September 06, 2012 Home|Journals & Publications|  AGA eDigest
AGA eDigest

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


Are Guidelines the Path to Medical Liability Reform?

John Allen, MD, MBA, AGAF, and several colleagues visited Washington during the Alliance of Specialty Medicine Legislative Fly In.

During their two-day visit, they heard representatives, senators and staff discuss issues that will affect GI practices. U.S. Representative Tom Price, R–GA, an orthopedic surgeon, talked about reforming the medical liability system and suggested that there might be support for using clinical guidelines as a “safe harbor” against malpractice litigation. Dr. Allen has heard this before and is skeptical despite his own work within the AGA on guidelines and quality improvement.

He asks, “Could we, as physicians, or the AGA, solve some of these problems and help our members? I think so.” Read more.


Is Radiofrequency Ablation for Barrett's Cost Effective?

Radiofrequency ablation (RFA) reduces the risk of esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus (BE) with high-grade dysplasia (HGD), but its effects in patients without dysplasia are debatable. By using updated data, researchers found that initial RFA might not be cost effective for patients with BE without dysplasia within the range of plausible rates of progression of BE to EAC, and might be prohibitively expensive from a policy perspective. In addition, these study results — published in Gastroenterology — found that RFA might be cost effective for confirmed and stable low-grade dysplasia. Initial RFA is more effective and less costly than endoscopic surveillance in high-grade dysplasia.

Gastroenterology 2012: 143(3): 567-575

Optical Diagnosis in Nonacademic Setting Disappointing

When small colorectal lesions are accurately characterized, adenomas can be removed and discarded without formal histopathology analysis. Previous studies in an academic setting showed that many lesions can be managed accurately on the basis of their endoscopic image (optical diagnosis). In a study appearing in Clinical Gastroenterology and Hepatology, researchers stated that even though many lesions were characterized by high-resolution endoscopy or narrow-band imaging with high confidence, optical diagnosis in a nonacademic setting proved to be disappointing, with a sensitivity of 77 percent and a specificity of 79 percent. Many lesions were accurately assigned to be removed or remain in situ, although few adenomas were assigned to remain in situ. Also, 19 percent of onsite recommendations for a surveillance interval proved to be inaccurate.

Clinical Gastroenterology and Hepatology 2012: 10(9): 1016-1020

Bile Acid Synthesis Associated with IBS-D

Variations in genes that regulate bile acid synthesis are associated with colonic transit in patients with IBS. According to data published in Clinical Gastroenterology and Hepatology, patients with IBS-diarrhea have greater body mass index, and synthesize and excrete higher levels of bile acid than individuals with IBS-constipation or healthy volunteers. Serum levels of C4 might be used to identify patients with IBS-diarrhea who have bile acid malabsorption. Studies are needed to determine if some patients have a genetic predisposition to this disorder.

Clinical Gastroenterology and Hepatology 2012: 10(9): 1009-1015.e3

Researchers Examine Factors that Predict Boceprevir Response

Little is known about factors associated with a sustained virologic response (SVR) among patients with hepatitis C virus (HCV) infection to treatment with protease inhibitors. The CC polymorphism at IL-28B rs12979860 is associated with response to triple therapy and can identify candidates for shorter treatment durations, suggest data published in Gastroenterology. A greater than or equal to one log10 decrease in HCV ribonucleic acid at week four of therapy is the strongest predictor of an SVR, regardless of polymorphisms in IL-28B.

Gastroenterology 2012: 143(3): 608-618.e5


The University of Chicago Remembers Joseph Kirsner

A memorial service for renowned gastroenterologist Joseph B. Kirsner, MD, PhD, will be held on Sept. 14, 2–3:30 p.m. CT at Rockefeller Memorial Chapel in Chicago, IL. Dr. Kirsner, the Louis Block distinguished service professor of medicine at the University of Chicago, died from kidney failure at his home in Chicago on July 7. He was 102.

For more information about the service or the reception that will follow, contact Erica Matagrano at 773-702-6073 or email

Read more about Dr. Kirsner’s life and legacy, and post comments at

Join Our Committees

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

If you would like to nominate yourself and/or another AGA member, please visit the AGA website and log in. Go to My AGA and select the “Submit Committee Nomination” link in the My Committee section to submit your nomination(s). Nominations must be received no later than Oct. 19, 2012. If you should encounter any difficulties with the online nomination process, please contact Diane Field ( at the AGA national office.

