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News From The Literature Phenotype at Diagnosis Predicts Recurrence Rates in Crohn's Disease Phenotype at diagnosis has a predictive value for disease recurrence with upper gastrointestinal disease being the most important positive predictor, find researchers in the latest issue of Gut. In Crohn's disease, studies associating phenotype at diagnosis and disease activity are important for patient counseling and health care planning. Doctors from the Netherlands calculated disease recurrence rates and correlated these with phenotypic traits at diagnosis, prospectively assembling a European-population-based inception cohort of Crohn's patients. The patients were classified according to the Vienna classification for disease phenotype at diagnosis and the researchers calculated surgical and non-surgical recurrence rates throughout a 10 year follow up period. Multivariate analysis was performed to classify risk factors present at diagnosis for recurrent disease. The team classified a total of 358 for phenotype at diagnosis. Of those classified, 73 percent had a first recurrence and 32 percent a first surgical recurrence during the first 10 years after diagnosis. The researchers found that patients with upper gastrointestinal disease at diagnosis had an excess risk of recurrence, noting that age 40 years at diagnosis was protective. The team observed that colonic disease was a protective characteristic for resective surgery and that more frequent resective surgical recurrences were reported from Copenhagen. – Newsfeed from GastroHep.com Gut; 2006: 55: 1124-30
Mutant Gene Causes Congenital Malabsorptive Diarrhea A newly discovered disorder characterized by malabsorptive diarrhea and a lack of intestinal enteroendocrine cells is caused by mutations in Neurogenin-3 (NEUROG3), reports last week's New England Journal of Medicine. NEUROG3 is expressed in endocrine progenitor cells and is required for endocrine-cell development in the pancreas and intestine. The NEUROG3 gene is therefore a candidate for the cause of a newly discovered autosomal recessive disorder which is characterized by generalized malabsorption and a paucity of enteroendocrine cells. Researchers from California screened genomic DNA from three unrelated patients with sparse enteroendocrine cells for mutations of NEUROG3. The team then tested the ability of the observed mutations to alter NEUROG3 function, using in vitro and in vivo assays. The investigators found that patients had few intestinal enteroendocrine cells positive for chromogranin A. However, the patients had normal numbers of Paneth's, goblet, and absorptive cells. The team identified two homozygous mutations in NEUROG3. Both of these mutations rendered the NEUROG3 protein unable to activate NEUROD1, a downstream target of NEUROG3. The investigators noted that the mutations compromised the ability of NEUROG3 to bind to an E-box element in the NEUROD1 promoter. – Newsfeed from GastroHep.com New England Journal of Medicine; 2006: 355(3): 270-80
Cancer Incidence Much Higher in People with Hep B or C The risk of hepatocellular carcinoma is 20 to 30 times greater with hepatitis B or C than in the uninfected population, report a team of doctors in the latest Journal of Hepatology. Risks of hepatocellular carcinoma following hepatitis B and/or hepatitis C virus infection are well known, while those for other cancers are less well understood. An Australian research team quantified the risk of cancers among persons diagnosed with hepatitis B and C infections, accessing data from 39,109 hepatitis B, 75,834 hepatitis C and 2,604 co-infected persons notified to the State health department from 1990 to 2002. The team of doctors probabilistically linked the data to the Cancer Registry and standardized incidence ratios for cancer were calculated. The match rate for any cancer was 3 percent, 2 percent and 3 percent for hepatitis B, hepatitis C and co-infected notifications, respectively. The doctors found that the standardized incidence ratios for hepatocellular carcinoma were 32, 23, and 30, for hepatitis B, C and co-infection, respectively. The team detected an increased risk for Burkitt's lymphoma and hepatitis B, and immunoproliferative malignancies following hepatitis C. – Newsfeed from GastroHep.com Journal of Hepatology; 2006: 45(2): 197-203
Smoking Does Not Decrease Pouchitis after Surgery in Ulcerative Colitis The latest issue of the Scandinavian Journal of Gastroenterology reports that smoking does not decrease the risk of pouchitis following ileal pouch anal anastomosis for ulcerative colitis. According to epidemiological studies, a smoking habit is strongly associated with inflammatory bowel disease (IBD) in that non-smokers, and especially recent ex-smokers, have an increased risk of ulcerative colitis. Conversely, concerning Crohn's disease, the risk is increased among smokers. Pouchitis is the major long-term complication of restorative proctocolectomy for ulcerative colitis and seems to be pathogenetically related to this condition. Swedish doctors tested the hypothesis that smoking reduces the risk of pouchitis, investigating whether cessation of smoking precedes the onset of the inflammation. The team included 410 living patients operated on for ulcerative colitis with proctocolectomy and ileal pouch anal anastomosis between 1982 and 1996. Data concerning smoking habits and pouchitis were obtained from questionnaires and from medical records. The correlation between smoking habits and incidence of pouchitis was statistically evaluated by means of a survival test and a multivariate analysis. The team reported that 80 percent completed the questionnaires. The researchers found that 29 percent of these patients had had at least one episode of pouchitis and that smoking habits during follow-up did not significantly influence the risk of pouchitis. The team observed that neither smoking habits before or at the time of ileal pouch anal anastomosis correlated with the incidence of pouchitis and that women had a decreased risk of pouchitis, compared to men. The researchers identified a non-significant tendency for smoking to increase the risk, which was more pronounced in women. – Newsfeed from GastroHep.com Scandinavian Journal of Gastroenterology; 2006: 41(8): 929-33
