December 06, 2012 Home|Journals & Publications|  AGA eDigest
AGA eDigest

News from the Literature | Education & Meetings | Practice | Awards | Research | Journals & Publications | GI Fellows


Don’t Stop Now — Fiscal Cliff Is Still Pending

AGA launched its first-ever virtual advocacy campaign this week to great success. Thank you to everyone who called members of Congress to tell them to “Stop the Cuts.”

But there is still more to be done. Congress is not any closer to a deal on the pending fiscal cliff, which will affect us and our patients on Jan. 1. Without congressional intervention during the lame-duck Congress, practice reimbursement will be slashed by 29 percent and research funding will be cut by 8 percent.

Call 855-806-2387 and tell your lawmakers to stop the cuts. If you have already talked with your lawmakers’ offices, please plan to make follow-up calls. If you have not called yet, pick up the phone today!

  • How to use the toll-free system: Do not hang up after your first call or message. When the office is disconnected, you will be transferred to the next one. Stay on the line until you have spoken with or left messages for your three lawmakers. Read more.
  • Suggested talking points: practice | research.
  • Read more about the AGA Virtual Advocacy Campaign.

Together, we have averted cuts in the past. We look forward to your continued support in advancing the science and practice of GI, and ensuring the health of our patients.


NAFLD Associated with Higher Risk of Liver Cancer

NAFLD has been implicated as a cause of hepatocellular carcinoma. White et al. performed a systematic review of epidemiology studies to confirm the association between these disorders. This systematic review, which was published in Clinical Gastroenterology and Hepatology, shows that despite several limitations, there is epidemiologic evidence to support an association between NAFLD or nonalcoholic steatohepatitis and an increased risk of hepatocellular carcinoma. Risk seems to be limited to individuals with cirrhosis.

Clinical Gastroenterology and Hepatology 2012: 10(12): 1342-1359.e2

Which Factor Is Most Strongly Associated with Obscure GI Bleeding Diagnosis?

Capsule enteroscopy is the best noninvasive tool to explore the entire small bowel of patients with obscure gastrointestinal bleeding; it has a diagnostic yield of 40 to 80 percent. However, little is known about the factors associated with a diagnosis of obscure gastrointestinal bleeding by capsule enteroscopy. In a study in Clinical Gastroenterology and Hepatology, Lecleire et al. found that a history of overt bleeding is the factor most strongly associated with a diagnosis of obscure gastrointestinal bleeding by capsule enteroscopy. Male gender, age greater than 60 years and inpatient status were also independent predictors of positive diagnosis by capsule enteroscopy.

Clinical Gastroenterology and Hepatology 2012: 10(12): 1376-1380

Teduglutide Reduces Need for Parenteral Support

Teduglutide, a glucagon-like peptide 2 analogue, might restore intestinal structural and functional integrity by promoting growth of the mucosa and reducing gastric emptying and secretion. These factors could increase fluid and nutrient absorption in patients with short-bowel syndrome with intestinal failure. Jeppesen et al. performed a prospective study to determine whether teduglutide reduces parenteral support in patients with short-bowel syndrome with intestinal failure. According to study results published in Gastroenterology, the 24 weeks of teduglutide treatment was generally well tolerated in patients with short-bowel syndrome with intestinal failure. Treatment with teduglutide reduced volumes and numbers of days of parenteral support for patients with short-bowel syndrome with intestinal failure.

Gastroenterology 2012: 143(6): 1473-1481.e3

Study Finds Similar Efficacies of Biliary, with or without Pancreatic, Sphincterotomy

The role of sphincter of Oddi manometry in the management of patients with idiopathic recurrent acute pancreatitis requires clarification. Coté et al. evaluated the therapeutic effects of endoscopic sphincterotomy in patients with recurrent acute pancreatitis and the prognostic significance of pancreatic sphincter dysfunction (SOD). Among patients with pancreatic SOD, a combination of biliary and pancreatic sphincterotomy, and biliary sphincterotomy have similar effects in preventing recurrence of acute pancreatitis. Study results published in Gastroenterology suggest that pancreatic SOD is an independent prognostic factor, identifying patients at higher risk for recurrent acute pancreatitis

Gastroenterology 2012: 143(6): 1502-1509.e1


Recertification Requirements: What You Need to Know

Note from our editors: This article is the second in a six-part series aimed to walk you through the American Board of Internal Medicine’s (ABIM) future implementation of changes in physician certification.

By John F. Kuemmerle, MD, AGAF

ABIM diplomates certified after 1989 hold time-limited certificates and must meet requirements for maintenance of certification (MOC) every 10 years to be eligible to take the recertification exam. Grandfathered physicians who hold time-unlimited certificates are not required, but are welcome and encouraged, to participate. At present, physicians must accrue 100 points during each 10-year cycle. Diplomates must obtain 20 points in self-evaluation of medical knowledge and in self-evaluation of practice performance;  the remaining 60 can be from either category. To assist gastroenterologists in meeting these requirements, AGA has developed an ABIM-approved online program that provides both types of MOC credit.

