American Gastroenterological Association - Advancing the Science and Practice of Gastroenterology

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LEADING THE NEWS

POLICY

Obama Speech Covers Important Issues for GI

President Obama delivered his annual State of the Union address in which he outlined his priorities for the coming year. As a result of the 2010 midterm elections and the tragic shooting in Arizona, the speech took on a conciliatory tone with the president trying to find common ground with Republicans and focusing on areas where they can work together.

The president talked about the Patient Protection and Affordable Care Act (PPACA) and stated that he was open to improving and amending the law. He stated that he supported repealing the 1099 provision and was open to ideas that would lower costs and improve care. President Obama also mentioned the need to reform medical liability since lawsuits drive up health-care costs, but did not offer specifics on how to change the system.

To learn more about the budget process and its effect on the practice of GI, read the AGA Washington Insider.

 

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.

FDA to Improve Review Process for Medical Devices

The FDA unveiled its plan to implement improvements to the 501(k) process used to clear approximately 3,000 new devices each year, covering 90 percent of device approvals. This process is used to show that these devices are at least as safe and effective as legally marketed products for the same use.

The AGA is pleased that the FDA is working to improve the 510(k) process to address safety, effectiveness and transparency issues for industry, medical professionals and the public. This will help bring new technologies for all specialties, including gastroenterology, to market in a more cost-effective and timely manner. This issue is particularly relevant to those who conduct research and are involved in working on new technologies. The ability to navigate the FDA process is a major part of device and drug adoption.

In August 2010, the FDA issued 55 recommendations on improving the 501(k) process. AGA commented to the FDA on these recommendations through the Alliance of Specialty Medicine and met with Jeffrey Shuren, MD, JD, director of the Center for Devices and Radiological Health (CDRH) at the FDA, and other FDA officials in follow-up to a letter sent in December 2010 to further discuss our concerns. The alliance expressed cautious optimism for the FDA's 501(k) plans.

After reviewing public comments, CDRH now intends to take 25 actions to improve the 510(k) process and overall program transparency in 2011 to help encourage device innovation in the U.S. The agency has asked the Institute of Medicine to provide input to the FDA on seven recommendations.

The FDA will also be establishing a network of external experts to review new technologies. This not only provides an opportunity for AGA to reach out to the agency and offer our expertise on review of new GI technologies, but it will also impact the new AGA Center for GI Innovation and Technology, which will focus on assisting inventors and industry with understanding the requirements that need to be met in order for new devices to be validated and adopted. More information about the new center will be published in the coming months.

Monitoring FDA activities and providing feedback to the agency are part of our broader efforts to support the development and adoption of new technology in GI. For a second year, the AGA will host Fostering Innovation and Technology in Digestive and Metabolic Diseases: A Conference for Inventors, Medical Device Companies and Investors on March 25-26, 2011, in Palo Alto, CA. The conference brings together inventors, investors and medical device companies to discuss and explore the requirements that must be met to ensure product safety and efficacy, as well as data requirement thresholds for approval, physician adoption and reimbursement. During the conference, attendees will also learn about the new AGA Center for GI Innovation and Technology.

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Download the Latest GI Insights Programs

Download the latest GI Insights programs broadcast through ReachMD XM 160, which features the field’s top gastroenterologists discussing today’s issues.

The latest programs include:

•    When PPIs Fail: Evaluating and Managing Patients with GERD.
•    Detecting Small Bowel Abnormalities in Pediatric Patients.
•    Evaluating Obscure GI Bleeding.

The programs are available via podcast on the AGA website and the ReachMD website. ReachMD XM 160 is the channel for medical professionals and brings you educational news and information on satellite radio, online and on demand. AGA members receive free access to the broadcasts online on the ReachMD website by using discount code AGA. Listen today.

This program is sponsored by Given Imaging.

Coding Cruise Combines Learning and Fun at Sea

Enhance your coding knowledge by taking part in an intensive GI coding, compliance and reimbursement conference cruise, sponsored by McVey Associates and the AGA Institute. The seven-day cruise is scheduled for March 27 to April 3 with three days of sessions devoted to coding and billing issues in the GI practice and ambulatory surgery/endoscopy center.

The program features the field’s best coding and practice management experts, including Cecile M. Katzoff, MGA, CGSC; Kathleen Mueller, RN, CPC, CCS-P, CMSCS, PCS; and Arlene Morrow, CPC, CMM, CMSCS. Topics to be covered include:

•    New technologies.
•    “Incident to.”
•    Evaluation and management updates.
•    International Classification of Diseases-10-CM.
•    Recovery audit contractors.
•    Auditing.
•    Physician reporting.
•    E-prescribing.
•    Electronic health records.

