Nov. 04, 2010
AGA eDigest AGA eDigest
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Clinical Practice

Education & Training



Eugene Chang, MD, AGAF
Basic Research Councillor

F. Taylor Wootton III,
Private Practice Councillor

Republicans Win Majority in House, Make Gains in Senate

Republicans made huge gains in the midterm elections, obtaining the majority in the House and winning at least six seats in the Senate, with three seats still in play and not decided. Republicans won more than the 39 seats needed to win the majority in the House — 64 seats at this point — which is a larger win than when the Republicans took control of Congress in 1994.


Lead Story, continued
The new health-care reform law played a huge role in the elections, with many candidates running on a platform to repeal it. Many Democrats who supported the legislation lost, as did more than half of the 30 Democrats who opposed the law.

Before the new session begins, Congress returns for the lame duck session the week of Nov. 15 with an agenda that includes a continuing resolution, preventing the 23 percent cut in Medicare physician payments and tax cuts. Congress will not likely address the health-care reform law until next year when the new Congress is sworn in, however Republicans are expected to attempt to make big changes to the law.

Read the AGA Washington Insider, a policy blog for GIs, to learn what is next for health-care reform.

Also, to help you prepare for the pending changes, AGA is planning two Webinars on health-care reform on implications for practices as well as for personal tax and small businesses on Dec. 3 and Dec. 13, respectively. These Webinars will help you understand key provisions of the health-care reform law and the impact on physician practices.

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CGH Image of the Month

Tearing of the Colon in a Patient with Collagenous Colitis
Rene van Velden, Isabelle Snieders, Rutger Quispel

A 63-year-old Caucasian woman presented with diarrhea for five months. She produced nonbloody watery stools more than 10 times a day. Physical examination was unremarkable, and routine laboratory test results were normal. Repeated fecal cultures revealed no infectious agents. At colonoscopy, the colonic wall appeared edematous and without visible vasculature. While passing the endoscope into the ascending colon, tearing of the colonic mucosa occurred on insufflation of air. On withdrawal of the endoscope, several linear mucosal tears were noted in the sigmoid colon, although no excessive force had been used on introduction or insufflation of excessive air had occurred (figure).

Read more.



Your AGA Foundation gifts support ...

altMathieu Darsigny, BSc, who received an AGA Student Abstract Prize this year.

"The AGA Student Abstract Prizes help foreign students attend international meetings that are crucial to the development of young talent. Digestive Disease Week® offers the opportunity to exchange with many of the best experts in the field. This meeting has stimulated my interest for gastroenterology and has nourished my motivation to pursue an academic career in research."

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Cirrhotic Patients at Risk for Health-Care-Associated Infections

Bacterial infections are a frequent and serious burden among patients with cirrhosis because they can further deteriorate liver function. In hospitalized cirrhotic patients, the most frequent infections are health-care associated and hospital acquired, according to results published in Clinical Gastroenterology and Hepatology. These infections are frequently resistant to antibiotics. As infections worsen, liver function deteriorates and mortality increases. Cirrhotic patients should be monitored closely for infections.

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Preterm Birth, Low Birth Weight More Common in IBD

There is limited data on pregnancy outcome in IBD from Eastern Europe. In a study published in the Scandinavian Journal of Gastroenterology, doctors found that preterm birth and low birth weight were more common in IBD. The medical treatment of the active disease during pregnancy did not increase the frequency of abnormal birth outcomes. Medical maintenance treatment should be continued during pregnancy to avoid relapses, although IBD seems to be an independent risk factor for low birth weight and preterm birth.

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Save 20 Percent on IBD Resources

AGA members save 20 percent on the Rome III book and computer-based learning program. These products offer a comprehensive collection of information for the evaluation and care of patients with functional GI disorders. Order online and enter the discount code AGAMEMBER to save.


Early Discontinuation of Antiviral Therapy Common in HCV Patients

A significant proportion of patients with hepatitis C virus (HCV) infection discontinue antiviral treatment prematurely. Risk factors for discontinuation before 48 weeks among patients with genotype 1 HCV vary over the course of therapy. According to a study in Clinical Gastroenterology and Hepatology, early discontinuation of antiviral therapy is common. Use of growth factors was the strongest independent predictor of treatment retention before 24 weeks and should be evaluated prospectively. Early interventions may also be warranted for other risk factors for early discontinuation such as pre-existing substance use, depression, cirrhosis or diabetes.

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Budesonide Effective in Eosinophilic Esophagitis Patients

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by dense tissue eosinophilia; it is refractory to PPI therapy. EoE affects all age groups, but most frequently, individuals between 20 and 50 years of age. Topical corticosteroids are effective in pediatric patients with EoE, but no controlled studies of corticosteroids have been reported in adult patients. According to data appearing in Gastroenterology, a 15-day course of treatment with budesonide is well tolerated and highly effective in inducing a histologic and clinical remission in adolescent and adult patients with active EoE.