Nominees will be contacted to confirm their interest and to obtain their curriculum vitae. The AGA Institute Appointments Committee will consider applications and select appointees for each committee. These selections will then be brought before the AGA Institute Governing Board for ratification. The appointees will begin serving their term June 1, 2013.

Leadership Nominations Due Oct. 1

The AGA Nominating Committee, chaired by C. Richard Boland, MD, AGAF, is in the midst of identifying candidates for the offices of vice president, secretary/treasurer, at-large councillor, education and training councillor, and eight nominees for the 2013–2014 AGA Nominating Committee.

AGA members are encouraged to submit nominations to ensure that the most qualified and committed candidates are selected to serve next year. Nominations must be submitted by Oct. 1.  Learn more about nominating yourself or one of your colleagues.


CGH Image of the Month

Intestinal Tuberculosis in an HIV-Infected Patient with Advanced Immunosuppression

A 35-year-old homosexual man was admitted to a hospital with a one-month history of fever, diarrhea and anorexia. He was diagnosed with HIV infection 11 years earlier and since then, had been treated with highly active antiretroviral therapy. On admission, the patient was alert with a body temperature of 39.5°C. Laboratory tests on admission showed a low CD4+ count (48 cells per μL) and elevated C-reactive protein (13.88 mg/dL).

Colonoscopy showed a few giant ulcers at the terminal ileum and a shallow ulcer at Bauhin's valve. A biopsy and aspiration of intestinal fluid from the lesions were then performed endoscopically. The biopsy specimen revealed numerous acid-fast bacilli on auramine staining.

Read more in Clinical Gastroenterology and Hepatology.

“A Gastroenterologist’s Guide to Probiotics”

The use of probiotics to treat gastrointestinal ailments is increasing among patients; therefore, it is important for GIs to improve their understanding of how probiotics work and what evidence is available to support practical use.

In this month’s Clinical Gastroenterology and Hepatology, Matthew A. Ciorba, MD, assistant professor of medicine at the Washington University, St. Louis School of Medicine, MO, offers a review that will provide health-care professionals with an understanding of the rationale and data that support or refute the role of probiotics in treating common GI disorders. He provides an overview of several commonly used probiotics and outlines which strains are likely to help patients with GI disorders based on benefits shown in clinical trials. Read more.

GastroSlides Images Focus on NAFLD

These images illustrate the epidemiology, physiology, diagnosis and treatment of a rapidly emerging health concern  — NAFLD, including NASH  — and are separated into the following sections:

•    Part I: Introduction, Epidemiology and Definitions
•    Part II: Pathophysiology
•    Part III: Diagnosis and Treatment
•    Part IV: Illustrative Cases

Order these slides individually as you need them or purchase a one-year subscription and have access to the entire GastroSlides library of more than 4,000 images. Preview and order slides.

Special offer: Get your free download of the GastroSlides unit on liver cancer (revised).

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

Improve Workflow to Meet Quality Assessment Thresholds

The AGA Digestive Health Outcomes Registry® helps practices improve their workflow to meet future quality assessment thresholds from CMS and health-care payors. If you do not start tracking the right data and outcomes now, you will most probably fail to meet those thresholds. Enroll today and take advantage of the AGA Registry’s six-month trial period at no cost if you decide to discontinue participation.
Visit to learn more. To enroll, contact an enrollment advisor at


Research Awards Support Young GIs’ Career Development

As part of its mission to create opportunities for young GIs to advance careers in research, the AGA Research Foundation offers funding to junior investigators working toward independent careers. Application deadlines are approaching for two awards from the foundation:

  • Research Scholar Awards provide $90,000 per year for two years to young faculty working toward independent careers in gastroenterology, hepatology or related areas. The awards’ objective is to enable young investigators to develop independent and productive research careers in digestive diseases by ensuring that a major proportion of their time is protected for research. Applications are due Oct. 19.
  • The AGA-Emmet B. Keeffe Award in Translational or Clinical Research in Liver Disease will provide a young physician investigator $85,000 for one year to pursue research on viral hepatitis, liver transplantation or other liver disease-themed areas. Applications are due Oct. 24. This award is funded by Vertex Pharmaceuticals and donations from the friends and family of Emmet Keeffe.

Complete eligibility requirements and application information for these and other research awards are available on the AGA website.

Your AGA Research Foundation Gifts Foster Professional Growth

Yiyun Cao of the Illinois Math and Science Academy received the 2012 AGA-Broad Student Research Fellowship Award for research conducted at the University of Chicago.

