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Guideline public comment period framework
AGA is dedicated to integrity and transparency in the development of clinical guidance.
W In addition, to keep academic integrity of the AGA guideline, clinical practice update, and clinical pathway process, AGA follows the framework outlined by the Council of Medical Specialty Societies (CMSS) in The Code for Interaction with Companies.
The Code for Interaction with Companies states:
“7.15. Societies will not permit Guideline development panel members or staff to discuss a Guideline’s development with Company employees or representatives, will not accept unpublished data from Companies, and will not permit Companies to review Guidelines in draft form, except if a Society permits public or member comment on draft Guidelines as a part of the Society’s published Guideline development process.”
The Clinical Guidelines Committee and Clinical Practice Updates Committee strive to keep AGA’s clinical practice tools independent of industry influence and remain solely based on scientific evidence. As a result of this effort, AGA’s writing panels and chairs will have no direct communication with industry. Companies will have the opportunity to submit feedback during the public comment period. The panel will review any comments submitted through the online platform along with feedback from the public. The writing panel will take these suggestions into consideration when making revisions following the public comment period.
AGA is dedicated to integrity and transparency in the development of clinical guidance.
W In addition, to keep academic integrity of the AGA guideline, clinical practice update, and clinical pathway process, AGA follows the framework outlined by the Council of Medical Specialty Societies (CMSS) in The Code for Interaction with Companies.
The Code for Interaction with Companies states:
“7.15. Societies will not permit Guideline development panel members or staff to discuss a Guideline’s development with Company employees or representatives, will not accept unpublished data from Companies, and will not permit Companies to review Guidelines in draft form, except if a Society permits public or member comment on draft Guidelines as a part of the Society’s published Guideline development process.”
The Clinical Guidelines Committee and Clinical Practice Updates Committee strive to keep AGA’s clinical practice tools independent of industry influence and remain solely based on scientific evidence. As a result of this effort, AGA’s writing panels and chairs will have no direct communication with industry. Companies will have the opportunity to submit feedback during the public comment period. The panel will review any comments submitted through the online platform along with feedback from the public. The writing panel will take these suggestions into consideration when making revisions following the public comment period.
AGA is dedicated to integrity and transparency in the development of clinical guidance.
W In addition, to keep academic integrity of the AGA guideline, clinical practice update, and clinical pathway process, AGA follows the framework outlined by the Council of Medical Specialty Societies (CMSS) in The Code for Interaction with Companies.
The Code for Interaction with Companies states:
“7.15. Societies will not permit Guideline development panel members or staff to discuss a Guideline’s development with Company employees or representatives, will not accept unpublished data from Companies, and will not permit Companies to review Guidelines in draft form, except if a Society permits public or member comment on draft Guidelines as a part of the Society’s published Guideline development process.”
The Clinical Guidelines Committee and Clinical Practice Updates Committee strive to keep AGA’s clinical practice tools independent of industry influence and remain solely based on scientific evidence. As a result of this effort, AGA’s writing panels and chairs will have no direct communication with industry. Companies will have the opportunity to submit feedback during the public comment period. The panel will review any comments submitted through the online platform along with feedback from the public. The writing panel will take these suggestions into consideration when making revisions following the public comment period.
2018 AGA legislative wins
To those who took time to advocate on behalf of your profession and patients, thank you. Because of your efforts, we achieved several key successes that benefit clinicians, researchers and patients.
Together we were able to help advance several AGA policy priorities — administrative burden relief, digestive disease research and funding, and patient access and protection — as well as the science and practice of gastroenterology.
This year, we will be counting on you, our members, to again lead the charge to achieve AGA’s mission — empowering clinicians and researchers to improve digestive health — by calling on legislators and regulators to ensure the voice of gastroenterology continue to be heard.
NIH funding increase
AGA advocated and secured a $2 billion increase in NIH funding for fiscal year (FY) 2019. When added to increases from the two previous fiscal years, NIH’s funding has increased by 30 percent over the past three years, which is the largest increase since the doubling period in the last decade.
IPAB repeal prevents automatic Medicare cuts
Congress repealed the Independent Payment Advisory Board (IPAB) that was created as part of the Affordable Care Act (ACA). AGA and all of organized medicine long opposed IPAB since its sole purpose was to make budgetary cuts to Medicare if it reached a certain threshold of spending.
MIPS changes means more flexibility for physicians
AGA and the physician community were successful in securing flexibility under the new Medicare Quality Payment Program and the Merit-based Incentive Payment System (MIPS) that were created under the Medicare Access and CHIP Reauthorization Act. The changes give CMS more flexibility in implementing the program and will ensure that physicians have an opportunity to be successful in MIPS.
500 AGA members prevent radical changes to outpatient documentation
In response to a CMS proposal to radically change how outpatient evaluation and management (E/M) services are documented, more than 500 AGA members urged CMS not to move forward with its plan. As a result, CMS withdrew or delayed many of the proposed changes to E/M services that negatively impacted reimbursement. CMS did move forward with several changes to E/M documentation in an effort to reduce administrative burden.
AGA members send more than 940 letters to Congress
AGA launched the Congressional Advocates Program to provide an infrastructure and tools for members to effectively advocate on behalf of their profession and patients. AGA members heeded our calls to action and sent more than 940 letters sent to Congress and federal agencies throughout 2018. We thank our advocates whose participation makes a difference.
To those who took time to advocate on behalf of your profession and patients, thank you. Because of your efforts, we achieved several key successes that benefit clinicians, researchers and patients.
Together we were able to help advance several AGA policy priorities — administrative burden relief, digestive disease research and funding, and patient access and protection — as well as the science and practice of gastroenterology.
This year, we will be counting on you, our members, to again lead the charge to achieve AGA’s mission — empowering clinicians and researchers to improve digestive health — by calling on legislators and regulators to ensure the voice of gastroenterology continue to be heard.
NIH funding increase
AGA advocated and secured a $2 billion increase in NIH funding for fiscal year (FY) 2019. When added to increases from the two previous fiscal years, NIH’s funding has increased by 30 percent over the past three years, which is the largest increase since the doubling period in the last decade.
IPAB repeal prevents automatic Medicare cuts
Congress repealed the Independent Payment Advisory Board (IPAB) that was created as part of the Affordable Care Act (ACA). AGA and all of organized medicine long opposed IPAB since its sole purpose was to make budgetary cuts to Medicare if it reached a certain threshold of spending.
MIPS changes means more flexibility for physicians
AGA and the physician community were successful in securing flexibility under the new Medicare Quality Payment Program and the Merit-based Incentive Payment System (MIPS) that were created under the Medicare Access and CHIP Reauthorization Act. The changes give CMS more flexibility in implementing the program and will ensure that physicians have an opportunity to be successful in MIPS.
500 AGA members prevent radical changes to outpatient documentation
In response to a CMS proposal to radically change how outpatient evaluation and management (E/M) services are documented, more than 500 AGA members urged CMS not to move forward with its plan. As a result, CMS withdrew or delayed many of the proposed changes to E/M services that negatively impacted reimbursement. CMS did move forward with several changes to E/M documentation in an effort to reduce administrative burden.
