UTHSC’s Colin Howden Helping Establish Two New Guidelines

Colin Howden, MD, describes it as a case of being in the right place at the right time.

Howden, chief of the Division of Gastroenterology in the College of Medicine at the University of Tennessee Health Science Center, was barely out of medical school at the University of Glasgow in his native Scotland when his fledgling career got a huge boost.

One of his mentors, John Reid, a professor whom Howden describes as a clinical pharmacologist, was approached by Astra, a pharmaceutical company, about developing a compound that at the time was simply a number. It later became omeprazole, a drug that proved to be revolutionary in the treatment of stomach acid. It was later marketed in the United States as Prilosec.

“As someone who had just started his training in gastroenterology, I was directed by Professor Reid to learn about omeprazole and how it might affect stomach acid production,” Howden said. “Together, we were among the first people in the world to actually give omeprazole to human beings to see what it would do to stomach acid secretion. It was the first in the class of drugs called PPIs, or proton pump inhibitors.

“I was able to produce and publish original research, and I had the opportunity of presenting some of that research in New Orleans in 1984 at the annual Digestive Disease Week conference.”

That occasion led to an introduction to another of Howden’s mentors, Professor Richard Hunt, who offered him a position in the Division of Gastroenterology at McMaster University in Hamilton, Ontario.

By then, Howden’s career was off and running. After two years in Canada, he returned to Scotland and worked for four years in teaching hospitals at the University of Glasgow. Then, in 1991, he accepted an offer from the University of South Carolina and has been in the United States ever since.

In 1999, he moved on to Northwestern University, and in 2014 he accepted an offer to come to UTHSC.

Howden is active in the two primary professional societies for gastroenterologists in the United States – the American College of Gastroenterology (ACG) and the American Gastroenterological Association.

“With the ACG, I am currently helping to author two important practice guidelines,” he said. “One is for the management of H. pylori infection. I’m one of four people in North America who are preparing a new, updated guideline for that, and we hope to have that finalized soon.

“The other guideline I’m involved in is a joint effort between the ACG and the Canadian Association of Gastroenterology for the evaluation and treatment of dyspepsia, which can have many causes, one of which is peptic ulcer.

“Most people with dyspepsia don’t have any obvious diagnosis to explain their symptoms, and sometimes we have to give them this diagnostic label of functional dyspepsia, which really means you have symptoms but I’m afraid we don’t have a precise cause for them. And that gets into the area of so-called functional gastrointestinal disorders, or this can overlap between brain-gut interactions and how some people perceive stomach or intestinal symptoms differently to others.”

Brain-gut interaction is a relatively new concept for some physicians and many patients.

“This term – disorders of brain-gut interaction – you’re probably going to hear a lot more about in the next few years,” Howden said.

For conditions such as irritable bowel syndrome or dyspepsia, Howden said symptoms “may include things like abdominal pain and disturbance of bowel habit, and yet diagnostic tests that we have available to us don’t really give us an explanation of why the patient is having these symptoms.

“In the past, these conditions were viewed differently by the medical profession. I think a lot of doctors assumed that these conditions were psychological, or psychosomatic, or were due to stress, and a lot of patients were given erroneous information. Patients may have been told in the past that your symptoms are stress-related, or it’s all in your head, or you’re imagining it.

“Those attitudes were quite wrong, and no reasonable physician would take them now. We like to get the message across that the symptoms are real and they are not imagined. They’re not in your head, they’re in your belly. The whole concept of brain-gut interaction implies that the brain and the gut are communicating the whole time, and although the intestinal tract and the brain are a long way apart, anatomically there is a very, very active connection, a connection of nerves between the brain and the gut. They’re constantly talking to each other, if you like.”

Howden’s wife, Jackie, also is from Scotland. She was head of nursing at a hospital in Glasgow before she came to the U.S. and was Northwestern University’s director of home healthcare for several years.

“She now tells me she’s retired,” Howden said.

Howden will be 60 this year but says he hasn’t given much thought to retiring or, for that matter, moving back to the UK.

“It’s a possibility,” he said, “but it’s not in my immediate plans.”

A lifelong rugby fan, Howden became a Chicago Cubs fan when he and Jackie lived in Chicago.

“We still follow the Cubs a little bit,” he said. “We used to live near Wrigley Field, and we walked to the occasional game.”

In a Q&A with a gastroenterology website several years ago, Howden commented that he was puzzled by some of the differences in medical practices between the U.S. and UK.

We asked him to cite an example.

“When medical students are being taught how to examine a patient’s abdomen, in the U.S. they’re taught that it’s very important that they use the stethoscope first before they lay a hand on it,” he said. “In the UK they are taught that listening to the abdomen with the stethoscope must be the last thing you do.

“When both sides of the Atlantic have adopted a completely opposite approach to something like that, it strikes me that neither is absolutely correct and probably it doesn’t matter.”

American College of Gastroenterology

American Gastroenterological Association