American Gastroenterological Association - Advancing the Science and Practice of Gastroenterology

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LEADING THE NEWS

NEWS FROM THE LITERATURE

IBD Travelers Not More Likely to Contract Intestinal Infections

There are few data on risk of travel for patients with IBD. A study in Clinical Gastroenterology and Hepatology found that patients with IBD have a higher rate of illness compared with controls during trips to industrialized countries, but not to developing or tropical regions. These findings indicate that most travel-associated illnesses stem from sporadic IBD flares rather than increased susceptibility to enteric infections.

Clinical Gastroenterology and Hepatology 2012: 10(2): 160-165

Smoking Increases Cancer Risk in BE

Esophageal adenocarcinoma arises from Barrett's esophagus (BE). Patients with this cancer have a poor prognosis. Identification of modifiable lifestyle factors that affect the risk of progression from BE to esophageal adenocarcinoma might prevent its development. According to a study in Gastroenterology,  smoking tobacco increases the risk of progression to cancer or high-grade dysplasia two-fold among patients with BE, compared with patients with BE who have never smoked. Smoking cessation strategies should be considered for BE patients.

Gastroenterology 2012: 142(2): 233-240

Colonoscopy Is Safe for Patients with GI Bleeding

Diverticular bleeding is the most common cause of acute severe lower gastrointestinal bleeding in Western countries. Diagnostic and therapeutic approaches, including endoscopy, radiology or surgery, have not been standardized. Colonoscopy can be a safe first-line diagnostic and therapeutic approach for patients with severe lower gastrointestinal bleeding, stated doctors in a study published in Clinical Gastroenterology and Hepatology. Endoscopic clipping provides hemostasis of active diverticular bleeding. Recurrent bleeding occurs in about 21 percent of patients treated with clips, at approximately four years, and most bleeding is self-limited or can be retreated by endoscopic clipping.

Clinical Gastroenterology and Hepatology 2012: 10(2): 131-137

Is Nonsurgical Management of Esophageal Tears Feasible?

Esophageal perforation is the most serious adverse event of pneumatic dilation (PD) for achalasia; it is usually managed by surgical repair. According to data appearing in Clinical Gastroenterology and Hepatology, an age of greater than 65 years is a significant risk factor for esophageal perforation after PD. Nonsurgical management of transmural esophageal tears is feasible, with favorable short-term and long-term outcomes, but is not devoid of complications.

Clinical Gastroenterology and Hepatology 2012: 10(2): 142-149

PRACTICE

CGH Image of the Month

Variceal Hemorrhage of Ascending Colon
Won Sohn, Hang Lak Lee and Kang Nyeong Lee

A 33-year-old woman with a history of systemic lupus erythematosus was admitted to the hospital with melena, hematochezia and syncope. Upper endoscopy did not demonstrate any bleeding source. Colonoscopy revealed varices between mid and distal ascending colon and blood clots at colonic mucosa (figure). Therefore, variceal hemorrhage in ascending colon was suspected. To find a cause of ascending colonic varices, abdominal CT angiography was performed. CT angiogram demonstrated development of collateral vessels at retroperitoneum, abdominal wall and drainage of both renal veins to the mentioned collateral vessels. However, liver cirrhosis, portal vein obstruction and splenomegaly were not found.

Read more in Clinical Gastroenterology and Hepatology.

UpToDate^® Free Topic of the Month

Produced in cooperation with the AGA Institute, UpToDate^® is a subscription-based clinical information resource available on the Web, CD-ROM and pocket PC handheld devices. Each month, a free topic is made available on the AGA website. This month's free topic is:

• Etiology of acute pancreatitis.

Nearly 232 physicians write more than 673 topic reviews for UpToDate in gastroenterology and hepatology alone. UpToDate provides gastroenterologists with access to more than 60,000 pages of original, peer-reviewed text, 160,000 MEDLINE abstracts, drug information and drug interactions databases, and hundreds of patient information handouts across 12 specialties. Moreover, UpToDate is used by tens of thousands of clinicians in more than 110 countries and by hundreds of premier medical institutions worldwide.

Order your subscription to UpToDate.

RESEARCH

Your AGA Research Foundation Gifts Support ...

… Jan Dabritz, of the University of Münster, Germany, who received the 2011 AGA Moti L. and Kamla Rustgi International Travel Award.

"I am honored to be selected as a recipient of this award for the third time, and I would like to thank Anil K. Rustgi, MD, his family, and the AGA Research Foundation for their support.”