AGA members send more than 940 letters to Congress
AGA launched the Congressional Advocates Program to provide an infrastructure and tools for members to effectively advocate on behalf of their profession and patients. AGA members heeded our calls to action and sent more than 940 letters sent to Congress and federal agencies throughout 2018. We thank our advocates whose participation makes a difference.
To those who took time to advocate on behalf of your profession and patients, thank you. Because of your efforts, we achieved several key successes that benefit clinicians, researchers and patients.
Together we were able to help advance several AGA policy priorities — administrative burden relief, digestive disease research and funding, and patient access and protection — as well as the science and practice of gastroenterology.
This year, we will be counting on you, our members, to again lead the charge to achieve AGA’s mission — empowering clinicians and researchers to improve digestive health — by calling on legislators and regulators to ensure the voice of gastroenterology continue to be heard.
NIH funding increase
AGA advocated and secured a $2 billion increase in NIH funding for fiscal year (FY) 2019. When added to increases from the two previous fiscal years, NIH’s funding has increased by 30 percent over the past three years, which is the largest increase since the doubling period in the last decade.
IPAB repeal prevents automatic Medicare cuts
Congress repealed the Independent Payment Advisory Board (IPAB) that was created as part of the Affordable Care Act (ACA). AGA and all of organized medicine long opposed IPAB since its sole purpose was to make budgetary cuts to Medicare if it reached a certain threshold of spending.
MIPS changes means more flexibility for physicians
AGA and the physician community were successful in securing flexibility under the new Medicare Quality Payment Program and the Merit-based Incentive Payment System (MIPS) that were created under the Medicare Access and CHIP Reauthorization Act. The changes give CMS more flexibility in implementing the program and will ensure that physicians have an opportunity to be successful in MIPS.
500 AGA members prevent radical changes to outpatient documentation
In response to a CMS proposal to radically change how outpatient evaluation and management (E/M) services are documented, more than 500 AGA members urged CMS not to move forward with its plan. As a result, CMS withdrew or delayed many of the proposed changes to E/M services that negatively impacted reimbursement. CMS did move forward with several changes to E/M documentation in an effort to reduce administrative burden.
AGA members send more than 940 letters to Congress
AGA launched the Congressional Advocates Program to provide an infrastructure and tools for members to effectively advocate on behalf of their profession and patients. AGA members heeded our calls to action and sent more than 940 letters sent to Congress and federal agencies throughout 2018. We thank our advocates whose participation makes a difference.
Help spark scientific breakthroughs with the AGA Research Foundation
The way we diagnose and treat patients is the result of years of research. But securing the future of the field is no small task. A donation to the charitable arm of the American Gastroenterological Association (AGA), the AGA Research Foundation, will help fill the funding gap and contribute to this tradition of discovery.
The foundation provides a key source of funding at a critical juncture in a young investigator’s career.
Help spark the scientific breakthroughs of today, so clinicians will have the tools to improve care tomorrow. Your tax-deductible donation will make a critical difference in retaining talented GI scientists, like Won Jae Huh, MD, whose research will impact the future care of patients.
“As a clinical researcher, funding for investigation is critical in scientific breakthroughs to promote more efficient and robust patient care. My project will provide novel insights into the role of distensibility in the treatment of patients with esophageal eosinophilia, potentially resulting in more efficient treatment selection and disease management.”
“This funding mechanism will secure my research time to investigate signaling pathways involved in the pathogenesis of Ménétrier’s disease, and will provide resources and support to launch my research career. The results from my research project will be helpful for treating Ménétrier’s disease patients.”
Help spark the scientific breakthroughs of today, so clinicians will have the tools to improve care tomorrow. Your tax-deductible donation will make a critical difference in retaining talented GI scientists, like Dr. Won Jae Huh, whose research will impact the future care of patients.
Donate on the foundation’s website at www.gastro.org/donateonline or by mail to 4930 Del Ray Avenue, Bethesda, MD 20814.
The way we diagnose and treat patients is the result of years of research. But securing the future of the field is no small task. A donation to the charitable arm of the American Gastroenterological Association (AGA), the AGA Research Foundation, will help fill the funding gap and contribute to this tradition of discovery.
The foundation provides a key source of funding at a critical juncture in a young investigator’s career.
Help spark the scientific breakthroughs of today, so clinicians will have the tools to improve care tomorrow. Your tax-deductible donation will make a critical difference in retaining talented GI scientists, like Won Jae Huh, MD, whose research will impact the future care of patients.
“As a clinical researcher, funding for investigation is critical in scientific breakthroughs to promote more efficient and robust patient care. My project will provide novel insights into the role of distensibility in the treatment of patients with esophageal eosinophilia, potentially resulting in more efficient treatment selection and disease management.”
“This funding mechanism will secure my research time to investigate signaling pathways involved in the pathogenesis of Ménétrier’s disease, and will provide resources and support to launch my research career. The results from my research project will be helpful for treating Ménétrier’s disease patients.”
Help spark the scientific breakthroughs of today, so clinicians will have the tools to improve care tomorrow. Your tax-deductible donation will make a critical difference in retaining talented GI scientists, like Dr. Won Jae Huh, whose research will impact the future care of patients.
Donate on the foundation’s website at www.gastro.org/donateonline or by mail to 4930 Del Ray Avenue, Bethesda, MD 20814.
The way we diagnose and treat patients is the result of years of research. But securing the future of the field is no small task. A donation to the charitable arm of the American Gastroenterological Association (AGA), the AGA Research Foundation, will help fill the funding gap and contribute to this tradition of discovery.
The foundation provides a key source of funding at a critical juncture in a young investigator’s career.
Help spark the scientific breakthroughs of today, so clinicians will have the tools to improve care tomorrow. Your tax-deductible donation will make a critical difference in retaining talented GI scientists, like Won Jae Huh, MD, whose research will impact the future care of patients.
“As a clinical researcher, funding for investigation is critical in scientific breakthroughs to promote more efficient and robust patient care. My project will provide novel insights into the role of distensibility in the treatment of patients with esophageal eosinophilia, potentially resulting in more efficient treatment selection and disease management.”
“This funding mechanism will secure my research time to investigate signaling pathways involved in the pathogenesis of Ménétrier’s disease, and will provide resources and support to launch my research career. The results from my research project will be helpful for treating Ménétrier’s disease patients.”
Help spark the scientific breakthroughs of today, so clinicians will have the tools to improve care tomorrow. Your tax-deductible donation will make a critical difference in retaining talented GI scientists, like Dr. Won Jae Huh, whose research will impact the future care of patients.
Donate on the foundation’s website at www.gastro.org/donateonline or by mail to 4930 Del Ray Avenue, Bethesda, MD 20814.
AGA to FDA: We support new labeling recommendations for probiotics
In a new comment letter to FDA, AGA commends FDA’s recent draft guidance – “Policy Regarding Quantitative Labeling of Dietary Supplements Containing Live Microbials” – clarifying the expectations of probiotics manufacturers who choose to specify the amount of a live microbial component in their product in colony forming units (CFUs).
Though manufacturers are not currently required to report CFUs, AGA feels strongly that all manufacturers of probiotic supplements should voluntarily report the composition of live microbials in their products as CFUs.
However, reporting CFUs alone provides insufficient information to consumers and health care professionals who may recommend probiotic supplements to their patients. In our comment letter, AGA encourages FDA to expand what information manufacturers are required to include. In addition to the conditions already outlined in FDA’s draft guidance, AGA recommends including the conditions of storage as well as an expiration or “use by” date.
