Balancing the challenges of research with the joys of clinical care
Andrew Ofosu, MD, MPH, loves the variety that GI medicine offers on a day-to-day basis.
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12/01/2025
Andrew Ofosu, MD, MPH, loves the variety that GI medicine offers on a day-to-day basis.
Some days are spent in the endoscopy suite, performing endoscopic retrograde cholangiopancreatography in patients with cholangitis, “which is usually a high-stakes situation,” he said. Other days he might be in clinic, helping to manage a patient with chronic pancreatitis.
“The contrast of the immediate impact of a procedure combined with the continuity of long-term relationships is special to me,” said Dr. Ofosu, an associate professor of medicine at the University of Cincinnati College of Medicine in Cincinnati, Ohio. He is also a member of the AGA’s Future Leaders program, which provides early-career GI physicians with opportunities to network and develop leadership skills.
In an interview, he discussed his research pursuits in pancreatic cancer and artificial intelligence (AI), as well as his unique methods for connecting with patients. The art of listening to patient concerns is crucial, he says, especially following a difficult diagnosis.
What’s it like to be part of the AGA Future Leaders Class of 2025–2026? How has the experience enriched your career?
Dr. Ofosu: My time being part of this group has been very transformative. It has provided mentorship from national leaders, enabled collaboration with peers across different institutions, and given me opportunities to refine my leadership skills. It has changed my perspective and created a network that has equipped me to contribute meaningfully to the gastroenterology community and to my institution.
What is the most challenging clinical case you’ve encountered?
Dr. Ofosu: One case that stands out involved a young patient with recurrent idiopathic pancreatitis. We went through all potential differential etiologies, including genetics, autoimmune disease, and structural causes. It became a long diagnostic journey. The challenge was not just the medical aspect, but the emotional aspect—when you don’t have all the answers. We were eventually able to identify the cause as genetic, and the patient is doing great now.
One of your research interests involves developing innovative ways to use AI in endoscopic ultrasound to identify and characterize lesions. Can you discuss some of those innovations?
Dr. Ofosu: This is definitely an area I am looking to explore. The goal is to leverage AI to improve the diagnostic capability of endoscopic ultrasound by analyzing images in real time. AI can help highlight features that distinguish benign from malignant tumors, provide real-time diagnostic support, improve diagnostic accuracy, and reduce unnecessary treatment.
In 2021, you conducted a study investigating demographics, clinical outcomes, and survival in early- and late-onset pancreatic adenocarcinoma (Pancreatology. 2021 Jan; doi: 10.1016/j.pan.2020.12.007). What did your study reveal, and what are the next steps?
Dr. Ofosu: We analyzed data from more than 136,000 patients with pancreatic adenocarcinoma, comparing those diagnosed under age 40 with older patients. Although pancreatic cancer is rare in younger individuals, both groups are increasingly presenting with advanced disease, and incidence is rising. Younger patients more often have tumors in the head of the pancreas, while older patients tend to have tumors in the body and tail. Overall survival remains poor—about six to seven months—but is slightly better in younger patients.
The next step is to better understand the biological drivers of early-onset pancreatic adenocarcinoma by integrating molecular profiling to identify distinct genetic patterns that could guide therapy. Ultimately, the goal is to improve early detection and tailor management strategies for this patient population.
What is your approach to patient communication and education?
Dr. Ofosu: I aim for clarity and empathy. GI diagnoses can be intimidating, so I use analogies and visuals to simplify complex conditions. I also make sure patients truly understand what we are discussing, because what a patient hears is not always what they think was explained.
Being honest and compassionate go hand in hand. I don’t shy away from delivering difficult news, but I always pause, listen, and acknowledge emotions. Patients and families appreciate transparency, even when the prognosis is tough, as long as they know I am fully present with them.
Can you share a memorable patient interaction that impacted you?
Dr. Ofosu: One patient with chronic pancreatitis due to alcohol use had limited economic and social support. Beyond medical management, what made a difference was sitting and listening, and helping connect the patient with resources and social support. It reinforced that medicine is not just about lab values—it’s about restoring dignity and focusing on the patient as a whole.
What do you think is the biggest misconception about your specialty?
Dr. Ofosu: That gastroenterology is all about procedures. In reality, it combines technical expertise with the cognitive aspects of long-term management of complex diseases. It requires a diverse skill set beyond endoscopy.
Lightning Round
Favorite season: Fall — he enjoys the changing leaves
Favorite weekend activity: Watching soccer with family and friends
Historical figure he’d like to have dinner with: Nelson Mandela
Go-to karaoke song: “Don’t Stop Believin’” by Journey
Bucket list item: Traveling to Europe and experiencing different cultures
Favorite childhood memory: Learning how to fly a kite
Skill he’d like to learn instantly: Playing the piano
Planner or spontaneous: Planner
Favorite holiday tradition: Sharing Christmas dinner with family
Summary content
7 Key Takeaways
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Developed a paper-based colorimetric sensor array for chemical threat detection.
