In parallel with these organizational developments, the field of gastroenterology itself has witnessed tremendous progress. Who could have envisaged the developments that have thoroughly revolutionized this field of medicine over this half-century? Endoscopy, an investigational tool that is now indispensable to gastroenterology practice, has emerged from a largely forgotten era of rigid or semi-flexible instruments to a time when fully flexible video-endoscopes and capsule endoscopy have become the norm and the ability to access any part of the digestive tract is expected. Modern endoscopes, coupled with an array of accessories, can provide a wealth of diagnostic information and now present an ever-expanding array of therapeutic possibilities; procedures that a short time ago were possible only through an open surgical approach are now being contemplated via natural orifice transluminal endoscopic surgical (NOTES) approaches. Meanwhile, the advent of the molecular era has provided the gastroenterologist with a completely new approach to diagnosis (the hepatitis alphabet continues to be added to, and genetic factors in the causation of virtually every gastrointestinal, pancreatic, and hepato-biliary disease are defined almost on a daily basis) and therapy (so-called biologicals, which target specific molecular pathways or mediators, are now playing an ever-increasing role in the management of hepatitis, inflammatory bowel disease, and digestive cancer). Fifty years ago the idea that peptic ulcer disease, gastric cancer, and gastric lymphoma might have an infectious cause would have been laughed at; now, the discovery of Helicobacter pylori and its role in these disorders has won a Nobel Prize. Advances in immunosuppression, surgery, and intensive care allow patients with end-stage liver disease to receive transplants and to expect to enjoy not only long-term survival, but also an excellent quality of life. Progress with the most challenging of organ transplantation procedures, small intestinal transplantation, continues.

There have been many, many more advances over these 50 years and many more will come; some may re-define the boundaries of this specialty, while others may diminish or augment the primacy of certain areas within it. Suffice it to say that the gastroenterologist of the future must have a sound grounding in medical science and must be equipped to cope, and indeed embrace, the changes that will inevitably come. Herein lies one of the major challenges that face gastroenterology today: ensuring that our future practitioners are appropriately trained to cope with a complex and ever-changing medical environment, yet one that must retain the patient and his or her illness at the center of our universe.