According to findings published in the most recent issue of Gastroenterology, computer-aided detection for computed tomographic colonography increases per-patient and per-polyp detection.

Computer-aided detection for computed tomographic colonography is as effective as optical colonoscopy for detection of significant adenomas. However, the unavoidable interaction between computer-aided detection and the reader has not been addressed. Doctors from England evaluated this interaction, evaluating 10 readers trained in computed tomography, but without special expertise in colonography. The readers interpreted computed tomographic colonography images of 107 patients, of which 60 had 142 polyps.

First, the readers interpreted the images without computer-aided detection. The readers then interpreted the images with computer-aided detection after a temporal separation of two months. Researchers determined per-patient and per-polyp detection by comparing responses with known results from a standard colonoscopy.

With computer-aided detection, 41 of the 60 patients with polyps were identified more frequently by readers. Per-patient sensitivity increased significantly in 70 percent of readers, while specificity dropped significantly in only 1 patient. The researchers noted that polyp detection increased significantly with computer-aided detection. On average, 12 more polyps were detected by each reader. The team found that small- and medium-sized polyps were significantly more likely to be detected when prompted correctly by computer-aided detection. However, overall performance was relatively poor; even with computer-aided detection.

The researchers identified that, on average, readers detected only 10 polyps that were 10 mm or more, and 24 polyps 6 mm or more. They observed that interpretation time was shortened significantly with computer-aided detection — by two minutes for patients with polyps and by three minutes for patients without. Overall, 90 percent of readers benefited significantly from computer-aided detection, either by increased sensitivity and/or by reduced interpretation time.

There is no clear influence of microsatellite instability status on survival, and response to chemotherapy, finds a study in the latest International Journal of Colorectal Disease.

High microsatellite instability occurs in about 15 percent of colorectal cancers. Clinical, as well as pathological, features differ from tumors exhibiting low microsatellite instability or microsatellite stability and conflicting data exists about the relevance of microsatellite instability in predicting the prognosis of colorectal cancer. There is also conflicting evidence about the benefit of 5-fluorouracil based chemotherapy in patients with colorectal cancer.

German researchers investigated the usefulness of microsatellite instability as a predictor of distinct clinical attributes influencing recurrence rate. The team also evaluated disease-free survival subject to the use of adjuvant or palliative chemotherapy with 5-fluorouracil in stage 2 to 4 of colorectal cancer. The researchers collected data and tumors of 416 consecutive stage 1 to 4 in colorectal cancer patients from 2000 to 2002. The team followed the patients for a median time of 33 months and microsatellite loci recommended by the National Cancer Institute were analyzed. The researchers used cox proportional hazard modeling to compare clinical data and survival and evaluated the associations for microsatellite instability and 5-fluorouracil treatment status with high microsatellite instability colorectal cancer. The researchers assessed the associations of microsatellite instability and 5-fluorouracil with low microsatellite instability or stability in colorectal cancer.

The researchers identified high microsatellite instability in 13 percent, low microsatellite instability in 5 percent and microsatellite stability tumors in 82 percent of patients studied. Colorectal cancer with high microsatellite instability tended to have a decreased likelihood of metastasising to regional lymph nodes. However, the researchers noted that age of diagnosis and tumor location did not differ. The team found no difference between high microsatellite instability and microsatellite stability groups regarding disease-free and overall survival when chemotherapy was not taken into account. Furthermore, survival under application of 5-fluorouracil did not correlate with microsatellite instability status.

Mailed brochures are effective in increasing patient adherence to primary care physician referral for screening colonoscopy, according to findings in the Annals of Internal Medicine.

Even when primary care physicians have face-to-face discussions with patients before making screening colonoscopy referrals, nonadherence can be substantial. Often, primary care physicians lack sufficient time to educate patients and address their potential misconceptions, and fears about this procedure. Investigators evaluated an innovative approach to increasing patient compliance with completion of the colonoscopy procedure, assessing whether an informational brochure sent to patients' home addresses after referral for colonoscopy would increase patient compliance.

The doctors conducted a randomized, controlled trial in two general internal medicine practices. The trial included 781 consecutive patients, 50 years of age or older, referred by their primary care physicians for screening colonoscopy. Doctors randomly assigned patients to a control group that received usual care or an intervention group, which received usual care plus an informational brochure. The brochure was mailed within 10 days of referral for screening colonoscopy. The brochure mentioned the name of the patient's primary care physician, and encouraged patients to schedule a procedure. The brochure also described colorectal cancer and polyps and the similar lifetime risks of colorectal cancer for men and women. In addition, colonoscopy and risk for perforation, the nature of bowel preparation for the procedure, and alternative screening tests were described.

