Nov. 18, 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

Tell Congress to Stop Physician Reimbursement Cuts

Congress has returned to DC for a lame-duck session with some "must-pass" unfinished business items. One of those items is the 23 percent Medicare physician payment cut that goes into effect on Dec. 1. AGA is vigorously advocating that Congress pass legislation to avert the severe cut. Please help us by contacting your legislators.


Lead Story, continued

Congress has failed year after year to provide physicians and seniors the stability they need by reforming the sustainable growth rate (SGR) formula, which sets physician reimbursement rates. This year alone, Congress enacted four short-term fixes. However, many of these provisions were passed after Congress let the cuts go into effect, which placed a huge burden on physician practices and impacted their ability to meet payroll and deliver high-quality care to patients. Congress must not let this happen again.

Please take a moment and contact your legislator and urge them to prevent the 23 percent cut in physician payments and ensure that Medicare beneficiaries continue to have access to the care that they deserve.

Although AGA continues to push for a permanent solution to the broken SGR system, Congress needs to enact at least a 13-month fix to the physician payment formula and prevent any disruptions in services to seniors.

The AGA, along with our allies in the Alliance of Specialty Medicine and all of organized medicine, will continue to advocate for a long-term solution to the Medicare payment formula that provides stability to physician practices and your patients.

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Gastroenterology Image of the Month


A Bleeding Gastric Tumor with Concurrent Hypervascular Hepatic Nodules
Sae Rom Hong, Songmi Noh, Hye-Suk Hong

Question: A 61-year-old man was admitted for dizziness and tarry stool for five days. Vital signs and laboratory results were within normal limits except for a decreased hemoglobin level of 6.6 g/dL. During an evaluation for suspected gastrointestinal bleeding using an endoscopic gastroduodenoscopy, a polypoid mass with central ulceration was detected in the antrum along the greater curvature of the stomach (figure).

The results of contrast-enhanced CT revealed a 4-cm, well-circumscribed, homogeneously enhancing tumor along the greater curvature side of the gastric antrum. Concurrently, multiple, small-sized, nodular lesions were suspected in the liver. What is the diagnosis for this patient?




Your AGA Foundation Gifts Support ...

altSaurabh Mehandru, MD, who received an Elsevier Pilot Grant this year.

"I am very grateful to the AGA Foundation for considering my application and for awarding me with this pilot research award. I will conduct research using a novel strategy to harness the immunizing properties of dendritic cells to induce GI mucosal immune responses. Notably, this grant will provide crucial funding to help me generate data in support of future proposals. In that, it will be a critical resource as I transition from a GI fellow to an independent investigator studying GI mucosal immunity with a novel HIV vaccine."

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Fellows: Apply for Career Development Grant

GI fellows who are interested in independent research careers are invited to apply for the Fellowship to Faculty Transition Award.

The award provides $40,000 per year for two years (total $80,000) to current trainees in gastroenterology-related fields so they may gain additional laboratory 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. Applicants must also be AGA trainee members at the time of application.

Apply now — applications are due Dec. 10. Complete eligibility requirements and application information are available online. For information about other research awards, visit

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Swallowing of Foreign Bodies Is Recurrent Problem

Guidelines support endoscopic removal of certain gastric foreign bodies and all foreign bodies lodged in the esophagus. In a study appearing in Clinical Gastroenterology and Hepatology, doctors found that endoscopic retrieval is relatively effective and safe, but often requires general anesthesia. These cases utilize significant hospital and fiscal resources. Attention should be focused on preventing these recurrent and costly episodes.

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New Blog Post

Read a new post from The AGA Journals Blog regarding the above study on swallowing foreign bodies: You Swallowed What?


Early Discontinuation of Antiviral Therapy Is Common

A significant proportion of patients with hepatitis C virus infection discontinue antiviral treatment prematurely. Risk factors for discontinuation before 48 weeks among patients with genotype 1 hepatitis C virus vary over the course of therapy. Data published in Clinical Gastroenterology and Hepatology suggests that early discontinuation of antiviral therapy was 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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Adolescent Obesity Associated with Severe Obesity in Adulthood

The prevalence of obesity has increased in recent years. However, individuals who are obese early in life have not been studied over time to determine whether they develop severe obesity in adulthood, thus limiting effective interventions to reduce severe obesity incidence and its potentially life-threatening-associated conditions. According to a study in the Journal of the American Medical Association, obesity in adolescence was significantly associated with increased risk of incident severe obesity in adulthood, with variations by gender and race/ethnicity.

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DRE Is Useful Tool for Identifying Patients with Dyssynergia

Dyssynergic defecation is a common cause of chronic constipation; its diagnosis requires anorectal physiological tests that are not widely available. It is not known whether digital rectal examination (DRE) can be used to identify dyssynergia. DRE appears to be a reliable tool for identifying dyssynergia in patients with chronic constipation and detecting normal — but not abnormal — sphincter tone, stated doctors in a study published in Clinical Gastroenterology and Hepatology. DREs could facilitate the selection of appropriate patients for further physiologic testing and treatment.