We acknowledge that researchers are evaluating other methods and units of measure besides CFUs for not only live microbials but also microbial bioactivity. However, in the absence of a widely accepted alternative, which may take several years to develop and adopt, AGA strongly encourages FDA and manufacturers to take the small step forward of using CFUs now rather than waiting for another solution to emerge.
Probiotics have been an important focus for the AGA Center for Gut Microbiome Research and Education due to the need for evidence-based guidance for health care providers and their patients. The center will continue to work to educate physicians, patients and industry on best practices to ensure safe use of probiotics.
In a new comment letter to FDA, AGA commends FDA’s recent draft guidance – “Policy Regarding Quantitative Labeling of Dietary Supplements Containing Live Microbials” – clarifying the expectations of probiotics manufacturers who choose to specify the amount of a live microbial component in their product in colony forming units (CFUs).
Though manufacturers are not currently required to report CFUs, AGA feels strongly that all manufacturers of probiotic supplements should voluntarily report the composition of live microbials in their products as CFUs.
However, reporting CFUs alone provides insufficient information to consumers and health care professionals who may recommend probiotic supplements to their patients. In our comment letter, AGA encourages FDA to expand what information manufacturers are required to include. In addition to the conditions already outlined in FDA’s draft guidance, AGA recommends including the conditions of storage as well as an expiration or “use by” date.
We acknowledge that researchers are evaluating other methods and units of measure besides CFUs for not only live microbials but also microbial bioactivity. However, in the absence of a widely accepted alternative, which may take several years to develop and adopt, AGA strongly encourages FDA and manufacturers to take the small step forward of using CFUs now rather than waiting for another solution to emerge.
Probiotics have been an important focus for the AGA Center for Gut Microbiome Research and Education due to the need for evidence-based guidance for health care providers and their patients. The center will continue to work to educate physicians, patients and industry on best practices to ensure safe use of probiotics.
In a new comment letter to FDA, AGA commends FDA’s recent draft guidance – “Policy Regarding Quantitative Labeling of Dietary Supplements Containing Live Microbials” – clarifying the expectations of probiotics manufacturers who choose to specify the amount of a live microbial component in their product in colony forming units (CFUs).
Though manufacturers are not currently required to report CFUs, AGA feels strongly that all manufacturers of probiotic supplements should voluntarily report the composition of live microbials in their products as CFUs.
However, reporting CFUs alone provides insufficient information to consumers and health care professionals who may recommend probiotic supplements to their patients. In our comment letter, AGA encourages FDA to expand what information manufacturers are required to include. In addition to the conditions already outlined in FDA’s draft guidance, AGA recommends including the conditions of storage as well as an expiration or “use by” date.
We acknowledge that researchers are evaluating other methods and units of measure besides CFUs for not only live microbials but also microbial bioactivity. However, in the absence of a widely accepted alternative, which may take several years to develop and adopt, AGA strongly encourages FDA and manufacturers to take the small step forward of using CFUs now rather than waiting for another solution to emerge.
Probiotics have been an important focus for the AGA Center for Gut Microbiome Research and Education due to the need for evidence-based guidance for health care providers and their patients. The center will continue to work to educate physicians, patients and industry on best practices to ensure safe use of probiotics.
Memorial and honorary gifts: a special tribute
Make a tribute gift to honor someone whose life has been touched by GI research or celebrate a special occasion such as a birthday while supporting the AGA Research Awards Program through the AGA Research Foundation. A tribute gift will make your loved one feel special because it honors their passion, and also help us fund research grants to talented young investigators whose work will shape the future of clinical care.
- Giving a gift to the AGA Research Foundation in memory of a loved one. A memorial gift is a meaningful way to celebrate the legacy of a family member, friend, or colleague.
- A gift today. An outright gift will help fund the AGA Research Awards Program. Your gift will assist in furthering basic digestive disease research which can ultimately advance research into all digestive diseases. The financial benefits include an income tax deduction and possible elimination of capital gains tax.
Learn more about ways to recognize and acknowledge someone by visit our website at www.gastro.org/contribute or contact Harmony Excellent at 301-272-1602 or [email protected].
Make a tribute gift to honor someone whose life has been touched by GI research or celebrate a special occasion such as a birthday while supporting the AGA Research Awards Program through the AGA Research Foundation. A tribute gift will make your loved one feel special because it honors their passion, and also help us fund research grants to talented young investigators whose work will shape the future of clinical care.
- Giving a gift to the AGA Research Foundation in memory of a loved one. A memorial gift is a meaningful way to celebrate the legacy of a family member, friend, or colleague.
- A gift today. An outright gift will help fund the AGA Research Awards Program. Your gift will assist in furthering basic digestive disease research which can ultimately advance research into all digestive diseases. The financial benefits include an income tax deduction and possible elimination of capital gains tax.
Learn more about ways to recognize and acknowledge someone by visit our website at www.gastro.org/contribute or contact Harmony Excellent at 301-272-1602 or [email protected].
Make a tribute gift to honor someone whose life has been touched by GI research or celebrate a special occasion such as a birthday while supporting the AGA Research Awards Program through the AGA Research Foundation. A tribute gift will make your loved one feel special because it honors their passion, and also help us fund research grants to talented young investigators whose work will shape the future of clinical care.
- Giving a gift to the AGA Research Foundation in memory of a loved one. A memorial gift is a meaningful way to celebrate the legacy of a family member, friend, or colleague.
- A gift today. An outright gift will help fund the AGA Research Awards Program. Your gift will assist in furthering basic digestive disease research which can ultimately advance research into all digestive diseases. The financial benefits include an income tax deduction and possible elimination of capital gains tax.
Learn more about ways to recognize and acknowledge someone by visit our website at www.gastro.org/contribute or contact Harmony Excellent at 301-272-1602 or [email protected].
Top AGA Community patient cases
about therapy and disease management options, best practices, and diagnoses.
In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Active colitis in a patient with previous colon cancer
This popular conversation centers around next steps for a 39-year-old previously treated for a large malignant tumor with a right hemicolectomy and chemotherapy. She was referred for a chromoendoscopy, which revealed four areas of nonpolypoid abnormal mucosa with indistinct borders and abnormal dye uptake. Biopsies also revealed low-grade dysplasia and minimally active colitis.
2. IBD in remission
A 66-year-old female with a history of Crohn’s disease is currently asymptomatic and in remission, but with low Remicade trough. The debate among physicians in the forum questions the need for further action or follow-up insight. 3. Eosinophilic esophagitis and duodenitis (http://ow.ly/kja130mRoDV)
This 40-year-old patient was originally seen for food bolus. The physician prescribed proton pump inhibitors (PPI) after a scope showed typical eosinophilic esophagitis (EoE) findings. Although he had symptoms of obstruction since he was 15, this was his first upper endoscopy. Biopsies following successful scopes showed eosinophilic duodenitis and the patient had no signs of eosinophilia in the stomach.
4. Eosinophilic esophagitis and gastric sleeve
A physician noted no established absolute contraindication for a 50-year-old patient who was seen for a presleeve gastrectomy. Others contributing to this thread shared concerns for the risk for gastroesophageal reflux disease (GERD) post-surgery and committing the patient to long-term steroids.