The team found that the overall adherence rate was 12 percentage points greater in the intervention group than in the control group. Doctors observed that older patients were more adherent than younger patients and noted that patients with low-income insurance plans — such as Medicaid — were less adherent, despite being sent a brochure. The team reported that the small number of clinical practices and minority patients included may limit generalizability of their study. The team did not determine the degree to which adherence was influenced by a reminder to schedule a procedure versus detailed information about colonoscopy.

Long-term Proton pump inhibitor (PPI) therapy is associated with an increased risk of hip fracture, reports a study in the Journal of the American Medical Association.

PPIs may interfere with calcium absorption through induction of hypochlorhydria and may also reduce bone resorption through inhibition of osteoclastic vacuolar proton pumps. Researchers in Philadelphia determined the association between PPI therapy and risk of hip fracture, conducting a nested case-control study using the General Practice Research Database from 1987 to 2003, which contains information on patients in the U.K. The study compared 13,556 patients to 135,386 controls.

The study cohort consisted of users of PPI therapy and nonusers of acid suppression drugs who were older than 50 years. The researchers evaluated all patients with an incident hip fracture. They selected controls using incidence density sampling matched for sex, index date and year of birth. In addition, the controls were matched for both calendar period and duration of up-to-standard follow-up before the index date. For comparison purposes, the researchers performed a similar nested case-control analysis for histamine 2 receptor antagonists (H2RAs). The team's main outcome measure was the risk of hip fractures associated with PPI use.

The adjusted odds ratio for hip fracture associated with more than one year of PPI therapy was 1.4. The team noted that the risk of hip fractures was significantly increased among patients prescribed long-term high-dose PPIs, with an odds ration of 2.65. The corresponding odds ratios for use of H2RAs were 1.23 and 1.3, respectively. The strength of the association increased with increasing duration of PPI therapy with an odds ratio of 1.4 at two, 1.5 at three and 1.6 at four years.

A study reported in the latest issue of Gastroenterology shows that rofecoxib significantly reduces the risk of colorectal adenomas, but also has serious toxicity.

In human and animal studies, nonsteroidal anti-inflammatory drugs have been associated with a reduced risk of colorectal neoplasia. While the underlying mechanisms are unknown, inhibition of cyclooxygenase (COX), particularly COX-2, is thought to play a role. investigators conducted a randomized, placebo-controlled, double-blind trial to assess whether use of the selective COX-2 inhibitor rofecoxib would reduce the risk of colorectal adenomas.

The investigators randomized 2,587 subjects with a recent history of histologically confirmed adenomas to receive daily placebo or 25 mg rofecoxib; randomization was stratified by baseline use of cardioprotective aspirin. The investigators planned colonoscopic follow-up evaluation for one and three years after randomization and the primary end point was all adenomas diagnosed during three years of treatment. In a modified intent-to-treat analysis, the investigators computed the relative risk of any adenoma after randomization. The team used Mantel-Haenszel statistics stratified by low-dose aspirin use at baseline.

Adenoma recurrence was less frequent for rofecoxib subjects than for those randomized to placebo. The investigators found that rofecoxib also conferred a reduction in risk of advanced adenomas. The chemopreventive effect was more pronounced in the first year than in the subsequent two years. The investigators noted that rofecoxib was associated with increased risks of upper gastrointestinal events, and serious thrombotic cardiovascular events.

Members of the 110th Congress were sworn in on Jan. 4, 2007 and the House elected Rep. Nancy Pelosi, D-CA, as the first female Speaker of the House. With the Democrats back in control of both the House and Senate for the first time since 1994, the House immediately enacted new “pay-go” budget rules and earmark reforms. The pay-go rules (short for pay-as-you-go) require any new spending or tax cuts which increase the deficit to be offset with a corresponding budget cut or tax increase. The earmark reform provision requires the sponsor of the earmark — usually projects that members request federal funding for through appropriations bills — to be identified in all appropriations, authorizing and tax legislation and to provide a justification for each earmark.

As part of the new Democratic agenda, the House plans to vote this week on H.R. 3, legislation that would authorize federal funding of stem cell research. President Bush has indicated that he will veto such legislation. The House will also vote on H.R. 4, the Medicare Prescription Drug Price Negotiation Act of 2007, which requires the Secretary of HHS to directly negotiate with pharmaceutical manufacturers to achieve discounted prices for Medicare-covered prescription drugs similar to the Veteran’s Administration. The Senate also plans to vote on both of these measures, but has not scheduled a date.