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Deadline Approaching for Probiotics Research Award

Abstract submissions are due Wednesday, Dec. 1 for the Institut Rosell Probiotics Challenge, which offers cash prizes to students at a recognized college or university who submit a probiotics-related abstract to DDW® 2011.

Three prizes in the amounts of $10,000 for first place, $5,000 for second place and $2,500 for third place will be awarded at DDW. The lead authors of the winning papers will present their work in the form of a poster at DDW 2011.

This challenge is designed to encourage awareness and education in probiotics worldwide. Successful projects will utilize probiotics products such as functional foods, dietary supplements or pharmaceuticals. Suggested areas of study include microbial characteristics, growth conditions, probiotic mechanisms of action, safety issues, and nutritional or Phase I clinical trials. Studies on micro-organisms, products, controls and placebos provided by Institut Rosell are strongly encouraged; however, the source of the organisms will not be a factor in the award process.

Undergraduates, graduate and medical students are eligible to apply. Students’ work must be supervised by a professor or physician who is a faculty member at their school and who will provide direction and attest to the integrity of the results. The work must not have been presented previously at any scientific conference, congress or symposium.

To apply, submit an abstract for DDW 2011 on or before Dec. 1. Students and advisors can obtain more information about the probiotics challenge by visiting

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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 Will Help You Prepare for the Future of Your Practice

With the implementation of health-care reform law, the changing of power in Congress and new regulatory issues, it is more important — and even harder — for health-care professionals to stay abreast of the issues that may affect our practice of medicine. To help gastroenterologists identify and understand these emerging issues, the AGA is launching an innovative new program: the AGA Think Tank on the Future of Practice.

Pending Practice Issues
Over the coming months, the think tank will take a deep look at important and often confusing practice issues. The first is accountable care organizations (ACOs). Lawrence R. Kosinski, MD, MBA, AGAF, FACG, managing partner, Illinois Gastroenterology Group, and John Garrett, MD, clinician, Asheville Gastroenterology Associates, are developing a program for the end of November focusing on ACOs that will help provide a basis for understanding your options. Stay tuned for more information.

In December, the think tank will focus on the recent elections and health-care reform by hosting two free one-hour webinars — one on key practice implications on Dec. 3 and one on small business and tax implications on Dec. 13. Presenters will include health-care policy experts from Hart Health Strategies, one of Washington's top health-care consulting firms, and the webinar will be moderated by AGA member clinicians. We hope you register and join us.

We Want to Hear from You
Are there local issues and trends that are affecting the way you practice medicine? What topics are you interested in learning more about? AGA is looking for members in practice to serve as virtual advisors to the AGA Governing Board. If you are interested in being considered or have topic ideas, please contact Aimee Frank, director of public relations, either via e-mail at or phone at 301-941-2620. AGA has an interest in increasing representation among women and minorities, and encourages members from those groups to get involved.

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Receive FDA Drug Alerts by E-Mail and Earn CME

Physicians can improve patient safety, decrease their liability, ensure regulatory compliance and, now, earn CME by registering to receive FDA-mandated drug safety notifications and risk evaluation and mitigation strategies by e-mail through the Health Care Notification Network (HCNN), a service of PDR Network. With the HCNN, physicians will receive notifications immediately, avoiding the lag time associated with traditional patient safety notices received by mail. HCNN is the only service that fulfills FDA guidelines for electronic communication of patient safety notices.

Most recently, PDR Network has partnered with The Doctors Company, the country’s largest professional medical liability carrier, to offer physicians CME — at no cost — through participation in the program.

How does HCNN work?

HCNN is free to all licensed U.S. physicians and is solely used for delivering patient safety alerts regarding drug and medical device recalls via e-mail. Governed by the not-for-profit iHealth Alliance, HCNN ensures the most rapid and effective delivery of important patient safety alerts. Based upon user-defined criteria, physicians can ensure that they receive those FDA-required product and drug alerts that are relevant to their practice.

Physicians can add three staff members to their accounts, ensuring the information is received. Electronic alerts that go unread for 24 hours from delivery are followed up with traditional paper-based alerts by mail, typically arriving a week or more after initial online notification from HCNN.

For more information and to register, visit the AGA Institute/HCNN Web site.

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Symposium Offers the Latest Advances in GI Oncology

For the eighth consecutive year, the AGA Institute, the American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology, and the Society of Surgical Oncology will co-sponsor the Gastrointestinal Cancers Symposium: Science and Multidisciplinary Management of GI Malignancies, which will be held Jan. 20 to 22, 2011, in San Francisco, CA. This is one of a few educational events that focuses on the science behind the latest clinical advances related to GI cancer diagnosis and treatment in a multi-disciplinary forum. View a video overview of the symposium.