Endoscopic Screening for Esophageal Cancer in High-risk Patients July's issue of Endoscopy reports that cancer endoscopic screening using Lugol staining is justified with head and neck cancer due to the high prevalence of esophageal cancer in these patients. The prevalence of esophageal squamous-cell carcinoma in high-risk patients had not yet been evaluated in a large prospective study. Likewise, the advantages of systematic Lugol staining during esophagoscopy had also not yet been assessed within this context. French researchers assessed the prevalence of this type of tumor in high-risk patients, examining the role of Lugol staining in endoscopic screening for esophageal squamous-cell carcinoma. The team established whether it is possible to identify a particularly high-risk group which would benefit from systematic screening by undertaking a prospective study in 62 endoscopy centers. The team enrolled a total of 1,095 patients divided into four groups, none of whom had any esophageal symptoms. Patients in Group 1 had presented with either a past history of or a recent head and neck or tracheobronchial squamous-cell carcinoma. Group 2 included patients with alcoholic chronic pancreatitis, while Group 3 had patients with alcoholic cirrhosis. The team included patients who were alcohol and tobacco addicts in Group 4. The patients underwent a meticulous endoscopic examination of the esophagus, followed by Lugol staining. The researchers found that the prevalence of esophageal squamous-cell carcinoma was 3 percent. The Group 1 patients showed the highest prevalence of carcinoma at 5 percent, and the highest prevalence of dysplasia at 4 percent. Of the 35 carcinomas detected in the 1,095 patients, the team noted that 20 percent were early lesions, and 20 percent were only detected after Lugol staining. The researchers observed high grade dysplasia only in Group 1 patients and 75 percent of these lesions were only diagnosed after Lugol staining. The overall prevalence of low-grade dysplasia was 2 percent. The researchers detected 77 percent of these only after Lugol staining. – Newsfeed from GastroHep.com Endoscopy; 2006: 38: 690-5
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Policy Update Energy and Commerce Hearing Held on Medicare Physician Payment On July 25, the Energy and Commerce Committee’s Subcommittee on Health held its first of two hearings entitled “Medicare Physician Payment: How to Build a Payment System that Provides Quality, Efficient Care for Medicare Beneficiaries.” Invited witnesses included the Congressional Budget Office, the Government Accountability Office, the Medicare Payment Advisory Commission (MedPAC) and The Commonwealth Fund. The main focus of the hearing was to address problems in the sustainable growth rate (SGR) formula and its negative impact on providing fair payments to physicians. The SGR unfairly uses a volume control mechanism that is tied to the gross domestic product. Unless the flaws in the SGR are addressed, physicians are facing a payment update of -4.6 percent for 2007 and almost 5 percent negative updates per year through 2013. MedPAC has specifically recommended that the SGR be eliminated and replaced by the Medicare Economic Index (MEI), though MedPAC has also stated that physicians may not receive the full MEI each year. In March 2007, MedPAC will report to Congress on alternatives to the SGR. At this time, there are several bills under development in Congress to address the SGR issue. Representative Michael Burgess, R-TX, introduced legislation to replace the SGR with the MEI on Jan. 1, 2007. Representative John Dingell, D-MI, stated that he plans on introducing legislation to provide two years of positive physician updates until there is a permanent solution. Due to the elections and the abbreviated legislative session, Congress has little time this year to address a permanent solution, but it is possible there may be a short-term fix enacted in a post-election lame duck session of Congress. Subcommittee members commented that there have been no cost solutions proposed to pay for elimination of the SGR. The committee will work on determining possible areas for cost savings. Every year that the expenditure target is exceeded contributes to higher negative updates in future years since remedies in past years have “borrowed” from future payments (with the exception of the remedy enacted last year). At this time, it is estimated to cost at least $180 billion over 10 years to fix the SGR system. One possible area of cost savings discussed is to explore lowering payments to Medicare HMO plans. Issues surrounding quality of care and pay for performance will be addressed at the next hearing.
