American Gastroenterological Association - Advancing the Science and Practice of Gastroenterology

News from the Literature | Policy | Practice | Announcements | Research | Education & Meetings | Journals & Publications

LEADING THE NEWS

NEWS FROM THE LITERATURE

CTE Detects Effects of Treatment in Patients with Crohn's

The use of computed tomography enterography (CTE) in patients with Crohn's disease has increased. However, there is little data available on how radiologic parameters of active disease change during treatment with infliximab and whether these changes correspond to symptoms, serum biomarkers or endoscopic appearance. In a study published in Clinical Gastroenterology and Hepatology, radiologic improvement was observed in 63.4 percent of patients with Crohn's disease who received infliximab therapy, despite a study design that was likely biased toward nonresponders. Radiologic response was not in good agreement with clinical symptoms, serum biomarkers or endoscopic appearance; CTE might be used as a complementary approach to identify mural healing or inflammation not detected by other methods.

Clinical Gastroenterology and Hepatology 2011; 9(8): 679-683.e1

Glucagon-Like Peptide-1-Based Therapy May Increase Pancreatitis Risk

Glucagon-like peptide-1-based therapy is gaining widespread use for type 2 diabetes, although there are concerns about risks for pancreatitis and pancreatic and thyroid cancers. There are also concerns that dipeptidyl peptidase-4 inhibitors could cause cancer, given their effects on immune function. In a study appearing in Gastroenterology, doctors state that these data are consistent with case reports and animal studies indicating an increased risk for pancreatitis with glucagon-like peptide-1-based therapy. The findings also raise caution about the potential long-term actions of these drugs to promote pancreatic cancer.

Gastroenterology 2011; 141(1): 150-156

Major Genes Associated with Barrett’s

Barrett’s esophagus occurs in 1 to 10 percent of the general population and is believed to be the precursor of esophageal adenocarcinoma. The incidence of esophageal adenocarcinoma has increased 350 percent in the last three decades without clear etiology. Finding predisposition genes may improve premorbid risk assessment, genetic counseling and management. Genome-wide multiplatform approaches may lead to the identification of genes important in Barrett’s esophagus/esophageal adenocarcinoma development. In a study published in the Journal of the American Medical Association, doctors found that MSR1 was significantly associated with the presence of Barrett’s esophagus/esophageal adenocarcinoma in derivation and validation samples, although it was only present in a small percentage of the cases.

Journal of the American Medical Association 2011; 306(4): 410-419

High-Dose Pegylated IFN-α, Ribavirin Induce Potent Response

In patients with chronic hepatitis C who failed to respond to standard therapy, high-dose pegylated interferon (IFN)-α and/or ribavirin could induce a stronger antiviral response and prevent treatment failure and hepatitis C virus resistance when combined with direct-acting antivirals. The influence of genetic determinants in this context remains unknown. According to study results in Gastroenterology, high-dose pegylated IFN-α with standard or high doses of ribavirin induces a potent antiviral response in a substantial number of patients who did not respond to standard therapy. The IL-28B genotype is an independent predictor of the antiviral response. High-dose pegylated IFN-α in combination with ribavirin and protease inhibitors appears as an attractive option for future study in this population.

Gastroenterology 2011; 141(1): 119-127

POLICY

I Can See Cecum from My House

John I. Allen, MD, MBA, AGAF, looks to the future and blogs about his thoughts on GI patient care as well as AGA’s plans to help practicing clinicians prepare for the future. Subscribe to the blog to receive an e-mail whenever the blog is updated. Read his post on the AGA Washington Insider.

PRACTICE

Partnering with Health Payors to Drive Incentives

Private health-care payors have embraced the trend towards value-based health care, seeking to lower health-care costs per beneficiary while determining which among their providers is delivering outcomes that meet performance thresholds. Programs such as UnitedHealthcare’s UnitedHealth Premium program utilize quality measures derived from health-care claims data to assess individual provider quality of care and cost efficiency, and provide benefits such as premium directory listings. Patient registries capturing the necessary quality measures for programs such as this can provide clinicians with the capability to meet the needs of multiple health payor programs, rather than devote effort separately and incur unnecessary redundant resource consumption. In another example, Aetna offers the potential to meet criteria for their Aetna Institutes of Excellence and Institutes of Quality programs, which offer a designation for facilities and providers that demonstrate an ability to provide high-quality, cost-effective care.

Given the quality measurement goals of patient registries, there is significant opportunity for integration with other payment incentive programs. The Bridges to Excellence program, through the Health Care Incentives Improvement Institute, provides recognition programs that can lead to per-patient incentive payments from participating health plans. The National Committee for Quality Assurance also provides quality measurement programs. These programs rely on clinical data to measure quality in the respective clinical domains, and compute aggregate quality scores to determine recognition status. Patient registries that already capture these data could be effectively integrated to allow registry participants to meet recognition needs across multiple recognition programs, and thus see potential gains in reimbursement across health payors.