More clinical cases and discussions are at https://community.gastro.org/discussions.
about therapy and disease management options, best practices, and diagnoses.
In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Active colitis in a patient with previous colon cancer
This popular conversation centers around next steps for a 39-year-old previously treated for a large malignant tumor with a right hemicolectomy and chemotherapy. She was referred for a chromoendoscopy, which revealed four areas of nonpolypoid abnormal mucosa with indistinct borders and abnormal dye uptake. Biopsies also revealed low-grade dysplasia and minimally active colitis.
2. IBD in remission
A 66-year-old female with a history of Crohn’s disease is currently asymptomatic and in remission, but with low Remicade trough. The debate among physicians in the forum questions the need for further action or follow-up insight. 3. Eosinophilic esophagitis and duodenitis (http://ow.ly/kja130mRoDV)
This 40-year-old patient was originally seen for food bolus. The physician prescribed proton pump inhibitors (PPI) after a scope showed typical eosinophilic esophagitis (EoE) findings. Although he had symptoms of obstruction since he was 15, this was his first upper endoscopy. Biopsies following successful scopes showed eosinophilic duodenitis and the patient had no signs of eosinophilia in the stomach.
4. Eosinophilic esophagitis and gastric sleeve
A physician noted no established absolute contraindication for a 50-year-old patient who was seen for a presleeve gastrectomy. Others contributing to this thread shared concerns for the risk for gastroesophageal reflux disease (GERD) post-surgery and committing the patient to long-term steroids.
More clinical cases and discussions are at https://community.gastro.org/discussions.
about therapy and disease management options, best practices, and diagnoses.
In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Active colitis in a patient with previous colon cancer
This popular conversation centers around next steps for a 39-year-old previously treated for a large malignant tumor with a right hemicolectomy and chemotherapy. She was referred for a chromoendoscopy, which revealed four areas of nonpolypoid abnormal mucosa with indistinct borders and abnormal dye uptake. Biopsies also revealed low-grade dysplasia and minimally active colitis.
2. IBD in remission
A 66-year-old female with a history of Crohn’s disease is currently asymptomatic and in remission, but with low Remicade trough. The debate among physicians in the forum questions the need for further action or follow-up insight. 3. Eosinophilic esophagitis and duodenitis (http://ow.ly/kja130mRoDV)
This 40-year-old patient was originally seen for food bolus. The physician prescribed proton pump inhibitors (PPI) after a scope showed typical eosinophilic esophagitis (EoE) findings. Although he had symptoms of obstruction since he was 15, this was his first upper endoscopy. Biopsies following successful scopes showed eosinophilic duodenitis and the patient had no signs of eosinophilia in the stomach.
4. Eosinophilic esophagitis and gastric sleeve
A physician noted no established absolute contraindication for a 50-year-old patient who was seen for a presleeve gastrectomy. Others contributing to this thread shared concerns for the risk for gastroesophageal reflux disease (GERD) post-surgery and committing the patient to long-term steroids.
More clinical cases and discussions are at https://community.gastro.org/discussions.
New editors appointed to CMGH
The next editorial team of the AGA’s basic and translational journal CMGH has been selected. Both editors are from the University of Pennsylvania Perelman School of Medicine. Dr. Kaestner is the Thomas and Evelyn Suor Butterworth Professor in Genetics. Dr. Pack is a professor of medicine and cell and developmental biology and is an attending gastroenterologist at the Hospital of the University of Pennsylvania.
CMGH debuted in 2015 with the mission of publishing impactful digestive biology research that ranges from mechanisms of normal function to pathobiology and covers a broad spectrum of themes in gastroenterology, hepatology, and pancreatology. CMGH is open access, published eight times a year, online-only and is indexed in Medline and PubMed Central. Carrying forward the tremendous success of the journal’s current editor-in-chief, Jerrold R. Turner, MD, PhD, AGAF, and his board of editors, Drs. Kaestner and Pack’s goals include advancing the impact and reputation of CMGH, ensuring the quality and fairness of the peer-review process and introducing new content that is important to the basic and translational research community.
Dr. Kaestner and Dr. Pack’s board of editors includes:
Jonathan Katz, MD
Perelman School of Medicine, University of Pennsylvania
Alison Simmons, MD, PhD
University of Oxford
Frank Tacke, MD, PhD
Rheinisch-Westfälische Technische University
In response to the appointment, Dr. Kaestner said, “We are extremely excited about the opportunity to build on the success of the current editorial team, which has already made CMGH a go-to journal for outstanding digestive disease research. Our goals will be to extend the reach of the journal and to ensure its growth as the premier publication for basic research in gastroenterology and hepatology.”
Dr. Pack added, “The remarkable success achieved by CMGH is a testament to the skill and dedication of Dr. Turner and his associate editors, Drs. Goldenring, Rescigno and Wells, as well as the tremendous growth of impactful basic research in digestive organ biology and disease. Dr. Kaestner and I look forward to maintaining the retiring editorial team’s standard of excellence as we expand the CMGH readership and its visibility in the basic research community.”
Dr. Kaestner and Dr. Pack will begin their term in July 2019.
The next editorial team of the AGA’s basic and translational journal CMGH has been selected. Both editors are from the University of Pennsylvania Perelman School of Medicine. Dr. Kaestner is the Thomas and Evelyn Suor Butterworth Professor in Genetics. Dr. Pack is a professor of medicine and cell and developmental biology and is an attending gastroenterologist at the Hospital of the University of Pennsylvania.
CMGH debuted in 2015 with the mission of publishing impactful digestive biology research that ranges from mechanisms of normal function to pathobiology and covers a broad spectrum of themes in gastroenterology, hepatology, and pancreatology. CMGH is open access, published eight times a year, online-only and is indexed in Medline and PubMed Central. Carrying forward the tremendous success of the journal’s current editor-in-chief, Jerrold R. Turner, MD, PhD, AGAF, and his board of editors, Drs. Kaestner and Pack’s goals include advancing the impact and reputation of CMGH, ensuring the quality and fairness of the peer-review process and introducing new content that is important to the basic and translational research community.
Dr. Kaestner and Dr. Pack’s board of editors includes:
Jonathan Katz, MD
Perelman School of Medicine, University of Pennsylvania
Alison Simmons, MD, PhD
University of Oxford
Frank Tacke, MD, PhD
Rheinisch-Westfälische Technische University
In response to the appointment, Dr. Kaestner said, “We are extremely excited about the opportunity to build on the success of the current editorial team, which has already made CMGH a go-to journal for outstanding digestive disease research. Our goals will be to extend the reach of the journal and to ensure its growth as the premier publication for basic research in gastroenterology and hepatology.”
Dr. Pack added, “The remarkable success achieved by CMGH is a testament to the skill and dedication of Dr. Turner and his associate editors, Drs. Goldenring, Rescigno and Wells, as well as the tremendous growth of impactful basic research in digestive organ biology and disease. Dr. Kaestner and I look forward to maintaining the retiring editorial team’s standard of excellence as we expand the CMGH readership and its visibility in the basic research community.”
Dr. Kaestner and Dr. Pack will begin their term in July 2019.
