Contact Information

Center for Outcomes Research and Education
VA Greater Los Angeles Healthcare System
11301 Wilshire Boulevard
Building 115, Room 215
Los Angeles, California 90073
On-campus mail: BVA Building 115, Room 318 179247
Tel: (310) 478-3711 x43360
Fax: (310) 268-4510
E-mail: bspiegel@mednet.ucla.edu
Web: www.researchcore.org

Biosketch

Dr. Spiegel is Assistant Professor of Medicine in the Division of Digestive Diseases, UCLA School of Medicine, and in the Division of Gastroenterology, VA Greater Los Angeles Health Care System. Dr. Spiegel is the Director of the UCLA/VA Center for Outcomes Research and Education, Co-Director of the Health Outcomes Core for the NIH-sponsored Center for Neurovisceral Sciences and Women's Health, and a member of the CURE Digestive Diseases Research Center. Dr. Spiegel attended Tufts University where he majored in Philosophy and Community Health, and received his M.D. with Alpha Omega Alpha honors from New York Medical College. He received training in internal medicine at Cedars-Sinai Medical Center in Los Angeles, and completed advanced studies in Health Services Research at the UCLA School of Public Health.

Dr. Spiegel's research interests have focused on acid-peptic disorders, chronic liver disease, gastrointestinal hemorrhage, and functional bowel disorders such as irritable bowel syndrome (IBS). His current primary research is to define strategies to improve the quality and cost-effectiveness of care for patients with IBS and dyspepsia. Toward that end, he has studied the cost-effectiveness of various tests in IBS including the role of colonoscopy and testing for celiac sprue. Dr. Spiegel is particularly interested in the role of the physician-patient relationship in IBS, and is currently conducting a randomized control study comparing a "model physician-patient relationship" versus usual care in the management of IBS.

Dr. Spiegel has published extensively in the field of digestive diseases health economics and health related quality of life. He has published cost-effectiveness analyses in several high impact journals on numerous topics including the use of cox-2 inhibitors in chronic arthritis, the use of proton pump inhibitors in dyspepsia, the appropriate use of upper endoscopy in gastrointestinal hemorrhage, and the use of antiviral therapies in chronic viral hepatitis. Dr. Spiegel has recently published a comprehensive survey and assessment of the entire body of health economic literature in digestive diseases. He is a peer-reviewer for numerous medical journals.

Selected References

Spiegel BMR, Vakil NB, Ofman JJ. Endoscopy for acute non-variceal upper gastrointestinal tract hemorrhage: is sooner better? A systematic review. Archives of Internal Medicine 2001;161:1393-1404

Spiegel BMR, Vakil NB, Ofman JJ. Dyspepsia management in primary care: a decision analysis of competing strategies. Gastroenterology 2002;122:1270-1285

Spiegel BMR, Ofman JJ, Vakil NB. Minimizing recurrent peptic ulcer hemorrhage after endoscopic hemostasis: the cost-effectiveness of competing strategies. American Journal of Gastroenterology 2003;98:86-97

Spiegel BMR, Targownik LE, Karsan HA, Dulai GS, Gralnek IM. Endoscopic screening for esophageal varices in cirrhosis: is it ever cost-effective? Hepatology 2003:37:366-77

Spiegel BMR, Targownik LE, Dulai GS, Gralnek IM. The cost-effectiveness of cyclooxygenase-2 selective inhibitors in the management of chronic arthritis. Annals of Internal Medicine 2003;138:795-806

Targownik LE, Gralnek IM, Dulai GS, Spiegel BMR, Oei T, Bernstein CN. Management of acute non-variceal upper gastrointestinal tract hemorrhage: comparison of a U.S. and a Canadian medical center. Canadian Journal of Gastroenterology 2003;17:489-95

Spiegel BMR, DeRosa VP, Gralnek IM, Wang V, Dulai GS. Testing for celiac sprue in diarrhea-predominant irritable bowel syndrome: a cost-effectiveness analysis. Gastroenterology 2004;126:1721-32

Targownik LE, Spiegel BM, Dulai GS, Karsan HA, Gralnek IM. The cost-effectiveness of hepatic pressure gradient monitoring in the prevention of recurrent variceal hemorrhage. American Journal of Gastroenterology 2004;99:1306-15

Spiegel BMR, Targownik LE, DeRosa V, Dulai GS, Gralnek IM, Chiou CF. The quality of published health economic analyses in digestive diseases: a systematic review and quantitative appraisal. Gastroenterology 2004;127:403-411

Spiegel BMR, Gralnek IM, Mayer EB, Bolus R, Dulai GS, Chang L, Naliboff B. Clinical determinants of health-related quality of life in patients with irritable bowel syndrome. Archives of Internal Medicine 2004;164:1773-1780