The Medicare Payment Advisory Commission (MedPAC) met last week to finalize its discussions on possible options for replacing the current sustainable growth rate (SGR), an expenditure target formula used to calculate annual physician payment updates under Medicare. Over the past several years, Congress has repeatedly overridden scheduled fee cuts under the SGR.

Due to the complexity of the subject, time constraints and inability to fully evaluate many abstract ideas — and because of lack of unanimous consent on the variety of issues under consideration — the Commission opted not to make any specific recommendations to Congress. Instead, the commission will present alternative paths for consideration on remedying the SGR and their advantages and disadvantages.

MedPAC’s report to Congress, to be released on March 1, was mandated under the Deficit Reduction Act. MedPAC was asked to review five possible alternatives to the SGR and ways to set expenditure targets: by geographic area, type of service, medical group, hospital medical staff and outliers. In addition, MedPAC looked at setting targets by specialty and by reconfiguring the SGR formula.

MedPAC also provided two pathways for consideration. Pathway 1 would repeal the SGR and develop and adopt new approaches for improving value. Pathway 2 would create a new system of expenditure targets using a phased approach, from rewarding or penalizing physicians based on individual quality performance, moving to differentiating payments by geography and eventually offering providers an opportunity to share in savings.

MedPAC will report to Congress that most physicians are accepting all or most new Medicare patients. Physicians report that practice changes in the past year include increasing their number of patients and expanding in-office tests, lab services and imaging services. Lastly, MedPAC recommended a 1.7 percent physician update for 2008, which includes $1.35 billion allocated under the Tax Releif and Health Care Act.

MedPAC is an advisory body to Congress and, as such, Congress is not bound to accept the commission’s recommendations. However, Congress does review and consider the commission’s suggestions. Transcripts of this meeting, as well as MedPAC’s reports to Congress, may be accessed on www.MedPAC.gov.

CMS has released an MLN Matters article pertaining to the recent legislative change updating the 2007 Medicare Physician Fee Schedule.

The Tax Relief and Health Care Act of 2006 sets the 2007 conversion factor for physician payment at the same level as in 2006 ($37.8975), reversing the statutorily mandated 5.0 percent negative update. This change is effective for services provided on or after Jan. 1, 2007.

Both CMS and your local carriers should now have new fee schedules published on their Web sites. CMS has also extended the Medicare participation enrollment period to Feb. 14, 2007; however, the effective date for any participation change is Jan. 1, 2007.

In early January, CMS will begin dissemination of another Medicare Contractor Provider Satisfaction Survey (MCPSS) to a new sample of 35,000 randomly selected Medicare providers. The survey is designed to garner quantifiable data on provider satisfaction levels with key services performed by the fee-for-service contractors that process and pay more than $280 billion in Medicare claims each year.

The MCPSS focuses on seven major aspects of the provider/contractor relationship: provider communications, provider inquiries, claims processing, appeals, provider enrollment, medical review, and provider audit and reimbursement. CMS will use the survey data to support claims processing improvement by contractors and to reform the Medicare Program.

Further information about the MCPSS and results of the 2006 survey are available at: http://www.cms.hhs.gov/MCPSS/.

The AGA Institute offers members access to an extensive listing of funding opportunities, updated monthly, via the Community of Science™ (COS) database, the largest, most comprehensive database of funding available. The COS database includes:

• More than 22,000 records representing over $33 billion in funding.
• Opportunities by sponsors throughout the world for recipients throughout the world.
• Sponsors include private foundations, public agencies, national and local governments, corporations and more.
• Funding for many purposes, such as research, collaborations, travel, curriculum development, conferences, fellowships, postdoctoral positions, equipment acquisitions, and capital or operating expenses.

Recent updates have been made in the following sections of the database tailored for GI, housed on the AGA Web site:

Awards Related to Gastroenterology
Awards Related to Irritable Bowel Syndrome
Awards Related to Liver

A listing of COS Funding Opportunities™ for gastroenterologists can be found online at the AGA Web site. The listing is available only to members and requires logging in to the site using your AGA member number.

Member-only registration and housing for DDW® 2007 opened Jan. 9, 2007. AGA members are encouraged to take advantage of this opportunity to reserve their first choice of hotel options and secure their admission to popular ticketed sessions before general registration opens on Jan. 18.

In addition, AGA members who register before the Apr. 13 early-bird registration deadline receive complimentary registration to DDW and pay discounted registration fees for the AGA Institute Spring Postgraduate Course.

