October 06, 2011 Home|Journals & Publications|  AGA eDigest
AGA eDigest

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

LEADING THE NEWS

Help AGA Support Vital Research Funds

The House Appropriations Committee unveiled their draft labor, HHS and education appropriations bill for fiscal year (FY) 2012 that includes $31.7 billion for NIH, representing a 3.3 percent increase over last year’s levels — the same as the administration’s request. According to the bill summary, the NIH funding will support the request level of at least 9,150 new and competing research grants, an increase of about 450 from FY 2011.

However, the Senate Appropriations Committee’s FY 2012 appropriations bill funds the NIH at $30.5 billion, a reduction of $180 million over last year’s levels. Since neither the House nor the Senate has passed their versions of the labor-HHS-education appropriations bills, these numbers will serve as the basis for negotiating positions as both sides seek to strike a deal on a larger spending package.

AGA continues to advocate for increases in NIH funding, despite the challenging budget atmosphere, and stresses the value that NIH brings in advancing medical progress and our nation’s economic competitiveness. Please contact your legislators and urge them not to cut these vital research funds.

Photo courtesy of the NIH.

NEWS FROM THE LITERATURE

Barrett's Patients Have Low Incidence of EAC

Data vary on the progression of low-grade dysplasia in patients with Barrett's esophagus. According to data published in Gastroenterology, study authors concluded that overall, patients with Barrett's esophagus and low-grade dysplasia have a low annual incidence of esophageal adenocarcinoma (EAC), similar to nondysplastic Barrett's esophagus. There are no risk factors known at this time for progression, and there is significant interobserver variation in diagnosis, even among expert pathologists.

Gastroenterology 2011; 141(4): 1179-1186.e1

Entecavir Monotherapy Is Effective in Suppressing HBV

In a study published in Gastroenterology, doctors investigated the efficacy of entecavir, a cyclopentyl guanosine nucleoside analogue, as monoprophylaxis in patients with chronic hepatitis B who received a liver transplant. Although only 26 percent of patients had complete viral suppression at the time of transplant, 91 percent lost hepatitis B surface antigen, with 98.8 percent achieving undetectable levels of hepatitis B virus DNA. They concluded that a hepatitis B immunoglobulin-free regimen of entecavir monotherapy is effective after liver transplantation for chronic hepatitis B.

Gastroenterology 2011; 141(4): 1212-1219

CRC Prevalence Is Comparable Among Genders

Although some studies have shown that men are at greater age-specific risk for advanced colorectal neoplasia than women, the age for referring patients to screening colonoscopy is independent of gender and usually recommended to be 50 years. A study in the Journal of the American Medical Association found that among a cohort of Austrian individuals undergoing screening colonoscopy, the prevalence and number needed to screen of advanced adenomas were comparable between men aged 45 to 49 years and women aged 55 to 59 years.
 
Journal of the American Medical Association 2011; 306(12): 1352-1358

Conservative Approach to Pancreatitis Improves Outcome

Treatment of patients with necrotizing pancreatitis has become more conservative and less invasive, but there are few data from prospective studies to support the efficacy of this change. In a study appearing in Gastroenterology, doctors found that approximately 62 percent of patients with necrotizing pancreatitis can be treated without an intervention and with low mortality. In patients with infected necrosis, delayed intervention and catheter drainage as first treatment improves outcome.

Gastroenterology 2011; 141(14): 1254-1263

PRACTICE

Payor Policy Work Group Continues to Benefit Members

The AGA Payor Policy Work Group’s (PPWG) efforts were recently successful in overturning two negative coverage decisions for radioembolization for primary and metastatic tumors of the liver and gastrointestinal motility disorders, diagnosis and treatment.

The PPWG continues to take an active role in ensuring payor coverage for proven procedures and therapies that advance the science and practice of gastroenterology for the patients you treat. Both of the recent coverage policies that were changed, due in part to comments that the AGA submitted, were for national payors that cover a large portion of the population.

The first comment letter was submitted to WellPoint for a review they were conducting for a national payor on radioembolization for primary and metastatic tumors of the liver. The AGA submitted initial comments on June 3, 2010. The payor followed up for additional comments in November 2010, to which the AGA reiterated our belief that this technology should be considered medically necessary to treat unresectable hepatic metastases from colorectal carcinoma refractive to chemotherapy. We were notified in July 2011 that the payor had changed their position for this indication from investigational to medically necessary.

