Having trouble viewing this e-mail? View the newsletter online.

July 15, 2010
AGA eDigest AGA eDigest
Renew Your Membership Now! print iconPrint Page email iconEmail Page view online iconView Online

Clinical Practice

Education & Training



Eugene Chang, MD, AGAF
Basic Research Councillor

F. Taylor Wootton III,
Private Practice Councillor

Final Rule for Meaningful Use of EHR Released

CMS and the Office of the National Coordinator (ONC) have jointly announced their final rules for both electronic health record (EHR) standards for certification and the Medicare and Medicaid EHR incentive programs, including the definition of meaningful use. The GI societies submitted extensive comments on these rules.


Lead Story, continued

Under the Health Information Technology for Economic and Clinical Health Act of 2009, eligible health-care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives. One of the two regulations announced defines the meaningful use objectives that providers must meet to qualify for the bonus payments. The other regulation identifies the technical capabilities required for certified EHR technology.

Announcement of these regulations marks the completion of multiple steps laying the groundwork for the incentive payments program. With meaningful use definitions in place, EHR system vendors can ensure that their systems deliver the required capabilities, providers can be assured that the system they acquire will support achievement of meaningful use objectives, and a concentrated five-year national initiative to adopt and use electronic records in health care can begin.

Read CMS' fact sheet with additional details, and learn more about the Medicare and Medicaid EHR incentive programs and the EHR and certification standards.

CMS and ONC training on the EHR incentive programs and certification will be on July 22 at 2 p.m. ET.

  print email top

Gastroenterology Image of the Month


A Rare Cause of Small Bowel Enterolith
Jen-Wei Chou

Question: A 41-year-old man presented to a hospital with a two-week history of epigastric pain. He also complained of vomiting and constipation, but denied having fever or melena. On examination, his upper abdomen was tender without muscle guarding or rebound tenderness. Laboratory data, esophagogastroduodenoscopy and colonoscopy disclosed unremarkable abnormalities. A plain film of the abdomen revealed focally dilated small bowel loops in the left upper quadrant, suggestive of partial small bowel obstruction. Abdominal CT demonstrated a long segmental annular thickening of bowel wall in the ileum. An intraluminal radiopaque mass was identified within the involved bowel lumen. Capsule endoscopy demonstrated multiple edematous and ulcerative mucosas accompanying with luminal strictures in the ileum. A 2-cm enterolith, causing incomplete obstruction of the bowel lumen, was identified at the site of a small bowel stricture (figure). What is the cause of this small bowel enterolith?




Awards Fund Specialized Areas of GI Research

Two upcoming research scholar awards from the AGA Foundation provide financial support to investigators studying gut microflora or GI cancer. A third award aids fellows who are interested in continuing their research careers.

Gut Microflora
The AGA-General Mills Bell Institute of Health and Nutrition Research Scholar Award in Gut Physiology and Health is available to young faculty (not fellows) who intend to spend 70 percent or more of their research time on the relationship of gut microflora to physiology and immune function.

The award's intent is to foster the scientific independence of junior investigators by ensuring that they have protected time for research. Candidates should be in the beginning years of their careers; no more than five years shall have elapsed following the completion of the applicant's clinical or postdoctoral training and the start date of this award.

GI Cancer
Established investigators may apply for the Funderburg Research Scholar Award in Gastric Biology Related to Cancer. Investigators working in the following fields are eligible: 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.

Applicants must hold faculty positions at accredited North American institutions, must be AGA members at the time of application and must have established themselves as independent investigators in the field of gastric biology.

Fellows Interested in Research Careers
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.

Applicants must be MDs or MD/PhDs currently in a gastroenterology-related fellowship, clinically active at a North American institution and committed to an academic career. They will have completed at least two years of research training at the start of this award. 