“I am honored to be a recipient of the 2012 AGA-Eli & Edythe Broad Student Research Fellowship Award. In the past year, I have worked in the lab of Bana Jabri, MD, at the University of Chicago studying the regulation of RGS1 in celiac disease, and have gained valuable experience in all the different aspects of science: experimentation, reading literature, and writing about and presenting my work. The AGA-Broad fellowship will allow me to greatly expand on this foundation in an environment which I know to be highly conducive to my growth as a scientist. Overall, the award will benefit my goals of getting a graduate degree and working in biomedical research by providing me with the opportunity to gain more experience and independence in the laboratory.”

Make a donation.


2014 AGA Clinical Congress Designed by GI Clinicians for GI Clinicians

Featuring expansive programming, the 2014 AGA Clinical Congress offers comprehensive information that is immediately applicable to GI practice. Attendees can explore recent advancements across the full spectrum of GI and hepatic disorders. A few of the scheduled presentations include:

  • “New Therapies for C. Difficile Diarrhea: Will they Make It Less Difficult to Treat?,” presented by Lawrence J. Brandt, MD, AGAF
  • “Endoscopy of the Future and GI Practice,” presented by Kenneth K. Wang, MD, AGAF
  • “Incidental Hepactic Lesions Incidentalomas: What Is the Follow-Up? How Do I Handle It?,” presented by Rajender Reddy, MD

In addition, a specialized practice management session closes out day one of the congress. A prominent faculty of active practitioners, who have been recognized as champions for the advancement and sustainability of GI practice, head this session on how GIs can thrive in the new world of accountable care. Scheduled presentations include:

  • “The AGA Roadmap: Tools for Successful GI Practice,” presented by John I. Allen, MD, MBA, AGAF
  • “Negotiating Value-Based Contracts for Colon Cancer Prevention,” presented by Scott R. Ketover, MD, AGAF
  • “ICD-10: Am I Ready?,” presented by Kathleen A. Mueller, RN, CPC, CCS-P, CMSCS, CCC, PCS
  • “What Happens When Colonoscopy Goes Away? Creating Non-Procedural Service Lines for the GI Practice,” presented by John F. Kuemmerle, MD, AGAF

Be sure to take advantage of early bird rates by registering for the congress on or before Nov. 20, 2013. The hotel reservation deadline is Dec. 23, 2013.

Learn more and register.


Study Authors Recap Research Findings

Watch David Hewett, MD, discuss his recently published Gastroenterology article, "Validation of a Simple Classification System for Endoscopic Diagnosis of Small Colorectal Polyps Using Narrow-Band Imaging."  Provide your thoughts and comments on this important study via the YouTube comments tool.


Watch Marcia Cruz-Correa, MD, PhD, AGAF, discuss her recently published article, "Ethnic and Sex Disparities in Colorectal Neoplasia Among Hispanic Patients Undergoing Screening Colonoscopy." Provide your thoughts and comments on this important study via the YouTube comments tool.

View our comprehensive library of video abstracts and educational videos on the AGA YouTube channel.

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 September issues of the journals.




Final Call for Nominations: Friedenwald Medal

Nominations are due Sept. 21 for the Julius Friedenwald Medal, the highest honor the AGA bestows on a member. This award recognizes an individual who has made lifelong contributions to the field of gastroenterology. All AGA members are encouraged to nominate their colleagues for this prestigious award.

To submit a nomination, forward a one-page letter of recommendation, in PDF file format, to Complete instructions and selection criteria are available on AGA's website.

Nominations are due Nov. 9 for other AGA member recognition prizes, including:

  • The Distinguished Achievement Award, which recognizes an individual who has made major accomplishments in clinical research, basic research, or an allied field that have advanced the science and/or practice of gastroenterology.
  • 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.

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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 email 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

Gastroenterology Division
Department of Medicine, Washington Hospital Center
Washington, D.C.

Announcing the availability of a staff position in the division of gastroenterology and hepatology at the Washington Hospital Center. Letters of inquiry or recommendations are invited.

The MedStar Washington Hospital Center (WHC) is an 850-bed acute care academic medical center located in midtown Washington, D.C. Along with the MedStar Georgetown University Medical Center, the WHC is part of the MedStar Health System and is the largest not-for-profit hospital in D.C., serving as a major tertiary care hospital to the Washington metropolitan area and local community with a focus on subspecialty care, and maintains its own research institute.