“The overall aim of my work is to reveal novel insights into the pathogenesis of Crohn’s disease and to identify mechanisms by which the modulation of innate immunity bears the potential of altering the natural history of this disease. Clinical trials showed that granulocyte macrophage-colony stimulating factor (GM-CSF) induces clinical response and remission in patients with active Crohn’s disease. Recent studies suggest a causal link between impaired inflammation and impaired bacterial clearance in Crohn’s disease due to alterations of monocytes/macrophages. As blood monocytes are the exclusive source of macrophages in inflamed intestinal mucosa, I therefore characterized GM-CSF-induced monocyte subsets in vitro and analyzed their role in experimental colitis in vivo.”

To make a donation, visit www.gastro.org/contribute.

Ribavirin Pregnancy Registry

Implemented in January 2004, the Ribavirin Pregnancy Registry is a voluntary and largely prospective registry collecting observational data on pregnancies and the outcomes following exposure to ribavirin during pregnancy. The development of this registry was mandated by the FDA and includes both direct exposure through the pregnant female and indirect exposure through her male sexual partner.

Reports of exposure will be accepted from health-care providers, pregnant patients or the male partners of pregnant patients, and the data collected are minimal and targeted. Data are collected at each trimester and at the outcome of the pregnancy through the obstetric health-care provider and, for a live birth, for 12 months after the birth through the pediatric health-care provider. Patient identity is confidential.

This registry is the primary source for collecting and evaluating direct and indirect exposures to ribavirin in pregnancy and the success of the registry relies on the participation of patients and health-care providers. For more information and details on how to participate, please visit the registry website.

EDUCATION & MEETINGS

Earn MOC Points with New Release from GI SAM^®

Assess your current knowledge on specific gastroenterology- and hepatology-related topics with the newest release from AGA’s GI SAM^® series, GI Imaging and Endoscopic Therapy & Cirrhosis and Liver Transplantation. Also, earn up to 10 American Board of Internal Medicine maintenance of certification points and 10 AMA PRA Category 1 Credits™.

Presented in an interactive case-based format, GI SAM modules cover a variety of GI and hepatology topics that explore the physiology, diagnosis and treatment protocols for the covered topic area. Entirely Web-based, GI SAM includes comprehensive testing scenarios with each module featuring 25 questions. Users receive instant feedback on answer choices, allowing for a better understanding of the content. Continuous author review, updates to treatment protocols, detailed images and extensive references further ensure that GI SAM delivers current and authoritative content.

Users can also revisit questions and topics in areas where additional learning is needed.
 
Other modules currently available include:

• Cancers of the GI Tract and Functional Bowel Disorders.
• Digestive Health and Disease in Women.
• Disorders of the Pancreas and GI Motility.
• Disorders of the Stomach and Viral Hepatitis.
• IBD and GI Bleeding.
• Inflammatory/Metabolic Liver Disease and Disorders of the Esophagus.

For more information on GI SAM and to view a list of upcoming modules, visit www.gilearn.org/gisam.

DDW^® Sessions are Designed for Fellows, Young GIs

AGA has developed special sessions at DDW^® 2012 to meet the unique needs of physicians who are new to the field. With the exception of the Spring Postgraduate Course, all of the sessions are free, but you must be registered for DDW to attend. DDW registration is free for AGA member trainees through April 11.

• AGA Spring Postgraduate Course (May 19 and 20): sharpen your clinical skills by learning about new therapies and diagnostic modalities for common digestive diseases. Register by April 11 to take advantage of the early registration discount.
• Networking Event (May 19): meet your peers and more established colleagues who serve as mentors, while enjoying refreshments.
• Career and Professional Related Issues (May 20): get advice on common career issues such as choosing a practice type and location, developing your CV, interviewing, negotiating contracts and maintaining a work-life balance.
• Board Review Session (May 20): this session serves as a primer for third-year fellows preparing for the board exam, as well as a review course for others wanting to test their knowledge.
• Developing International Research Partnerships (May 20): meet mentors and peers to help you advance your career in GI research.
• Fellows Teaching Fellows (May 21): taught by current GI fellows, this session will highlight tools for success for GI fellows and residents.
• Advancement in Skills for Clinical Practice (May 21): learn about practice management, working with support staff, patient communication, joining a national outcomes database, and financial aspects of clinical practice.
• Advance Your Leadership Skills: How to Rise to a Position of Leadership in Gastroenterology or Hepatology (May 22): learn about the attributes of a successful leader, develop a leadership growth plan and practice challenging decision-making.