The second positive change that the AGA influenced over the past few months was with UnitedHealthcare for their coverage policy on gastrointestinal motility disorders, diagnosis and treatment. The AGA submitted comments on June 22, 2011, supporting coverage for various motility procedures, including the wireless motility capsule (WMC; SmartPill®). We were recently notified that UnitedHealthcare changed their policy to consider the WMC proven for diagnosing and evaluating gastrointestinal motility disorders, including gastroparesis. The policy is effective Oct. 1, 2011.

In our commitment to transparency, AGA letters to payors regarding coverage issues are available in the practice section of the AGA website. View copies of recent letter submissions. AGA comment letters do not constitute an endorsement of a particular procedure, pharmaceutical company, medical device and/or diagnostic test, and should not be used for marketing purposes. Members are welcome to share AGA comments letters with payors, as appropriate, in an effort to assist with obtaining coverage and reimbursement for procedures.

For more information, contact Adam R. Borden, MHA, senior manager of technology and reimbursement, at 301-941-2629 or aborden@gastro.org.

CGH Image of the Month

Biliary-Colonic Fistula
Justin Smyth, Bobby V.M. Dasari, Robert Hannon

An 88-year-old man presented to the surgical clinic with a two-month history of diarrhea, weight loss and early satiety. He had a background history of prostate carcinoma and had regular renal dialysis for idiopathic chronic renal failure. He had no previous abdominal surgery. He was cachectic, but not jaundiced. Abdominal and digital rectal examination was unremarkable. He was found to have normocytic anemia. The remaining serum liver function tests were within normal limits. Gastroscopy showed inflammation in the second part of the duodenum. On barium enema examination, there was free flow of contrast from the hepatic flexure of colon into the biliary tree demonstrating a biliary-colonic fistula (figure).

Read more in Clinical Gastroenterology and Hepatology.

New Guide Compares Benefits, Risks of GERD Treatments

The Agency for Healthcare Research and Quality (AHRQ) released a new guide for patients that compares the benefits and risks of GERD treatments. The guide is based on an updated evidence report for AHRQ’s Effective Health Care Program by the Tufts Medical Center Evidence-based Practice Center.
 
The AHRQ report concluded that established drug-based therapy is effective. It also concluded that laparoscopic fundoplication is at least as effective as drug-based medical treatment for some patients, but also had a higher risk of serious side effects. Another surgical treatment using an endoscopic variation of fundoplication also has been used to treat GERD, but AHRQ's analysis found there is not enough evidence to compare this type of surgery's effectiveness with other treatments.

The report also found that PPIs tend to be more effective than other drugs, but comparisons show few consistent differences between PPI types or dosages. PPIs cause some side effects, such as diarrhea and headaches, but these were generally not serious.

AHRQ is also seeking comments on key questions associated with the following:

Both topics are open for comments until Oct. 28.

Deadline for eRx Incentive Program Exemptions Is Nov. 1

The deadline to submit a significant hardship exemption request and rationale for the 2012 Medicare electronic prescribing (eRx) payment adjustment is Nov. 1.
 
Eligible professionals and group practices should determine if they are subject to the adjustment by reviewing the MLN Matters article SE1107. If you believe that you may be subject to the 2012 payment adjustment, you should determine if you meet any of the hardship exemption categories specified by CMS in the 2011 Medicare eRx incentive program final rule. A quick reference guide is also available to help you understand the changes that the final rule made to the incentive program. 

To be considered for an exemption, an eligible professional must:

  • Have registered for either the Medicare or Medicaid electronic health record (EHR) incentive program.
  • Provide identifying information as to the certified EHR technology that has been adopted for use no later than Oct. 1, 2011. In order to qualify for an exemption to the 2012 eRx payment adjustment under this significant hardship exemption category, it is not necessary that an eligible professional receive an incentive payment under the Medicare or Medicaid EHR incentive program.

For the Medicaid EHR incentive program, eligible professionals wishing to register in states that have not yet launched their respective EHR incentive programs may initiate the registration process at the CMS registration and attestation system and obtain a registration number, but will not be able to successfully complete registration. If a state has not launched its Medicaid EHR incentive program, the state name will not appear in the drop-down menu for eligible professionals to choose from. However, a registration number is assigned even if registration is not successfully completed.

