As a medical student, Byron L. Cryer, MD, was fascinated by the diagnostic tools of gastroenterology: the ability to enter a patient’s body, move around, and see firsthand what’s going on.

“There’s an immediate diagnostic capability and, in many cases, an immediate therapeutic capability because you can do something about the problem while you’re there with the endoscope,” said Cryer, chairman of internal medicine at Baylor University Medical Center, Dallas.

It reminded him of a movie he loved as a kid, Fantastic Voyage, in which people are miniaturized and travel through the human body. “Being able to enter the body with a scope and navigate through it felt very much like that to me,” he noted.

That said, gastroenterology isn’t just about procedures, said Cryer, whose own career diversified into the clinical, research, and policy areas of medicine. Internationally known for his studies on the gastrointestinal (GI) effects of nonsteroidal anti-inflammatory drugs (NSAIDs), Cryer has served on multiple panels with the American Gastroenterological Association (AGA) and has worked as a consultant with the FDA’s Center for Drug Evaluation and Research. Recently, he assumed the role as AGA’s president.

Physicians are in a unique position to understand and recognize the issues that affect people’s daily lives and to appreciate their policy implications, said Cryer. “That’s why I believe it’s important, in addition to everything else we do, to spend time serving as advocates — particularly policy advocates — for the issues that matter to our patients.”

Medicine has come a long way in treating patients for GI conditions — but there’s more work ahead in improving access to new and expensive therapies, he said in an interview.

Why did you choose gastroenterology?

What really sealed the deal for me came about a year and a half into medical school.

Up to that point, we’d spent countless hours in classrooms listening to lecture after lecture from different professors. In all that time, I had never seen an African American physician come to the front of the room and teach us.

Then, one morning in January, an African American physician walked in, made his way to the front of the class and began lecturing. I remember pausing and thinking, Wait a minute. I’ve never seen this before in my medical school experience.

That physician was, and still is, a gastroenterologist.

Seeing him was incredibly impactful. And I decided, if gastroenterology was a good specialty for him, then that must be a good specialty for me. Between 8 and 9 o’clock that morning, I decided on my career path. An hour earlier, I had no idea what specialty I would ultimately pursue.

What I learned from that experience was the profound impact of role models. Often, people are role models without even realizing it.

That experience also shaped my own sense of professional responsibility. It made mentoring, professional development, and serving as a role model the central parts of my career. As I’ve progressed through my medical life, I’ve come to fully appreciate the impact that mentors and role models can have and the obligation we have as physicians to help those who come behind us.

What do you think is the biggest misconception about the profession?

I think many people view gastroenterology primarily as a profession centered on colonoscopies. While colon cancer prevention is certainly an important part of what we do, the misconception is that it’s all we do.

The reality is that our specialty encompasses a wide range of complex conditions involving the entire GI tract — the esophagus, stomach, intestines, liver, pancreas, and biliary tract.

I think it’s important for the average patient to understand that gastroenterology is much more than endoscopy. At our core, every gastroenterologist began as an internist. Before becoming gastroenterologists, we were all internal medicine physicians — a specialty focused on preventing, diagnosing, and treating disease in adults, with an emphasis on managing complex and chronic conditions.

So while many people associate us with scopes and procedures, the truth is that gastroenterology is much broader. It combines preventive care, chronic disease management, advanced endoscopic procedures, and research.

What is the most challenging case you’ve encountered?

Recently, I cared for a young, hardworking construction worker who didn’t have an insurance. He had been experiencing persistent abdominal pain and weight loss. During an endoscopy, we were able to identify something previously undiagnosed: he had gastric cancer.

The challenging and frustrating part of that case was that while we had the resources to diagnose his condition, we did not have the resources to provide him with the latest and most effective gastric cancer treatments available.

One of the most remarkable things I’ve witnessed during my career has been the progress of medical research. Several cancers that were once considered death sentences are now treatable and, in some cases, curable. Gastric cancer is one of them. The advances in treatment have been extraordinary.

However, these newer therapies are also extremely expensive. Although they can be remarkably effective, I was unable to identify the resources needed to get this patient access to those treatments. His disease progressed rapidly, and he died a few months ago.

What makes that experience so difficult is knowing that therapies existed that might have helped him, but they were ultimately out of reach. It’s part of a larger national conversation about healthcare.

Could you talk about your research with NSAIDs?

Researchers were discovering substances in the stomach called prostaglandins, which are responsible for prevention of injury. When one takes an NSAID, it lowers the levels of prostaglandins in the GI tract. This lowers the protective ability of the stomach and then ulcers ensue.

Medications like NSAIDs are highly effective treatments for important conditions, whether it’s pain management or the prevention of heart attacks and strokes in patients taking aspirin for cardiovascular disease.

So in many cases, simply telling patients not to take these medications may seem like an obvious solution, but it’s not a practical one.

Instead, our approach shifted toward prevention — finding co-therapies or medications that could be given alongside aspirin or NSAIDs to reduce the risk of developing bleeding ulcers.

Over the years, there has been tremendous progress in that area. One of the earliest therapies developed was misoprostol, a synthetic prostaglandin that helps prevent NSAID-related ulcers. Subsequently, researchers discovered that acid-reducing medications could also lower the risk for ulcer formation. That meant patients could continue receiving the benefits of an NSAID while reducing its GI side effects through the concomitant use of medications that suppress gastric acid.

We also learned that different formulations of NSAIDs carry different risks. About 20 years ago, an entirely new class of medications called COX-2 selective inhibitors was developed. Drugs such as Vioxx and Celebrex can provide effective pain relief and reduce inflammation while causing fewer GI side effects than traditional NSAIDs.

A lot of my time and scientific investigation has been spent in identifying GI safer strategies to be able to deliver pain relief and deliver effective reduction in inflammation without the GI side effects.

How do you handle difficult conversations with patients or families?

Difficult conversations are hard. At their core, they require three things: honesty, empathy, and clarity.

By clarity, I mean speaking in a way that patients and their families can understand. Physicians often slip into “doctor talk” and use medical jargon that the average person doesn’t understand. It’s our responsibility to break things down and make sure patients truly understand what we’re telling them.

Empathy is equally important. In those moments, the patient needs to be the sole focus of our attention. We shouldn’t appear rushed. We need to put the laptops, computers, and keyboards aside and focus entirely on the patient and their needs. We also need to be honest about what we know and clear about what we don’t know. If patients ask a question and we don’t have the answer, we should say so.

I try to be straightforward while recognizing that patients may be hearing startling information for the first time and that there are strong emotions involved. So I try to be clear, honest, and empathetic, and then provide time for questions and give patients and families the opportunity to ask everything that’s on their minds.

Most of all, it’s important that they never feel rushed during that interaction.

Cryer had no disclosures.

Jennifer Lubell is a freelance medical writer in the Greater Washington Area.