To meet the need for self-evaluation of medical knowledge credits, AGA offers six GI Self-Assessment Modules (GI SAM®) totaling 60 ABIM MOC points, with two additional 10-point modules coming in 2013. In addition, each GI SAM module is eligible for 10 AMA PRA Category 1 CreditsTM.

AGA also offers guidebooks that provide concise monographs linked to questions in the ABIM annual update in gastroenterology self-evaluation process modules. The monographs provide a concise critique of each specific clinical disorder with relevant references to guide further learning. Completion of each annual update is worth 10 MOC points towards ABIM recertification.

To satisfy the requirements for self-evaluation of practice performance, AGA offers the procedural sedation/patient safety practice improvement module (PIM). Upon completion of this PIM, physicians earn MOC 20 points meeting requirements for self-assessment of practice performance. This module is an intuitive user-friendly online portal that guides physicians through a chart abstraction of de-identified patient data, compiling these data to help them identify practice patterns and select interventions that can improve practice performance.

Learn more about how AGA can assist you in meeting ABIM’s requirements for recertification.

Trainee and Young GI Track Returns to DDW® 2013

At Digestive Disease Week® (DDW) 2013, AGA will again offer special sessions designed to meet the unique needs of physicians who are new to the field. Participants will learn about all aspects of starting a career in clinical practice or research, have the opportunity to network with mentors and peers, and review board material. Save the date for these trainee track sessions:

  • AGA Spring Postgraduate Course: Putting Patients First: Actionable Evidence for Clinical Practice, Saturday, May 18 and Sunday May 19. This clinically-focused course offers you immediately applicable information. Trainees may register at a reduced registration fee.
  • Mentor and Advisor Program: A Networking Event for Trainees, Saturday, May 18. Meet your peers and more established colleagues who serve as mentors, while enjoying refreshments.
  • Board Review Session, Monday, May 20. Designed around content from the new Digestive Diseases Self-Education Program® (DDSEP) 7, this session serves as a primer for third-year fellows preparing for the board exam, and as a review course for others. Discount coupons for DDSEP 7 will be available to attendees.
  • Career and Professional Related Issues, Monday, May 20. Get advice on common career issues such as choosing a practice type and location, developing your CV, interviewing, negotiating contracts and work-life balance.
  • Maximizing Opportunities within Fellowship Training: Advice from Fellows and Faculty, Monday, May 20. Learn how to create a niche within GI, discuss career options and explore advanced clinical training opportunities.

With the exception of the Spring Postgraduate Course, these sessions are free, but you must be registered for DDW to attend. DDW registration opens Jan. 9 for AGA members. AGA trainee members can attend for free if they register by April 10. More information is available on the DDW website.

Help Influence Conference Topic

Submit a proposal for the 2014 James W. Freston Single Topic Conference. All finalized proposals are due Dec. 13, 2012.


CGH Image of the Month

Mirizzi Syndrome: Recognition on Magnetic Resonance Cholangiopancreatography

A 57-year-old woman presented with low-grade right upper-quadrant pain lasting for seven days. Ultrasound of the abdomen showed multiple calculi in the gallbladder and mild diffuse thickening of the gallbladder walls and improper evaluation in the gallbladder neck region. Magnetic resonance cholangiopancreatography subsequently was performed, which revealed a large calculus in the region of the cystic duct eroding into the common hepatic duct. Multiple calculi of varying sizes also were present in the cystic duct, neck and lumen of the gallbladder. The common hepatic, right hepatic, left hepatic and bilobar intrahepatic channels were dilated mildly. The bile duct distal to the impacted stone in the common hepatic duct was normal in caliber. Incidental pancreas divisum was noted. The diagnosis of Mirizzi syndrome was suggested, which was confirmed on subsequent open cholecystectomy. A cholangioplasty and T-tube placement were also performed.

Read more in Clinical Gastroenterology and Hepatology.

Earning a Medicare Bonus for IBD Made Easier

The CMS-qualified AGA Digestive Health Recognition Program™ (DHRP) provides clinicians with an easy and inexpensive way to report on the IBD measures group as part of the CMS Physician Quality Reporting System (PQRS). Using DHRP, a physician who treats at least 30 Medicare Part B patients can potentially earn a 0.5 percent bonus on all Medicare Part B allowable charges for calendar year 2012. Starting in 2013, however, not participating in PQRS will lead to a Medicare penalty on all Part B charges.

Physicians can estimate their potential bonus payment using the online Medicare bonus calculator.