Attendees will have an opportunity to schedule one-on-one consulting sessions with the faculty at no additional fee. Appointments will be booked during the conference on a first-come, first-served basis.

Learn more.

Stay Current with Coding Changes
Next audio conference: March 23. Sponsored by McVey Associates and AGA Institute. Learn more.

RESEARCH

Call for Nominations for AGA Registry

The Research and Publications Committee of the AGA Digestive Health Outcomes Registry™ serves to promote and approve research and publication of data derived from the AGA Registry, for the benefit of its members and the profession.

 

The role of the committee is to:

•    Develop guidelines for submission and review of proposals as well as other matters critical to the review and oversight process.
•    Evaluate and rate the relative scientific merit of all investigator-initiated research requests made of the registry for external use of data via previously utilized metrics, including those used by the NIH, and via relevance to AGA’s mission.

We are seeking nominations for the following:

•    Methodologist/statistician with expertise in performing research on large data sets.
•    Senior investigators.
•    Private practice member.
•    Special consideration for women and underrepresented minority nominees.

Nominations should be submitted via e-mail to Stacey Hinton, AGA staff liaison, by Friday, Feb. 11.

 

Few HCV-Infected Veterans Receive HCC Surveillance

Surveillance for hepatocellular carcinoma is recommended for patients with hepatitis C virus (HCV) infection and cirrhosis. However, whether surveillance is being done as recommended is unknown. Data published in the Annals of Internal Medicine suggest that few HCV-infected veterans with cirrhosis received routine hepatocellular carcinoma surveillance. New strategies are needed to improve the implementation of hepatocellular carcinoma surveillance in clinical practice.

Annals of Internal Medicine; 2011: 154(2): 85-93

 

Anti-TNF Agents Affect Older Patients Differently

Few data are available on the effects of biologic therapies in patients more than 65 years old with IBD. According to a study in Clinical Gastroenterology and Hepatology, patients older than 65 years treated with tumor necrosis factor (TNF) inhibitors for IBD have a high rate of severe infections and mortality compared with younger patients or patients of the same age that did not receive these therapeutics. The effects of anti-TNF agents in older patients with IBD should be more thoroughly investigated because these patients have higher mortality related to hospitalization than younger patients.

Clinical Gastroenterology and Hepatology; 2011: 9(1): 30-35

 

High-Quality Colonoscopy Is Important

Colonoscopy may have a greater protective effect for distal colorectal cancer (CRC) than proximal CRC. Serrated polyps are frequently located in the proximal colon, can be missed during colonoscopy and may progress to CRC. Doctors found that in an average-risk screening cohort, the detection of proximal serrated polyps was highly variable and endoscopist dependent. A significant proportion of proximal serrated polyps may be missed during colonoscopy. In their study, which was published in Clinical Gastroenterology and Hepatology, the doctors added that high-quality colonoscopy is important for the detection and resection of all polyps with neoplastic potential.

Clinical Gastroenterology and Hepatology; 2011: 9(1): 42-46

 

CFTR Variant Increases Pancreatitis Risk

Idiopathic chronic pancreatitis (ICP) is a complex inflammatory disorder associated with multiple genetic and environmental factors. In individuals without cystic fibrosis (CF), variants of CFTR that inhibit bicarbonate conductance but maintain chloride conductance might selectively impair secretion of pancreatic juice, leading to trypsin activation and pancreatitis. The CFTR variant p.R75Q causes a selective defect in bicarbonate conductance and increases risk of pancreatitis, according to study results appearing in Gastroenterology. Co-inheritance of p.R75Q or CF causing CFTR variants with SPINK1 variants significantly increases the risk of ICP.

Gastroenterology; 2011: 140(1): 162-171

 

Your AGA Research Foundation Gifts Support ...

... Kelli VanDussen, BS, who received an AGA Foundation Student Abstract Prize in 2010 for her work, “Notch signaling induces expression of the intestinal stem cell marker olfactomedin 4” at the University of Michigan.

"I was honored to be a recipient of the AGA Student Abstract Prize. The proceeds from this award helped support my attendance at Digestive Disease Week® (DDW) 2010, the preeminent annual conference for both clinical and gastroenterological research. This was my third appearance at a DDW meeting. Each attendance has enhanced my training experience by providing a platform for presentation of my research to the scientific community, for networking opportunities, and for advancing my knowledge of the current state of the gastrointestinal research field. The 2010 DDW meeting was particularly important for me in transitioning from a graduate student position to a post-doctoral position, and I enjoyed talking to potential mentors for the next stage of my scientific career."

