News from the Literature | Practice | Research | Education & Meetings | Journals & Publications
LEADING THE NEWS
Senate Fails to Repeal Health-Care Law
Yesterday, the Senate failed on a vote of 47 to 51 to repeal the Patient Protection and Affordable Health Care Act (PPACA). The repeal was offered as an amendment by Senate Minority Leader Mitch McConnell, R-KY, to the Federal Aviation Administration funding bill. All Republicans voted for repeal and all Democrats who were present for the vote opposed it. This will likely be the first of many attempts by the Republicans to offer repeal votes. Emboldened by a Florida judge who ruled that the health-care law is unconstitutional, Sen. McConnell has vowed to offer this amendment again on other bills.
The Senate did approve an amendment offered by Sen. Debbie Stabenow, D-MI, to repeal the provision in PPACA that requires businesses to file a 1099 tax form every time they make a purchase of $600 or more. Her amendment was overwhelmingly approved by a vote of 81 to 17. The House will now have to vote on this issue, although the 1099 tax form repeal has strong bipartisan support and President Obama has stated he would support eliminating it. The AGA supports the elimination of the 1099 tax form provision since it would be a paperwork and regulatory burden on physician practices.
The AGA will continue to monitor health-care reform implementation and efforts to repeal and replace many of the provisions in the law in Congress. Look for more updates in AGA eDigest and the AGA Washington Insider.
NEWS FROM THE LITERATURE
Can Canines Smell CRC?
Early detection and early treatment are of vital importance to the successful treatment of various cancers. The development of a novel screening method that is as economical and non-invasive as the fecal occult blood test for early detection of colorectal cancer (CRC) is needed. Doctors used canine scent detection to determine whether odor material can become an effective tool in CRC screening. The study, published in Gut, shows that a specific cancer scent exists and that cancer-specific chemical compounds may be circulating throughout the body. These odor materials may become effective tools in CRC screening. In the future, studies designed to identify cancer-specific volatile organic compounds will be important for the development of new methods for early detection of CRC.
Gut; 2011: doi:10.1136/gut.2010.218305
EEI Responds to Proton Pump Inhibition
Despite consensus recommendations, eosinophilic esophagitis (EoE) is commonly diagnosed upon esophageal eosinophilic infiltration (EEI). In adults with EEI, doctors found that 75 percent of unselected patients and 50 percent with an EoE phenotype respond to PPI therapy; pH monitoring is poorly predictive of response. Patients with PPI-responsive EEI greater than 35 eosinophils per high power field are phenotypically undistinguishable from EoE patients. The study results, published in Clinical Gastroenterology and Hepatology, suggest that EoE might be overestimated without clinical and pathologic follow-up of patient response to PPI therapy.
Clinical Gastroenterology and Hepatology; 2011: 9(2): 110-117
Peginterferon Results in Sustained HDV RNA Clearance
Chronic infection with hepatitis B virus and hepatitis delta virus results in the most severe form of viral hepatitis. There is no currently approved treatment. In a study published in the New England Journal of Medicine, doctors found that treatment with peginterferon alfa-2a for 48 weeks, with or without adefovir, resulted in sustained hepatitis delta virus RNA clearance in about one quarter of patients with hepatitis delta infection.
New England Journal of Medicine; 2011; 364: 322-331
Radioembolization Results in Reduced Toxicity in HCC Patients
Chemoembolization is one of several standard-of-care treatments for hepatocellular carcinoma (HCC). Radioembolization with Yttrium-90 microspheres is a novel, transarterial approach to radiation therapy. In a study in Gastroenterology, doctors found that patients with HCC treated by chemoembolization or radioembolization with Yttrium-90 microspheres had similar survival times. Radioembolization resulted in longer time to progression and less toxicity than chemoembolization. Post hoc analyses of sample size indicated that a randomized study with more than 1,000 patients would be required to establish equivalence of survival times between patients treated with these two therapies.
Gastroenterology; 2011: 140(2): 497-507.e2
PRACTICE
CGH Image of the Month
Small-Bowel Adenocarcinoma
Ivan Jovanovic, Lucia C. Fry, Klaus Mönkemüller
A 63-year-old man with coronary artery disease and hypertension was admitted to a hospital because of progressive shortness of breath and chest pain. The patient had several episodes of melena starting 24 hours before presentation. On clinical examination, the patient was pale. His hemoglobin level was 7.5 g/L with a hematocrit of 24 percent. The remaining laboratory parameters were within reference ranges. Esophagogastroduodenoscopy and colonoscopy were unremarkable. An oral double-balloon enteroscopy disclosed a circumferential, partially stenosing, jejunal tumor 80 cm distal to the pylorus. During surgery, a partially obstructing mass was found (figure).
