?
I began as a student in the lab for coagulation and fibrinolysis and started studying fibrinolytic activity in ulcerative colitis biopsies. At that time the concept of intravascular coagulation was raised and my research switched to turnover studies with purified fibrinogen and plasminogen in human and animal cirrhosis and portal hypertension, the topic of my PhD thesis. I became fascinated with literature reports of small bowel capsule biopsies, electron microscopy, fat absorption/malabsorption etc. and decided to continue my studies in Seattle, in the USA a fundamental step in my carrier.

Which field within the gastroenterology did you choose for your research activity?
The correct answer is all fields in gastroenterology: peptic ulcer, gastritis, H. Pylori, reflux disease, esophageal columnar metaplasia, celiac disease, lymphpathology, IBD etc. Indeed a generalist except for liver diseases.

How do you see the development of gastroenterology of having become a serious discipline on its own?
The development of gastroenterology has been spectacular up to the point now that gastroenterology is the most dynamic discipline within the medical arena for various reasons; the largest number of novel diseases, the largest cancer load, the largest immune organ, high number of technological developments, rising number of endoscopic therapeutic interventions etc.

Which were the main turning points in the development of gastroenterology that you consider most important?
The development of endoscopy, both diagnostic and therapeutic was of vital importance, the unique combination of “brains and hands”; the discovery of H. Pylori, largely eliminating PUD, the development of modern imaging modalities; PPIs and monoclonals.

Which gastro problems do you find the most challenging ones?
Metaplastic syndromes; IBD; GERD, intestinal disorders, upper and lower bleeding, microbiome and bacterial overgrowth etc.

What was your ambition to develop your institute in the AMC? Which were the main characteristics, results worth mentioning?
I succeeded in getting the job in Amsterdam and started alone and gradually expanded the group with people that I had trained: all ambitious and eager to be involved in research on all aspects of gastroenterology. This resulted in well over 100 PhD theses which obviously was a major educational drive also for myself. Those were the golden times for gastro because endoscopy was exploding; I vividly remember the thrill of the first flexible polypectomy, the first ERCP and sphincterotomy, the first biliary and enteric prosthesis, laser photocoagulation etc. but also H. Pylori, anti-TNF therapy. In retrospect there was really only one ambition throughout all those years: contributing to the development of our discipline, to stimulate basic and applied research and to pass my eagerness and drive to the many talented young physicians.

As a professor, educating young doctor generations, what was your secret to make gastroenterology attractive?
Be an example of high ethical standard, always stressing genuine care for the patient as first priority, passing on my eagerness to know and understand, always asking the critical questions, stimulating and coaching young doctors, creating an atmosphere of comradeship without hierarchical structure, always supporting individual preferences of the staff and fellows, incentive to develop novel ideas and pioneering in technology, stressing the need for evidence based medicine through well conducted randomised controlled trials, bringing all the research together in one Tytgat institute, full of highly talented and eager young doctors.

What are the function and the main idea of Gastro Update Europe, that you are one of the initiators of?
The purpose of Gastroeurope is to summarize the major achievements during the past year in the various GI-Hep fields, selected and presented by some of the top European clinicians in an attempt to pass on knowledge to the young and older gastroenterologists-hepatologists who want to be informed of all relevant clinical developments.

How active are you professionally as a professor emeritus and how active are you in your hobby: music?
Since my retirement in 2002 I have stopped clinical medicine but remained up to this day fully active in many other aspects, reading literature, preparing lectures, participating in activities of the European Postgraduate Gastrosurgical School which I created several years ago, reviewing publications and theses, being active in the Dutch academy of sciences etc.
After surgery for a cervical hernia (disease of old endoscopists) with paresis of my left arm, playing clarinet is limited to the emotional moments in life when the whole family and the 12 grandchildren unite.