Esophageal Disease Research Funding Available

Young investigators interested in clinical research in esophageal diseases are encouraged to apply for the AGA Foundation’s June and Donald O. Castell, MD, Esophageal Clinical Research Award. This award provides $35,000 for research and/or salary support to young faculty (not fellows) who have demonstrated exceptional promise and have some record of accomplishment in research.

To be eligible for the award, candidates must:

•    Have an MD, PhD or equivalent degree.
•    Hold a full-time faculty position (assistant professor or below) at a North American institution or professional institute for seven years or less.
•    Be AGA members at the time of application submission.
•    Devote at least 50 percent of their efforts to research related to esophageal function or diseases.

The application deadline is April 1, 2011. For more information about this award and other funding opportunities, visit the AGA website at www.gastro.org.

Learn More About Other Funding Opportunities
Find more funding opportunities on the AGA Foundation website.

EDUCATION & MEETINGS

Use GastroSlides as a Teaching Resource

The AGA’s GastroSlides contain the field’s most extensive collection of GI and liver images. With more than 4,000 images in its repository, the slides are an outstanding teaching tool that can be used in a variety of applications, such as presentations, grand rounds discussions, grant applications, publications, a teaching curriculum and self-education.

The slides combine the latest basic science and clinical information with high-quality graphics and state-of-the-art animations to help explain the complex concepts and processes related to major GI and liver disorders. Liver topics cover hepatocelluar carcinoma, autoimmune liver disease, cirrhosis and portal hypertension, NAFLD, and viral hepatitis. GI topics include digestive health and disease in women, GI endoscopic imaging (only available on DVD), pancreatitis, IBD, IBS, Barrett's esophagus, and the genetic and molecular basis of GI and liver disease.

Using actual clinical examples, the slides provide a better understanding of these important and frequently challenging conditions. Features of the slides include:

•    The ability to search by keyword or topic to help you quickly and easily locate slides relevant to your needs.
•    The flexibility to prepare new individualized slides using the components of existing images to create customized slides for different lectures.
•    An extensive citation resource that can be used for lectures and serve as a permanent reference tool.

GastroSlides offers affordable pricing options allowing you to buy slides individually as you need them or purchase an annual subscription and have access to the entire GastroSlides library for one year.

Preview all slides and order online at www.gastroslides.org.

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

JOURNALS & PUBLICATIONS

CGH Editor-in-Chief Needed

AGA seeks applications for editor-in-chief of its official clinical practice journal Clinical Gastroenterology and Hepatology (CGH) from qualified members. CGH is the go-to resource on a broad spectrum of themes in clinical gastroenterology and hepatology, providing the best, most actionable information in the field.

This exciting and challenging position requires an energetic and passionate individual to direct the intellectual content of the journal, ensuring its quality and relevancy to clinical investigators and practicing physicians. To keep pace with the rapidly evolving field of medical publishing, candidates must be forward thinking, creative and open to change. Interested candidates must be AGA members and board certified in gastroenterology and hepatology; past experience on a journal editorial board is desirable.

The term of this position is five years and begins July 1, 2012. Completed applications are due April 1, 2011.

For additional information, contact Thoba Khumalo Petrovic at tkhumalo@gastro.org or 301-941-9780.

Sell AGA Books to Your Patients

Patients look to their health-care providers for information and advice on how to cope with a multitude of GI conditions. Keep your patients well informed by having books from the AGA Press on IBD, IBS, celiac disease and childhood obesity on hand for patients to buy and take home.

"It has been nice to have copies of ‘Real Life with Celiac Disease’ for sale in the office. Patients can leave with a comprehensive resource that I feel confident can answer any questions we may not have had time to cover during our visit," said Christine Doherty, a private practitioner from Milford, NH.

In addition to providing a valuable service for patients, selling AGA books can generate additional revenue for your practice. By buying books in bulk at a significant discount and then reselling them at the list price, you profit from each sale. Bulk pricing begins at six or more copies.

Contact AGA Press publisher Christine Charlip at ccharlip@gastro.org with questions or for more information.

Jobs. Talent. Better Connections.
Visit www.gicareersearch.com, AGA's online career center, to advance your career or post your open positions.

Classifieds

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.