Researchers in the latest issue of the Journal of the American Medical Association stated that in their large, prospective study of men without known diverticular disease, nut, corn and popcorn consumption did not increase the risk of diverticulosis or diverticular complications. They added that the recommendation to avoid these foods to prevent diverticular complications should be reconsidered.

Patients with diverticular disease are frequently advised to avoid eating nuts, corn, popcorn and seeds to reduce the risk of complications. However, there is little evidence to support this recommendation.

The Health Professionals Follow-Up Study is a cohort of men followed prospectively from 1986 to 2004. The patients were evaluated via self-administered questionnaires about medical and dietary information. Men reporting newly diagnosed diverticulosis or diverticulitis were mailed supplemental questionnaires. Researchers in Washington assessed 47,228 men, 40 to 75 years old, who at baseline were free of diverticulosis or its complications, cancer and inflammatory bowel disease, and returned a food-frequency questionnaire. The team's main outcome measures included incident diverticulitis and diverticular bleeding.

During 18 years of follow up, there were 801 incident cases of diverticulitis and 383 incident cases of diverticular bleeding. The researchers found inverse associations between nut and popcorn consumption and the risk of diverticulitis. The multivariate hazard ratios for men with the highest intake of each food compared with men with the lowest intake were 0.8 for nuts and 0.7 for popcorn. No associations were seen between corn consumption and diverticulitis or between nut, corn or popcorn consumption and diverticular bleeding or uncomplicated diverticulosis.

According to a study published in Gut, the diagnosis of colorectal cancer is delayed or missed in a substantial number of patients when conducting surveillance strictly according to formal guidelines.

Colonoscopic surveillance is recommended to detect dysplasia or asymptomatic cancer in patients with inflammatory bowel disease (IBD). In this study, researchers from the Netherlands evaluated the time between the onset of IBD and colorectal carcinoma (CRC). The team used a nationwide automated pathology database to identify patients with IBD-associated colorectal carcinoma in seven centers between January 1990 and June 2006.

They identified 149 patients with confirmed diagnoses of IBD and CRC and found that 22 percent to 28 percent of patients developed cancer before recommended starting points of surveillance. Using onset of symptoms to calculate the time interval, the team determined that 17 percent to 22 percent of patients would present with cancer prior to the surveillance starting points.

A meta-analysis in this month’s issue of Alimentary Pharmacology and Therapeutics found high-dose proton pump inhibitors (PPIs) seem more effective than standard-dose for curing Helicobacter pylori (H. pylori) infection in seven-day triple therapy.

The evidence on whether high-dose PPIs increase cure rates in H. pylori treatment has not been previously assessed. A research team in Spain evaluated whether high-dose PPI was more effective than standard dose in triple therapy. They performed a systematic search of multiple databases and abstracts submitted to Digestive Diseases Week^®, the European Helicobacter Study Group Congress and United European Gastroenterology Week. They identified six suitable studies that compared a standard dose of a PPI with high-dose PPI, both twice a day, in triple therapy combining a PPI plus clarithromycin and either amoxicillin or metronidazole.

The researchers found that a mean intention-to-treat cure rate of 82 percent was achieved with high-dose PPI and one of 74 percent with standard dose. Furthermore, subgroup analysis showed that the maximum increase was observed when the PPI compared was omeprazole 20 mg or pantoprazole 40 mg versus esomeprazole 40 mg.

A study in the latest Scandinavian Journal of Gastroenterology stated patients with short-bowel syndrome show poor quality of life (QOL) compared with that of the general population as well as impairment of mainly physical health compared with patients with inflammatory bowel disease (IBD).

Patients with short-bowel syndrome have impaired health-related QOL. In this study, investigators from Sweden assessed QOL in patients with short-bowel syndrome and compared these patients with the general population and with patients with IBD.

The research team used four validated questionnaires to measure QOL (SF-36), psychological distress, fatigue and gastrointestinal symptoms. They evaluated 26 patients attending a short-bowel syndrome clinic at a tertiary referral center, 286 individuals from the general population and 41 patients with IBD.

They found that short-bowel syndrome patients had significantly lower SF-36 physical and mental component summaries than those in the general population. These patients also had significantly lower SF-36 physical component summaries compared with those of IBD patients. The investigators determined that fatigue and gastrointestinal symptoms were more severe in short-bowel syndrome patients compared with IBD patients.