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:
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.
Physician Quality Reporting Educational Products Available
CMS has posted the following physician quality reporting educational products on the CMS website:
- Measures list.
- Measure specifications manual for claims and registry reporting of individual measures and release notes .
- Implementation guide.
- Measures groups specifications manual and release notes.
- Getting started with 2011 physician quality reporting of measures groups.
- Qualified electronic health (EHR) vendors for physician quality reporting and electronic prescribing (eRx) incentive programs.
- EHR documents for eligible professionals — this zipped file contains physician quality reporting EHR measure specifications, an EHR downloadable resource table and related release notes.
Visit the spotlight page on the CMS website for the listing of these educational products and the corresponding section page where they can be found.
Read further information on physician quality reporting.
CMS Issues Guidance on Annual Wellness Visit Claims
On Dec. 3, 2010, CMS issued a change request, which directed the implementation of Medicare’s annual wellness visit (AWV) (G0348 and G0439) in accordance with section 4103 of the Affordable Care Act. Coverage and payment of the AWV were effective Jan. 1, 2011.
It has been brought to CMS’ attention that some providers billing for the AWV have included the “routine service” diagnosis code on their claims. Some contractors have in place auto-deny edits whenever this “routine service” diagnosis is included on the claim since Medicare typically does not pay for routine services. Consequently, some contractors are denying AWV claims when they should be paid.
For contractors that auto-denied claims with G0348/G0439 when billed with a routine service diagnosis code, mass adjustments will be initiated on Jan. 31, 2011. No provider action is required.
Point of Care Tools in the Palm of Your Hand
Partnering with Epocrates, a leading developer of mobile clinical reference tools, AGA Institute is able to offer its members significant savings on Epocrates exclusive products. At a 20 percent discount, AGA members can take advantage of on-demand tools that help save time and enable better clinical decisions.
Reference tools include:
- Epocrates® Essentials — features the most critical drug, disease and diagnostic information needed for patient care, and is organized in an easy-to-use, continually updated, affordable application.
- Epocrates® Essentials Deluxe — includes all the features of Epocrates Essentials plus a complete International Classification of Diseases-9 coder and Current Procedural Terminology® coding reference. Also includes a medical dictionary with definitions for more than 100,000 terms.
- Epocrates® RX Pro — find information on thousands of brand name and generic drugs as well as an infectious disease treatment guide. You will have access to the MultiCheck® drug interaction analyzer, MobileCME™ learning system and more.
- Epocrates® Online Premium — Web-based product that includes hundreds of brand name over-the-counter drug products and alternative medicines, pill images and identifiers, English and Spanish handouts, clinical tables and guidelines, dose converters, and much more.
Products are compatible with the following platforms: iPhone/iPod Touch, Blackberry, Palm, Android and Windows Mobile.
To receive the member only discount, log in to the AGA website and click on the unique link that will redirect you to the Epocrates website. Your AGA member discount will be applied upon checkout.
About Epocrates
Epocrates, Inc. provides physicians with point-of-care access (via PDA or the Internet) to up-to-date information on drugs, diseases and diagnostics. More than 900,000 health-care professionals, including one in three U.S. physicians, use Epocrates’ innovative mobile and Web-based products to help them reduce medical errors, improve patient care and increase productivity.
RESEARCH
Your AGA Research Foundation Gifts Support ...
... Porfirio Nava-Dominguez, who received an AGA Research Scholar Award this year.
“My research will address a scientific issue of significant concern in the American health system and will define and conceptualize new schemes of how the immune system can regulate the epithelial barrier and vice versa. Using the funding provided by the research scholar award, I will continue to investigate the function of intestinal epithelial desmosomal cadherins and determine the impact of inflammation and inflammatory cytokines on these proteins. Additionally, I will analyze and determine the contribution of these proteins to the epithelial barrier breakdown during IBD. In addition to providing me with the necessary resources to continue to develop this project, the AGA Research Scholar Award has also granted me an important first step towards establishing a research track record as an independent investigator.”
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.