NIH Announces Creation of Commission Working Groups The NIH has announced the creation of 13 Working Groups as an integral part of creating a long-range research plan under the National Commission on Digestive Diseases. As part of the announcement, the NIH also issued a call for nominations for the Working Groups. The Commission has long been one of the AGA’s highest legislative priorities. In late 2004, the AGA secured legislative language creating the Commission and has worked closely with policymakers on the establishment of the important group. As noted on the commission Web site, individuals must be nominated for a specific Working Group and no nomination will be complete until the nominees’ curriculum vitae (CV) is received. Nominees must meet the following requirements:
The Working Groups will report directly to the Commission and will be chaired by a member of the Commission. Each Working Group will consist of six to eight members and will be charged with preparing a report relevant to the scope of the Working Group The recommendations from the Working Groups will be submitted to the full Commission for review and approval in meetings open to the public. The reports then will be incorporated into the final report of the Commission. For more information and to view a list of the Working Groups, please go to the commission Web site at http://www.niddk.nih.gov/federal/ncdd/index.htm. Nominations will be accepted until Aug. 18, 2006.
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News For Clinicians GI-specific Patient Satisfaction Tools Developed — Member Feedback Sought The AGA Institute’s Center for Quality in Practice (CQIP) has developed GI-specific patient satisfaction tools for the outpatient office and endoscopy settings. The Center’s Advisory Group is exploring mechanisms for collecting patient satisfaction data for our members using the newly developed tools and reporting the data back to practices in a confidential and meaningful way. To ensure the final survey tools meet the needs of AGA members, the AGA Institute is asking members to review the survey tools and provide feedback before the tools are finalized. The survey tools and a member feedback form have been posted on the AGA Web site and will remain through Aug. 15. The AGA Institute encourages all members who see patients to review the survey tools and provide their feedback. Members who have questions about these survey tools or other information related to the AGA Institute’s Center for Quality in Practice can contact Debbie Robin, senior director for quality at drobin@gastro.org.
Call for Editor for New AGA Institute Press Publication In January 2007 the AGA Institute Press will launch a new monthly publication entitled GI & Hepatology News. This publication will be the official newspaper of the Association. The newspaper will provide a wide range of content comprised of: techniques and approaches employed by experts in gastroenterology, hepatology, endoscopy and related areas; opinion and commentary from noted authorities in their respective fields on the latest published findings and important relevant educational opportunities and developments. Industry news content will be provided by Elsevier’s International News Group. Content will be based on coverage of research findings and relevant major North American and selected international meetings, including coverage of Association-sponsored meetings and symposia. The newspaper will also include select Association news. The AGA Institute Press is now accepting applications for the position of editor of GI & Hepatology News. The editor position is a volunteer position and is not part of the Association’s paid managerial staff. The editor will be responsible for the intellectual and physical quality of the publication as well as its fiscal integrity. A permanent editorial office in Bethesda, Maryland, staffed by a managing editor and an editorial assistant, will coordinate the newspaper’s review and production process. The term of the position is five years. To obtain more information or to request an application for the position, contact Debra Raden, at draden@gastro.org, or (301) 941-2635. Completed applications are due Aug. 31, 2006.