The Medicare Payment Advisory Commission (MedPAC) met last week to discuss physician resource use, public reporting of physicians’ financial relationships and having an expert panel on new research regarding use of imaging services.

MedPAC recommended to Congress in March 2005 that the Medicare program use claims data to measure physician resource use and provide confidential feedback. This recommendation was included in the recently enacted Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) legislation. Section 131 of the legislation directs the secretary to establish a physician feedback program, under which the secretary shall use claims data to make confidential reports to physicians that measure the resources involved in furnishing care to individuals. This program requires education and outreach to physicians. MIPPA also requires evaluation of the physician feedback program by the general accountability office (GAO) by March 1, 2011.

CMS is currently conducting a pilot project on physician resource use, which includes four acute conditions (community-acquired pneumonia, urinary tract infection, hip fracture and cholecystitis) and five chronic conditions (congestive heart failure, chronic obstructive pulmonary disease, prostate cancer, coronary artery disease and acute myocardial infarction).

In MedPAC’s June 2008 report to Congress, the commission expressed interest in a public reporting system for physicians. MedPAC is specifically interested in generating policy options for physicians’ financial relationships with drug and device manufacturers, as well as physicians’ relationships with hospitals and ambulatory surgery centers (ASCs). There have been efforts to regulate these relationships voluntarily, through guidelines by organizations such as the Pharmaceutical Research and Manufacturers of America (PhRMA), and official guidance, such as from the office of the inspector general. At this time, MedPAC wants the physician’s financial relationships to be reported by the drug companies, hospitals or ASCs, and not by individual physicians. MedPAC will continue its work on this issue and report to Congress next year.

MedPAC continues to examine the growth in imaging services, which continues to be the fastest-growing physician service in Medicare. Imaging services, especially advanced imaging modalities like MR and CT, have grown twice as fast as other physician services. MedPAC heard from an expert panel, including the GAO, on the impact of physician ownership and self-referral on the increased utilization of imaging services in Medicare. MedPAC has previously recommended prohibiting physician self-referral of nuclear medicine services and physician ownership of entities that lease space or equipment to health-care providers to which they refer their patients. MedPAC has also recommended that CMS reduce the technical component payment for multiple imaging services performed on contiguous body parts and to increase bundling of imaging services. CMS adopted the multiple procedure discount in 2006 in a budget neutral manner so that savings would be distributed to other areas of physician services.

Under the MIPPA legislation, providers of advanced imaging modalities such as CT, MR and PET will be required to meet mandatory accreditation standards by Jan. 1, 2012. Most of the MedPAC members and the expert panel agreed that accreditation was an area that could help improve quality and patient care, although members were not in agreement on prior authorization, which the GAO recommended in their June report. Although most of the panelists spoke of the disparities in imaging growth that exist geographically and by condition and test, there is currently no data available that examine what imaging is inappropriate or how advanced imaging can save money in other areas of Medicare, reduced hospitals stays or surgeries, etc. MedPAC and Congress will continue to examine this area and the GAO is examining the impact of the imaging cuts from the Deficit Reduction Act (DRA) on growth.

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.

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 more than $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 to the database of awards related to digestive diseases/disorders, housed on the AGA Web site.

A listing of COS Funding Opportunities™ for gastroenterologists can be found online on the AGA Web site. The listing is available only to members and requires logging-in to the site using your AGA member ID [&MASID;].

In an effort to educate gastroenterology practices about the Physician Quality Reporting Initiative (PQRI), CMS and the AGA Institute will jointly host a Special Open Door Forum on Tuesday, Sept. 23, 2008, from 2-3:30 p.m. ET.

Participation in the PQRI program is voluntary; however, participating is an opportunity for your practice to assess its readiness for pay-for-performance and other quality programs. PQRI is a mechanism for practices to begin collecting and reporting data related to evidence-based performance measures.

CMS is expected to move to value-based payment over the next few years. Reporting data related to quality of care through the PQRI is an opportunity to help your practice prepare for that transition. Successful PQRI reporting for the 2008 program will yield a bonus of 1.5 percent (of allowable Medicare charges) and a 2 percent bonus in 2009.

