American Gastroenterological Association - Advancing the Science and Practice of Gastroenterology

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LEADING THE NEWS

NEWS FROM THE LITERATURE

CRP Levels Associated with Response to Infliximab Therapy

Infliximab is an antibody against tumor necrosis factor-α that is used to treat patients with moderate to severe Crohn's disease. C-reactive protein (CRP) is a marker used to identify and follow individuals with Crohn's disease. According to data appearing in Clinical Gastroenterology and Hepatology, CRP is a good marker of disease activity in patients treated with infliximab. Increased levels of CRP indicate mucosal inflammation and a likelihood of clinical relapse.

Clinical Gastroenterology and Hepatology 2011; 9(5): 421-427.e1

JNK Signaling Promotes Intestinal Tumorigenesis

Signaling by the mammalian target of rapamycin complex 1 (mTORC1) has been implicated in various human cancers. mTORC1 signaling is activated in intestinal tumors of adenomatous polyposis coli (Apc^Δ716) mice, a model of familial adenomatous polyposis; in these mice, the mTORC1 inhibitor RAD001 can block tumor formation. However, the precise mechanism of mTORC1 signaling in intestinal tumors is not clear. In a study published in Gastroenterology, doctors found that c-Jun-NH₂ terminal kinase (JNK) is required for activation of mTORC1 in intestinal tumor cells. JNK inhibitors might be developed as therapeutics or to prevent development of intestinal tumors.

Gastroenterology 2011; 140(5): 1556-1563.e6

Long-Term Budesonide Treatment Effective for EoE Patients

Topical corticosteroids are effective in inducing clinical and histologic remission in patients with eosinophilic esophagitis (EoE). However, the best long-term management strategy for this chronic inflammatory disease has not been determined. Data published in Clinical Gastroenterology and Hepatology suggest that low-dose budesonide is more effective than placebo in maintaining EoE in histologic and clinical remission. Signs of esophageal remodeling showed a trend toward normalization. Long-term administration of topical corticosteroids was well tolerated without induction of epithelial atrophy.

Clinical Gastroenterology and Hepatology 2011; 9(5): 400-409.e1

β-Catenin Alterations Associated with CRC Survival

Alterations of the WNT signaling pathway and cadherin-associated protein β 1 (CTNNB1 or β-catenin) have been implicated in colorectal carcinogenesis and metabolic diseases. Among obese patients only, activation of CTNNB1 was associated with better colorectal cancer (CRC)-specific and overall survival, according to a study published in the Journal of the American Medical Association. Post-diagnosis physical activity was associated with better CRC-specific survival only among patients with negative status for nuclear CTNNB1. These molecular pathological epidemiology findings suggest that the effects of alterations in the WNT-CTNNB1 pathway on outcome are modified by BMI and physical activity.

Journal of the American Medical Association 2011; 305(16): 1685-1694

PRACTICE

CGH Image of the Month

Endoscopy in Microstomia: Thinking Outside the Box
Raja Shekhar R. Sappati-Biyyani, Annette Kyprianou, D. Roy Ferguson

A 43-year-old woman with a history of systemic sclerosis, GERD, hypertension and hyperlipidemia was admitted to the hospital with complaints of nausea, bilious vomiting and abdominal pain. Scleroderma was diagnosed in 2006 when she was admitted with worsening shortness of breath and hypertensive crises along with renal failure. The patient developed skin tightening, sclerodactyly, esophageal dysmotility, calcinosis, Raynaud phenomenon and telangiectasis. The patient was referred to undergo esophagogastroduodenoscopy for further evaluation.

On physical examination, the patient had poor oral hygiene, but had a complete set of teeth. However, the intercommissural distance, the interincisal distance and the maximum oral aperture were all reduced severely. Microstomia restricted insertion of both adult and pediatric bite blocks for the procedure. We successfully completed the procedure using a bite block made of a 10-mL plastic syringe (figure).

Read more in Clinical Gastroenterology and Hepatology.