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Can detect 12 chemical agents, including industrial toxins.
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Production cost is under 20 cents per chip.
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Utilizes dye-loaded silica particles on self-adhesive paper.
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Provides rapid, simultaneous identification through image analysis.
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Inspired by the mammalian olfactory system for pattern recognition.
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Future developments include a machine learning-enabled reader device.
The guidelines emphasize four-hour gastric emptying studies over two-hour testing. How do you see this affecting diagnostic workflows in practice?
Dr. Staller: Moving to a four-hour solid-meal scintigraphy will actually simplify decision-making. The two-hour reads miss a meaningful proportion of delayed emptying; standardizing on four hours reduces false negatives and the “maybe gastroparesis” purgatory that leads to repeat testing. Practically, it means closer coordination with nuclear medicine (longer slots, consistent standardized meal), updating order sets to default to a four-hour protocol, and educating front-line teams so patients arrive appropriately prepped. The payoff is fewer equivocal studies and more confident treatment plans.
Metoclopramide and erythromycin are the only agents conditionally recommended for initial therapy. How does this align with what is being currently prescribed?
Dr. Staller: This largely mirrors real-world practice. Metoclopramide remains the only FDA-approved prokinetic for gastroparesis, and short “pulsed” erythromycin courses are familiar to many of us—recognizing tachyphylaxis limits durability. Our recommendation is “conditional” because the underlying evidence is modest and patient responses are heterogeneous, but it formalizes what many clinicians already do: start with metoclopramide (lowest effective dose, limited duration, counsel on neurologic adverse effects) and reserve erythromycin for targeted use (exacerbations, bridging).
Several agents, including domperidone and prucalopride, received recommendations against first-line use. How will that influence discussions with patients who ask about these therapies?
Dr. Staller: Two points I share with patients: evidence and access/safety. For domperidone, the data quality is mixed, and US access is through an FDA IND mechanism; you’re committing patients to EKG monitoring and a non-trivial administrative lift. For prucalopride, the gastroparesis-specific evidence isn’t strong enough yet to justify first-line use. So, our stance is not “never,” it’s just “not first.” If someone fails or cannot tolerate initial therapy, we can revisit these options through shared decision-making, setting expectations about benefit, monitoring, and off-label use. The guideline language helps clinicians have a transparent, evidence-based conversation at the first visit.
The guidelines suggest reserving procedures like G-POEM and gastric electrical stimulation for refractory cases. In your practice, how do you decide when a patient is “refractory” to medical therapy?
Dr. Staller: I define “refractory” with three anchors.
1. Adequate trials of foundational care: dietary optimization and glycemic control; an antiemetic; and at least one prokinetic at appropriate dose/duration (with intolerance documented if stopped early).
2. Persistent, function-limiting symptoms: ongoing nausea/vomiting, weight loss, dehydration, ER visits/hospitalizations, or malnutrition despite the above—ideally tracked with a validated instrument (e.g., GCSI) plus nutritional metrics.
3. Objective correlation: delayed emptying on a standardized 4-hour solid-meal study that aligns with the clinical picture (and medications that slow emptying addressed).
At that point, referral to a center with procedural expertise for G-POEM or consideration of gastric electrical stimulation becomes appropriate, with multidisciplinary evaluation (GI, nutrition, psychology, and, when needed, surgery).
What role do you see dietary modification and glycemic control playing alongside pharmacologic therapy in light of these recommendations?
Dr. Staller: They’re the bedrock. A small-particle, lower-fat, calorie-dense diet—often leaning on nutrient-rich liquids—can meaningfully reduce symptom burden. Partnering with dietitians early pays dividends. For diabetes, tighter glycemic control can improve gastric emptying and symptoms; I explicitly review medications that can slow emptying (e.g., opioids; consider timing/necessity of GLP-1 receptor agonists) and encourage continuous glucose monitor-informed adjustments. Pharmacotherapy sits on top of those pillars; without them, medications will likely underperform.
The guideline notes “considerable unmet need” in gastroparesis treatment. Where do you think future therapies or research are most urgently needed?
Dr. Staller: I see three major areas.
1. Truly durable prokinetics: agents that improve emptying and symptoms over months, with better safety than legacy options (e.g., next-gen motilin/ghrelin agonists, better-studied 5-HT4 strategies).
2. Endotyping and biomarkers: we need to stop treating all gastroparesis as one disease. Clinical, physiologic, and microbiome/omic signatures that predict who benefits from which therapy (drug vs G-POEM vs GES) would transform care.
3. Patient-centered trials: larger, longer RCTs that prioritize validated symptom and quality-of-life outcomes, include nutritional endpoints, and reflect real-world medication confounders.
Our guideline intentionally highlights these gaps to hopefully catalyze better trials and smarter referral pathways.
Dr. Staller is with the Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston.