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Emerging leaders of gastroenterology and hepatology in the Asia‐Pacific region

Twenty-five years ago, a pathologist at a teaching hospital in Perth, Western Australia, shared his novel observations with a young gastroenterology trainee who was looking for a research project. The observation, the culture of a curved bacillus with a spiral flagellum from the gastric mucosa of patients with duodenal ulcer disease and gastritis, led to the discovery that gastritis, peptic ulcer, and gastric cancer were the frequent outcomes of Helicobacter pylori infection. The initial discovery, it has been said, was not well received, and it took several years for the world’s attention to be re-focused on the fact that peptic ulcer disease, least of all gastric cancer, could have an infectious cause. The pathologist, Robin Warren, and the gastroenterology trainee, Barry J Marshall, were jointly awarded the Nobel Prize for Physiology and Medicine in 2005 for this discovery, which, by leading to cures for Helicobacter pylori infection, has changed the course of gastroenterology and relieved suffering for more than hundreds of millions of people affected by these common disorders. At about the same time, two young Taiwanese hepatologists, working with their mentor, Professor JL Sung, were charting the natural history of liver disease resulting from chronic infection with the hepatitis B virus (HBV). Based on cohorts of tens of thousands of affected people, they obtained great insights that set the stage for the first community-wide introduction of hepatitis B vaccination in 1984. Only 12 years later, they showed that hepatitis B vaccination could reduce one of the most feared disease outcomes, primary liver cancer (hepatocellular carcinoma, HCC), which occurs even in children in that highly endemic area of HBV infection. The natural history studies also provided understanding about the complex relationships between HBV replication and the host immune response that ultimately sets the stage for cirrhosis and HCC. These concepts have informed the basis for timely intervention with antiviral therapy, which even at the stage of cirrhosis can prevent later hepatic decompensation and HCC. Those two young hepatologists under Professor Sung’s tutelage, Ding-Shinn Chen andYun-Fan Liaw, published their first papers in Chinese, and in each case it was not until a few years later that their abstracts or letters were first published in English language journals. Both have gone on to become major international figures in hepatology, and in addition to their many distinguished scientific contributions and leadership roles in the region, have now themselves trained and influenced a whole new generation of hepatologists. These ‘case studies’ in professional development demonstrate how important it is to encourage the emergence of leaders in gastroenterology and hepatology in the Asia-Pacific region. In each case, the contributions made have directly influenced the course of common diseases, thereby dramatically improving the health of people in this populous segment of the world. But, in addition, they have had major flow-on effects that influence the training of even greater numbers of investigators, effective educators, and clinicians. The argument that it is important to foster emergence of new leaders is, in our view, unassailable. There are, however, challenges to fostering recognition of fledgling investigators and academic leaders in Asia and the Pacific. The distances are vast, local economies range from the strongest in the world to among the weakest, population densities are considerable – often with insufficient infrastructure for medical education and specialist clinical, least of all, research training, and there is no common language. In countries like Japan, Australia, Taiwan, the Hong Kong zone of China, and Korea, numerous academic leaders have made conspicuous contributions to our specialty over the last few decades, and local structures (for example national meetings and related international forums) are in place to facilitate the development of new leaders. In many other countries, including the economically less privileged and those with weaker Englishlanguage skills, the challenges of emerging as an international leader in our specialty are daunting, perhaps seemingly insurmountable at times. The strengthening of Asia-Pacific Digestive Week (APDW) and the Asia-Pacific Association for Study of the Liver (APASL) annual scientific meetings have provided major regional English language meetings where, increasingly, young investigators can present their work for critical comment from regional leaders and peers. As discussed previously in these columns, the Journal of Gastroenterology and Hepatology and its Foundation (JGH F) are proud to be associated with these developments, serving as they do its mission of fostering the development of research and education in gastroenterology and hepatology in the Asia-Pacific region. In this issue of the Journal, two review articles are published as the result of another initiative of the JGH F, the sponsorship of two annual Emerging Leader Lectureships. The first review, entitled ‘How do we improve outcomes for gastric cancer?’ is by Associate-Professor Khay-Guan Yeoh from the Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore. The second, ‘Revisiting the natural history of chronic hepatitis B: Impact of new concepts on clinical management’ is written by Associate-Professor Man-Fung Yuen of the Department of Medicine, The University of Hong Kong and Queen Mary Hospital, Hong Kong. These texts record the content of the inaugural Emerging Leader Lectures, delivered in Cebu at APDW November 2006. By happy coincidence, the topics overlap those that have been the subjects for the ‘international stars’ in gastroenterology and hepatology mentioned earlier in this article. More detailed discussion of the significance of the findings and conclusions revealed in these reviews is contained in adjacent editorials in this issue of the Journal. However, it is salient to note here that the pace of research and resultant improvements in Accepted for publication 19 February 2007.