Participate in PQRS, eRx Q-and-A

CMS will host a national provider conference call on the 2011 Physician Quality Reporting System and electronic prescribing (eRx) incentive program from 1:30 to 3 p.m. ET, on Tuesday, May 17.

Topics that will be covered include:

• Highlights of the 2009 Physician Quality Reporting System and eRx experience report.
• Measures versus measures groups.
• Understanding measure numerator and measure denominator.

A slide presentation will be available for download on the Physician Quality Reporting System Web page, and will be posted prior to the call.

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:

• Proctalgia fugax.

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

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.

Your AGA Research Foundation Gifts Support ...

Pooja Linsewala, who received a 2010 AGA-Eli and Edythe Broad Foundation Student Research Fellowship Award.

“I feel tremendously honored to receive the Student Research Fellowship Award and would like to thank the AGA Research Foundation for the support and opportunities it has provided me for the future. I am especially grateful to Nicholas F. La Russo, MD, AGAF, my mentor at the Mayo Clinic, for his encouragement and guidance … The research process has been an inspirational experience, deepening my interest and broadening my understanding of scientific research. In the process of learning basic laboratory procedures, using highly advanced technological equipment and interpreting raw data to prepare publication quality figures, I am obtaining the knowledge that will become the building blocks of my scientific career … It will help me achieve my dreams of attending medical school and it will make me a better physician.”

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

EDUCATION & MEETINGS

New Releases: DDW^® 2010 CME Webcasts

Earn CME with newly released webcasts on growth development and aging, including:

•    The Role of Enteral Nutrition in the Treatment of Pediatric IBD.
•    Osteoporosis and Arthritis: Diagnosis and Management.
•    Hepatobiliary Diseases.

To view the webcasts on growth development and aging, visit the AGA Institute’s CME library.

The National Budget
AGA's resident politico discusses how the fiscal year 2011 budget will impact GI, and how you can learn more at this week's DDW®.

JOURNALS & PUBLICATIONS

Gastroenterology Publishes Special Issue on IBD

The editors of Gastroenterology are pleased to announce the publication of this year’s highly anticipated special 13th issue. Published each May, the 13th issue is devoted to a particular topic of broad interest that spans basic science, translational medicine, clinical investigation and population science. This year’s comprehensive review series, titled “Inflammatory Bowel Disease: An Update on Fundamental Biology and Clinical Management,” includes the latest updates on challenging treatment paradigms, as well as advances in the understanding of IBD that may lead to future treatment modalities.

In conjunction with editor-in-chief Anil K. Rustgi, MD, this issue was developed by guest editors Richard S. Blumberg, MD, AGAF, and Judy H. Cho, MD, as well as Gastroenterology associate editors James D. Lewis, MD, MSCE, AGAF, and Gary D. Wu, MD. Their expertise guided the contributing authors — all international authorities in their respective specialties. A wide range of important and timely topics are discussed, including:

• Genetic and environmental factors that influence the pathogenesis of IBD.
• The role of innate immune mechanisms and microbiota in IBD.
• State-of-the-art clinical advances for diagnosis and treatment.

In the introduction to the issue, the editors state “ … this collection of articles will serve as a highly valuable update for those who are immersed in the field, a user-friendly entre into the field for those who follow IBD literature more casually and a trigger to prompt discussion about the pathology and therapy of IBD for everyone who reads Gastroenterology.”

To access this high-quality and compelling issue now, go to www.gastrojournal.org and look under the news and announcements section, where you can click on the issue’s cover to access the table of contents.

Journal Editors' Picks

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

Gastroenterology

• Use of Aspirin or Nonsteroidal Anti-inflammatory Drugs Increases Risk for Diverticulitis and Diverticular Bleeding; By Lisa L. Strate, et al.
• The Zollinger–Ellison Syndrome and Mismeasurement of Gastrin; By Jens F. Rehfeld, et al.
• Survivors of Childhood Cancer Have Increased Risk of Gastrointestinal Complications Later in Life; By Robert Goldsby, et al.
• Combining Clinical, Pathology, and Gene Expression Data to Predict Recurrence of Hepatocellular Carcinoma; By Augusto Villanueva, et al.
• JNK Signaling Promotes Intestinal Tumorigenesis Through Activation of mTOR Complex 1 in Apc^Δ716 Mice; By Teruaki Fujishita, et al.