JOURNALS & PUBLICATIONS

EPT Interpretation Criteria Published

The “Chicago Classification Criteria of Esophageal Motility Disorders Defined in High Resolution Esophageal Pressure Topography” (EPT) has been published in Neurogastroenterology and Motility as part of a supplement dedicated to high-resolution manometry. This manuscript is the product of several iterations of refinement by an international working group spanning a period of more than four years.

The aims of this publication are three-fold:

1. To serve as a guide and reference for clinicians adopting this new technology into their practice.
2. To standardize criteria for interpretation of EPT based on the highest possible standard of data.
3. To differentiate EPT as a novel diagnostic test — distinct from esophageal manometry — utilizing unique technology and requiring specific training in interpretation.

In November 2011, the AGA Institute Governing Board sent a letter of support regarding the paper to the corresponding author, Peter J. Kahrilas, MD.

View This Month's Journal Highlights, All in One Place

The editors of Gastroenterology and Clinical Gastroenterology and Hepatology (CGH) would like to bring to your attention highlighted articles from the February issues of the journals.

Gastroenterology

•  Tobacco Smoking Increases the Risk of High-Grade Dysplasia and Cancer Among Patients With Barrett's Esophagus; By Helen G. Coleman, et al.
• Smoking Increases the Risk for Colorectal Adenomas in Patients With Lynch Syndrome; By Renate M. Winkels, et al.
• A High-Fiber Diet Does Not Protect Against Asymptomatic Diverticulosis; By Anne F. Peery, et al.
• Deficiency of Claudin-18 Causes Paracellular H+ Leakage, Up-regulation of Interleukin-1β, and Atrophic Gastritis in Mice; By Daisuke Hayashi, et al.
• Inflammation and Disruption of the Mucosal Architecture in Claudin-7–Deficient Mice; By Lei Ding, et al. 

CGH

• Travel-Associated Health Risks for Patients With Inflammatory Bowel Disease; By Shomron Ben-Horin, et al.
• Histologic and Imaging Features of Mural Nodules in Mucinous Pancreatic Cysts; By Ning Zhong, et al.
• Factors Related to Fatigue in Patients With Cirrhosis Before and After Liver Transplantation; By Evangelos Kalaitzakis, et al.
• Conservative Management of Esophageal Perforations During Pneumatic Dilation for Idiopathic Esophageal Achalasia; By Tim Vanuytsel, et al.
• Latest Generation, Wide-Angle, High-Definition Colonoscopes Increase Adenoma Detection Rate; By Andreas Adler, et al.

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 12.9, 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 www.editorialmanager.com/gastro.

For important information on how to report clinical trials, go to www.gastrojournal.org/authorinfo. To review the current and past issues of the journal, go to www.gastrojournal.org.

ANNOUNCEMENTS

Final Call: Website Medical Editor Request for Applications

The AGA is soliciting applications from interested members for the position of website medical editor. The individual selected will oversee the management and growth of the AGA’s family of websites, consistent with governing board strategic directives and program initiatives.

The current editor, Geoffrey L. Braden, MD, AGAF, will complete his term in May 2012. The new editor takes up the role immediately following.

The website medical editor will:

• Provide leadership and oversight of the AGA’s online presence.
• Direct strategy for www.gastro.org, including mobile devices.
• Work with the national office staff and committees to conceptualize and implement new online features and mobile tools/applications.
• Critically evaluate existing features and proposals for new functionality.
• Review requests to add or delete content to www.gastro.org.
• Evaluate requests for links to and from external sites.
• Review requests for major modifications to www.gastro.org.
• Serve as chair of the AGA E-Communications Advisory Board.

The position is for a term of three years and will entail a time commitment and place leadership demands on the individual appointed.

The deadline for receipt of applications is noon on Monday, Feb. 6, 2012. All inquiries regarding this position will be treated in confidence. Learn more and view application requirements.

News Worth Retweeting

Here are some of our popular news items on Twitter from last week:

• CDC says cancer screening rates fall short of goals: ow.ly/8J6T5.
• AGA Continues to Advocate for Fair, Equitable Reimbursement: ow.ly/8HBdE.
• What is the association between #celiac disease & GI cancer? Find out in today's post from The AGA Journals Blog. ow.ly/8EkBC.
• A look at the trends and implications of anesthesiologist involvement in screening colonoscopy. CGH: ow.ly/8DaaW.
• Feb. Editor's Essential Reading takes a look at the factors that relate to fatigue in patients w/ cirrhosis. CGH: ow.ly/8IHrr.