Applications for all awards are due Sept. 4. Complete eligibility requirements and application information are available on the foundation Web site.

  print email top

H. Pylori Associated with Esophageal Cancer Risk

Infection with Helicobacter pylori (H. pylori) is associated with reduced risk of esophageal adenocarcinoma (EAC), but it is not clear whether this reduction is modified by genotype, other host characteristics or environmental factors. Furthermore, little is known about the association between H. pylori and adenocarcinomas of the esophagogastric junction (EGJAC) or squamous cell carcinomas (ESCC). According to data appearing in Gastroenterology, H. pylori infection is inversely associated with risks of EAC and EGJAC (but not ESCC); the reduction in risk is similar across subgroups of potential modifiers.

  print email top

Low-Dose Infliximab Prevents Crohn's Disease Recurrence

Infliximab might prevent postsurgical recurrence of Crohn's disease. However, it is unclear whether long-term therapy is necessary and whether alternative strategies could be applied to minimize potential side effects and reduce the costs of treatment. According to study results published in Clinical Gastroenterology and Hepatology, long-term maintenance therapy with infliximab is required to maintain mucosal integrity in patients after surgery for Crohn's disease. However, a dose of 3 mg/kg (a 40 percent reduction from the standard dose) was sufficient to avoid disease recurrence, determined by endoscopy, in all patients at one year. Fecal calprotectin levels correlate with mucosal status at different infliximab doses.

  print email top

Crohn's Disease Resource for Your Patients

In "IBD Self-Management: The AGA Guide to Crohn's Disease and Ulcerative Colitis," your patients will learn how to cope with flares, get the nutrition they need and understand their medication and surgical options.

Order your copy today.


IL-28B Polymorphism Is Strong Predictor of SVR

Doctors recently identified a polymorphism upstream of interleukin (IL)-28B to be associated with a two-fold difference in sustained virologic response (SVR) rates to pegylated interferon-alfa and ribavirin therapy in a large cohort of treatment-naive, adherent patients with chronic hepatitis C virus genotype 1 (HCV-1) infection. In a study published in Gastroenterology, they found that in treatment-naive HCV-1 patients treated with pegylated interferon and ribavirin, a polymorphism upstream of IL-28B is associated with increased on-treatment and SVR, and effectively predicts treatment outcome.

  print email top

Doctors Study Renal Failure in Cirrhotic Patients

Hepatorenal syndrome is a well characterized type of terminal renal failure that occurs in patients with cirrhosis with ascites. Information about other types of functional renal failure in these patients is scarce. In a study in Clinical Gastroenterology and Hepatology, approximately 50 percent of the cirrhotic patients with ascites developed some type of functional renal failure during the follow-up period; renal failure was associated with worse prognosis. Efforts should be made to prevent renal failure in cirrhotic patients with ascites.

  print email top


Societies Clarify Proper Reporting of E/M & Drug Infusion Services

AGA, ACG and ASGE have become aware of several insurance companies that have denied payment for evaluation and management (E/M) services when provided on the same day as drug infusion services. While the stated reasons seem to vary, one common theme is the apparent belief by the payor that all physician work is encompassed by the reimbursement structure of the drug infusion codes, regardless of level of physician work involved in the patient visit. With the exception of E/M service code 99211 (level one, office or other outpatient visit, established patient), which is bundled with and should not be coded on the same day as drug infusion codes, this is an incorrect interpretation of the valuation of the drug infusion codes.

Read a background document that reviews the history surrounding the development of the drug infusion codes by the AMA current procedural terminology (CPT) editorial panel, as well as the physician work and practice expense valuation of these codes by the AMA/Specialty Society Relative Value Update Committee. It concludes with a review of the specific language taken from the CPT® manual, which provides instruction regarding reporting of drug infusion services in conjunction with E/M services.

  print email top


HAE Case Studies Available Online

Hereditary angioedema (HAE) is a rare genetic condition that is commonly misdiagnosed. It can cause acute attacks of abdominal pain accompanied by nausea, vomiting and/or diarrhea — symptoms that mimic other GI conditions such as appendicitis, IBD or IBS. Abdominal symptoms may occur in 70 percent to 80 percent of HAE patients, and approximately one-third of patients with undiagnosed HAE reportedly have undergone unnecessary surgery for abdominal attacks.

Missing the diagnosis of this rare disease not only prolongs a patient's suffering, but because HAE attacks can be fatal, misdiagnosis also puts patients at significant risk. The HAE: Learn About It, Talk About It program, presented by AGA in partnership with the American College of Asthma, Allergy and Immunology, provides information to help physicians become familiar with the symptoms and make a timely, accurate diagnosis.

