Thinking Globally

The paradox isn’t lost on Florian Rieder, MD. 

“To provide the best care for the individual,” he says, “you have to think globally.” 

Dr. Rieder, a gastroenterologist and physician-scientist, is leading a remarkably ambitious new program within Cleveland Clinic’s Digestive Disease Institute (DDI) to globalize clinical care, research and education — the mainstays of the international health system’s mission. 

“The differences among patients around the world help us to better understand disease,” says Dr. Rieder, who received the prestigious Sherman Emerging Leader Prize in 2019 for his contributions to the field of inflammatory bowel disease (IBD). 

“What works well in Ohio, for example, may not necessarily be the ideal way to treat patients elsewhere,” he says. “If we can compare and learn from different patient populations, we can increase our chances for success.” 

The team leading the global IBD program in Cleveland Clinic’s Digestive Disease Institute includes, from left, Samantha Gauriloff, Erika Kohler, Dr. Florian Rieder and Cory McMahan. | Photo: Shawn Green

DDI’s global program was launched this year with an initial focus on IBD, the overarching term for a group of diseases that cause chronic inflammation in the gastrointestinal (GI) tract. The main types of IBD are Crohn’s disease and ulcerative colitis. Symptoms may flare up suddenly and cause intense stomach cramps and diarrhea, among other issues. Beyond the gut, IBD can affect overall physical health, emotional well-being and mental health. 

There currently is no cure for IBD. But treatments can help patients with this lifelong illness to manage symptoms and to minimize disruptions to day-to-day life. With cases of IBD on the rise, affecting nearly 5 million people around the world and counting, medical advances can’t come soon enough. 

To this end, DDI is aligning IBD care, research and education across Cleveland Clinic, more closely interconnecting its main campus in Ohio with the health system’s facilities in Florida, London and Abu Dhabi. 

“What we’re hoping for is that we’ll have a precision medicine approach to digestive diseases across a global spectrum,” says DDI Chief Miguel Regueiro, MD. “By studying patient populations from different parts of the world, we can better understand why people get these diseases — and, most importantly, how to treat them and how to prevent them.” 

GLOBAL CARE

At the heart of DDI’s global program is a drive to ensure that patients around the world receive the same high standard of care. The ultimate goal? If someone comes to Cleveland Clinic seeking treatment, they’ll benefit from the same advanced protocols and practices, regardless of location. 

“It’s better for the patient,” Dr. Rieder says, “because you have even more access to IBD experts around the world.” 

A key component is the development of global clinical care pathways. These will provide consistency as physicians on different continents use evidence-based approaches to treat IBD. 

“Historically, relationships with international institutions have been largely clinical referral patterns,” says Matthew Kroh, MD, Vice Chair of Innovation and Technology in DDI. 

“This is different,” he says. “It’s a concerted effort to not just treat patients, but to investigate their problems and figure out how we can deliver better care across cultures and continents. We want to ensure that patients can receive the same quality of care without having to travel far from home.” 

It’s still early days, but DDI has already created a global multidisciplinary team case conference. 

“To review cases, we’ve integrated our sites in Ohio, Florida, London and Abu Dhabi,” says Program Manager Samantha Gauriloff. “Specialists from every site are coming together to offer their expertise.” 

The virtual conference allows Cleveland Clinic caregivers from around the world to discuss complex cases, share insights and collaborate on best practices. 

By way of example, suppose a physician in Florida wants to consult a colleague with specific expertise in pediatric Crohn’s disease. An IBD radiologist in London might fit the bill. With DDI increasingly transcending borders, an easy connection can be made. 

“This is the kind of global resource-sharing we’re building,” Gauriloff says. 

As a result of these efforts, DDI hopes to see improvements in clinical outcomes across locations. 

GLOBAL RESEARCH

DDI is also taking bold steps to advance IBD research. 

“The integration of medicine globally is the key to the future,” says Tony Lembo, MD, Vice Chair of Research in DDI. “Having input from physician-scientists in Ohio, Florida, London and Abu Dhabi will help all of us. We’ll learn from each other.” 

With the creation of a joint research infrastructure, DDI is looking to empower caregivers across its international sites to collaborate on studies and clinical trials that will shape IBD treatment going forward. 