CGH

• Long-Term Budesonide Maintenance Treatment Is Partially Effective for Patients With Eosinophilic Esophagitis; By Alex Straumann, et al.
• Characteristics of Patients With Nonalcoholic Steatohepatitis Who Develop Hepatocellular Carcinoma; By Kohichiroh Yasui et al.
• Many Patients With Primary Sclerosing Cholangitis and Increased Serum Levels of Carbohydrate Antigen 19-9 Do Not Have Cholangiocarcinoma; By Emmanouil Sinakos, et al.
• Factors That Contribute to Blood Loss in Patients With Colonic Angiodysplasia From a Population-Based Study; By Naomi G. Diggs, et al.
• Levels of C-reactive Protein Are Associated With Response to Infliximab Therapy in Patients With Crohn's Disease; By Matthias Jürgens, et al.

Listen to the Latest Journal Podcasts

Download the latest journal podcasts on popular articles from Gastroenterology and Clinical Gastroenterology and Hepatology (CGH).

Recent podcasts from Gastroenterology include:

• Aspirin or Nonsteroidal Anti-inflammatory Drug Use Increases Risk for Diverticulitis and Diverticular Bleeding.
• Microscopic Colitis.
• Management of Barrett's Esophagus.

Recent podcasts from CGH include:

• Symptoms May Not Indicate Failure of Anti-Tumor Necrosis Factor Therapy in Crohn's Disease.
• Noncardiac Chest Pain — Evaluation and Treatment.
• Renal Dysfunction as a Predictor of Mortality in Cirrhotic Patients with Spontaneous Bacterial Peritonitis.

Each podcast lasts approximately 10 to 15 minutes and can be downloaded to an iPod or any other media player. Podcasts are available through iTunes. Subscription to the podcasts is free and you will receive automatic updates on your iPod as new podcasts are added.

ANNOUNCEMENTS

Boston Scientific Devices Stolen

Boston Scientific Corporation is alerting the public about a stolen shipment of endoscopy and urology/women’s health medical devices. These devices were stolen while en route to Boston Scientifics’ sterilization facility sometime between April 8, 2011, and April 11, 2011.

The labels on these devices state that they are sterile; however, they were stolen prior to being sterilized and are non-sterile. Use of these non-sterile devices may lead to infection.

If you have any of these identified devices in your current inventory or receive any future delivery of these batches of devices, do not use the devices and contact Boston Scientific.

Learn more.

FDA Committee Recommends Approval of Hepatitis C Drugs

Last week, AGA staff attended the FDA Antiviral Drugs Committee meetings where there was unanimous agreement to recommend approval to the FDA of two hepatitis C drugs: boceprevir (manufactured by Merck) and telaprevir (manufactured by Vertex Pharmaceuticals). Both drugs had a proposed indication for the treatment of chronic hepatitis C genotype 1 infection in combination with peginterferon alfa and ribavirin in adult patients with compensated liver disease who are previously untreated or who have failed previous therapy.

The panel suggested that Merck conduct post-market studies on its drug. One specific issue was the absence of null responders — patients who had tried and failed treatment — in the study. The panel suggested that the FDA include this on the label until Merck has a chance to gather data to see how these types of patients react to boceprevir. The panel also requested that Merck conduct studies on patients with HIV, minority groups and those who have had organ transplants.

One issue raised about telaprevir was that patients in the trial experienced an eczema-like rash; however, the panel felt that physician and patient education is sufficient to manage that potential side effect.

Both boceprevir and telaprevir improve cure rates to more than 30 percent above what we have today. Sales of both drugs combined could be $7 billion a year in just three years. The FDA's final decision on the drugs is expected by the end of May 2011.