The preliminary program for DDW 2007, the registration and housing form, the AGA Spring Postgraduate Course brochure, and other registration materials are now available online. Download registration materials.

The AGA Institute is pleased to announce that registration is now open for the third annual Gastroenterology Training Examination (GTE)™. GI training directors will be able to offer the exam at their institution any day during the two-week period of April 10–24, 2007. The GTE is a standardized measurement tool unique to GI, whose primary goal is to measure the progress of training and promote continuous improvements to the GI curriculum.

The GTE has proven to be statistically valid in measuring the performance of GI fellows. The second annual GTE, held April 18-25, 2006, was extremely successful. A total of 131 programs registered 788 fellows. These numbers show an increase in participation of 16 percent for fellows and 11 percent for programs over the first annual GTE held in April 2005. This increase in registration reflects a continued level of confidence among training programs that the GTE serves as a valid means of gauging training progress.

This year’s GTE will be again administered as a formal, closed-book exam covering the broad spectrum of GI and liver topics. However, this year’s exam offers several new features, including:

• A user-friendly, web-based format.
• A test window expanded to two full weeks.
• Flexibility to schedule multiple exam sessions on the same day.
• New content to assess additional skills and knowledge.
• An additional 50 test questions, increasing the total number of questions to 200.
• New images from AGA Institute’s Gastroenterology Teaching Project.
• Immediate post-exam scoring for fellows of items answered correctly.

The deadline for training programs to register their fellows is April 2, 2007. The exam fee is $250 per fellow. For more information, visit www.gastro.org/GTE.

The AGA Institute funds the GTE to support the professional development of all gastroenterology fellows.

Advances in GI clinical care are happening at a rapid pace. In response to the changing field, AGA Institute’s 2007 Spring Postgraduate Course, 21st Century Tools for Managing Gastrointestinal and Liver Disease, to be held May 19-20, in Washington, DC, will expose attendees to new clinical approaches and technologies, as well as their implications in day-to-day practice.

This year’s course will be led by course director, Francis M. Giardiello, MD, and course co-directors, Marcia Cruz-Correa, MD, PhD, and Jean-Pierre Raufman, MD. Over two days, attendees will hear from an expert panel who, using a case-based approach, will focus on nutrition, obesity, use of genetic testing and other molecular technologies, endoscopy and noninvasive imaging, and other innovations in the delivery of clinical care.

The course offers a flexible format that allows attendees to pick and choose their sessions while providing an opportunity to customize the course to meet their needs and interests. The course consists of six general session presentations and panel discussions as well as a choice of 18 luncheon breakout sessions and nine clinical challenge sessions. Simultaneous oral translation in Spanish of the general sessions will be offered and you can reserve your headset when you register for the course.

A syllabus containing abstracts, key points, references, slides, graphs, charts and tables will be provided to all attendees. In addition, individuals can purchase a subscription to the sessions online and/or a course CD-ROM, including audio and slides from lectures and breakout sessions. Additional copies of the syllabus will also be available for purchase on site.

For complete course information and to register, visit www.gastro.org/pgcourse. Register by April 13, 2007 and take advantage of a $75 early-bird discount. Advanced registration is encouraged.

This activity has been approved for AMA PRA Category 1 Credit(s)™.

The National Pancreas Foundation is holding a Fellows Symposium from April 13 to 15, 2007, in Chicago.

This will be a key opportunity to mingle with and learn from the best minds in the field, within the relaxed and comfortable setting of Indian Lakes resort. Attending mentors will include, among others: Phillip P. Toskes, professor of medicine, University of Florida College of Medicine, Gainesville; Peter A. Banks, director of the Center for Pancreatic Disease at Brigham & Women’s Hospital, Boston; David C. Whitcomb, director of the Center of Genomic Sciences, Gastroenterology, Hepatology and Nutrition, University of Pittsburgh; Jeffrey B. Matthews, chair of the Department of Surgery, University of Chicago; Steven D. Freedman, director of the Pancreas Center at Beth Israel Hospital, Boston; Andres Gelrud, co-director of the University of Cincinnati Pancreatic Disease Center; and Ashok Saluja, vice chair of the Department of Surgery, University of Minnesota, Minneapolis.

Topics will include presentations around acute and chronic pancreatitis, surgery for chronic pancreatitis, pancreatic cancer, imaging and endoscopy. A wide array of break out sessions and workshops covering genetics, pain management, maldigestion, pediatrics, cystic lesions, autoimmune pancreatitis and other topics will bring attendees up to date on the latest in pancreatic research and emerging challenges in this field.

