Featured Spotlight Team Member

Javier Villafuerte, MDDr. Javier Villafuerte

This edition's Physician Spotlight is on our third year clinical fellow in gastroenterology, Dr. Javier Villafuerte, who has a focused interest in celiac disease and research.

How did you come to join the Celiac Center at BIDMC?

At the end of medical school, while working on my thesis on microscopic colitis, I realized how little was known about diarrheal illnesses and how exciting it is to work in research that can impact patients' lives. I applied to the Latin American Initiative program which paired Latin American physicians with research mentors within HMS. Very fortunately, I was selected and paired with Dr. Ciaran Kelly at BIDMC. I arrived in February 2012, joining the research activities and later the clinical activities of the Celiac Center.

How did you become interested in celiac disease as a specialty?

By the end of medical school, I had already developed a keen interest in diarrheal diseases, especially those mediated by the immune system. Working in celiac disease research with Dr. Ciaran Kelly, Dr. Dan Leffler, and dietitian Melinda Dennis sparked my passion for understanding celiac disease and my love of caring for patients suffering from it. Even though awareness of the disease continues to grow, very few clinicians and even gastroenterologists can correctly diagnose and effectively manage it. After two steady years of working in clinic with Dr. Kelly, I feel I have learned enough to make a difference in the lives of patients with celiac disease and look forward to learning more.

What is the focus of your current clinical and research work?

I work with Dr. Kelly in his clinics, primarily seeing patients with gluten-related disorders. In the Inflammatory Bowel Disease Center, I am working with Dr. Sarah Flier in the advanced care of patients with ulcerative colitis and Crohn's disease. I am also training in video capsule endoscopy, a less invasive way to evaluate the small intestine.

In research, I am collaborating on studies examining vitamin deficiencies in celiac disease, one of which will be presented at the American College of Gastroenterology meeting in October 2020 and will be included in the next Celiac Center e-newsletter.

My recent editorial about pregnancy outcomes in women without celiac disease following a gluten-free diet with co-author, Dr. Jocelyn Silvester, was published in Digestive Diseases and Sciences in July 2020. I am also researching blood and stool tests as a way to diagnose and predict outcomes of Clostridioides difficile (C-diff), a bacteria that can cause major complications in the colon.

Download Dr. Javier Villafuerte's research information

How have you seen COVID-19 affect the health of your patients with celiac disease?

During the (first and hopefully only) peak of the pandemic in Boston, most of our outpatient clinics and endoscopy services shut down to decrease risk of contagion. Though our clinics later re-opened via telephone, most of the gastroenterology fellows, including myself, were reassigned to the intensive care units to help care for an unprecedented number of sick patients with COVID-19.

In the midst of this crisis, most of our patients with celiac disease stayed home. Restaurants and take-out became very limited, and with extra time on their hands, many began to eat exclusively home cooked meals. Most patients reported generally doing better as they were less likely to experience accidental gluten exposures or cross-contact. Despite this positive situation for some, other patients undergoing evaluation for a new diagnosis of celiac disease had significantly limited access to endoscopy to confirm their diagnosis.

There has been a push, especially in Europe, to diagnose celiac disease based on blood tests only, without endoscopy and biopsy, due to decreased availability of endoscopy. While this is well-intentioned, based on our data, over two-thirds of adult patients with suspected celiac disease cannot be diagnosed reliably without endoscopy.

Our endoscopy leadership has fortunately built protocols, which several major gastroenterology societies have adopted, to safely perform endoscopy to help inform major decisions, such as confirming celiac disease and starting a gluten-free diet. These protocols have allowed us to give our patients the care they needed in the middle of the adversity of a pandemic.

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