Encourage Students to Enter Scientific Research Careers
In an effort to stimulate interest in research careers related to digestive diseases among high school and undergraduate students, the AGA Foundation is accepting applications for its AGA student research fellowship awards. This award provides recipients with a $2,500 stipend to perform research in digestive diseases or nutrition, under the supervision of an AGA preceptor, for a minimum of 10 weeks. The research may take place at any time during the year.
“Today’s students are the future of GI,” states Nicholas F. LaRusso, AGA Foundation chair. “Students who study science at the early stages of their schooling are more likely to pursue a future scientific career.”
For 2011, 10 awards will be designated for underrepresented and/or underprivileged/undergraduate students. Eligible candidates will include, but are not limited to, Black Americans, Hispanic or Latino Americans, Native Americans, and Pacific Islanders.
“The vast majority of medical students today come from the upper two quintiles of family income and we are becoming a privileged profession,” Ian Taylor, MD, PhD, AGAF, AGA Institute president, states. “A major issue is the narrowness of the pipeline in terms of students from underprivileged backgrounds who are coming out of high school and college prepared and motivated to undertake careers in medicine and GI. As such, we must encourage students at an early stage to get involved in GI research and, in so doing, expose them to established GI researchers who love what they are doing. I believe that diversity in its broadest definition is important to any profession that seeks to serve a population as diverse as we see here in the U.S.”
The deadline to apply for this award is March 25, 2011. The award start date is July 1, 2011.
For more information about this and other AGA Foundation funding, visit the AGA website at www.fdhn.org.
Support of this program by The Eli and Edythe Broad Foundation is gratefully acknowledged.
EDUCATION & MEETINGS
Free Webinar Helps in HAE Diagnosis
Hereditary angioedema (HAE) is a rare genetic condition that is commonly misdiagnosed. It can cause acute attacks of abdominal pain, accompanied by nausea, vomiting and/or diarrhea — symptoms that mimic other GI conditions such as appendicitis, IBD or IBS. Abdominal symptoms may occur in 70 percent to 80 percent of HAE patients, and approximately one-third of patients with undiagnosed HAE reportedly have undergone unnecessary surgery for abdominal attacks.
Missing the diagnosis of this rare disease not only prolongs a patient’s suffering, but because HAE attacks can be fatal, misdiagnosis also puts patients at significant risk. The HAE: Learn About It, Talk About It program, presented by AGA in partnership with the American College of Asthma, Allergy and Immunology, provides information and resources to help physicians become familiar with the symptoms and make a timely, accurate diagnosis.
One of these resources is a free, on demand 30-minute webinar that can help physicians accurately diagnose HAE and make the appropriate referrals. Other resources include a printable checklist, case studies and a fact sheet to use when counseling HAE patients.
This program is supported by ViroPharma Inc.
UC Virtual Clinic Enhances Patient Management Skills
Upon identifying professional practice gaps in knowledge, competence and performance for physicians who manage and treat patients with ulcerative colitis (UC), the AGA Institute launched its UC Virtual Clinic — an innovative approach to case-based learning.
This two-part series focuses on the management of a virtual patient through two office visits, providing learners with clinically relevant, practical and engaging educational experiences that replicate the real world of the busy clinician.
Each visit is a CME accredited activity (0.05 AMA PRA Category 1 credit) featuring prominent clinicians and recognized subject matter experts. The patient visit format has been designed to maximize learner engagement, increase clinical knowledge, competence and performance, and address continuity of care issues.
Access the AGA UC Virtual Clinic now.
This activity is supported by an educational grant from Centocor Ortho Biotech Services, Inc. and Abbott Laboratories.
| Learn More about IBD at Spring Postgraduate Course |
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This year’s course has nine IBD-related sessions covering the latest management issues. Learn More |
AGA Members Save 20 Percent on Rome III Book and Slides
AGA members will receive a 20 percent discount on the purchase of educational products from the Rome Foundation.
The Rome III book, available in English and Spanish, is designed for one-stop learning about functional GI disorders. It serves as a valuable resource to general and specialist physicians, mental health professionals, and basic and clinical investigators.
The Rome Foundation computer-based learning program is a collection of state-of-the-art slides that brings to life information from the Rome III book, and updates this information from the recent scientific literature.
Designed by the world’s leading experts on functional GI disorders, the program is the product of a two-year effort by international clinicians and investigators. Using animations and videos, the slides illustrate concepts that can be difficult to explain verbally. Every image includes a clearly written description with key references.