The following case studies can help improve your understanding of HAE and its clinical presentation:

  • Case 1: an 18-year-old Caucasian woman with no family history of HAE or angioedema and no obvious medical conditions began experiencing episodes of severe abdominal pain after starting a birth control pill.
  • Case 2: a 51-year-old Caucasian woman with no family history of HAE or a medical history of significant urticaria was referred for an allergy consultation after experiencing non-pruritic lip and facial swelling for two weeks.
  • Case 3: a 37-year-old Caucasian woman, previously diagnosed with angioedema, was seen in the Institute for Allergy & Asthma after experiencing a recurrence of abdominal attacks.
  • Case 4: a 20-year-old woman with no family history of HAE presented to the emergency department with intractable abdominal pain, nausea and vomiting.

Visit AGA's Web site for more HAE resources, including a free 30-minute archived Webinar, a fact sheet and a checklist to use when counseling patients with HAE.

This program is supported by ViroPharma Inc.

  print email top

Free Online Monograph Focuses on IBS, Constipation & Acid-Related Disorders

A host of breakthroughs and advances in the management of gastrointestinal disorders, such as IBS, chronic constipation, GERD and Barrett's esophagus, have been introduced at recent Digestive Disease Week® meetings. This free monograph recaps the cutting-edge information and interprets how the data will affect clinicians' ability to provide optimal care for patients with these syndromes.

The free monograph will help users to:

  • Identify and implement diagnostic and management recommendations of the latest U.S. guidelines on IBS.
  • Assess the latest evidence on the diagnosis and management of chronic constipation.
  • Utilize the recommendations from the recent AGA Institute medical position statement on GERD to effectively diagnose and treat patients.
  • Analyze the challenges surrounding the management of Barrett's esophagus and extra-esophageal manifestations of GERD.

View the monograph.

This program has been approved for 3 AMA PRA Category 1 Credits™.

This activity is supported through educational grants from Sucampo Pharmaceuticals, Inc. and Takeda Pharmaceuticals North America, Inc.

  print email top

Functional GI Disorders Slides

The Rome Foundation's computer-based learning program brings to life information from the Rome III book, with updates from the recent scientific literature. Slides include animations and videos, conceptual slides that illustrate complex ideas, and key studies from the literature. Notes and legends give a description of each slide with key references. Learn more and buy online.


Unparalleled Perspective on GI Mucosal Injury Offered at Conference

The mucosal lining in the GI tract is faced with numerous and often contradictory challenges from luminal components. It must:

  • Rapidly process and sterilize large quantities of ingested foodstuffs of varying textures and compositions.
  • Secrete and absorb more than 150 mEq of concentrated HCl daily.
  • Maintain isosmotic conditions despite ingestion of substances of 0-2000 mOsm/l.
  • Foster the growth of commensal bacteria.
  • Rapidly renew and repair itself.
  • Sense the luminal content for acidity, nutrient content and class of microbial flora.

Inappropriate or pathological sensing of the luminal content or aberrant repair responses can manifest as disorders such as chronic inflammation, neoplasm, ulceration and esophagitis. Traditionally, gut mucosal responses have been categorized by specific diseases, such as colon cancer, celiac disease, Barrett's esophagus and IBD, without recognition of the commonality of the injurious processes and their responses.

The AGA Institute is holding a conference in which the field's top experts will provide insight into the pathophysiological basis of multiple gut mucosal diseases under the unified theme of mucosal response to injury. Gastrointestinal Response to Injury will be held Sept. 28 to Oct. 1 at the InterContinental Montelucia Resort & Spa in Scottsdale, AZ. Blending clinical and basic science, the conference provides unparalleled depth into how erosive, inflammatory and neoplastic mucosal diseases can arise from pathological alterations of host defense and repair processes.

An added feature is the presence of two pre-conference events: Microbes and Mucosal Immunity 2010 and the AGA Institute-Japanese-American Association of Gastrointestinal and Ulcer-Acid Researchers Young Investigators Forum, both aimed at introducing young investigators to the field.

Register early to secure your space at the conference and to reserve your hotel room. GI fellows can register at a reduced fee and are eligible to apply for a travel award. The pre-registration deadline is Monday, Sept. 20; the hotel reservation deadline is Tuesday, Sept. 7. For more information and to register, visit www.gastro.org/GIRI.

Funded by the Takeda Endowment in support of the James W. Freston Single Topic Conference.

The AGA Institute gratefully acknowledges NIH/NIDDK for their partial support for these programs.

This activity has been approved for AMA PRA Category 1 Credits.

  print email top


CMS Administrator Is Appointed

President Obama announced a recess appointment for Donald M. Berwick, MD, MPP, FRCP, as administrator of CMS. Dr. Berwick is president, CEO and co-founder of the Institute for Healthcare Improvement, one of the nation's leading authorities on health-care quality and improvement issues. He is also clinical professor of pediatrics and health-care policy at the Harvard Medical School.