Targownik LE, Spiegel BMR, Dulai GS, Gralnek IM, Farrell J. Colonic stent vs. emergency surgery for management of acute left-sided malignant colonic obstruction: A decision analysis. Gastrointestinal Endoscopy 2004;60:865-74

Kanwal F, Dulai GS, Spiegel BMR, Yee HF, Gralnek IM. Recipient Characteristics and Post-Liver Transplantation Outcomes Before and After MELD. Alimentary Pharmacology and Therapeutics 2005;15;21:169-77

Dulai GS, Shekelle P, Jensen DM, Spiegel BMR, Chen J, Oh D, Kahn K. Dysplasia and risk of neoplastic progression in a regional Veteran's Administration Barrett's surveillance cohort. American Journal of Gastroenterology 2005;100:775-83

Spiegel BMR, Younossi ZM, Hays RD, Revicki D, Robbins S, Kanwal F. The impact of hepatitis C on health related quality of life: a systematic review of the literature. Hepatology 2005;41:790-800

Karsan HA, Morton SC, Shekelle PG, Suttorp MJ, Spiegel BMR, Edelstein MA, Shanman R, Gralnek IM. Combination endoscopic band ligation and sclerotherapy compared with endoscopic band ligation alone for the secondary prophylaxis of esophageal variceal hemorrhage: a meta-analysis. Digestive Diseases and Sciences 2005;50:399-406

Spiegel BMR, Chiou CF, Ofman JJ. Minimizing complications from nonsteroidal anti-inflammatory drugs: the cost-effectiveness of competing strategies in varying risk groups. Arthritis Care and Research 2005;15:185-97

Bloom M, Barghout V, Kahler K, Bentkover J, Kurth H, Gralnek IM, Spiegel BMR. Budget Impact of Tegaserod on a Managed Care Organization Formulary. American Journal of Managed Care 2005;11:S27-S34

Kanwal F, Gralnek IM, Martin P, Dulai GS, Martin P, Spiegel BMR. The cost-effectiveness of competing therapies in the management of chronic infection with hepatitis B virus. Annals of Internal Medicine 2005;142:821-31.

Tan S, Tillisch K, Bolus R, Olivas T, Naliboff L, Chang L, Spiegel BMR, Mayer EA S. Subgrouping of irritable bowel syndrome patients using traditional Chinese medicine symptom classification - a pilot study. Am J Chin Med. 2005;33(3):365-79

Kanwal F, Gralnek IM, Hays RD, Spiegel BMR, Dulai GS, Bozzette S, Asch S. Impact of chronic viral hepatitis on health related quality of life in HIV: results from a nationally representative sample. American Journal of Gastroenterology. 2005;100:1984-94

Spiegel BMR, Kanwal F, Naliboff B, Mayer E. The impact of somatization on gastrointestinal health resource use in irritable bowel syndrome. American Journal of Gastroenterology 2005;100:2262-73

Spiegel BMR, Chen K, Broder M, Chiou Chiun-Fang. Erythropoietic Growth Factors for the management of treatment-related anemia in hepatitis C: clinical and economic consequences. Clinical Gastroenterology and Hepatology 2005;3:1034-42

Spiegel BMR, Gralnek IM, Bolus R, Mayer E, Chang L, Dulai GS, Naliboff B. Is a negative colonoscopy associated with improved health-related quality of life or reassurance in irritable bowel syndrome? Gastrointestinal Endoscopy 2005;62:892-899

Spiegel BMR, Farid M, Gralnek IM, Dulai GS, Kanwal F. Comparing rates of dyspepsia with coxib versus NSAID+PPI combination therapy: a systematic review and meta-analysis. American Journal of Medicine 2006; 119(5):448.e27-36

Spiegel BMR, Lim B, Mann N, Dulai GS, Gralnek IM. The cost-effectiveness of intravenous versus oral proton pump inhibitor therapy in the management of peptic ulcer hemorrhage: a cost-effectiveness analysis. Clinical Gastroenterology and Hepatology 2006;4:988-997

Kanwal F, Farid M, Gralnek IM, Dulai G, Martin P, Chen G, Spiegel BMR. Treatment alternatives for hepatitis B cirrhosis: a cost-effectiveness analysis. American Journal of Gastroenterology 2006;101:2076-89

Gralnek IM, Fennerty B, Spiegel BMR. The effectiveness of esomeprazole in erosive esophagitis: a meta-analysis. Clin Gastroenterol Hepatol. 2006;4:1452-8

Spiegel BMR, Bolus R, Han S, Tong M, Esrailian E, Talley J, Tran T, Smith J, Karsan H, Durazo F, Bacon B, Martin P, Younossi Z, Hwa-Ong S, Kanwal F. Development and validation of a disease-targeted health-related quality of life instrument in chronic hepatitis B infection: the HBQOL v1.0. Hepatology 2007;46:113-21

Spiegel BMR, Schoenfeld P, Naliboff B. Prevalence of suicidal behavior in patients with chronic abdominal pain and irritable bowel syndrome: a systematic review. Aliment Pharmacol Ther. 2007;26:183-193.