The program was updated in 2009 and now includes:
- A new brain imaging module, with 39 newly created slides focusing on this area of GI medicine.
- A total of 34 new slides added to the treatment module. These additional slides include the newly adopted ACG evidence-based guidelines for IBS treatment.
The slides are available for purchase as a complete set of 825 images, as modules or as individual slides.
Both products can be purchased from the Rome Foundation’s online store. Enter the discount code AGAMEMBER to save 20 percent on your order.
JOURNALS & PUBLICATIONS
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 Anil K. Rustgi, MD, 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.
Gastro & CGH Video Abstracts of the Month
Watch Jasmohan S. Bajaj, MD, discuss his recently published Gastroenterology article, “Rifaximin Improves Driving Simulator Performance in a Randomized Trial of Patients with Minimal Hepatic Encephalopathy.” Provide your thoughts and comments on this important study via the YouTube comments tool.
Watch Stanley Martin Cohen, MD, discuss his recently published Clinical Gastroenterology and Hepatology article, “Legal Ramifications for Physicians of Patients Who Drive with Hepatic Encephalopathy.” Provide your thoughts and comments on this important study via the YouTube comments tool.
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Place GI Position Listings and Activity Announcements
For only $82.50, you can place an ad of 100 words or less in two consecutive issues and for $165 in four consecutive issues. Ads can also be placed in AGA Perspectives, AGA's bi-monthly magazine. Ads that are placed in either or both of these publications are automatically posted in the classifieds section of our website. If you place ads in both AGA Perspectives and AGA eDigest, you will receive a 10 percent discount. For more information, contact Alissa Cruz at acruz@gastro.org or 301-272-1603.
Kentucky
IBD
The Division of Gastroenterology, Hepatology and Nutrition at the University of Louisville School of Medicine is seeking a gastroenterologist with a primary clinical and research interest in IBD who would be instrumental in developing a Center for Excellence in IBD. There is considerable support for clinical and bench research and excellent collaboration.
This will be an integral part of the Division of Gastroenterology, Hepatology at the University of Louisville. J-1 visa conversion will be considered. The University of Louisville is an equal opportunity affirmative action employer. Interested candidates are invited to submit a curriculum vitae to Kristine Krueger, MD, professor and chief of academic affairs, division of gastroenterology, hepatology and nutrition, University of Louisville School of Medicine, Louisville, KY 40292 or gimed@louisville.edu.
GI Motility
The Division of Gastroenterology, Hepatology and Nutrition at the University of Louisville School of Medicine is seeking a gastroenterologist with a primary clinical and research interest in GI motility and functional bowel disease who would be instrumental in developing a Center for Excellence in Motility. There is considerable support for clinical and bench research and excellent collaboration.
This will be an integral part of the Division of Gastroenterology, Hepatology at the University of Louisville. J-1 visa conversion will be considered. The University of Louisville is an equal opportunity affirmative action employer. Interested candidates are invited to submit a curriculum vitae to Kristine Krueger, MD, professor and chief of academic affairs, division of gastroenterology, hepatology and nutrition, University of Louisville School of Medicine, Louisville, KY 40292 or gimed@louisville.edu.
Therapeutic Endoscopy
The Division of Gastroenterology, Hepatology and Nutrition at the University of Louisville School of Medicine is seeking a talented and energetic BC/BE assistant or associate full-time faculty member. This individual will play a large role in the expansion of therapeutic endoscopy and endoscopic ultrasound and will be instrumental in establishing a Center for Excellence in GI Oncology. There is considerable support for research and excellent collaboration with investigators at the Brown Cancer Center. Interested individuals should send curriculum vitae and cover letter to Kristine Krueger, MD, professor and chief of academic affairs, division of gastroenterology, hepatology and nutrition, University of Louisville School of Medicine, Louisville, KY 40292 or gimed@louisville.edu.
Pennsylvania
Mercy Health System of Southeastern Pennsylvania
Mercy Health System of Southeastern Pennsylvania (a member of Catholic Health East) has an immediate opening for a BC/BE gastroenterologist for a well-established practice at Mercy Philadelphia Hospital, a community-based hospital in West Philadelphia. Responsibilities include office hours, inpatient consults and procedures, including endoscopy and colonoscopy. Call coverage is 1:4. We offer a competitive compensation and benefits package. Interested candidates should submit CV and cover letter to Deborah Leonard at dleonard2@mercyhealth or call 610-567-5322.