“We’re uncovering so many details that have never been addressed before,” says Cory McMahan, DDI Research Administrator. “There’s no existing pathway for what we’re doing. It’s groundbreaking. An overarching goal is to one day actively say we’re enrolling patients in clinical trials across three different countries under one umbrella.” 

The more diverse those patients turn out to be, the better. 

“Diversity is a big factor,” Dr. Lembo says. “We need to conduct clinical trials that are diverse and representative of the individuals who ultimately receive the treatment. This means doing multicenter trials across populations. This is crucial because so many different factors can significantly impact the results of a trial.” 

The establishment of a global IBD biobank will lay the foundation for future studies by ensuring that biosamples collected in Ohio, Florida, London and Abu Dhabi can be shared with international research teams. Additionally, standardized protocols for radiology and pathology support units promise to further integrate research within DDI’s global network.

“The idea is to capture disease patterns and understand differences between these diverse global sites,” Dr. Regueiro says. 

Vastly expanded data registries also could shine a new light on IBD. Already in the works: a global registry focused on patients with an ostomy — a surgery to help the body remove waste in the aftermath of damage to the digestive system or the urinary system. 

“Our goal is to be able to share patient data and to analyze it seamlessly across our locations,” Gauriloff says. “What does it look like when we include patients from London and Abu Dhabi? The results can change drastically — and they should. We’re not treating patients only in the United States.”  

GLOBAL EDUCATION

To truly transform the future of digestive health, DDI recognizes the importance of training the next generation of caregivers. 

“Education is essential to our global initiative,” Dr. Regueiro says. “We need to make sure that all caregivers in the U.S., the U.K. and the UAE are trained to the same high standards. They’ll also benefit from exposure to different healthcare systems and patient populations, which will ultimately help them do their jobs better.”

DDI has launched two new global IBD educational series. The virtual learning opportunities are available to providers both within and outside the Cleveland Clinic system. With an emphasis on the importance of collaboration and knowledge-sharing, the series are geared toward fostering an international community of IBD specialists who can work together to improve patient outcomes worldwide. 

“Providers around the world can join to discuss the latest IBD developments and treatments,” McMahan says. “It’s important that everyone has access to the same information, no matter where they are.” 

The prospect of a global IBD research fellowship offers many exciting possibilities, too. 

“We want to establish an opportunity where a fellow can rotate among all four Cleveland Clinic sites.” Dr. Rieder says. “They’ll gain experience in clinical care and research at each location. This would not only benefit them, but it would also help integrate our practices and knowledge across all sites.” 

GLOBAL IMPACT

Suffice it to say that all of the above will not come easy. 

In seeking to throw its arms around the world, DDI is rising to a range of challenges. They range from nuts-and-bolts practicalities such as trying to find mutually convenient meeting times for participants in multiple time zones to significantly more complex matters, including complying with the varying regulations that govern research in different nations. 

“There are challenges, but the secret sauce is that we know each other, we respect each other and we’ve worked together on multiple other projects,” Dr. Kroh says. “We’re all committed to making this succeed.” 

Philanthropy will go a long way toward making DDI’s global vision a reality. 

“We’ll rely on donors to support these groundbreaking efforts,” McMahan says. “There’s a lot of work to be done with compliance and the logistics of using samples from London or Abu Dhabi and bringing them to Cleveland Clinic’s biorepository. Donor support will be crucial for advancing the biobank as well as other aspects of the program.” 

Philanthropy can make “a tremendous impact,” according to Dr. Kroh. 

“The expense of new IBD medications can be quite high,” he says. “It’s important to study these medications properly, not just in North America, but around the world, to make sure they’re the best treatments for patients with these complicated diseases.” 

The return on investment? A first-of-its-kind program at Cleveland Clinic. And maybe anywhere. 

“To the best of my knowledge, no other medical system has accomplished a complete global integration like this,” Dr. Rieder says. “What we’re setting out to do here at Cleveland Clinic is very ambitious, but the commitment behind it is strong. We’re creating something that hasn’t existed before — a global platform for IBD care, research and education.” ◼