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Ribavirin Pregnancy Registry

Implemented in January 2004, the Ribavirin Pregnancy Registry is a voluntary and largely prospective registry collecting observational data on pregnancies and the outcomes following exposure to ribavirin during pregnancy. The development of this registry was mandated by the FDA and includes both direct exposure through the pregnant female and indirect exposure through her male sexual partner.

Reports of exposure will be accepted from health-care providers, pregnant patients or the male partners of pregnant patients, and the data collected are minimal and targeted. Data are collected at each trimester and at the outcome of the pregnancy through the obstetric health-care provider and, for a live birth, for 12 months after the birth through the pediatric health-care provider. Patient identity is confidential.

This registry is the primary source for collecting and evaluating direct and indirect exposures to ribavirin in pregnancy, and the success of the registry relies on the participation of patients and health-care providers. For more information and details on how to participate, please visit the registry Web site.

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CMS 2011 Final Rule Updates

CMS Releases 2011 Physician Fee Schedule Final Rule
CMS released its final rule for policy changes to the 2011 physician fee schedule effective Jan. 1, 2011, and its implementation of key provisions under recently enacted health-care reform legislation, the Patient Protection and Affordable Care Act.

Read the CMS press release and the CMS fact sheets:

CMS will accept comments on certain aspects of the final rule with a comment period until Jan. 2, 2011. The final rule will be published in the Federal Register on Nov. 29. Read key components of the final rule.

AGA anticipates that Congress will attempt to craft a long-term solution to the sustainable growth rate formula and, if that cannot be achieved, will pass another temporary fix to overturn the large cuts. AGA will continue to provide updated information on congressional action on physician reimbursements.

CMS Releases 2011 Final Rule on HOPDs and ASCs
CMS also released its final rule affecting 4,000 hospital outpatient departments (HOPDs) and 5,000 ambulatory surgery centers (ASCs) for services furnished on or after Jan. 1, 2011. The rule, which implements both policy changes from CMS and recent health-care reform legislation from the Patient Protection and Affordable Care Act (ACA), will be published in the Nov. 24 Federal Register.

See the impact on commonly billed GI procedures in the HOPD and ASC settings and read key components of the final rule. A comprehensive summary of the rule will be in next week’s AGA eDigest. Read the CMS press release and fact sheet.

Under the final rule, the ACA waives beneficiary cost sharing for most Medicare-covered preventive services, including the initial preventive physical examination or “welcome to Medicare visit.” This waiver applies not only to the 20 percent co-insurance for the physician's service, but also to any cost sharing relating to the separate payment to the facility when the service is furnished in an HOPD or ASC setting. The AGA advocated heavily for this change and is pleased that CMS is implementing this waiver in all three settings — physician, HOPD and ASC. AGA continues to work with our advocates in Congress to ensure that the co-insurance is also waived when a screening colonoscopy becomes therapeutic.

Stay tuned to AGA eDigest and the AGA Washington Insider for a more comprehensive analysis of both of these rules and their impact on GI.

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UpToDate® Free Topic of the Month

Produced in cooperation with the AGA Institute, UpToDate® is a subscription-based clinical information resource available on the Web, CD-ROM and pocket PC handheld devices. Each month, a free topic is made available on the AGA Web site. This month's free topic is:

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.

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Small Bowel Capsule Endoscopy in Pediatric Patients Reviewed

Listen in as Stanley Cohen, MD, from the Children's Center for Digestive Healthcare in Atlanta, GA, and host Mark H. DeLegge, MD, AGAF, review the applications and contraindications for small bowel capsule endoscopy in the pediatric patient population. The program will be broadcast on satellite radio on XM 160 through Nov. 9 and will be available via podcast on the AGA Web site and the ReachMD Web site.

ReachMD XM 160 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 160, features the field's top gastroenterologists discussing today's issues. AGA members receive free access to the broadcasts online on the ReachMD Web site by using discount code AGA. Listen today.

This program is sponsored by Given Imaging.

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Workshop Offers Tools for Career Success in Clinical Practice

Advance your career and network with your peers at the AGA Practice Skills Workshop, an optional one-day workshop held immediately following the AGA Clinical Congress on Sunday, Jan. 16, 2011. The workshop is designed to help fellows and young GIs build a successful career in academic or clinical practice in gastroenterology by providing them necessary information and tools to advance their career. Participants can also earn up to 6.75 AMA PRA Category 1 Credits™.

The workshop brings together both young and experienced faculty who have been through this process and have developed down-to-earth, practical advice. The program covers issues ranging from reimbursement strategies and compliance issues to practice options and evaluating and negotiating job opportunities.

Topical highlights include:

  • Organizing Your Job Search.
  • Your Curriculum Vitae and Interviewing Successfully.
  • When Your Practice Changes: Mergers and Acquisitions.
  • Gastroenterologists and Accountable Care Organizations.
  • Regulations, Fraud and Abuse: How to Avoid Jail.

You must register for the congress in order to attend this workshop. Registration is free for AGA member trainees. Space is limited; register early to reserve your spot at the workshop.