Submitting the IBD measures group using the AGA DHRP also gives you the option to submit your results to Bridges to Excellence (BTE) for evaluation. If you achieve a minimum threshold for measure performance, you will receive BTE recognition, which can result in premium designation status as well as additional bonuses from health payors.

AGA's PQRS option is faster, easier and cheaper than claims-based submission for PQRS, and is the only PQRS reporting option designed by and for gastroenterologists. Learn how to participate in PQRS through a complimentary webinar at 12:30 p.m. on Dec. 11, 2012. Register today for Protect Your Bottom Line and Achieve Excellence: The AGA Digestive Health Recognition Program™.

GastroSlides Images Focus on Cirrhosis

These images focus on the causes, diagnosis and management of cirrhosis and its most common complication — portal hypertension — and are separated into the following sections:

  • Part I: Cirrhosis: Definition, Natural History and Diagnosis
  • Part II: Pathophysiology and Types of Portal Hypertension
  • Part III: Hyperdynamic Circulatory State
  • Part IV: Varices and Variceal Hemorrhage
  • Part V: Ascites
  • Part VI: Spontaneous Bacterial Peritonitis
  • Part VII: Hepatorenal Syndrome
  • Part VIII: Hepatic Encephalopathy
  • Part IX: Hepatopulmonary Syndrome
  • Part X: Portopulmonary Hypertension
  • Part XI: Liver Transplant

Order these slides individually as you need them or purchase a one-year subscription and have access to the entire GastroSlides library of more than 4,000 images. Preview and order slides.

Special offer: get your free download of the GastroSlides unit on liver cancer (revised).

GastroSlides is a continuing education resource directed by the AGA Institute Education and Training Committee.

2013 PQRS Specifications Released

For 2013, professionals who satisfactorily report data on the CMS Physician Quality Reporting System (PQRS) quality measures are eligible for an incentive equal to 0.5 percent of total estimated Medicare Part B allowed charges during the applicable reporting period. CMS has released the specifications for the 2013 PQRS reporting options and measures.

New measures include:

  • Endoscopy and Polyp Surveillance: Appropriate Follow-Up Interval for Normal Colonoscopy in Average-Risk Patients for claims and registry reporting.
  • Participation by a Hospital, Physician or Other Clinician in a Systematic Clinical Database Registry that Includes Consensus-Endorsed Quality for claims and registry reporting.

Additionally, the minimum patient count for reporting measures groups has been lowered from 30 to 20 for individuals reporting measures groups via claims and registry for the 2013 and 2014 PQRS incentives. For the 2013 PQRS, there are 26 measures groups listed in Tables 97-122 of the final rule.

Unlike previous years, participation in PQRS 2013 will impact payment adjustments beyond the current year’s reporting. More specifically, eligible professionals who do not satisfactorily report quality data under the PQRS 2013 are subject to a 1.5 percent payment reduction in 2015. Access additional details regarding payment adjustments.

Look for additional information about the 2013 PQRS and key program changes in AGA eDigest over the next few weeks.


Nominations Due Tomorrow Night for Clinician Award

Nominations for the private practice category of the AGA Distinguished Clinician Award are due tomorrow, Dec. 7, by midnight ET. To nominate a colleague who has demonstrated excellence in private practice, please include the following items in a single PDF file:

  • The nominee’s CV.
  • Letter(s) of recommendation — maximum two pages per letter — that identify the specific accomplishments of the nominee.
  • A bibliography.

Forward the nomination materials, as well as any questions about the award, to

Awards Available for Researchers at All Levels

As part of its mission to advance the science of gastroenterology, the AGA Research Foundation annually awards more than $1 million in research grants to investigators working in GI and related areas. Application deadlines are approaching for the following awards:

For students:

For junior investigators:

For junior or established investigators:

Complete details about each award and application instructions are available on the AGA website.


Antivirals May Lower Risk of Liver Cancer Recurrence

Using antiviral drugs after "curative" surgery for hepatitis B-related liver cancer may lower the risk of cancer recurrence, according to a Taiwanese study presented at AASLD’s annual meeting and simultaneously published online in the Journal of the American Medical Association. The cumulative six-year incidence of hepatocellular carcinoma recurrence was significantly lower for patients who were treated with the nucleoside analogues lamivudine, entecavir or telbivudine than it was for patients who were not given these agents.

Learn more in a recent article posted on the new website

Fellow Plans to Impact the Field through NAFLD Study

Ana Guzman received a 2012 AGA-Horizon Pharma Fellow Abstract Prize for research conducted at the University of Ottawa. She states:

“This experience will give me the opportunity to explore an area of research, which already sparks my interest, at much greater depth, thus building a stronger foundation to embark in a career in medicine. This award will grant me the opportunity to see firsthand how all the knowledge that I have gained during my undergraduate years applies to real life. My desire to pursue a career in medicine in part stems from my aspiration in making a positive difference in people’s lives. My participation in the proposed project will allow me to make a difference in people’s health through the study of NAFLD. I strongly believe that my skills will enable me to fulfill the duties and responsibilities associated with the research project and I shall quickly prove to be an integral part of preceptor Johane Allard, MD. I would like to thank the review panel for granting me the AGA Student Research Fellowship Awards.”