To initiate registration, visit https://ehrincentives.cms.gov/hitech/login.action. Obtaining a CMS EHR incentive programs registration number, even if the registration is not successfully completed, suffices for the purposes of applying for a significant hardship exemption for the 2012 Medicare eRx payment adjustment.

To request an exemption, individual eligible professionals must submit their hardship exemption requests through the quality communications support page, and group practices participating under the group practice reporting option must submit hardship exemption requests via a letter to CMS.

Learn more.

Save the Date: Oct. 18, 1:30–3 p.m. ET

To help eligible professionals better understand the changes in the 2011 eRx incentive program rules and how to submit a significant hardship exemption request, CMS will host a national provider call on the Physician Quality Reporting System and eRx incentive program.

Visit http://www.eventsvc.com/blhtechnologies/ to register for this session. Registration will close at 12 p.m. ET on Oct. 18 or when available space has been filled, so registry early.

The presentation will be posted at least one day before the call at in the downloads section of the CMS website.

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.

RESEARCH

Connect with Colleagues Using AGA’s Researcher Directory

As part of the AGA’s mission to support multiple aspects of research, AGA has developed the directory of GI researchers, a free, online tool designed to help members connect with others who perform GI and liver disease research.

As a benefit of AGA membership, the directory is open to all members who perform research at no cost. You can use the directory to identify potential collaborators, identify resources that may be shared among fellow researchers, identify potential mentors and indicate interest in participating in pharmaceutical or device clinical trials.

To begin, watch this short instructional video that describes how the directory works and how to search participants' profiles; then, create your profile.

 To access the directory, visit http://gastro.org/ResearcherDirectory.

EDUCATION & MEETINGS

Surgery Still Necessary for IBD

Surgery still remains integral to the management of ulcerative colitis and Crohn’s disease. A complication of IBD is the most common reason for surgery; in ulcerative colitis, it is dysplasia/cancer or toxic colitis, and in Crohn’s disease, it is an obstructing fibrostenotic stricture or penetrating fistula/abscess. Medical treatment after Crohn’s disease surgery is necessary to reduce the chance of recurrence, whereas a total proctocolectomy is curative for ulcerative colitis.

Surgery should not be viewed as a failure of treatment, but rather a necessary intervention to correct irreversible bowel damage or dysplasia/cancer. Patients with bowel surgery for IBD often have a significant improvement in their symptoms, nutrition, quality of life and overall health. Preventing Crohn’s disease recurrence after surgery is the challenge. Earlier initiation of immunomodulators or anti-TNF treatments in the highest risk patients after Crohn’s disease surgery may significantly reduce recurrence. For some Crohn’s disease patients, it may also be reasonable to pursue surgery as the primary treatment followed by medical therapy.

More on this topic will be covered at the AGA Clinical Congress, which will be held Jan. 20 and 21, 2012, in Miami, FL. Miguel D. Reguiero, MD, AGAF, from the University of Pittsburgh, PA, will delve further into why surgery is still necessary for managing IBD. There will also be IBD-related sessions on the complications of treatment with immune modulators and biologics as well as managing Crohn’s disease and IBD in children and in pregnancy. Learn more about this session and others at www.gilearn.org/clinicalcongress.

Abstract Deadline Approaching for Clinical Congress

GI fellows in training are encouraged to submit an abstract for this year's clinical congress. The abstract submission deadline is Oct. 31. Learn more.

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.

GI FELLOWS

Ventana Wins Clearance for H. Pylori Antibody

Roche's Ventana unit has garnered 510(k) clearance for its anti-Helicobacter pylori (H. pylori) rabbit monoclonal primary antibody. It is the first H. pylori antibody to receive FDA clearance, and, when used in immunohistochemical staining, helps detect the bacterium, according to the company.

The company's H. pylori antibody allows for a more accurate patient diagnosis, even when very few organisms are present. The high contrast staining of the organisms permits pathologists to view more bacteria than can be detected with special stains.

Learn more.

