Overwhelmed with patients, decreases in reimbursement means spending time on a good history and physical examination is very challenging

Terence Angtuaco, MD, president of Premier Gastroenterology Associates in Little Rock, is a man of many talents. His passion for gastroenterology led to prolific research and publication activities while doing specialty training in liver transplant medicine at Rush University in Chicago, where he did his fellowship.

In addition to his medical career, he studied and competed in Taekwondo for 11 years, has a 4th degree black belt and was World Champion in 2010. He plays a lot of tennis and actively competes in USTA sanctioned tournaments and leagues. He is also studying how to play the drums, enjoys writing poetry, and is currently working on finishing two books he hopes will be published soon.

He finds gastroenterology a very dynamic field of medicine.

"There is constantly new research coming out and new technology being developed," Angtuaco said. "Digestive diseases are very common and there are still a lot of questions on many important diseases that need to be answered. It is not uncommon that GI symptoms are what lead patients to go see their PCPs. There are also many gastrointestinal complications that can be prevented by proactive preventive measures."

He finds gastroenterology the perfect choice that allows him to enjoy the mental challenge of tackling difficult medical cases and the physical challenge of fixing pathologies with his hands doing endoscopic procedures.

Angtuaco appreciates having the platform to make a difference in someone's life.

"Certainly, it is about helping the patient feel better by treating their digestive diseases but, more so, it is about making patients feel that someone truly cares about them," he said. "This is a great profession where patients entrust their lives to us and trust us with information that is personal and sensitive. I do not take this for granted and take great care to earn and maintain that trust. More than anything else, being a doctor allows me to serve God and do something important and impactful with my life that is beyond looking out for my own self-interests."

IBS is one of the most common GI problems. But there are many other diseases that present like IBS.

"It is important to do a thorough investigation and rule out important causes other than IBS before committing to that diagnosis," Angtuaco said. "It is also important to protect IBS patients from unnecessary procedures, surgeries, and tests. In patients presenting with vague symptoms, it takes less time to order these than to spend time with the patient and do a thorough investigation to find out the true underlying cause. In this day and age when physicians are overwhelmed with the number of patients and the decrease in reimbursement, spending time to get a good history and physical examination has become a very challenging task."

There has been a lot of research done studying the link between the alteration of normal bacteria in the human body and certain diseases.

"Probiotics are live microorganisms, either bacteria or yeast, that are ingested in the form of food or dietary supplements," he said. "They are the good bacteria and yeast that help the body maintain its normal and healthy composition of microorganisms. They produce substances that help keep us healthy and support our immune system in its fight against diseases. Prebiotics are nondigestible food components that promotes the growth and enhance the actions of the healthy microorganisms our body needs. Probiotics have been found effective in the treatment of antibiotic-associated diarrhea, C. difficile infection, inflammatory bowel disease, IBS, constipation, diarrhea, and many other non-gastrointestinal related diseases."

He talks to patients about eating more fiber and exercising. Most adults consume less than half the daily recommended amount of fiber needed, 25 to 30 grams.

"Fiber helps keep our digestive tract healthy by promoting regular elimination of stools and absorbing toxins," he said. "It also helps maintain cardiovascular health by helping maintain healthy cholesterol levels and blood sugar levels. Regular exercise has tremendous benefits for the cardiovascular system, our gastrointestinal health, and our mental health."

Eating an apple a day is good advice that has persisted for decades.

"Apples are a good source of fiber," Angtuaco said. "A medium-sized apple has about 4 grams of fiber. It is also a good source of several vitamins and minerals. Because of its fiber content, it helps with weight loss, cardiovascular health, and blood sugar control. It contains polyphenols that have antioxidant effects, lowers blood pressure, and lowers the risk of stroke. It contains pectin, a non-absorbable fiber that acts as a prebiotic that feeds the good bacteria in the colon."

LPR or laryngopharyngeal reflux is a very important GI issue that PCPs, ENT specialists, and pulmonologists need to be aware of. Angtuaco said increased awareness about its presentation helps in early intervention and prevents possible long-term complications. Symptoms of LPR include chronic cough, hoarseness, excessive throat mucus, frequent throat clearing, the feeling of having a lump in the throat (globus pharyngeus), recurrent asthma exacerbation, recurrent sinusitis, recurrent bronchitis, recurrent ear infections, chronic nasal congestion, and runny nose, especially after meals (post-prandial rhinorrhea).

Born in Manila, Philippines, Angtuaco migrated to the U.S. after graduating from medical school in 1993. He comes from a family of physicians. His father was a surgeon, his mother was a pediatrician and his wife, Josephine, is a pediatrician. Her three siblings and their father are doctors, too. His grand-uncle was the dean of the medical school Angtuaco attended.

"Several of his children are doctors, with two of them in Little Rock," Angtuaco said. "One of them, Edgardo, was a neuro-radiologist at UAMS for many years and recently passed away. The other, Edward, is still practicing radiology at Radiology Associates, PA."

Currently there are six Dr. Angtuaco's in Little Rock including Terence, his wife, Edward, and Teresita, who is a radiologist at UAMS. Sylvia is a cardiologist at Arkansas Children's Hospital and Michael is an interventional cardiologist at ACH.

Premier Gastroenterology Associates is comprised of seven GI doctors (Terence Angtuaco, Angelo Coppola, Brian Hughes, Steve Jones, David McElreath, Dhaval Patel, and Paul Svoboda) who left the Little Rock Diagnostic Clinic and formed the group in June 2018. The partners built a state-of-the-art clinic and ambulatory surgery center at the Premier Medical Plaza on Rodney Parham Road.

"We provide all the basic GI services plus more including capsule endoscopy, Restech pH study for LPR, argon plasma coagulation therapy, weight loss management including gastric balloon placement and dietitian service, and fecal incontinence treatment," Angtuaco said.

Angtuaco and his wife have three children. Tyler graduated from Pulaski Academy (PA) and is now a sophomore student at UCLA. Julienne is a junior at PA and Jaymie is a freshman at PA.

"All our kids play a lot of tennis," he said. "Julienne and Jaymie are still actively competing in USTA sanctioned tournaments and also play for PA. Tyler once played for PA and was state champion during his senior year."

Angtuaco completed an Internal Medicine residency at Mount Sinai Beth Israel Medical Center in Manhattan, N.Y., in 1998. He is a former assistant professor of medicine at the UAMS and practiced at the Central Arkansas Veterans Hospital.

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