Successful reporting requires an understanding of the measures applicable to your practice and the specifications of those measures. Listen in on Sept. 23 as a gastroenterologist and a GI practice administrator will discuss:

• The measures typically selected by GI practices.
• The PQRI implementation process.
• Simple steps that you can use to collect and report quality data.

CMS staff will be available to answer questions regarding PQRI and how it relates to your individual practice.

We strongly urge you to have at least one staff member from your practice participate in this call.

Conference slides will be available closer to the conference date. View call-in details.

The FDA announced on Sept. 3 that the manufacturers of Humira, Cimzia, Enbrel and Remicade must strengthen the existing warnings and precaution sections of the drugs' prescribing information and medication guides relating to the risk of developing opportunistic fungal infections. Click here to read the FDA’s press release.

The four drugs, known as tumor necrosis factor alpha blockers (TNF-alpha blockers), suppress the immune system and are approved to treat a variety of conditions, including rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis and Crohn's disease.

Since the initial approval of the four TNF blockers, the prescribing information for these drugs has included information about the risk of serious infections, including fungal infections. However, based on reports reviewed by the FDA, health-care professionals are not consistently recognizing cases of histoplasmosis and other invasive fungal infections, leading to delays in treatment.

TNF blocker manufacturers are required to submit safety labeling changes, including strengthened warnings and revisions to the medication guides to the FDA within 30 days or provide a reason why they do not believe labeling changes are necessary.

Additional warning information is available online.

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 Web site. This month’s free topic is:

• Evaluation of obscure gastrointestinal bleeding

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.

Pancreatic cancer is not the most common kind of cancer, but it is one of the most deadly. Because there are no early-stage symptoms for pancreatic cancer, diagnosis is often delayed until after the cancer has metastasized. The search for a clue to the onset of this disease and new treatments for it is a priority. David C. Whitcomb, MD, PhD, professor of medicine, chief of gastroenterology and medical director of the Comprehensive Pancreas Program at the University of Pittsburgh School of Medicine, discusses the latest biomarkers for cancer on the pancreas with host Mark DeLegge, MD, AGAF.

ReachMD XM 157 is the channel for medical professionals and brings you educational news and information on satellite radio, online and on-demand. GI Insights, broadcast through ReachMD XM 157, features the field’s top gastroenterologists discussing today’s issues. Each week, a new topic will air twice per day for the first week it is released. AGA members receive free access to the broadcasts online on the ReachMD Web site by using discount code AGA. Broadcasts are also available as podcast downloads on the AGA Web site. Learn more today!

AGA Institute, ACG, ASGE and the Society of Gastroenterology Nurses and Associates (SGNA) have teamed up to develop www.SedationFacts.org, a new online resource for GI physicians, trainees and nurses seeking information about endoscopic sedation.

Intended as a central repository for endoscopic sedation news, reference materials and guidelines, the site offers a range of information designed to address all aspects of this topic. All content is developed and reviewed by physicians and nurses who are subject-matter experts, and is updated regularly.

Content includes:

• An overview of frequently-used as well as less-common sedation drugs.
• The physiology of sedation.
• Definitions of the various levels of sedation.
• ASA patient standards and the difference between anesthesia and sedation.
• Best practices and safety guidelines.
• Standards and regulations by state.
• Practice management/economic implications of sedation.

The site is free to use and registration is not required. Starting in October 2008, site users can also opt to register for a free, monthly e-mail newsletter highlighting the latest developments in the field.

SedationFacts.org is funded by an educational grant from Ethicon Endo-Surgery, Inc.

The AGA Institute is holding its second Clinical Congress at the Venetian Hotel Resort Casino in Las Vegas on Jan. 23-25, 2009. Designed by clinicians for clinicians, the 2.5 day congress is rich with state-of-the-art clinical information with immediately applicable information for your practice. In addition to its comprehensive clinical program, the congress includes a substantial practice management element as well as an exhibit hall. Attendees can earn up to 23 AMA PRA Category 1 Credits™.

The congress program includes a combination of lectures and small-group breakout sessions covering a wide range of GI and liver topics. A panel of more than 30 renowned experts will present the latest information on the detection, management and treatment of liver disease, functional bowel disease, esophageal disease, GI malignancy and IBD. The small-group breakout sessions will allow attendees to explore these areas in greater detail, ask questions, and engage in discussion with colleagues and faculty.