Dr. Berwick has served as vice chair of the U.S. Preventive Services Task Force, the first "independent member" of the Board of Trustees of the American Hospital Association, and as chair on the National Advisory Council of the Agency for Healthcare Research and Quality. An elected member of the Institute of Medicine (IOM), Dr. Berwick now serves on the IOM's governing council. He served on President Clinton's advisory commission on consumer protection and quality in the health-care industry. Co-chaired by the secretaries of health and human services and labor, the commission was charged with developing a broader understanding of issues facing the rapidly evolving health-care delivery system and building consensus on ways to assure and improve the quality of health care.

Learn more about recess appointments by reading the AGA Washington Insider, a policy blog for GIs.

  print email top

FDA Provides Guidance to Enteral Feeding Tube Manufacturers

FDA is aware that standard luer lock connectors are found on a variety of tubing sets, solution bags and other medical products. The ease of connection between these luer lock connectors have led to misconnections that have inadvertently linked unrelated systems, and at times, have resulted in serious adverse events. Luer lock misconnections are often under-recognized; therefore, adverse events resulting from such misconnections are likely to be under-reported.

Learn more.

  print email top

Call for Nominations: Recognition Prizes

All AGA members are encouraged to nominate their colleagues for member recognition prizes, which honor individuals for their outstanding contributions to the field of gastroenterology.

Nominations are due Sept. 24 for the Julius Friedenwald Medal. This is the highest honor the AGA bestows on a member. This award recognizes an individual who has made lifelong contributions to the field.

Nominations are due Nov. 12 for:

  • The Distinguished Achievement Award, which recognizes an individual who has made a major specific accomplishment in clinical or basic research in gastroenterology or an allied field.
  • The Distinguished Clinician Awards, which recognize two individuals, one in private practice and one in clinical academic practice, who have exemplified leadership and excellence in the practice of gastroenterology.
  • The Distinguished Educator Award, which recognizes an individual for his or her achievements as an outstanding educator over a lifelong career.
  • The Distinguished Mentor Award, which recognizes an individual for his or her achievements as an outstanding mentor over a lifelong career.
  • The AGA Research Service Award, which recognizes an individual who has dedicated an extraordinary effort to advocacy for the advancement of gastroenterological science and research.

Complete nomination instructions, selection criteria and more information about each award are available through the links above. For more information, visit AGA's Web site or contact info@fdhn.org.

  print email top

Apply Now for the 2011 Train the Trainers Program

Application deadline: Aug. 11

This exciting program will bring two trainers to Chennai, India, April 10–15, 2011, to attend intensive and interactive sessions dedicated to the development of teaching and training skills.

Learn more.


Leadership Nominations Due Oct. 1

The AGA Nominating Committee, chaired by Robert S. Sandler, MD, MPH, AGAF, is in the midst of identifying candidates for the offices of vice president, basic research councillor, community private practice councillor and eight nominees for the 2011–2012 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 submitted by Oct. 1.

  • Each member may nominate only one person per available position. (Each member may submit one nomination each for vice president, basic research councillor, community private practice councillor and up to eight nominations for members of the Nominating Committee.)
  • Officers and councillors on the Governing Board and members of the current Nominating Committee are prohibited from proposing, supporting or endorsing candidates for nomination.
  • Only full members may be considered for vice president and councillor.
  • Only full members or senior members may be considered for the Nominating Committee.
  • Current and prior Nominating Committee members are not eligible to serve on the committee again for five years.
  • Letters of support from members are limited to two per nominee, specified in advance by the prospective nominee. The letters should not summarize the nominee's curriculum vitae (CV), but should address the nominee's personal qualities, strengths and weaknesses.

Nominate yourself or one of your colleagues. Nominations will only be accepted electronically. You must have your member ID number in order to submit your nominations electronically. To get your member number, call AGA Member Services at 301-941-2651 or e-mail member@gastro.org.

The deadline for receipt of nominations is Oct. 1, 2010. The committee chair will contact nominees to request CVs and determine interest and willingness to serve.