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

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Start Your Career Search at the Congress

Use's Conference Connection™ tool to set up face-to-face meetings with potential employers at the congress.

Visit to learn more.


Nutritional Management of Celiac Disease Is Focus of New Online Module

The AGA Institute's nutrition toolkit series has released a new online module, Nutritional Management of Celiac Disease, offering information and strategies on how to best counsel your patients on maintaining a gluten-free diet, overcoming the barriers to staying gluten free and ensuring proper nutrition. Participants can earn up to 0.75 AMA PRA Category 1 credits™.

Additional modules in the toolkit series include:

  • Nutrition Therapy in Acute Pancreatitis.
  • Nutrition and IBD.
  • Obesity for the Gastroenterologist.
  • Nutrition in the Patient with Liver Disease.

Each online module includes slides with corresponding audio delivered by subject-matter experts as well as pre- and post-test questions. A score report will be provided upon completion.

The nutrition toolkit series is an online education component of the AGA Institute's nutrition and obesity initiative. The initiative includes access to AGA Institute obesity-related educational materials located under the nutrition and obesity topic area of the practice resource library. Additional modules on obesity- and nutrition-related issues are in development and will be made available throughout the year.

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

The celiac module is sponsored by the General Mills Bell Institute of Health and Nutrition.

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Methotrexate Injection Recalled Due to Presence of Glass Particulates

Sandoz and the FDA notified health-care professionals of a recall of methotrexate injection, 50mg/2mL and 250mg/10mL vials, due to small glass flakes detected in a limited number of vials in four lots. The flakes are the result of delamination of the glass used to manufacture the vials of the two dosage presentations.

Methotrexate is an anti-metabolite used in the treatment of neoplastic diseases, severe psoriasis and rheumatoid arthritis, including polyarticular juvenile rheumatoid arthritis. Many health-care professionals also use methotrexate for the treatment of IBD.

Customers and patients should immediately discontinue use of this product, and patients should contact their physician or health-care provider if they experience any problem that might be related to the use of this product. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.

Learn more.

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Former AGA President Helps Mayo Sustain Its Edge

In any large enterprise, innovation presents an inherent challenge because, overwhelmingly, the processes, structures and resources that guide people's actions are optimized for the work that must be done well today. Health-care organizations in particular must focus relentlessly on achieving error-free care, making it hard for their people to switch gears into the often messy and inefficient pursuit of tomorrow's breakthroughs.

Born in 2006 as the brainchild of former AGA president and current foundation chair, Nicholas F. LaRusso, MD, AGAF, the Mayo Clinic's new center for innovation helps people across the organization take their new ideas to the next level of development. It has found that allowing employees to engage in unofficial activity is one of the most agreed-upon conditions for innovation. Rather than saying that innovation is someone else's job in the organization, it signals to people that they are allowed and expected to spend a proportion of their work week imagining better solutions.

Learn more.

Source: Harvard Business Review

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Final Call for Nominations: Member Recognition Prizes

Ensure that your colleagues are recognized by the AGA for their accomplishments. Nominate them for member recognition prizes by the deadline of Nov. 12.

All AGA members are encouraged to submit nominations 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 on AGA's Web site. Please contact with questions about the nomination process.

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Nominate Research Mentors for Recognition at DDW®

The AGA Institute is now accepting nominations for the AGA Council Section Research Mentor Awards. Six of the AGA Council sections will recognize a dedicated and inspiring research mentor at DDW® 2011. All AGA members are encouraged to submit nominations.


AGA Governing Board Member Stuart H. Danovitch, MD, Dies of Pancreatic Cancer

A distinguished gastroenterologist and hepatologist, Stuart H. Danovitch, MD, died on Oct. 28 of pancreatic cancer at his home in Washington, DC. From 1974 until he retired in 2006, he was in private practice and was full professor at George Washington Medical School and a special consultant at the NIH and Naval Medical Center. He was a member of the AGA Governing Board, and was awarded the Distinguished Clinician Award in 2001, an award usually reserved for clinicians in full-time academic medicine.

Read more about Dr. Danovitch's accomplishments.

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Download Recent Journal Podcasts

Listen in each month as the AGA Institute presents thought-provoking podcasts on popular articles from Gastroenterology and Clinical Gastroenterology and Hepatology (CGH). Each podcast lasts approximately 10 to 15 minutes and can be downloaded to an iPod or any other media player. Podcasts are available through iTunes. Subscription to the podcasts is free and you will receive automatic updates on your iPod as new podcasts are added.

Recent podcasts from Gastroenterology include:

Recent podcasts from CGH include:

Podcasts are hosted by the journals' online editor, John F. Kuemmerle, MD, AGAF, professor of medicine and physiology at the Medical College of Virginia Campus at Virginia Commonwealth University. Each month, he will present a mix of author interviews and expert opinion based on articles from the latest issues of Gastroenterology and CGH.

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New Blog Post

Read a new post from The AGA Journals Blog: Relief from Gastroparesis?


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 For important information on how to report clinical trials, go to To review the current and past issues of the journal, go to

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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 or 301-272-1603.

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