The next editorial team of the AGA’s basic and translational journal CMGH has been selected. Both editors are from the University of Pennsylvania Perelman School of Medicine. Dr. Kaestner is the Thomas and Evelyn Suor Butterworth Professor in Genetics. Dr. Pack is a professor of medicine and cell and developmental biology and is an attending gastroenterologist at the Hospital of the University of Pennsylvania.
CMGH debuted in 2015 with the mission of publishing impactful digestive biology research that ranges from mechanisms of normal function to pathobiology and covers a broad spectrum of themes in gastroenterology, hepatology, and pancreatology. CMGH is open access, published eight times a year, online-only and is indexed in Medline and PubMed Central. Carrying forward the tremendous success of the journal’s current editor-in-chief, Jerrold R. Turner, MD, PhD, AGAF, and his board of editors, Drs. Kaestner and Pack’s goals include advancing the impact and reputation of CMGH, ensuring the quality and fairness of the peer-review process and introducing new content that is important to the basic and translational research community.
Dr. Kaestner and Dr. Pack’s board of editors includes:
Jonathan Katz, MD
Perelman School of Medicine, University of Pennsylvania
Alison Simmons, MD, PhD
University of Oxford
Frank Tacke, MD, PhD
Rheinisch-Westfälische Technische University
In response to the appointment, Dr. Kaestner said, “We are extremely excited about the opportunity to build on the success of the current editorial team, which has already made CMGH a go-to journal for outstanding digestive disease research. Our goals will be to extend the reach of the journal and to ensure its growth as the premier publication for basic research in gastroenterology and hepatology.”
Dr. Pack added, “The remarkable success achieved by CMGH is a testament to the skill and dedication of Dr. Turner and his associate editors, Drs. Goldenring, Rescigno and Wells, as well as the tremendous growth of impactful basic research in digestive organ biology and disease. Dr. Kaestner and I look forward to maintaining the retiring editorial team’s standard of excellence as we expand the CMGH readership and its visibility in the basic research community.”
Dr. Kaestner and Dr. Pack will begin their term in July 2019.
A clinician’s guide to microbiome testing
The intestinal microbiota, also commonly known as the “gut microbiome” is integral to human physiology and has wide-ranging effects on the development and function of the immune system, energy metabolism and nervous system activity. There is a lot of excitement around the potential of targeting the microbiome therapeutically to promote health and to prevent or treat medical conditions. Further, as DNA sequencing technologies and computational methods continue to improve (as reviewed by Rob Knight and colleagues in a prior editorial), there is significant interest in developing microbiome-based diagnostics for clinical applications.
The industry has recognized the consumer interest in microbiome-based diagnostics as an opportunity, and a number of commercial laboratories are marketing tests directly to patients. Physicians, particularly gastroenterologists, are increasingly being asked by their patients to help interpret such test reports; in some cases, the patient may even request a physician order to purchase the tests for insurance coverage or other reasons.
Earlier this year, AGA members had a robust discussion in the AGA Community about microbiome-based tests, requirements for physician authorization, and the clinical utility (if any) of the results of such tests. below.
Limitations of microbiome sequencing. Microbiome datasets have the same limitations as any other sample-dependent dataset. First and foremost, a single stool sample will tell you something about a person’s microbiome profile only at the time and location that the sample was collected. How the sample was collected and how it was stored may significantly impact the analysis. The analysis generally provides an overview of bacterial families and genera, but little information about the viruses, protozoa and fungi. Furthermore, stool analysis may not reflect well the microbiome composition at the mucosal surface in the intestine. As a result, a single analysis of an individual stool sample merely provides a snapshot of the fecal microbiome that is incomplete and extremely limited in what we can learn from it.
“Good” vs. “bad.” The reports resulting from microbiome-based tests often describe the patient’s microbiome profile in terms of how much “good” and “bad” bacteria are present. This kind of a classification framework represents a naïve and cartoonish view of the microbial world. Instead, it is important to appreciate microbial communities as functional networks, and that their functionality cannot be defined as a mere summation of individual microorganisms. Microbes, just like people, vary their behavior in accordance with the context that may be provided by the activity of other microbes and the host. Whether a particular species or strain is helpful or harmful depends on what other bacteria are present, their density, how they interact with each other (e.g., are they mutually beneficial or competitive?), and factors from the human host such as their diet or immune system activity. For example, Clostridioides difficile is a potential pathogen, yet it also naturally exists in the intestines of many people as a nonharmful, commensal species. Its pathogenic potential depends on the state of the other intestinal microbes and host factors, such as presence of anti-C. difficile toxin antibodies.
Importantly, microbiome tests, which generally provide only a low-resolution microbial community overview, are not designed for pathogen identification. That is best done with targeted diagnostics. Even then, as well illustrated by the C. difficileexample, diagnosis of an infection cannot be made on the basis of laboratory testing alone and requires clinical information.
Taxonomy vs. function. Current technology allows a fairly inexpensive characterization of most bacterial taxa (at family and genus levels). However, taxonomy is not easily translated into functional information. Different taxa of microbes may be able to execute the same chemical transformations. In contrast, functional information depends on the genes present and how much are these genes expressed. However, obtaining this kind of information is much more resource intensive. Measurements of metabolites may also provide very valuable functional information, but proper sample collection for metabolomics is much more difficult.
Interindividual variability. The consistent lesson we’ve learned from the microbiome literature is that there is not a single “healthy” microbiome profile. We have not identified a particular microbiome profile that is predictive of a particular disease, though many researchers are working to develop microbiome-based indices for diseases such as inflammatory bowel disease or obesity. Crowd-sourced studies such as the American Gut Project are working to expand and diversify microbiome datasets so that we can better understand the variability and begin to identify reproducible microbiome signatures. The microbiome data is extremely multidimensional and complex. Therefore, developing predictive patterns will likely require analyses of millions of samples linked to highly granular clinical metadata. Microbiome-based tests have potential to transform clinical care and become incorporated into the personalized medicine paradigm. However, we are at the very beginning of understanding what one’s microbiome profile means for their susceptibility to or progression of disease. As patients approach their health care providers with requests to order commercial microbiome-based tests or to help interpret a report, it is important to set the expectation that these tests are not well suited for diagnoses of infectious diseases or validated in specific diagnoses of any diseases. There are far more unknowns than knowns regarding the role of the microbiome and human health.
For those interested in learning more on this topic, I will be discussing it at the 2019 Gut Microbiota for Health World Summit with my colleague Diane Hoffmann, JD, MS, from the University of Maryland School of Law. The AGA Center for Gut Microbiome Research and Education’s scientific advisory board, on which Diane and I both serve, has also recognized the need for additional guidance. I would encourage my gastroenterology colleagues to continue sharing their experiences with microbiome-based tests through the AGA Community platform.
Recommended reading
- • Staley C, Kaiser T, Khoruts A. Clinician guide to microbiome testing. Dig Dis Sci. 2018 Sep 28. doi: 10.1007/s10620-018-5299-6.
- • Allaband C, McDonald D, Vazquez-Baeza Y, Minich JJ, Tripathi A, Brenner DA, et al. Microbiome 101: Studying, Analyzing, and Interpreting Gut Microbiome Data for Clinicians. Clin Gastroenterol Hepatol 2018. doi: 10.1016/j.cgh.2018.09.017. • Costello EK, Stagaman K, Dethlefsen L, Bohannan BJ, Relman DA. The application of ecological theory toward an understanding of the human microbiome. Science 2012. doi: 10.1126/science.1224203. Epub 2012 Jun 6.