Members Sought to Serve on Committees

AGA and AGA Institute committees recommend and oversee new and existing policies and programs. Committee service offers members several benefits — you can network with other physicians and scientists, pursue a special interest, or make an impact in an area that is important to you. The following committees will have open positions for members:

• AGA Political Action Committee (four positions open)
• Clinical Practice & Quality Management Committee (three positions open)
• Education & Training Committee (three positions open)
• Ethics Committee (two positions open)
• Finance & Operations Committee (one position open)
• International Committee (one position open)
• Nominating Committee (four positions open)
• Public Affairs & Advocacy Committee (two positions open)
• Publications Committee (two positions open)
• Research Awards Panel (six positions open)
• Research Policy Committee (three positions open)
• Underrepresented Minorities Committee (two positions open)
• Women's Committee (two positions open)

If you would like to nominate yourself and/or another AGA member, please visit https://netFORUM.gastro.org/eweb and log in. Under “Member Services,” complete your nomination(s) by accessing the committee nomination form. Nominations must be received no later than May 31, 2011. If you should encounter any difficulties with the online nomination process, please contact Diane Field (dfield@gastro.org) at the AGA National Office.

Nominees will be contacted to confirm their interest and to obtain their curriculum vitae. As president-elect, Loren Laine, MD, AGAF, will consider applications and select appointees for each committee. These selections will then be brought before the AGA Governing Board for ratification. The appointees ratified will begin serving their term in June 2012.

Become an AGA Fellow — Applications Now Being Accepted

The AGA is accepting applications for fellowship, the organization’s highest level of membership. The prestigious designation of fellowship is awarded to select members for their outstanding contributions to the field of gastroenterology. To date, 1,694 members have been honored as AGA fellows.

Fellowship in the AGA is by application only and applicants must meet certain criteria in order to apply. One such criterion is membership in the AGA for at least seven years.

As an AGA fellow, you will have the use of the letters “AGAF” in your professional activities. You will also receive a recognition pin and certificate upon acceptance and be listed as a fellow on the AGA website. During DDW^® 2012, you will be recognized with a ribbon denoting your fellowship status, and your name will be printed in the Recognition and Research Awards booklet.

The review and selection process for this program falls under the oversight of the Fellowship Recognition Committee, with final approval by the AGA Governing Board. Fellows will be selected based on superior achievements in clinical practice or in research. Applicants will be notified of their acceptance by Jan. 31, 2012. Fellowship will commence upon notification of acceptance.
 
The application deadline for 2012 is July 18, 2011. Eligibility requirements and an application can be found online.

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

District of Columbia
Gastroenterologist BC/BE to join suburban Washington, DC busy 100 percent outpatient consultative GI practice with adjacent accredited endoscopy center. Practice includes onsite PillCam small bowel studies. Applicant must be experienced in all endoscopic procedures. Early pathway to partnership. E-mail resume to drdbd@aol.com or fax to 301-897-5290.

Maryland
Large multi-specialty practice serving Montgomery County, MD seeks a BE/BC gastroenterologist.  Excellent opportunity to join a large private practice with an integrated referral system. Please forward your CV to elliotrgoldstein@yahoo.com.

North Dakota
Procedure-Oriented Practice: Sanford Health Fargo is currently seeking BC/BE gastroenterologists. Excellent productivity-based opportunity — 60 percent endoscopy and 40 percent outpatient. Seven endoscopy suites just steps from the clinic. Hospital consults only; 100 percent hospitalist coverage. ERCP and EUS skills are desirable but not required. Call 1:8. Opportunity exists to teach medical students and internal medicine residents. Offering a competitive compensation plan with two years guaranteed salary, plus incentives and a comprehensive benefits package. Willing to sponsor physicians with H1B or J1 visas.

Fargo, North Dakota, a diverse metropolitan community of 190,000, offers exceptional K-12 and higher education systems, world-class health care, affordable housing, low cost of living and a myriad of cultural and entertainment opportunities. The only things lacking are traffic jams and high crime rates. Visit www.fmchamber.com and www.fargo.k12.nd.us to learn more or contact:

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

AA/EOE