Have any news that you would like us to share with our AGA members? Please send them to communications@gastro.org or share them on our social media channels:

• Become an AGA fan on Facebook.
• Join our LinkedIn group.
• Follow us on Twitter @AmerGastroAssn.
• Check out our videos on YouTube.

Classifieds

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 e-mail 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.

Global Probiotics Council — Young Investigator Grant for Probiotics Research
The Global Probiotics Council, a committee established in 2004 by DANONE and YAKULT HONSHA CO., LTD., has announced the fifth annual Young Investigator Grant for Probiotics Research. The purpose of the two annual grants of $50,000 each is to contribute to the advancement of probiotics and gastrointestinal microbiota research in the U.S., and to impact academic and career development of young investigators, attracting them into the field of probiotics and microbiota.

Deadline: Feb. 15, 2012.

The official announcement and description of this opportunity may be found at:
http://www.probioticsresearch.com/.

North Dakota
Regional Leaders in Gastroenterology
Immediate openings for BC/BE gastroenterologists interested in practicing in an organization experiencing dynamic growth and development. This procedure-oriented practice with Sanford Health Fargo offers you a great work-life balance with a call schedule of 1:8. Procedures performed include ERCP, EUS, SpyGlass^® and capsule studies. Consults only in 583-bed level II trauma center with EMR and PACS. Opportunity to teach medical students and IM residents. Sanford Health Fargo consists of 585+ physicians located in Fargo and 34 regional primary care clinics.

Fargo, ND, with a metro population of 190,000, is a diverse, stimulating and family-oriented city with all the amenities that make for a satisfying and fulfilling life. We offer exceptional K-12 and higher education systems, world-class health care, affordable housing, low cost of living, and myriad cultural and entertainment opportunities.

Jean Keller, physician recruiter
Sanford Health Physician Placement
Phone: 701-280-4853
E-mail: Jean.Keller@sanfordhealth.org

J1 candidates accepted.

New York
Extraordinary Opportunities with a Pace-Setting Institution in Rochester, NY: Rochester General Health System
Rochester General Hospital is seeking a BC/BE gastroenterologist to join our progressive and expanding GI team. Our gastroenterologists provide consultative services to both inpatients and outpatients, and combine high-tech services with highly skilled and compassionate care to prevent, diagnose and treat a wide range of gastrointestinal and liver disorders. Doctors throughout the region refer their most complex cases to our expert gastroenterologists, whose specialties include colon cancer screening, hepatobiliary and pancreatic disease, and IBD.

Our physicians, all board certified in internal medicine and gastroenterology, use minimally invasive techniques and procedures in a fully equipped endoscopy center. We work closely as a team with highly skilled nurse practitioners, radiologists, oncologists, surgeons and other health professionals. Blending private and academic practice, we participate in advanced clinical research, including the region’s only stem-cell study for the treatment of Crohn’s disease, to help move their field forward and provide even better care for our patients.

Highlights of Rochester General Health System

• A top 100 integrated health network and the third largest employer in the region encompassing seven affiliates, including Rochester General Hospital and Newark-Wayne Community Hospital.
• First in New York state for overall medical care, according to the latest report from CareChex^®.
• Only Thomson Reuters top 100 cardiac hospital in the region.
• Nurse magnet designation.
• National top 20 robotic surgery center.
• World class medical and dental staff.
• Large primary care referral base.
• Recognized leader in quality improvement and commitment to deliver unparalleled patient care inclusive of an institute for patient safety and clinical excellence as a means to develop a comprehensive program of patient safety education initiatives, performance improvement processes, and prevention techniques.
• Cutting edge EMR system.
• State-of-the-art emergency department with average annual patient volume of 110,000.
• Innovative affiliations/strategic partnerships with Rochester Institute of Technology, Cleveland Clinic, Roswell Park Cancer Institute and Carestream Health.
• For more information on our health-care system, visit: www.rochestergeneral.org.

Highlights of Rochester, NY
Rochester provides residents with an exceptional quality of life. We have the arts, sports and culture of a big city, and the comfort and easy commutes of a small town. Rochester’s unsurpassed private and public educational institutions include 15 of the country’s finest colleges and universities, and public high schools ranked among the 100 best high schools in America. Rochester is ranked fourth on Forbes magazine’s list of most affordable cities and third best metropolitan region in the country for raising a family.

If you are looking to join a nationally recognized health system known for its unwavering commitment to patient care, an atmosphere of innovation and collaboration, and unparalleled physician support from a dedicated physician services team devoted to enhancing the physician experience, please contact: kathy.peishel@rochestergeneral.org or alison.ayres@rochestergeneral.org.

EOE