Dr. Khoruts, of the University of Minnesota, is a member of the AGA Center for Gut Microbiome Research & Education scientific advisory board.
The intestinal microbiota, also commonly known as the “gut microbiome” is integral to human physiology and has wide-ranging effects on the development and function of the immune system, energy metabolism and nervous system activity. There is a lot of excitement around the potential of targeting the microbiome therapeutically to promote health and to prevent or treat medical conditions. Further, as DNA sequencing technologies and computational methods continue to improve (as reviewed by Rob Knight and colleagues in a prior editorial), there is significant interest in developing microbiome-based diagnostics for clinical applications.
The industry has recognized the consumer interest in microbiome-based diagnostics as an opportunity, and a number of commercial laboratories are marketing tests directly to patients. Physicians, particularly gastroenterologists, are increasingly being asked by their patients to help interpret such test reports; in some cases, the patient may even request a physician order to purchase the tests for insurance coverage or other reasons.
Earlier this year, AGA members had a robust discussion in the AGA Community about microbiome-based tests, requirements for physician authorization, and the clinical utility (if any) of the results of such tests. below.
Limitations of microbiome sequencing. Microbiome datasets have the same limitations as any other sample-dependent dataset. First and foremost, a single stool sample will tell you something about a person’s microbiome profile only at the time and location that the sample was collected. How the sample was collected and how it was stored may significantly impact the analysis. The analysis generally provides an overview of bacterial families and genera, but little information about the viruses, protozoa and fungi. Furthermore, stool analysis may not reflect well the microbiome composition at the mucosal surface in the intestine. As a result, a single analysis of an individual stool sample merely provides a snapshot of the fecal microbiome that is incomplete and extremely limited in what we can learn from it.
“Good” vs. “bad.” The reports resulting from microbiome-based tests often describe the patient’s microbiome profile in terms of how much “good” and “bad” bacteria are present. This kind of a classification framework represents a naïve and cartoonish view of the microbial world. Instead, it is important to appreciate microbial communities as functional networks, and that their functionality cannot be defined as a mere summation of individual microorganisms. Microbes, just like people, vary their behavior in accordance with the context that may be provided by the activity of other microbes and the host. Whether a particular species or strain is helpful or harmful depends on what other bacteria are present, their density, how they interact with each other (e.g., are they mutually beneficial or competitive?), and factors from the human host such as their diet or immune system activity. For example, Clostridioides difficile is a potential pathogen, yet it also naturally exists in the intestines of many people as a nonharmful, commensal species. Its pathogenic potential depends on the state of the other intestinal microbes and host factors, such as presence of anti-C. difficile toxin antibodies.
Importantly, microbiome tests, which generally provide only a low-resolution microbial community overview, are not designed for pathogen identification. That is best done with targeted diagnostics. Even then, as well illustrated by the C. difficileexample, diagnosis of an infection cannot be made on the basis of laboratory testing alone and requires clinical information.
Taxonomy vs. function. Current technology allows a fairly inexpensive characterization of most bacterial taxa (at family and genus levels). However, taxonomy is not easily translated into functional information. Different taxa of microbes may be able to execute the same chemical transformations. In contrast, functional information depends on the genes present and how much are these genes expressed. However, obtaining this kind of information is much more resource intensive. Measurements of metabolites may also provide very valuable functional information, but proper sample collection for metabolomics is much more difficult.
Interindividual variability. The consistent lesson we’ve learned from the microbiome literature is that there is not a single “healthy” microbiome profile. We have not identified a particular microbiome profile that is predictive of a particular disease, though many researchers are working to develop microbiome-based indices for diseases such as inflammatory bowel disease or obesity. Crowd-sourced studies such as the American Gut Project are working to expand and diversify microbiome datasets so that we can better understand the variability and begin to identify reproducible microbiome signatures. The microbiome data is extremely multidimensional and complex. Therefore, developing predictive patterns will likely require analyses of millions of samples linked to highly granular clinical metadata. Microbiome-based tests have potential to transform clinical care and become incorporated into the personalized medicine paradigm. However, we are at the very beginning of understanding what one’s microbiome profile means for their susceptibility to or progression of disease. As patients approach their health care providers with requests to order commercial microbiome-based tests or to help interpret a report, it is important to set the expectation that these tests are not well suited for diagnoses of infectious diseases or validated in specific diagnoses of any diseases. There are far more unknowns than knowns regarding the role of the microbiome and human health.
For those interested in learning more on this topic, I will be discussing it at the 2019 Gut Microbiota for Health World Summit with my colleague Diane Hoffmann, JD, MS, from the University of Maryland School of Law. The AGA Center for Gut Microbiome Research and Education’s scientific advisory board, on which Diane and I both serve, has also recognized the need for additional guidance. I would encourage my gastroenterology colleagues to continue sharing their experiences with microbiome-based tests through the AGA Community platform.
Recommended reading
- • Staley C, Kaiser T, Khoruts A. Clinician guide to microbiome testing. Dig Dis Sci. 2018 Sep 28. doi: 10.1007/s10620-018-5299-6.
- • Allaband C, McDonald D, Vazquez-Baeza Y, Minich JJ, Tripathi A, Brenner DA, et al. Microbiome 101: Studying, Analyzing, and Interpreting Gut Microbiome Data for Clinicians. Clin Gastroenterol Hepatol 2018. doi: 10.1016/j.cgh.2018.09.017. • Costello EK, Stagaman K, Dethlefsen L, Bohannan BJ, Relman DA. The application of ecological theory toward an understanding of the human microbiome. Science 2012. doi: 10.1126/science.1224203. Epub 2012 Jun 6.
Dr. Khoruts, of the University of Minnesota, is a member of the AGA Center for Gut Microbiome Research & Education scientific advisory board.
The intestinal microbiota, also commonly known as the “gut microbiome” is integral to human physiology and has wide-ranging effects on the development and function of the immune system, energy metabolism and nervous system activity. There is a lot of excitement around the potential of targeting the microbiome therapeutically to promote health and to prevent or treat medical conditions. Further, as DNA sequencing technologies and computational methods continue to improve (as reviewed by Rob Knight and colleagues in a prior editorial), there is significant interest in developing microbiome-based diagnostics for clinical applications.
The industry has recognized the consumer interest in microbiome-based diagnostics as an opportunity, and a number of commercial laboratories are marketing tests directly to patients. Physicians, particularly gastroenterologists, are increasingly being asked by their patients to help interpret such test reports; in some cases, the patient may even request a physician order to purchase the tests for insurance coverage or other reasons.
Earlier this year, AGA members had a robust discussion in the AGA Community about microbiome-based tests, requirements for physician authorization, and the clinical utility (if any) of the results of such tests. below.
Limitations of microbiome sequencing. Microbiome datasets have the same limitations as any other sample-dependent dataset. First and foremost, a single stool sample will tell you something about a person’s microbiome profile only at the time and location that the sample was collected. How the sample was collected and how it was stored may significantly impact the analysis. The analysis generally provides an overview of bacterial families and genera, but little information about the viruses, protozoa and fungi. Furthermore, stool analysis may not reflect well the microbiome composition at the mucosal surface in the intestine. As a result, a single analysis of an individual stool sample merely provides a snapshot of the fecal microbiome that is incomplete and extremely limited in what we can learn from it.