The symposium offers educational sessions and abstract presentations focused on each type of GI cancer, including esophageal, gastric, hepatobiliary, pancreatic, small bowel, colon and rectal.

Program highlights include:

  • Comparing the European and U.S. Approaches for Colorectal Cancer Screening.
  • Utility of Circulating Tumor Cells in Oncology.
  • Review of New Guidelines for Hepatocellular Cancer Diagnosis.
  • A Stage-Specific Approach to Esophageal-Gastric Cancer.
  • Cell of Origin of Pancreatic Cancer: The Link between Pancreas Development and Cancer.
  • Update on Treatment of Carcinoma of the Anal Canal.

Designed as a discussion-based meeting, the symposium will foster dialogue among oncologists, gastroenterologists and other members of the cancer care community.

The early bird registration deadline is Dec. 15. Registration fees will increase by $150 after this date. For further details and to register, visit

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Deadline Extended: Distinguished Educator Award

Nominations are now due Dec. 3 for the Distinguished Educator Award, which recognizes an AGA member for his or her achievements over a lifelong career in education. Nominate a colleague now.


AGA Member Benefit: Discount on Rome III Book

AGA members will receive a 20 percent discount on the purchase of educational products from the Rome Foundation.

The Rome III book, available in English and Spanish, is designed for one-stop learning about functional GI disorders. A useful tool for self-study, its 17 chapters include information on:

  • The Rome III diagnostic criteria for all 28 adult and 17 pediatric functional gastrointestinal disorder (FGID) diagnoses.
  • "Red flag" questions to aid the clinician in identifying symptoms and signs that would suggest further evaluation to exclude other diagnoses or a mental health referral.
  • The most up-to-date information on the epidemiology, psychosocial and cultural features, patho-physiology, diagnosis and treatment of more than 45 functional GI disorders commonly seen in clinical practice.
  • New chapters, which include pharmacology and pharmaco-kinetics, socio-cultural influences relating to gender, age and cultural influences, and functional abdominal pain.
  • Expanded information on pediatric FGID with chapters on neonate/toddler and child/adolescent.

Also available is the Rome Foundation computer-based learning program, a collection of state-of-the-art slides that brings to life information from the Rome III book and updates this information from the recent scientific literature.

Both products can be purchased from the Rome Foundation’s online store. Enter the discount code AGAMEMBER to save 20 percent on your order.

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Pre-Order DDSEP® 6 by Nov. 30 and Save

The field's most comprehensive self-education program returns with the release of Digestive Diseases Self-Education Program® 6 in December. Pre-order by Nov. 30 and save $50.



CMS Creates New Center for Medicare and Medicaid Innovation

CMS has formally established the new Center for Medicare and Medicaid Innovation. The center will examine new ways of delivering health care and paying health-care providers that can save money for Medicare and Medicaid while improving the quality of care.

The innovation center will consult stakeholders across the health-care sector, including hospitals, doctors, consumers, payors, states, employers, advocates, relevant federal agencies and others to obtain direct input on its operations and to build partnerships with those interested in its work. The organization will also test models that include establishing an "open innovation community" that serves as an information clearinghouse of best practices in health-care innovation. Learn more about the innovation center and its initiatives.

CMS also launched new demonstration projects that will support efforts to better coordinate care and improve health outcomes for patients. In addition, it announced several new initiatives to strengthen primary care and better coordinate care for patients. Read the full listing of initiatives.

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Osteoporosis Drugs Undergo Label Change

The FDA has updated the public regarding information previously communicated describing the risk of atypical fractures of the thigh, known as subtrochanteric and diaphyseal femur fractures, in patients who take bisphosphonates for osteoporosis. This information will be added to the warnings and precautions section of the labels approved to treat osteoporosis, including Fosamax, Fosamax Plus D, Actonel, Actonel with calcium, Boniva, Atelvia and Reclast (and their generic products). A medication guide will also be required to be given to patients when they pick up their bisphosphonate prescription.

IBD patients are at higher risk for osteoporosis (due to medications) and some studies suggest an association with Crohn’s disease. Therefore, those patients are often prescribed these medications for prevention.

Read the full alert.

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Journal Editors' Picks

The editors of Gastroenterology and Clinical Gastroenterology and Hepatology (CGH) would like to bring to your attention the following highlighted articles from the November issues of the journals:



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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.

Global Probiotics Council — Young Investigator Grant for Probiotics Research (YIGPRO)

The Global Probiotics Council (GPC), a committee established in 2004 by DANONE and Yakult Honsha Co., Ltd., has announced the fourth annual Young Investigator Grant for Probiotics Research (YIGPRO). The purpose of the two annual grants of $50,000 each is to contribute to the advancement of probiotics and gastrointestinal microbiota research in the U.S., and to impact academic and career development of young investigators, attracting them into the field of probiotics and microbiota.

Deadline: Feb. 15, 2011.

The official announcement and description of this opportunity may be found at:

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