Digestive Disease Institute in Abu Dhabi Growing By Leaps and Bounds

In the first three years of his tenure as Chairman of the Digestive Disease Institute (DDI) at Cleveland Clinic Abu Dhabi, Matthew Kroh, MD, significantly expanded the size and scope of this Center of Excellence.

Growing existing programs was one of Dr. Kroh’s stated goals. Consult QD caught up with him for a progress update on his other goals: adding selected subspecialties and starting programs in medical research and education.

Q: What is the DDI in Abu Dhabi like today?

Dr. Kroh: We have tripled in size. We now have 46 physicians in gastroenterology, colorectal surgery and general surgery and more than 200 care providers, including registered nurses, wound-care nurses, dietitians and enterostomal therapists.

Our clinical programs have expanded both in number and in volume. We offer more than 14 specialties and are embracing the concept of subspecialty centers, in which physicians and surgeons work side by side. This model of care is unique in this region and has been warmly received. To date, we have established a center for hepatology and liver transplantation and a center in which our foregut surgeons work with GI motility specialists to care for patients with esophageal disorders.

We are very proud of our multidisciplinary inflammatory bowel disease (IBD) program, which includes colorectal surgeons and gastroenterologists with IBD expertise. IBD was thought to be uncommon in the Mideast; it was considered an American or European disease, so patients here were treated ad hoc and care was very fragmented. Our comprehensive program that includes support groups and community outreach has become a huge resource for the community.

Q: Have you developed any other programs that meet a specific need in the Middle East?

Dr. Kroh: The rate of obesity in the Middle East is among the highest in the world, and for reasons we don’t entirely understand, people tend to develop diabetes at a lower weight. Surgical intervention is the most effective and durable treatment to prevent or reverse diabetes, and our bariatric surgery program is thriving. We expect to do 450 bariatric cases this year, and nearly one-third will be complex revisions. We have become the tertiary referral center in the region for patients with complications from bariatric surgery.

Q: One of your goals was to start an education program. Has that happened?

Dr. Kroh: Medical research and education were not in our initial charter, but the need quickly became clear. We started a five-year general surgery residency program that is now in its second year. Residents rotate through every surgical specialty we offer and partner in disease-specific clinics with their medical counterparts. We are training four surgical residents per year. Currently, all are residents of the United Arab Emirates (UAE). Some may choose to stay for fellowship training or seek additional training abroad.

Q: What about continuing medical education?

Dr. Kroh: This year, we held a combined meeting of the 4th International Digestive Disease Symposium and the 3rd Diabetes, Obesity, and Cardiovascular Disease Summit. The three-day meeting, with faculty from Cleveland Clinic and around the world, attracted more than 400 attendees from across the UAE and eight countries in the region. We will host the meeting here again in 2020.

Q: Is the institute conducting research?

Dr. Kroh: We have two full-time research fellows dedicated to digestive diseases spearheading this area. Our research is primarily being conducted in liver disease and minimally invasive surgery. Shiva Kumar, MD, the Chair of Gastroenterology, has conducted some very productive research projects in end-stage liver disease. Recently, we were awarded the first external grant from a medical school in Dubai to study fatty liver disease in obese Middle East patients.

Q: How closely are you aligned with Cleveland Clinic in Ohio?

Dr. Kroh: We maintain contact with our colleagues in the States to benefit all aspects of patient care, research and education.

For example, our minimally invasive surgery group has a webinar every Monday with our counterparts at Cleveland Clinic’s main campus and Cleveland Clinic Florida. We work together on joint projects, and the papers we produce are authored by physicians at three different Cleveland Clinic locations.

I continue to travel back to the main campus in Cleveland almost every quarter, and members of our staff visit as well. Sara ElOuali, MD, one of our staff gastroenterologists, is currently pursuing a one-year fellowship in interventional therapies for IBD there. Her entrance into this program was the result of her clinical performance and interest in the specialty, as well as her direct interaction with the Cleveland team.

General surgery fellows from Cleveland Clinic’s main campus have also come to Abu Dhabi, and students, residents and fellows from around the world have rotated here. We are considering sending our fellows to Cleveland as well.

Q: Now that you’ve been at Cleveland Clinic Abu Dhabi for three years, what are the highlights of your experience?

Dr. Kroh: Patients are grateful for the world-class care we provide. Healthcare was always available, but it was necessary to travel to get complex care. They are proud they can get the style and quality of Cleveland Clinic care at home.

Interestingly, 80% of the UAE is comprised of expats. Our DDI physicians have diverse backgrounds, with about 20% coming from North American, 30% from Europe and 50% from the Middle East and Southeast Asia. It has been a great opportunity to meet colleagues — now partners — with different ways of practicing. The experience has been rich and deeply rewarding.