The practice management component of the congress will be held Sunday, Jan. 25 from 1-5 p.m. Registrants can choose to attend only these sessions or add them to their registration for an additional fee. The sessions focus on practice mergers, coding and compliance, and choosing the right EMR.

The congress also includes an exhibit hall, which will be open each day. Like the congress itself, the exhibit hall is tailored specifically to meet the needs of clinicians. Representatives from a variety of companies will be on hand to demonstrate new products and services and provide new information on cutting-edge treatment and patient management options. A partial list of exhibiting companies is available.

Register by Dec. 31 and take advantage of a $75 early bird discount; advanced registration is encouraged. AGA member trainees can register for free. Travel awards in the amount of $500 are also available for AGA member trainees on a first-come, first-serve basis. For more information and to register, visit www.gastro.org/clinicalcongress.

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

The educational sessions at the Clinical Congress are supported in part by educational grants from AstraZeneca, Bayer Healthcare, Centocor, Salix Pharmaceuticals and SmartPill.

The AGA Institute wishes to thank the following companies for supporting the Clinical Congress, excluding the educational sessions: AstraZeneca (Grand Sponsor), Takeda Pharmaceuticals North America, Inc. (Premier Sponsor) and Onyx Pharmaceuticals/Bayer Healthcare (Principal Sponsor).

Did you participate in the 2007 PQRI? If so, providers can complete a brief, confidential online survey. All results will be anonymous and the survey will take 10-15 minutes. Information gathered from the survey process will allow the AMA and other medical specialty and state organizations to effectively advocate for changes in the PQRI.

The AGA Nominating Committee, chaired by Mark Donowitz, MD, AGAF, is in the midst of identifying candidates for the offices of vice president, secretary/treasurer-elect, clinical research councillor, community private practice councillor and eight nominees for the 2009-2010 Nominating Committee ballot. 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 postmarked by Oct. 10.

Visit the AGA Web site for more information on the positions available and directions on how to submit nominations.

Nominations are now being accepted for the Julius Friedenwald Medal, the highest honor that the AGA bestows on its members. The medal is presented annually to an individual who has performed outstanding work in the field of gastroenterology and has provided significant services to the AGA over his or her lifetime.

All AGA members are encouraged to nominate colleagues for this award. Nominations must include the following: a cover letter summarizing the contributions of the nominee to the field of gastroenterology, a curriculum vitae and a bibliography. All nominations are due Sept. 30. The recipient will be selected during the November meeting of the AGA Governing Board and honored at the May 2009 President’s Dinner, held during Digestive Disease Week^® in Chicago.

Complete nomination instructions, selection criteria and more information about the award are available here.

Nominations for all other AGA Recognition Prizes are due Nov. 15. These awards include:

• William Beaumont Prize in Gastroenterology
• Distinguished Clinician Awards
• Distinguished Educator Award
• Distinguished Mentor Award
• Research Service Award

For more information about the awards and for complete nomination instructions, please visit www.gastro.org/membership or contact info@fdhn.org.

Gastroenterology is committed to advancing clinical practice in the field of digestive disease. Recognizing that clinical trials generally have the greatest impact of all studies on clinical practice, Editor Anil K. Rustgi, MD, and his associate editors strongly encourage authors to submit their manuscripts on clinical trials (diagnostic validation, therapeutic efficacy) of drugs, biological materials and devices in digestive, liver and pancreatic diseases, including studies at phases I, II and especially III to Gastroenterology for consideration. The journal is also interested in publishing trials in endoscopic and imaging modalities.

There are several important reasons to submit clinical trial research for publication in Gastroenterology:

• With an impact factor of 11.7, Gastroenterology is the premier journal in the field.
• Gastroenterology is the journal that will directly reach the largest portion of physicians who care for and make treatment decisions for patients with gastrointestinal or liver disease.
• Authors who submit their manuscripts to Gastroenterology typically will receive decisions within three weeks or fewer — the journal's time from submission to decision for all types of manuscripts is 23 days.
• Accepted manuscripts will be available online to AGA members and nonmember subscribers within two weeks of acceptance.

To submit your manuscript to Gastroenterology, go to www.editorialmanager.com/gastro. For important information on how to report clinical trials, go to www.gastrojournal.org/authorinfo. To review the current and past issues of the journal, go to www.gastrojournal.org.