The attending physician staff of the department of medicine includes 110 full-time teaching faculty and 450 voluntary staff. The gastroenterology division enjoys clinical, research and education programs, including a fully accredited gastroenterology fellowship program. Staff physicians manage hospitalized and ambulatory patients in an interdisciplinary setting and take an active role in the implementation of clinical research protocols and practice guidelines. Currently, the Gastroenterology Center of Excellence at Washington Hospital Center is developing initiatives in hepatology, advanced therapeutic endoscopy and endoscopic ultrasound, a clinical research consortium, and our endoscopy unit is performing 10,000 procedures annually. We are now recruiting experienced subspecialists with expertise in hepatology, inflammatory bowel diseases and GI motility for further expanding the clinical and research centers of excellence within our gastroenterology division. The immediately adjacent Veterans Administration Hospital and National Childrens Medical Center provide opportunities for collaboration. The gastroenterology faculty provide clinical consultation, resident and fellow education, clinical research, and clinical trials. Significant collaborative and academic opportunities have developed with Georgetown University since the acquisition by MedStar Health of the Georgetown University Hospital; full-time faculty at the WHC are eligible for academic faculty positions with the Georgetown University School of Medicine, equivalent to full-time faculty at Georgetown Hospital.

Interested candidates should send CV to: Leonard Wartofsky, MD, MACP; Chairman, Department of Medicine, Washington Hospital Center; 110 Irving Street, NW, Suite 2A-62, Washington, D.C. 20010; fax to 202-877-6292; or email to:


Sensational practice with state-of-the-art endoscopy center in a beautiful location.

Gastroenterologist to join our extremely busy practice and ASC in beautiful Savannah, GA.

  • Partnership opportunity after two years with the practice.
  • Highly competitive base salary.
  • A very productive practice with an endoscopy center.
  • Located in the heart of the medical area in gorgeous Savannah, GA.
  • Call schedule is 1/8.
  • This is a single-specialty practice with solid reputation.
  • Outpatient procedures performed at our endoscopy center or three area hospitals.
  • Moving expenses are provided.
  • Full family medical benefits.
  • Malpractice coverage.
  • Great vacation time paid with CME.

Our Mission Statement
To provide our patients with a comfortable and pleasant setting for receiving the best quality endoscopic care in southeast Georgia.

Applicant should possess strong clinical and endoscopic skills. Therapeutic ERCP and EUS would be a strong plus. Board certification is required, but we will help you reach that status if you are not there already. Applicant should also be personable, flexible, energetic and a hard-working individual.

Our physicians participate in continuing education by serving as part-time professors at our largest local health system.

Lynne Marini, CEO
Fax: 912-790-2702

New Jersey

Well-established GI practice in northern New Jersey looking for a part-time gastroenterology associate. Long-term position. Two to three days per week. No night or weekend call. Malpractice, health and pension.

Contact Cathy Shanahan at 973-633-1484. Fax: 973-633-7980. Email:

New York

Looking for GI associate to join three-person, well-established, busy GI group in New York City with two locations in Manhattan and Brooklyn. Must be fluent in Chinese. Competitive salary, benefits and partner track. Email CV to:

North Carolina

Hepatologist — North Carolina

Asheville Gastroenterology Associates seeks a second hepatologist to provide patient care and participate in an extensive clinical research program.

Our practice is a 17-physician single specialty GI group in Asheville, NC. We have a long history of providing advanced GI care at our main office, our practice-owned ASC endoscopy unit, three satellite offices, and at Mission Hospital, the main regional medical center for western North Carolina. As the only GI practice in Asheville, we enjoy a large referral base.

Our current hepatology program supports two liver-dedicated midlevel providers and a hepatitis clinical nurse specialist. We have established relationships with transplant centers throughout the region. We have an active clinical research program allowing our patients access to cutting edge therapies for chronic liver disease. We currently have 31 clinical trials and work with both industry sponsored and investigator initiated studies. In addition, teaching opportunities are available for medical students and medical residents if desired.

In the mountains of western North Carolina, Asheville has been long known as a vacation destination. It offers natural beauty, world class outdoor recreation, a vibrant downtown and arts scene, and recently has become known for its thriving microbreweries. It is frequently on everyone’s list of top locations in which to vacation, work or retire. Due to this and a strong regional hospital, Asheville has attracted a superb medical community.

A potential candidate could choose to practice either hepatology exclusively, or hepatology plus general gastroenterology. The size and spirit of the practice allow for subspecialization, teamwork and an attractive call schedule.

Please contact Mr. Frank Chapman, COO at