Learn How to Improve Patient Scheduling and Access Register for a complimentary audio conference presented by the AGA Institute and Physicians Practice and learn strategies for improving patient scheduling and access. The course is part of a complimentary CME series that provides gastroenterologists — particularly those who treat patients with HCV — with information to help improve the operational side of their practices, so they can concentrate on providing better patient care. Speaker Nick Fabrizio, PhD, will offer insights on juggling busy clinic and surgery schedules while caring for challenging HCV patients. Fabrizio will describe basic scheduling methodologies and techniques for improving patient care. The audio conference will take place on Tuesday, Aug. 22, 2006, from noon to 1 p.m. ET. Register online to attend the audio conference and to receive a copy of the August issue of the Patient-Centered Gastroenterology Practice newsletter. This issue’s topics include: scheduling strategies to improve balance between gastroenterologist and patient needs, legal and ethical considerations of HCV treatment, and electronic solutions to meet the challenges of patient tracking. For more information, visit the The Patient-Centered Gastroenterology Practice Web site, call (866) 858-7434, or e-mail info@physicianspractice.com. Medical Education Solutions Group designates that this activity has been approved for AMA PRA Category 1 Credit. This program is supported by an educational grant from Roche Laboratories Inc.
New Online Case Studies Available AGA Institute Cases Online, a series of online interactive cases, has released two new cases:
Each case offers at one hour of Category 1 credit. AGA Institute Cases Online provides an evidence-based, in-depth review of the latest diagnostic and therapeutic approaches to major gastrointestinal and liver disorders. Accompanying visuals are derived from the popular Gastroenterology Teaching Project slide sets. Other cases in the series include:
For more information about the cases and other AGA Institute online education programs, please visit Online Education under the Education & Training section of www.gastro.org. The AGA is accredited by the ACCME to provide continuing medical education for physicians.
AGA Foundation Awards Available The AGA Foundation for Digestive Health and Nutrition awards nearly $3 million annually for basic and clinical research in gastrointestinal disorders. Awards are available for students, fellows, junior faculty and the established investigator. Applicants are advised to check the Foundation Web site —www.fdhn.org — frequently for updated award information. Among the awards being offered is the Designated Research Award in Research Related to Pancreatitis. This award, which provides $75,000 per year for three years, enables young investigators to develop independent and productive research careers, with a focus on pancreatic disease, by ensuring that a major proportion of their time is protected for research. Non-recipient applicants for this award will be considered for the Research Scholar Awards. The deadline for the Designated Research Award in Research Related to Pancreatitis is Sept. 5, 2006 with an award start date of July 1, 2007. One of the new awards offered by the AGA Foundation is the Bridging Grants Awards. These awards will provide interim support to AGA Members who have submitted grants to NIH that were approved on the basis of scientific merit, but received priority scores out of the funding range. Each award will provide $50,000 to help pay for the researcher’s laboratory supplies and personnel. Two awards will be offered following the NIH review cycles. Deadlines for the Bridging Grants Awards are Sept. 14, 2006, Jan. 14, 2007 and May 14, 2007. Awards will start upon approval. For a complete listing of all AGA Foundation award guidelines, eligibility requirements, deadline dates and electronic applications, visit the Foundation Web site at www.fdhn.org.
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News For Academic Clinicians & Researchers New Online Case Studies Available AGA Institute Cases Online, a series of online interactive cases, has released two new cases:
Each case offers at one hour of Category 1 credit. AGA Institute Cases Online provides an evidence-based, in-depth review of the latest diagnostic and therapeutic approaches to major gastrointestinal and liver disorders. Accompanying visuals are derived from the popular Gastroenterology Teaching Project slide sets. Other cases in the series include:
For more information about the cases and other AGA Institute online education programs, please visit Online Education under the Education & Training section of www.gastro.org. The AGA is accredited by the ACCME to provide continuing medical education for physicians.