Singh H, Latosinsky S, Spiegel BM, Targownik LE. The cost-effectiveness of colonic stenting as a bridge to curative surgery in patients with acute left-sided malignant colonic obstruction: a Canadian perspective. Can J Gastroenterol. 2006 ;20:779-85

Esrailian E, Spiegel BMR, Targownik L, Dulai GS, Gralnek IM. Differences in the management of Crohn's disease among experts and community providers, based on a national survey of sample case vignettes. Aliment Pharmacol Ther. 2007;26:1005-18

Spiegel BMR, Esrailian E, Laine L, Chamberlain M. Clinical relevance of adjuvant chemotherapy in glioblastoma multiforme: a meta-analysis of competing agents. Manuscript in press at CNS Drugs 2007;21:775-87.

Spiegel BMR, Esrailian E, Eisen G. The budget impact of screening for esophageal varices in cirrhosis. Manuscript in press at Gastrointestinal Endoscopy.

Kanwal F, Hoang T, Spiegel BMR, Dominitz J, Goetz M, Gifford A, Asch S. Predictors of treatment in patients with chronic hepatitis C virus infection-Role of patient versus non-patient factors. Manuscript in press at Hepatology 2007

Huang E, Esrailian E, Spiegel BMR. The cost-effectiveness of competing therapies for hepatic encephalopathy: a decision analysis. Manuscript in press at Alimentary Pharmacology and Therapeutics.

Spiegel BMR, Dulai GS. Peptic ulcer disease and stress-related mucosal disease (chapter 80), In: Hospital Medicine; 2d ed. [Book]. Wachter B, Goldman L, Hollander H, eds. Lippincott, Williams & Wilkins, 2005

Spiegel BMR, Singh I. Gastrointestinal motility problems in the critical care setting. In: Intensive Care Medicine; 6th ed. [Book]. Irwin, Rippe, etd. Lippincott Williams & Wilkins, 2006 [in press

Spiegel B. Meperidine or morphine in acute pancreatitis? [Letter]. American Family Physician 2001;64:219

Spiegel BMR, Gralnek IM. Potential bias in favor of coxibs [Letter Reply]. Annals of Internal Medicine 2004;140:761-2

Spiegel BMR, Targownik L, Dulai GS, Karsan HA, Gralnek IM. Endoscopic screening for esophageal varices in cirrhosis and the cost of variceal hemorrhage [Letter Reply]. Hepatology 2004

Spiegel BMR, Kanwal F. Premature to eliminate lamivudine in the treatment of hepatitis B [Letter Reply]. Annals of Internal Medicine 2005

Spiegel BMR, Gralnek IM. Evidence-based Gastroenterology [Book review]. Gastroenterology 2003;124:1996-19971.

Spiegel BMR. Negotiating the therapeutic staircase in inflammatory bowel disease. The Gastroenterology Fellow 2004;2:12-18

Spiegel BMR. Diagnosis and Management of Superior Mesenteric Artery Embolism. The Gastroenterology Fellow 2004;2:19-22

Spiegel, BMR; Horn JR; Mathis AS. Chronically questioned about chronic constipation? Postgraduate Institute of Medicine Special Report; May 2007

Spiegel BMR. The impact of negative diagnostic tests in the management of non-ulcer dyspepsia: is no news good news? Evidence-Based Gastroenterology 2002;3:47-48

Spiegel BMR, Gralnek IM. Early medical therapy reduces intra-gastric blood in upper gastrointestinal tract hemorrhage: a difference that makes a difference? Evidence-Based Gastroenterology 2002;3:40-41

Spiegel BMR, Gralnek IM. Carvedilol or propranolol for variceal prophylaxis: Unconfidence intervals confound the choice. Evidence-Based Gastroenterology 2003;4:107-109

Spiegel BMR. How much do coxibs cost? Evidence-Based Gastroenterology 2004;5:10-11

Spiegel BMR, Dulai, GS. Rethinking the safety of clopidogrel: lessons learned from ulcers in Asia. Evidence-Based Gastroenterology 2005

Spiegel BMR, Dulai GS. PPI therapy in nonulcer dyspepsia: still working after all these years. Evidence-Based Gastroenterology 2005

Spiegel BMR. Barrett's esophagus and cancer: overview / overdone? Audio-Digest Gastroenterology 2006(Sept);20:9

Spiegel BMR. Do physicians follow evidence-based guidelines in the diagnostic work-up of IBS? In Press at Nature Clinical Practice Gastroenterology and Hepatology.

Spiegel, BMR. A letter a day keep the cancer away: improving colon cancer screening adherence with a mailed brochure. Evidence-Based Gastroenterology 2007.