As existing sources of medical-society, guidelines-driven quality measurement, patient registries have the capacity to meet reporting requirements for such programs using clinically derived, detailed data based on endorsed and validated measures. Additionally, registries can serve as a single source for capturing and reporting health payor program quality data, reducing redundancy, and providing consistency of measurement across payors and care environments. The AGA is working with numerous health payors and quality measurement and reporting organizations to design incentive programs that are driven by quality measures reported by the AGA Digestive Health Outcomes Registry™, including IBD management and colorectal cancer prevention outcome measures.

How Are You Measuring Quality?
Learn how the AGA Digestive Health Outcomes Registry™ can help you assess and improve outcomes in GI patient care.

CGH Image of the Month

Sporadic Medullary Carcinoma of the Ileum
Thierry Peycru, Julien Jarry, Isabelle Soubeyran

A 76-year-old woman was hospitalized for an acute intestinal obstruction. The abdominal CT scan showed an ileal mass (figure) causing a mechanical obstruction. During surgery, doctors discovered a large mass, which encompassed the last three ileum loops, the cecum and the right fallopian tube. An en bloc resection was performed. Examination of the specimen revealed a medullary-type adenocarcinoma originating from the distal ileum and spreading to the cecum.

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:

• Diagnostic and therapeutic abdominal paracentesis.

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.

ANNOUNCEMENTS

IOM Recommends Replacing 510(k); FDA Disagrees

The Institute of Medicine (IOM) has said that the U.S. fast-track approval process for medical devices is fatally flawed and should be replaced, but the FDA said the recommendation was a non-starter.

The FDA had asked for the IOM report as part of a broad agency review of its device unit, an area dogged by high staff turnover, funding woes and major recalls of devices ranging from artificial hips to heart defibrillators.

The IOM found the fast-track approval process, called 510(k), does not adequately protect patients, and recommended a more thorough approval process likely to raise the costs for device makers with pre-market and post-market device reviews. However, the finding was swiftly rejected by the FDA's top device official.

Read the complete Reuters article on the IOM’s report.

AGA’s Favorite Tweets from Last Week

Starting today, you will notice a new feature in AGA eDigest that highlights news items of interest featured via Twitter. If there are any articles 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:

• Become an AGA fan on Facebook.
• Join our LinkedIn group.
• Follow us on Twitter @AmerGastroAssn.
• Check out our videos on YouTube.

Our favorite tweets from last week include:

• @Rndubois: Advocates feel that pancreatic cancer needs more funding and more research: http://t.co/n79ubpo.
• @Doctor_V: 33 charts: Can @USFHealth create a more empathetic physician? http://t.co/WzLilUa.
• @RyanMadanickMD: A Blog post by a former classmate of mine: Wait a minute (or maybe 30…) http://bit.ly/qJBVD1 #hcsm #patient.
• Veins in palms scanned to reduce medical errors at NYC hospital. http://t.co/uZFAwF3 via @Reuters.

RESEARCH

Your AGA Research Foundation Gifts Support ...

 … James Franciosi, MD, MS, MSCE, who received the June and Donald O. Castell Esophageal Clinical Research Award in 2011.

“This award will provide me with the opportunity to conduct my research project entitled, “Long-term Pediatric Eosinophilic Esophagitis Therapies: Are We Causing Harm?” In this project, we aim to determine the impact of long-term dietary elimination and swallowed corticosteroid therapies for pediatric eosinophilic esophagitis (EoE) on bone mineral density. EoE has the potential to compromise bone mineral density in growing children. Through the support that this grant provides, we are seeking to generate initial pilot data for future NIH NIDDK-directed funding mechanisms of larger, multisite longitudinal investigations.”

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

Deadlines Approaching for Research Awards

Investigators at all stages of their careers are invited to apply for research funding from the AGA Research Foundation. Applications are due in early September for the following grants:

For established investigators:
Established investigators may apply for the R. Robert and Sally Funderburg Research Scholar Award in Gastric Biology Related to Cancer. Investigators working in the fields of gastric mucosal cell biology, regeneration and regulation of cell growth (not as they relate to peptic ulcer disease or repair), inflammation (including Helicobacter pylori) as precancerous lesions, genetics of gastric carcinoma, oncogenes in gastric epithelial malignancies, epidemiology of gastric cancer, etiology of gastric epithelial malignancies, or clinical research in the diagnosis or treatment of gastric carcinoma are eligible. Applications are due Sept. 2.

For fellows:
GI fellows who are interested in independent research careers are invited to apply for the Fellowship to Faculty Transition Award, which provides salary support to further research training in gastrointestinal, liver function or related diseases. The additional two years of research training provided by this award should broaden and expand the scope of investigative tools available to the recipient, generally in basic disciplines such as cell or molecular biology or immunology. Applications are due Sept. 2.

For junior faculty:
Research scholar awards, including the AGA-Takeda Research Scholar Award in GERD, provide $60,000 per year for two years to young faculty (not fellows) 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 Sept. 9.