Stay Up to Date on GI News via Twitter

Some of our most retweeted news items of interest last week include:

  • Rates of medication adherence are very low in pediatric #IBD patients; Pg 6. GI & Hep News: http://ow.ly/6GvDu @Doctor_V.
  • Remicade Gets FDA OK for Ulcerative Colitis in Kids: bit.ly/pFOwxD from @medpagetoday.
  • Gastro Comment from the Editor, by Dr. Anna Lok: How is authorship determined for research papers? http://ow.ly/6HGry.
  • AGA and CDC to Expand Access to Colorectal Cancer Screening: http://ow.ly/6IPq4.
  • Tanaka Yukari expresses her thanks to AGA for our relief efforts during her experience of earthquake and tsunami in Japan http://ow.ly/6IQyL.

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:

AWARDS

Call for Nominations: Member Recognition Prizes

Each year, the AGA honors a number of individuals for their outstanding contributions to the field of gastroenterology. Nominations are due Nov. 11 for the following awards:

  • The William Beaumont Prize in Gastroenterology, which recognizes an individual who has made a major contribution (a single accomplishment or series of accomplishments) that has significantly advanced gastroenterological basic or clinical research.
  • The Distinguished Clinician Awards, which recognize two individuals, one in private practice and one in clinical academic practice, who have exemplified leadership and excellence in the practice of gastroenterology.
  • The Distinguished Educator Award, which recognizes an individual for his or her achievements as an outstanding educator over a lifelong career.
  • The Distinguished Mentor Award, which recognizes an individual for his or her achievements as an outstanding mentor over a lifelong career.
  • The AGA Research Service Award, which recognizes an individual who has dedicated an extraordinary effort to advocacy for the advancement of gastroenterological science and research.

Complete nomination instructions, selection criteria and more information about each award are available on AGA's website. Please contact awards@gastro.org with questions about the nomination process

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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.

Colorado
GASTROENTEROLOGIST: Denver Health Medical Center, nationally recognized as the premier safety net provider in the country, is actively recruiting faculty with clinical interests in luminal gastroenterology who will be using the strengths of our integrated delivery and information systems to provide, understand, evaluate and improve the delivery of digestive health care to all who live in the Denver metro area. Our program is fully integrated with the University of Colorado School of Medicine GI division, including appropriate academic rank and a combined fellowship. Please contact Joel Levine, MD, GI chief at Joel.Levine@dhha.org for further information.

GASTROENTEROLOGISTS/CLINICAL HEAD OF GI: The division of gastroenterology and hepatology at the University of Colorado Denver is seeking talented and energetic clinical academicians. The university serves as a tertiary referral center for the Rocky Mountain region, and the division has outstanding programs in endoscopy, transplantation, early detection and chemoprevention of colon cancer, and other clinical research. Applications are sought from individuals with strong clinical academic and leadership skills. Salary is based on the academic level of entry and individual qualifications and responsibilities. The Denver area provides a beautiful outdoor-oriented environment to complement the opportunities provided through the university. CVs and applications will be processed via www.jobsatcu.com, position number 811902.

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 has immediate openings for BC/BE gastroenterologists in a procedure-oriented practice. Call 1:8. 100 percent hospitalist coverage; hospital consults only. Procedures performed include: ERCP, EUS and capsule endoscopy. ERCP and EUS skills are desirable, but not necessary. Opportunity to teach medical students and IM residents. Level II 583-bed trauma center with electronic medical records and PACS. Sanford Health Fargo consists of 585+ physicians located in Fargo and 32 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 Physician Placement
Phone: 701-280-4853
E-mail: jean.keller@sanfordhealth.org
www.sanfordhealth.org

Virginia
Hospital-employed group practice seeking gastroenterologist with ERCP skills. This is an established four-person group located at the campus of Augusta Health. This entity is part of a larger 50-physician multi-specialty group affiliated with Augusta Health, Inc. This is a dynamic physician-driven organization serving the cities of Staunton and Waynesboro, and a large surrounding area consisting of a population of approximately 200,000. Augusta Health is a sole community provider and holds the majority market share position for many services. Very competitive salary and benefits. No J-1 available. Contact: Arlene Macellaro, director, physician recruitment/practice development, 540-332-4462.

Washington
Seattle area: hospital employed, joining two GI physicians seeking ERCP experience and interest in growing Puget Sound community of 54,000 population. 45 minutes to Seattle. Associated with a new 137-bed hospital. 1-4 call. Excellent salary, bonus and benefits. 800-831-5475 E/M: donohueandassoc@aol.com.