“Good” vs. “bad.” The reports resulting from microbiome-based tests often describe the patient’s microbiome profile in terms of how much “good” and “bad” bacteria are present. This kind of a classification framework represents a naïve and cartoonish view of the microbial world. Instead, it is important to appreciate microbial communities as functional networks, and that their functionality cannot be defined as a mere summation of individual microorganisms. Microbes, just like people, vary their behavior in accordance with the context that may be provided by the activity of other microbes and the host. Whether a particular species or strain is helpful or harmful depends on what other bacteria are present, their density, how they interact with each other (e.g., are they mutually beneficial or competitive?), and factors from the human host such as their diet or immune system activity. For example, Clostridioides difficile is a potential pathogen, yet it also naturally exists in the intestines of many people as a nonharmful, commensal species. Its pathogenic potential depends on the state of the other intestinal microbes and host factors, such as presence of anti-C. difficile toxin antibodies.
Importantly, microbiome tests, which generally provide only a low-resolution microbial community overview, are not designed for pathogen identification. That is best done with targeted diagnostics. Even then, as well illustrated by the C. difficileexample, diagnosis of an infection cannot be made on the basis of laboratory testing alone and requires clinical information.
Taxonomy vs. function. Current technology allows a fairly inexpensive characterization of most bacterial taxa (at family and genus levels). However, taxonomy is not easily translated into functional information. Different taxa of microbes may be able to execute the same chemical transformations. In contrast, functional information depends on the genes present and how much are these genes expressed. However, obtaining this kind of information is much more resource intensive. Measurements of metabolites may also provide very valuable functional information, but proper sample collection for metabolomics is much more difficult.
Interindividual variability. The consistent lesson we’ve learned from the microbiome literature is that there is not a single “healthy” microbiome profile. We have not identified a particular microbiome profile that is predictive of a particular disease, though many researchers are working to develop microbiome-based indices for diseases such as inflammatory bowel disease or obesity. Crowd-sourced studies such as the American Gut Project are working to expand and diversify microbiome datasets so that we can better understand the variability and begin to identify reproducible microbiome signatures. The microbiome data is extremely multidimensional and complex. Therefore, developing predictive patterns will likely require analyses of millions of samples linked to highly granular clinical metadata. Microbiome-based tests have potential to transform clinical care and become incorporated into the personalized medicine paradigm. However, we are at the very beginning of understanding what one’s microbiome profile means for their susceptibility to or progression of disease. As patients approach their health care providers with requests to order commercial microbiome-based tests or to help interpret a report, it is important to set the expectation that these tests are not well suited for diagnoses of infectious diseases or validated in specific diagnoses of any diseases. There are far more unknowns than knowns regarding the role of the microbiome and human health.
For those interested in learning more on this topic, I will be discussing it at the 2019 Gut Microbiota for Health World Summit with my colleague Diane Hoffmann, JD, MS, from the University of Maryland School of Law. The AGA Center for Gut Microbiome Research and Education’s scientific advisory board, on which Diane and I both serve, has also recognized the need for additional guidance. I would encourage my gastroenterology colleagues to continue sharing their experiences with microbiome-based tests through the AGA Community platform.
Recommended reading
- • Staley C, Kaiser T, Khoruts A. Clinician guide to microbiome testing. Dig Dis Sci. 2018 Sep 28. doi: 10.1007/s10620-018-5299-6.
- • Allaband C, McDonald D, Vazquez-Baeza Y, Minich JJ, Tripathi A, Brenner DA, et al. Microbiome 101: Studying, Analyzing, and Interpreting Gut Microbiome Data for Clinicians. Clin Gastroenterol Hepatol 2018. doi: 10.1016/j.cgh.2018.09.017. • Costello EK, Stagaman K, Dethlefsen L, Bohannan BJ, Relman DA. The application of ecological theory toward an understanding of the human microbiome. Science 2012. doi: 10.1126/science.1224203. Epub 2012 Jun 6.
Dr. Khoruts, of the University of Minnesota, is a member of the AGA Center for Gut Microbiome Research & Education scientific advisory board.
Rising microbiome investigator: Lea Ann Chen, MD
We spoke with Dr. Chen, assistant professor of medicine at New York University and the recipient of the AGA Research Foundation’s 2016 Research Scholar Award, to learn about her work on the gut microbiome and inflammatory bowel disease (IBD).
How would you sum up your research in one sentence?
I study longitudinal changes of the gut microbiome as it relates to gastrointestinal illnesses, particularly IBD.
What impact do you hope your research will have on patients?
I hope that my research will provide greater insights into the role of gut microbes in disease pathogenesis and activity to ultimately inform the development of new diagnostics and treatments.
What inspired you to focus your research career on the gut microbiome?
I’ve long been fascinated by ecological systems and host-microbe interactions. As technologies to study the gut microbiome became more readily available, I was eager, and somewhat relieved, to be able to combine my research interests with my clinical interest in gastroenterology.
What recent publication from your lab best represents your work, if anyone wants to learn more?
In this study, we show that gut bacterial disturbances are resolved after fecal transplantation in children without IBD but are only transiently resolved in those with IBD.
Hourigan S.*, Chen L.A.*, Grigoryan Z., et al. Microbiome changes associated with sustained eradication of Clostridium difficile after fecal microbiota transplantation in children with and without inflammatory bowel disease. Aliment Pharmacol Ther. 2015;42:741-52.
You’re involved with several AGA initiatives including the Future Leaders Program and the FMT National Registry. How has being an AGA member impacted your career?
AGA has provided key mentorship and training opportunities that have been instrumental in my career development. It has further helped me discover a diverse community of clinicians and scientists who are amazing role models, resources and colleagues. I really had no inkling what was in store when I first joined AGA as a trainee, but I feel very lucky that I did and am grateful for how AGA membership has really enriched my life as a gastroenterologist.
We spoke with Dr. Chen, assistant professor of medicine at New York University and the recipient of the AGA Research Foundation’s 2016 Research Scholar Award, to learn about her work on the gut microbiome and inflammatory bowel disease (IBD).
How would you sum up your research in one sentence?
I study longitudinal changes of the gut microbiome as it relates to gastrointestinal illnesses, particularly IBD.
What impact do you hope your research will have on patients?
I hope that my research will provide greater insights into the role of gut microbes in disease pathogenesis and activity to ultimately inform the development of new diagnostics and treatments.
What inspired you to focus your research career on the gut microbiome?
I’ve long been fascinated by ecological systems and host-microbe interactions. As technologies to study the gut microbiome became more readily available, I was eager, and somewhat relieved, to be able to combine my research interests with my clinical interest in gastroenterology.
What recent publication from your lab best represents your work, if anyone wants to learn more?
In this study, we show that gut bacterial disturbances are resolved after fecal transplantation in children without IBD but are only transiently resolved in those with IBD.
Hourigan S.*, Chen L.A.*, Grigoryan Z., et al. Microbiome changes associated with sustained eradication of Clostridium difficile after fecal microbiota transplantation in children with and without inflammatory bowel disease. Aliment Pharmacol Ther. 2015;42:741-52.