Vice President. The AGA Institute vice president is elected for a one-year term and succeeds automatically to the office of president-elect, the office of president and then to past president, serving one year in each office. In the absence of both the president and president-elect, the vice president would preside at meetings of the Governing Board and Executive Committee. The vice president serves as a member of the Executive Committee (throughout the four-year tenure) and as liaison between the International Committee and the Governing Board. The vice president also serves as a member of the Finance & Operations and the Executive Compensation Committees, and as an ex officio member of the AGA Governing Board.

Councillors. AGA Institute councillors are elected from the membership for a three-year term. Councillors are directors of the AGA Institute and hence are responsible for managing and overseeing the activities of the AGA Institute. Further, the basic research councillor shall be actively engaged in basic research in a health-care institution and be responsible for representing the views of this constituency at Governing Board meetings. The basic research councillor also serves as liaison between the Research Policy Committee and the Governing Board. The community private practice councillor shall be actively engaged in community private practice and be responsible for representing the views of this constituency at Governing Board meetings. The community private practice councillor also serves as an editor for AGA eDigest, as a member of the E-Communications Advisory Board, and as liaison between the Practice Management & Economics Committee and the Governing Board.

Nominating Committee. Nominating Committee members serve for one year and are responsible for selecting future officers and councillors for the AGA Institute as well as the members who are placed on the ballot for election to the AGA Nominating Committee for the following year. The AGA Nominating Committee is comprised of nine members: the chair (past chair of the AGA Governing Board), four members elected from a ballot of eight candidates and four members appointed by the AGA Governing Board.

The Nominating Committee will hold two teleconferences in the fall and a face-to-face meeting in January.

  print email top

Application Deadline Approaching for AGA Fellowship

Deadline extended to July 21, 2010

Less than a week left to apply for AGA fellowship. Fellowship honors superior achievement in clinical private or academic practice and in basic or clinical research. AGA members must meet specific criteria in order to apply.

View details and apply.



AGA Selects New Editor-in-Chief for Gastroenterology

Gastroenterology is proud to announce the selection of its next editor-in-chief, M. Bishr Omary, MD, PhD. Dr. Omary’s appointment was unanimously approved by the AGA Institute Governing Board, and he will assume leadership of the journal in July 2011. Dr. Omary already has considerable experience with Gastroenterology, having served on the board of editors since 2006, on which he currently is co-senior associate editor. He is also an associate editor for Molecular Biology of the Cell, and has served on the editorial boards of the American Journal of Physiology and Hepatology.

In addition to his extensive editorial experience, Dr. Omary is the professor and chair of the department of molecular and integrative physiology, professor of internal medicine, and H. Marvin Pollard professor of gastroenterology at the University of Michigan Medical School. He formerly served as chief of GI at Stanford University, has received two Department of Veterans Affairs career development awards and is a former Pew biomedical scholar. As a long-time member of the AGA, Dr. Omary has served on several of its committees, has been a member of the Academic Skills Workshop faculty and has served on the AGA Institute Leadership Cabinet. He currently chairs the research awards panel.

"It is a great honor and privilege for the University of Michigan team to be selected," Dr. Omary said. "We plan to build on the tradition of excellence and the outstanding record that Dr. [Anil K.] Rustgi has achieved since taking over as the editor-in-chief in 2006." The AGA and Gastroenterology congratulate Dr. Omary on his appointment and share his excitement for his upcoming term.

  print email top

Call for Papers on Clinical Trials: Gastroenterology

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 12.9, 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 GI or liver disease.
  • Authors who submit their manuscripts to Gastroenterology typically will receive decisions within three weeks or fewer.
  • Accepted manuscripts will be published online and indexed on PubMed within 10 days 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.

  print email top


Place GI position listings and activity announcements in AGA 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, AGA's 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 Alissa Cruz at acruz@gastro.org or 301-272-1603.

BC/BE GI wanted for busy practice with five other gastroenterologists in a beautiful coastal community. 100 percent GI practice with physician-owned endoscopy center onsite. Practice services one nearby hospital. Call rotation 1/7, ERCP optional. Excellent compensation. Benefits include malpractice insurance, paid vacation, pension profit sharing, CME and relocation allowance. Fast track to partnership. Please fax CV to 860-442-2136 or e-mail to jsullivan@coastaldigestive.com.

Jobs. Talent. Better Connections.

Visit the career center today.

  print email top

Copyright © American Gastroenterological Association
4930 Del Ray Avenue, Bethesda, MD 20814 301.654.2055 (p) 301.654.5920 (f)

To opt out of AGA e-mails, log in to your account and select Email Opt Outs.