Make a donation.


Call for Papers on Clinical Trials: Gastroenterology

Gastroenterology is committed to advancing clinical practice in the field of digestive disease. Recognizing that clinical trials generally have the greatest impact of all studies on clinical practice, Editor Bishr Omary, MD, PhD, and his associate editors strongly encourage authors to submit their manuscripts on clinical trials (diagnostic validation, therapeutic efficacy) of drugs, biological materials and devices in digestive, liver and pancreatic diseases, including studies at Phases I, II and especially III, to Gastroenterology for consideration. The journal is also interested in publishing trials in endoscopic and imaging modalities.

There are several important reasons to submit clinical trial research for publication in Gastroenterology:

  • With an impact factor of 11.68, Gastroenterology is the premier journal in the field.
  • Gastroenterology is the journal that will directly reach the largest portion of physicians who care for and make treatment decisions for patients with GI or liver disease.
  • Authors who submit their manuscripts to Gastroenterology typically will receive decisions within three weeks or fewer.
  • Accepted manuscripts will be published online and indexed on PubMed within 10 days of acceptance.

To submit your manuscript to Gastroenterology, go to

For important information on how to report clinical trials, go to To review the current and past issues of the journal, go to


AGA Comments on Proposed Regulation to Ban Magnets

AGA submitted comments in support of a proposed regulation issued by the U.S. Consumer Product and Safety Commission (CPSC). The CPSC is proposing to ban the sale of high-powered magnets that are part of magnet sets — sets that often contain 200 or more BB-sized magnets. The proposed rule is in response to the growing number of ingestions of these small, rare earth magnets by infants, children and teenagers. The proposed rule follows a recent legal action by the CPSC against two of the major manufacturers of these magnets sets (Maxfield and Oberton and Zen Magnets) after they refused to voluntarily cease sales of their products.

Zofran Recalled Due to Potential For Serious Cardiac Risks

FDA is notifying health-care professionals that the 32 mg, single IV dose of the anti-nausea drug Zofran (ondansetron hydrochloride) will no longer be marketed because of the potential for serious cardiac risks. The agency anticipates that these products will be removed from the market through early 2013.

Read the complete safety alert.

Renew Your Membership to Avoid a Lapse in Benefits

AGA member dues payments for 2013 were due on Dec. 1, 2012. If you have not already renewed, your member benefits will expire on Dec. 31, 2012. Renew now to avoid an extended lapse in your benefits.

The fastest and easiest way to renew your membership is online. Simply link to the members-only area of the AGA website, log in using your AGA username and personal password, and select “Renew Membership.” After you renew your membership, you will automatically be sent a payment confirmation.

While renewing, take a moment to review your member profile to be sure that all of the information is correct. An accurate member profile ensures timely receipt of journals, publications and other materials from AGA.

If you have any questions about your membership, contact AGA Member Services at 301-941-2651 or

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Place GI Position Listings and Activity Announcements

For as little as $82.50, you can place a classified ad of 100 words or less in AGA's weekly email newsletter, AGA eDigest, or AGA's bi-monthly magazine, AGA Perspectives. If you place ads in both AGA Perspectives and AGA eDigest, you will receive a 10 percent discount. Advertising in either includes a free online classified listing. Learn more.

Gastroenterology of the Rockies is recruiting a board-certified/board-eligible gastroenterologist to join their successful and thriving practice covering the greater Denver and Boulder areas of Colorado. Our group consists of nine board-certified gastroenterologists and four nurse practitioners, located across five clinical sites, which include four physician-owned endoscopy centers and a GI pathology lab.

ERCP skills required. Advanced fellowship training in EUS is desirable but not required.

This unique opportunity includes:

  • Partnership track with strong, reputable group.
  • State-of-the-art infrastructure.
  • Fully electronic environment, meaningful use attested.
  • Professionally managed.
  • Outstanding quality of life with easy access to the metropolitan amenities of Denver and the outdoor activities of the Rocky Mountains.
  • Exceptional schools.

For more information about this opportunity please contact:

Nick Goralsky
Telephone: 720-932-7721

Washington, D.C. Suburb/Northern Virginia
Outstanding opportunity for BC/BE gastroenterologist to join prestigious and very busy GE group with two physicians, a PA and NP on staff. 100 percent GI practice with office endoscopy center on site. Associated with premier university-affiliated teaching hospital with hospitalists, house staff and medical students. Please email CV to