The National Pancreas Foundation wants to stimulate interest and opportunity for young researchers regarding future study of the pancreas. To that end, it is offering a one time grant — a travel scholarship — to qualified applicants so that they may attend. Applications are due Feb. 1, 2007. For more information, and to find application forms, log on to http://www.pancreasfoundation.org/physicians.htm.

There are many individuals in public and private sector, who dedicate considerable time and/or expertise to the advancement of gastroenterological science and research. Their commitment and hard work play a significant role in the achievements of GI societies, clinicians, researchers and physicians nationwide. From lobbying congress to supporting scientists and trainees in digestive disease research, these behind-the-scenes contributions are invaluable. In recognition of these contributions, the American Gastroenterological Association will bestow the new AGA Research Service Award.

The AGA Research Service Award will recognize an individual who has significantly advanced gastroenterological science and research. The recipient will be an individual, in either the public or private sector, who has dedicated considerable time and/or expertise and served above and beyond his or her scope of responsibility. This is not an annual award; the award will be presented only when an exceptional candidate is brought to the attention of the Selection Committee and the candidate receives a unanimous vote. The recipient will be honored with a crystal award during the NIH/PhD reception at Digestive Disease Week®.

Criteria for the award are available online and nomination packets, which are to include all letters of support, are due no later than March 1, 2007. Hard copy submissions will not be accepted. Please send nomination packets, via e-mail to, awards@gastro.org. For more information about the new AGA Research Service Award and other AGA recognition prizes, please visit www.gastro.org. Go to Membership/Membership Recognition Prizes for complete information.

Annually, the Gastroenterology Research Group (GRG), in collaboration with AGA, presents the AGA/GRG Young Investigator Award, the Fellow Travel Award and the Abstract of the Year, to promising young investigators and trainees. Members of GRG and AGA are encouraged to submit nominations for these honors.

The GRG/AGA Young Investigator Clinical Science Award is given to recognize the specific achievements of a young clinical investigator whose research focus is in the area of digestive and/or liver diseases. Applicants must be independent investigators who have held a faculty position for fewer than seven years and be a member of the GRG. This prestigious award includes a prize of $3,000 to be awarded at the GRG Spring Symposium at DDW® 2007.

Similarly, the GRG/AGA Young Investigator Basic Research Award is given to recognize the specific achievements of a young basic research scientist whose research is focused on the area of digestive and/or liver disease. Applicants must be independent investigators who have held a faculty position for fewer than seven years and be a member of the GRG. This prestigious award includes a prize of $3,000 to be awarded at the GRG Spring Symposium at DDW 2007.

Nomination packets for the Young Investigator Awards in Clinical Science and Basic Research are to be e-mailed and include a cover letter summarizing the nominee’s specific clinical or basic research accomplishments, a curriculum vitae and a second nominating letter from a colleague at a different institution. Nominations are due Feb. 14, 2007.

The GRG/AGA Fellow Travel Award provides travel grants in the amount of $500 to individuals chosen to present outstanding abstracts, of which they are first authors, at DDW 2007. Qualified applicants are MD or PhD postdoctoral fellows who are active or trainee members of both the GRG and AGA and are sponsored by a member of both organizations.

To apply for this award, GRG/AGA members should submit an application packet by e-mail to include a completed application, a copy of the accepted DDW 2007 abstract, a copy of the DDW 2007 acceptance letter, a one-page letter of recommendation from a sponsor that describes the applicant’s research involvement and a one-page statement from the applicant, detailing his/her role in the research. Application packets are due March 14, 2007.

The GRG/AGA Abstract of the Year award recipient is selected by the GRG and awarded to the single best trainee abstract submitted for the GRG/AGA Fellow Travel Awards for special recognition at DDW 2007. A prize of $1,000 will be awarded to encourage trainees to become more involved in digestive disease research. Applicants for the GRG/AGA Fellow Travel Awards are automatically eligible for this award.

For complete details about the Young Investigator, Fellow Travel and Abstract of the Year Awards, please visit www.gastroresearch.org. All application and nomination packets are to be submitted via e-mail to awards@gastro.org. (Note: this address is different from the announcement document.) All letters and supporting documentation are to be included in the initial submission. A review panel comprised of members of the GRG Steering Committee will select award recipients by mid April 2007.

For more information, please call (301) 222-4012 or send an e-mail to awards@gastro.org. For information about AGA awards, please visit www.fdhn.org.