You’re involved with several AGA initiatives including the Future Leaders Program and the FMT National Registry. How has being an AGA member impacted your career?
AGA has provided key mentorship and training opportunities that have been instrumental in my career development. It has further helped me discover a diverse community of clinicians and scientists who are amazing role models, resources and colleagues. I really had no inkling what was in store when I first joined AGA as a trainee, but I feel very lucky that I did and am grateful for how AGA membership has really enriched my life as a gastroenterologist.
We spoke with Dr. Chen, assistant professor of medicine at New York University and the recipient of the AGA Research Foundation’s 2016 Research Scholar Award, to learn about her work on the gut microbiome and inflammatory bowel disease (IBD).
How would you sum up your research in one sentence?
I study longitudinal changes of the gut microbiome as it relates to gastrointestinal illnesses, particularly IBD.
What impact do you hope your research will have on patients?
I hope that my research will provide greater insights into the role of gut microbes in disease pathogenesis and activity to ultimately inform the development of new diagnostics and treatments.
What inspired you to focus your research career on the gut microbiome?
I’ve long been fascinated by ecological systems and host-microbe interactions. As technologies to study the gut microbiome became more readily available, I was eager, and somewhat relieved, to be able to combine my research interests with my clinical interest in gastroenterology.
What recent publication from your lab best represents your work, if anyone wants to learn more?
In this study, we show that gut bacterial disturbances are resolved after fecal transplantation in children without IBD but are only transiently resolved in those with IBD.
Hourigan S.*, Chen L.A.*, Grigoryan Z., et al. Microbiome changes associated with sustained eradication of Clostridium difficile after fecal microbiota transplantation in children with and without inflammatory bowel disease. Aliment Pharmacol Ther. 2015;42:741-52.
You’re involved with several AGA initiatives including the Future Leaders Program and the FMT National Registry. How has being an AGA member impacted your career?
AGA has provided key mentorship and training opportunities that have been instrumental in my career development. It has further helped me discover a diverse community of clinicians and scientists who are amazing role models, resources and colleagues. I really had no inkling what was in store when I first joined AGA as a trainee, but I feel very lucky that I did and am grateful for how AGA membership has really enriched my life as a gastroenterologist.
Top AGA Community patient cases
Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org/discussions) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses.
In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Severe colitis in asymptomatic patient on screening colonoscopy (http://ow.ly/OBNp30mttPD)
Check out an update on the forum’s most popular case, involving a 51-year-old male seen for a screening colonoscopy. Biopsied samples of patchy areas throughout the colon revealed severe active chronic colitis with lymphoplasmacytic infiltrate, crypts and crypt abscesses, and no granulomas.
2. Paraplegic colonic gas (http://ow.ly/ChNM30mtEia)
Symptoms started 2 years ago for this 28-year-old paraplegic male, who was hospitalized with multiple episodes of postprandial abdominal bloating and pain. He has a permanent catheter and is on a diet mostly of meat and specific vegetables. His physician solicited the community for help with management of colonic gas and symptoms.
3. Small submucosal nodule and gastric intestinal metaplasia (http://ow.ly/Qqii30mtEpo)
The physician needs advice on next steps for a 55-year-old female who had an EGD for dyspepsia. Biopsies of a 1-cm nodule and surrounding areas revealed moderate chronic inactive gastritis with focal intestinal metaplasia and reactive hyperplastic changes with no dysplasia.
4. Perianal Crohn’s preceding luminal disease (http://ow.ly/GHV430mtEwo)
This extensive case of a 16-year-old female started with severe constipation, until she developed a painful abscess on the right perianal region. Perianal fistula with abundant granulation tissue and mucoid discharge was noted, and biopsies revealed inflammation with fibrosis, giant cell reaction, and granulomatous inflammation. This past summer, an MR enterography and pelvic MRI revealed a small right perianal intersphincteric fistula with possible drainage through the skin.
More clinical cases and discussions are at https://community.gastro.org/discussions.
Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org/discussions) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses.
In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Severe colitis in asymptomatic patient on screening colonoscopy (http://ow.ly/OBNp30mttPD)
Check out an update on the forum’s most popular case, involving a 51-year-old male seen for a screening colonoscopy. Biopsied samples of patchy areas throughout the colon revealed severe active chronic colitis with lymphoplasmacytic infiltrate, crypts and crypt abscesses, and no granulomas.
2. Paraplegic colonic gas (http://ow.ly/ChNM30mtEia)
Symptoms started 2 years ago for this 28-year-old paraplegic male, who was hospitalized with multiple episodes of postprandial abdominal bloating and pain. He has a permanent catheter and is on a diet mostly of meat and specific vegetables. His physician solicited the community for help with management of colonic gas and symptoms.
3. Small submucosal nodule and gastric intestinal metaplasia (http://ow.ly/Qqii30mtEpo)
The physician needs advice on next steps for a 55-year-old female who had an EGD for dyspepsia. Biopsies of a 1-cm nodule and surrounding areas revealed moderate chronic inactive gastritis with focal intestinal metaplasia and reactive hyperplastic changes with no dysplasia.
4. Perianal Crohn’s preceding luminal disease (http://ow.ly/GHV430mtEwo)
This extensive case of a 16-year-old female started with severe constipation, until she developed a painful abscess on the right perianal region. Perianal fistula with abundant granulation tissue and mucoid discharge was noted, and biopsies revealed inflammation with fibrosis, giant cell reaction, and granulomatous inflammation. This past summer, an MR enterography and pelvic MRI revealed a small right perianal intersphincteric fistula with possible drainage through the skin.
More clinical cases and discussions are at https://community.gastro.org/discussions.
Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org/discussions) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses.
In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Severe colitis in asymptomatic patient on screening colonoscopy (http://ow.ly/OBNp30mttPD)
Check out an update on the forum’s most popular case, involving a 51-year-old male seen for a screening colonoscopy. Biopsied samples of patchy areas throughout the colon revealed severe active chronic colitis with lymphoplasmacytic infiltrate, crypts and crypt abscesses, and no granulomas.
2. Paraplegic colonic gas (http://ow.ly/ChNM30mtEia)
Symptoms started 2 years ago for this 28-year-old paraplegic male, who was hospitalized with multiple episodes of postprandial abdominal bloating and pain. He has a permanent catheter and is on a diet mostly of meat and specific vegetables. His physician solicited the community for help with management of colonic gas and symptoms.
3. Small submucosal nodule and gastric intestinal metaplasia (http://ow.ly/Qqii30mtEpo)
The physician needs advice on next steps for a 55-year-old female who had an EGD for dyspepsia. Biopsies of a 1-cm nodule and surrounding areas revealed moderate chronic inactive gastritis with focal intestinal metaplasia and reactive hyperplastic changes with no dysplasia.
4. Perianal Crohn’s preceding luminal disease (http://ow.ly/GHV430mtEwo)
This extensive case of a 16-year-old female started with severe constipation, until she developed a painful abscess on the right perianal region. Perianal fistula with abundant granulation tissue and mucoid discharge was noted, and biopsies revealed inflammation with fibrosis, giant cell reaction, and granulomatous inflammation. This past summer, an MR enterography and pelvic MRI revealed a small right perianal intersphincteric fistula with possible drainage through the skin.
More clinical cases and discussions are at https://community.gastro.org/discussions.