Disclosure of Registration of Clinical Trials for Journals When submitting manuscripts describing results of clinical trials to Gastroenterology and Clinical Gastroenterology and Hepatology (CGH), authors are now required to disclose information on the registration status of the trial. This requirement is regarded as a transitional step toward a policy of mandating registration of the clinical trial as a condition for publication in the AGA Institute journals. A clinical trial is defined as any research project that prospectively assigns human subjects to intervention and comparison groups to study the cause-and-effect relationship between a medical intervention and a health outcome. The trial must have at least one prospectively assigned concurrent control or comparison group in order to trigger the requirement for registration. The final policy is expected to be implemented in December 2007, at which time both journals will adopt the recommendations put forth by the International Committee of Medical Journal Editors (ICMJE). Gastroenterology and CGH editors Anil K. Rustgi, MD, and Michael Camilleri, MD support the ICMJE policy. For more information on the ICMJE recommendations, please go to http://www.icmje.org/#clin_trials. For studies that start after 2007, or those in which the final patient completed treatment after December 2007, full registration will be required. As part of the electronic submission process, authors will be required to provide the clinical trial number obtained from the trials Web site. Clinical trials should be registered at an appropriate online trial registry such as: www.clinicaltrials.gov, www.isrctn.org, www.umin.ac.jp/ctr/index.htm, www.actr.org.au or www.trialregister.nl.
AGA Foundation Awards Available The AGA Foundation for Digestive Health and Nutrition awards nearly $3 million annually for basic and clinical research in gastrointestinal disorders. Awards are available for students, fellows, junior faculty and the established investigator. Applicants are advised to check the Foundation Web site —www.fdhn.org — frequently for updated award information. Among the awards being offered is the Designated Research Award in Research Related to Pancreatitis. This award, which provides $75,000 per year for three years, enables young investigators to develop independent and productive research careers, with a focus on pancreatic disease, by ensuring that a major proportion of their time is protected for research. Non-recipient applicants for this award will be considered for the Research Scholar Awards. The deadline for the Designated Research Award in Research Related to Pancreatitis is Sept. 5, 2006 with an award start date of July 1, 2007. One of the new awards offered by the AGA Foundation is the Bridging Grants Awards. These awards will provide interim support to AGA Members who have submitted grants to NIH that were approved on the basis of scientific merit, but received priority scores out of the funding range. Each award will provide $50,000 to help pay for the researcher’s laboratory supplies and personnel. Two awards will be offered following the NIH review cycles. Deadlines for the Bridging Grants Awards are Sept. 14, 2006, Jan. 14, 2007 and May 14, 2007. Awards will start upon approval. For a complete listing of all AGA Foundation award guidelines, eligibility requirements, deadline dates and electronic applications, visit the Foundation Web site at www.fdhn.org.
Call for Editor for New AGA Institute Press Publication In January 2007 the AGA Institute Press will launch a new monthly publication entitled GI & Hepatology News. This publication will be the official newspaper of the Association. The newspaper will provide a wide range of content comprised of: techniques and approaches employed by experts in gastroenterology, hepatology, endoscopy and related areas; opinion and commentary from noted authorities in their respective fields on the latest published findings and important relevant educational opportunities and developments. Industry news content will be provided by Elsevier’s International News Group. Content will be based on coverage of research findings and relevant major North American and selected international meetings, including coverage of Association-sponsored meetings and symposia. The newspaper will also include select Association news. The AGA Institute Press is now accepting applications for the position of editor of GI & Hepatology News. The editor position is a volunteer position and is not part of the Association’s paid managerial staff. The editor will be responsible for the intellectual and physical quality of the publication as well as its fiscal integrity. A permanent editorial office in Bethesda, Maryland, staffed by a managing editor and an editorial assistant, will coordinate the newspaper’s review and production process. The term of the position is five years. To obtain more information or to request an application for the position, contact Debra Raden, at draden@gastro.org, or (301) 941-2635. Completed applications are due Aug. 31, 2006.
