Raj Shah and Richard Henriquez found that gabapentinoids, a family of drugs used to prevent seizures and commonly used for nerve pain, reduced alcohol withdrawal symptoms and slowed the progressions of liver disease better than another FDA-approved drug for alcohol use disorder.

Both physicians have been chief residents at the Orlando VA Medical Center during their Greater Orlando-Osceola Internal Medicine residency training sponsored by the UCF-HCA Healthcare’s Graduate Medical Education Consortium. Henriquez now serves as an attending physician at the VA, where he helps run the UCF residency and cares for patients. He plans to apply for board certification in addiction medicine this summer and is also a UCF undergraduate alum. Shah will graduate in June from UCF’s Internal Medicine of Greater Orlando – Osceola residency and then join the consortium’s first Gastroenterology fellowship, where he will care for patients at the VA and HCA Florida Osceola Hospital.

Alcohol Misuse, Liver Disease Increasing

Nearly 30 million people in the United States – ranging in age from 12 to adulthood – have alcohol use disorder and that number is increasing. So is alcohol-related liver disease, which can lead to death, liver failure and transplantation, and other serious health ailments.

“Alcohol use disorder is a huge public health issue that needs to be brought to the forefront of research,” Henriquez says. “We were looking for more ammunition to have in our toolbox and this study might open a path for it,”

The research was presented recently during Digestive Disease Week in Washington D.C. The physicians used the VA’s extensive patient database to analyze about 49,000 patients who had been diagnosed with alcohol use disorder and were being treated with acamprosate, an FDA-approved drug for alcohol dependency, or gabapentin.

The physicians found that a statistically significant 15.8% of patients on Acamprosate advanced to severe liver disease, including scarring, cirrhosis, alcohol hepatitis or liver cancer, compared with 13.4% of the veterans taking gabapentin. For patients with pre-existing liver disease, 30.4% of those taking acamprosate saw their liver disease worsen, compared with 25.8% of those on gabapentin.

Acamprosate is only used for alcohol use disorder. Because gabapentinoids are used to treat pain from shingles and neuropathy (a common complication from diabetes), they are much more understood and prescribed by primary care physicians. Use of the drug tripled from 2002 to 2015 and it is one of the 10 most frequently prescribed medications nationwide, according to the study. The physician researchers hope that their findings will encourage more doctors to consider using gabapentinoids to treat patients with alcohol use dependency before they suffer significant liver damage. They point to statistics showing that only about 2.2% of alcohol-dependent patients use prescription drugs to help treat their addiction. One of the reasons, they say, is that patients must take two acamprosate pills three times a day and can suffer serious side effects if they drink alcohol while taking the drug.

Gabapentin treats pain by soothing the nervous system. As such, it may address mental health issues such as anxiety that can lead patients to drink heavily and subsequently damage their livers, Shah told media at the national conference.

“If we’re able to, with gabapentin, kill two birds with one stone — able to treat their pains as well as their alcohol use disorder — then it’s warranted, using gabapentin versus just using acamprosate,” he says.

Both researchers said more studies are needed to replicate their findings. They emphasize that physicians should not conclude that gabapentinoids are better than other FDA-approved drugs to treat alcohol use disorder, only that it is another option for patients and providers.

“Each physician should review patients holistically at an individual level, considering their chronic medical problems and preferences while weighing the risks and benefits,” Henriquez says.

How Research Impacts Patient Care

Both physicians said awareness is key to addressing alcohol use disorder and its serious damage to health.

“When education and risk awareness of the dangers of alcohol misuse goes up, usage tends to go down,” Henriquez says. “That’s why we need to put an emphasis on education and treatment.”

Shah wants to become a gastroenterologist to help provide that care. He noted that lifestyle habits are increasing all forms of liver disease. One of the reasons UCF and HCA Healthcare created the new gastroenterology fellowship is to address a physician shortage in that specialty. Both physicians said they came to UCF for graduate medical education because the Internal Medicine program of Greater Orlando-Osceola offered a family-like atmosphere and emphasized research and other academic pursuits. The opportunity to care for veterans and residents of Osceola County, one of Florida’s fastest-growing and most complex communities, also allowed them to care for an incredible variety of patients and conditions.

Abdo Asmar has led the Internal Medicine Residency of Greater Orlando- Osceola since UCF’s inaugural program began in 2014. Today, the UCF-HCA Graduate Medical Education Consortium is one of the fastest growing in Florida, with more than 620 physicians training in 39 accredited programs this summer.

Asmar says Shah and Henriquez’s research shows their commitment to improving health for all.

“These physicians are difference makers,” he says. “And through their research, they are demonstrating a commitment to advancing science and patient care. With research, you go beyond the patient who is sitting in front of you. You improve care for patients you will never see.”

The two new programs recently received ACGME (Accreditation Council for Graduate Medical Education) accreditation and are seeking applicants to begin training in July 2024. With the additions, the UCF-HCA Florida Healthcare Graduate Medical Education Consortium has 37 accredited programs from the Florida panhandle to Orlando, making it one of the fastest growing in the state. By July, the consortium will have 600 physicians in training in high-need specialties that include primary care, surgery, OB-GYN, psychiatry, endocrinology, emergency medicine and geriatrics.

Stephen Cico, UCF’s associate dean for graduate medical education and the consortium’s designated institutional official (DIO), says the programs will help improve patients’ access to care and address the state’s physician shortage.

“The internal medicine residency will fill the great need in Florida for access to primary care physicians especially in the panhandle,” he says. “Their clinics and hospital will care for some of those who have the hardest time accessing medical care. The GI fellowship will provide patients in Greater Orlando with additional access to GI physicians and procedures such as colonoscopies while also providing care for GI emergencies.”

The internal medicine residency will accept 12 physicians a year for its three-year program — training 36 doctors when at full complement — and will participate in this year’s National Match Day March 15. The GI fellowship will accept two physicians a year who have completed their internal medicine residency training for its three-year program — for a total of six at full complement.

Amanda Finley will lead the internal medicine residency. She completed medical school at the West Virginia School of Osteopathic Medicine and later completed residency training at Magnolia Regional Health Center in Mississippi, where she was chief resident and stayed to serve as faculty. She was founding program director and designated institutional official at Henry County Medical Center in Tennessee, where she worked with the Health Resources Service Administration to create a rural residency program.

“Our commitment to creating a healthy and innovative learning environment make our new residency an amazing place to train,” she says. “Our goal is to ensure that residents achieve clinical excellence in a supportive family environment where we focus on giving and receiving feedback that take our professional performance to the highest level.”

Vinay Katukuri will lead the GI fellowship. He completed his medical education in India and then pursued residency training at Wayne State şŁ˝ÇÖ±˛Ą in Michigan. Following this, he completed his gastroenterology fellowship at the şŁ˝ÇÖ±˛Ą of Michigan, followed by an advanced endoscopy fellowship at Thomas Jefferson şŁ˝ÇÖ±˛Ą in Philadelphia. He served as interventional faculty at Henry Ford Health System and actively participated in teaching residents and fellows, including those specializing in advanced endoscopy. While at Henry Ford Health System, he was chosen to participate in the inaugural fellowship program for entrepreneurs in digital health. Katukuri later relocated to Florida, where he established his own practice.

“In addition to meeting the community’s need for gastroenterology services, the new fellowship training program aims to improve access to colon cancer prevention, which is crucial given the rising incidence of cancer,” he says.

Graduate medical education programs are key to addressing Florida’s physician shortage because the majority of doctors locate their practices near where they completed their residency or fellowship training. Medical school graduates cannot practice medicine independently but must complete residency training in their field of specialty.