Complete eligibility requirements and application information are available on the AGA website.

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.

EDUCATION & MEETINGS

2012 AGA Clinical Congress to Present Latest in Patient Care

The 2012 AGA Clinical Congress of Gastroenterology and Hepatology: Practice, Evidence and Quality in 2012 will review the latest updates on key clinical issues that arise in everyday practice. Congress director, Marcia R. Cruz-Correa, MD, PhD, AGAF, and congress co-director, David A. Lieberman, MD, AGAF, have developed a comprehensive clinically focused program that covers the full spectrum of GI and hepatic disorders, helping attendees to enhance their clinical decision-making skills and improve patient care. The congress will be held on Jan. 20 and 21, at the Loews Miami Beach Hotel, FL.

The in-depth congress program includes six general sessions and nine breakout sessions, allowing attendees to customize their learning experience. Program highlights include:

• Technical and Quality Improvements in Colonoscopy — What Is Likely to Impact your Practice?
• Update on Treatment Options for Hepatitis C.
• Food Allergies and Eosinophilic Gastroenteritis: Real or Imagined?
• Biliary Dyskinesia: Advances in Diagnosis and Management.
• Gastroparesis: Evolving Tools.
• My IBD Patient: Complications of Treatment with Immune Modulators and Biologics.

The program also incorporates the latest information on how to best manage and treat pediatric patients. One of the most interesting aspects of the program is a review of difficult patient cases, which are submitted by attendees and chosen by the faculty. Attendees are encouraged to submit a case to be considered for review. Prizes will be awarded to those whose cases are selected. 

Special incentives are available for AGA member trainees, including free registration for the congress and a corresponding practice skills workshop, which follows the congress on Jan. 22, and eligibility to receive a travel award.

Trainees can also submit an abstract and present their research. This is a valuable opportunity to receive feedback from the faculty and other attendees in a small, relaxed environment. Selected abstracts will be published in Clinical Gastroenterology and Hepatology. Abstract submission will open on Aug. 15.

Other events held alongside the congress include a practice management course, a practice skills workshop for trainees and a maintenance of certification (MOC) review course. Congress registrants can register for the practice management course or the MOC course at a discount. Those who register for the congress on or before Oct. 31 will receive free access to the 2012 congress online sessions.

Learn more and register.

Train the Trainers Program
Apply now for this exciting program that will bring two educators to Xi’an, China, April 15–20, 2012, to develop their teaching and training skills. Learn More

JOURNALS & PUBLICATIONS

Gastro & CGH Video Abstracts of the Month

Watch Patrick Tan, MD, discuss his recently published Gastroenterology article, “Intrinsic Subtypes of Gastric Cancer, Based on Gene Expression Pattern, Predict Survival and Respond Differently to Chemotherapy.” Provide your thoughts and comments on this important study via the YouTube comments tool.

 

Also watch Timothy B. Gardner, MD, discuss his recently published Clinical Gastroenterology and Hepatology article, “Early Fluid Resuscitation Reduces Morbidity Among Patients with Acute Pancreatitis.” 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.

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.

Central Pennsylvania
Excellent opportunity for BC/BE gastroenterologist. Well-established, seven-physician practice with state-of-the-art ASC, fully operational EMR and soon-to-open new office with growth potential. Outstanding salary, benefits and incentive compensation plan. Learn more about our practice at www.gicare.com. Fax curriculum vitae to 717-761-0465, attention: Lisa Scicchitano or e-mail lscicchitano@gicare.com. 

North Carolina
Gastroenterologist Opportunities — Charlotte, NC

The division of gastroenterology at Carolinas Medical Center (CMC) has recently established a new and growing GI fellowship program and is seeking two full-time faculty members who have a commitment to excellence in clinical care and teaching. One of the candidates should have a strong interest and expertise in EUS, and while not required, additional experience with ERCP would be desirable. The other candidate should have strong general GI skills along with an interest in clinical research related to an additional area of focus such as esophageal disease, pancreatic disease, IBD, motility or QI.

CMC is one of the most comprehensive acute care hospitals in the Carolinas, and the largest hospital in Carolinas HealthCare System (CHS), which comprises more than 30 affiliated hospitals. With 874 beds and the region’s only level one trauma center, CMC treats patients from a widespread geographic area. Each year, CMC has more than 50,000 inpatient discharges, more than 6,500 newborn deliveries, more than 31,000 surgical procedures, and more than 110,000 emergency department visits.

We offer award-winning facilities, excellent benefits and a quality of life second to none. CHS is committed to being the leading provider of health-care services and sponsor of educational programs.

For more information or to submit a CV for consideration, please contact:

Geri Deutschman at geri.deutschman@carolinashealthcare.org.

704-355-6931 Office / 800-847-5084 Toll Free / 704-355-5033 Fax

http://physicians.carolinashealthcare.org

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. August 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.