GI-specific Patient Satisfaction Tools Developed — Member Feedback Sought The AGA Institute’s Center for Quality in Practice (CQIP) has developed GI-specific patient satisfaction tools for the outpatient office and endoscopy settings. The Center’s Advisory Group is exploring mechanisms for collecting patient satisfaction data for our members using the newly developed tools and reporting the data back to practices in a confidential and meaningful way. To ensure the final survey tools meet the needs of AGA members, the AGA Institute is asking members to review the survey tools and provide feedback before the tools are finalized. The survey tools and a member feedback form have been posted on the AGA Web site and will remain through Aug. 15. The AGA Institute encourages all members who see patients to review the survey tools and provide their feedback. Members who have questions about these survey tools or other information related to the AGA Institute’s Center for Quality in Practice can contact Debbie Robin, senior director for quality at drobin@gastro.org.
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News for Trainees AGA Foundation Awards Available The AGA Foundation for Digestive Health and Nutrition awards nearly $3 million annually for basic and clinical research in gastrointestinal disorders. Awards are available for students, fellows, junior faculty and the established investigator. Applicants are advised to check the Foundation Web site —www.fdhn.org — frequently for updated award information. Among the awards being offered is the Designated Research Award in Research Related to Pancreatitis. This award, which provides $75,000 per year for three years, enables young investigators to develop independent and productive research careers, with a focus on pancreatic disease, by ensuring that a major proportion of their time is protected for research. Non-recipient applicants for this award will be considered for the Research Scholar Awards. The deadline for the Designated Research Award in Research Related to Pancreatitis is Sept. 5, 2006 with an award start date of July 1, 2007. One of the new awards offered by the AGA Foundation is the Bridging Grants Awards. These awards will provide interim support to AGA Members who have submitted grants to NIH that were approved on the basis of scientific merit, but received priority scores out of the funding range. Each award will provide $50,000 to help pay for the researcher’s laboratory supplies and personnel. Two awards will be offered following the NIH review cycles. Deadlines for the Bridging Grants Awards are Sept. 14, 2006, Jan. 14, 2007 and May 14, 2007. Awards will start upon approval. For a complete listing of all AGA Foundation award guidelines, eligibility requirements, deadline dates and electronic applications, visit the Foundation Web site at www.fdhn.org.
GI-specific Patient Satisfaction Tools Developed — Member Feedback Sought The AGA Institute’s Center for Quality in Practice (CQIP) has developed GI-specific patient satisfaction tools for the outpatient office and endoscopy settings. The Center’s Advisory Group is exploring mechanisms for collecting patient satisfaction data for our members using the newly developed tools and reporting the data back to practices in a confidential and meaningful way. To ensure the final survey tools meet the needs of AGA members, the AGA Institute is asking members to review the survey tools and provide feedback before the tools are finalized. The survey tools and a member feedback form have been posted on the AGA Web site and will remain through Aug. 15. The AGA Institute encourages all members who see patients to review the survey tools and provide their feedback. Members who have questions about these survey tools or other information related to the AGA Institute’s Center for Quality in Practice can contact Debbie Robin, senior director for quality at drobin@gastro.org.
New Online Case Studies Available AGA Institute Cases Online, a series of online interactive cases, has released two new cases:
Each case offers at one hour of Category 1 credit. AGA Institute Cases Online provides an evidence-based, in-depth review of the latest diagnostic and therapeutic approaches to major gastrointestinal and liver disorders. Accompanying visuals are derived from the popular Gastroenterology Teaching Project slide sets. Other cases in the series include:
For more information about the cases and other AGA Institute online education programs, please visit Online Education under the Education & Training section of www.gastro.org. The AGA is accredited by the ACCME to provide continuing medical education for physicians.
Place GI position listings and activity announcements in eDigest. 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, AGA¹s bi-monthly magazine. If you place ads in both AGA Perspectives and AGA eDigest, you will receive a 10 percent discount. For more information, contact Vivian Hayward at vhayward@gastro.org or (301) 654-2055. Alaska Arizona North Carolina Nurse Practitioner – Gastroenterology. Experienced NP needed for busy practice in Hendersonville, NC. Competitive salary and excellent benefits package. Interested candidates fax resume with references to (828) 696-3868 or e-mail bagalloway@bellsouth.net. Oregon
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Attention Trainees Renew Your AGA Membership for 2007 Now!
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