A Tribute to Paul H. Guth, MD (1927–2017)
This article serves to commemorate and honor the career of Paul H. Guth, MD, an accomplished gastrointestinal physiologist and clinician who passed away on July 4, 2017 at the age of 90 after a brief illness. As his mentee and collaborator, it is my hope that this article succinctly highlights and commemorates the many accomplishments of his career as well as to remember the warm, caring, and helpful person that he was to his colleagues, friends, and family.
Paul was an inquisitive scientist, deeply devoted and passionate about his research and supportive of his colleagues. He left a strong legacy to his family, his professional colleagues, students, mentees, fellow scientists, and clinicians. My aim is to briefly summarize his career and also to emphasize his personal qualities that endeared him to so many. Please note that Paul has already published reminiscences about his most esteemed mentor Mort Grossman that provide additional insight into his long professional career [1, 2].
Paul is regarded as one of the global leaders in the field of gastric cytoprotection, which entails the study of how the gastric mucosa is defended against the highly acidic luminal content, which, with a pH as low as 1, is capable of necrosing most living tissue. How the gastric mucosa remained healthy in such a caustic environment was a major interest in the field of gastroenterology (GI) up to the 1980s, when the twin discoveries of proton pump inhibitors and the microorganism Helicobacter pylori substantially lessened the clinical impact of (and research interest in) peptic ulcer disease (PUD). Nevertheless, PUD persists clinically; in particular in those ingesting nonsteroidal anti-inflammatory drugs (NSAIDs) and importantly, the mechanisms that protect against acid-induced injury remain vital for the study of tissue injury in general. Paul’s pioneering efforts, in particular his many studies of the gastric microcirculation and the contribution of oxygen-derived free radicals toward mucosal injury and protection, stand as some of the most significant early contributions toward the understanding of fundamental injury mechanisms that have current broad application, specifically toward the mechanism of tissue injury due to ischemia–reperfusion. His highest impact publication, which has been cited in almost 400 research publications since its publication in 1985, addresses the contributions of oxygen-derived free radicals toward the severity of hemorrhagic shock-induced gastric lesions .
Perhaps lesser known are Paul’s clinical contributions. He was a practicing gastroenterologist for his entire career, originally working at the Orange County General Hospital and later at the West Los Angeles VA Medical Center. Even after retirement, Paul volunteered at the Sepulveda Ambulatory Care Center, making valuable contributions to the care of Veterans well into his 80s. Paul was author of several important randomized controlled clinical trials (RCTs), in particular the first published RCT of the effect of nasogastric suction on the outcome of acute alcoholic pancreatitis . Though lacking the sophisticated statistical analysis, industry funding, and multiple authorships typical of currently published RCTs, this study was confirmed by several subsequent RCTs, changing clinical practice in favor of avoiding nasogastric suction in patients hospitalized for mild alcoholic pancreatitis. Paul also was senior author of a study of the ascitic leukocyte counts in infected and sterile ascites, published in 1976, that was the first to show that the leukocyte count effectively differentiated infected from non-infected ascites . These studies are a testament to Paul’s well-developed insight into the importance of clinical problems combined with an organizational ability and persistence needed to see the project to completion.
Along with my colleagues who knew him well, we will all miss his presence in our professional and personal lives.
We would like to thank Professors Thomas Brzozowski, Sandor Szabo, Koji Takeuchi, and Felix Leung for their helpful comments, photographs, and reminiscences.
- 10.Pedersen SF, Novak I, Alves F, Schwab A, Pardo LA. Alternating pH landscapes shape epithelial cancer initiation and progression: Focus on pancreatic cancer. Bioessays. 2017;39.Google Scholar