News from AGA

What if all you had to do to ensure that the AGA Research Foundation can have an impact for years to come is to write a simple sentence? Sound impossible?

The AGA Research Foundation provides a key source of funding at a critical juncture in a young investigators’ career. Securing the future of the talented investigators we serve really is as simple as one sentence. By including a gift to the AGA Research Foundation in your will, you can support our mission tomorrow without giving away any of your assets today.

Including the AGA Research Foundation in your will is a popular gift to give because it is:

• • Affordable. The actual giving of your gift occurs after your lifetime, so your current income is not affected.
• • Flexible. Until your will goes into effect, you are free to alter your plans or change your mind.
• • Versatile. You can give a specific item, a set amount of money, or a percentage of your estate. You can also make your gift contingent upon certain events.

We hope you’ll consider including a gift to the AGA Research Foundation in your will or living trust. It’s simple – just a few sentences in your will or trust are all that is needed. The official bequest language for the AGA Research Foundation is: “I, [name], of [city, state, ZIP], give, devise and bequeath to the AGA Research Foundation [written amount or percentage of the estate or description of property] for its unrestricted use and purpose.”

[email protected]

What if all you had to do to ensure that the AGA Research Foundation can have an impact for years to come is to write a simple sentence? Sound impossible?

The AGA Research Foundation provides a key source of funding at a critical juncture in a young investigators’ career. Securing the future of the talented investigators we serve really is as simple as one sentence. By including a gift to the AGA Research Foundation in your will, you can support our mission tomorrow without giving away any of your assets today.

Including the AGA Research Foundation in your will is a popular gift to give because it is:

• • Affordable. The actual giving of your gift occurs after your lifetime, so your current income is not affected.
• • Flexible. Until your will goes into effect, you are free to alter your plans or change your mind.
• • Versatile. You can give a specific item, a set amount of money, or a percentage of your estate. You can also make your gift contingent upon certain events.

We hope you’ll consider including a gift to the AGA Research Foundation in your will or living trust. It’s simple – just a few sentences in your will or trust are all that is needed. The official bequest language for the AGA Research Foundation is: “I, [name], of [city, state, ZIP], give, devise and bequeath to the AGA Research Foundation [written amount or percentage of the estate or description of property] for its unrestricted use and purpose.”

[email protected]

What if all you had to do to ensure that the AGA Research Foundation can have an impact for years to come is to write a simple sentence? Sound impossible?

The AGA Research Foundation provides a key source of funding at a critical juncture in a young investigators’ career. Securing the future of the talented investigators we serve really is as simple as one sentence. By including a gift to the AGA Research Foundation in your will, you can support our mission tomorrow without giving away any of your assets today.

Including the AGA Research Foundation in your will is a popular gift to give because it is:

• • Affordable. The actual giving of your gift occurs after your lifetime, so your current income is not affected.
• • Flexible. Until your will goes into effect, you are free to alter your plans or change your mind.
• • Versatile. You can give a specific item, a set amount of money, or a percentage of your estate. You can also make your gift contingent upon certain events.

We hope you’ll consider including a gift to the AGA Research Foundation in your will or living trust. It’s simple – just a few sentences in your will or trust are all that is needed. The official bequest language for the AGA Research Foundation is: “I, [name], of [city, state, ZIP], give, devise and bequeath to the AGA Research Foundation [written amount or percentage of the estate or description of property] for its unrestricted use and purpose.”

[email protected]

AGA spends a lot of time on Capitol Hill advocating to help gastroenterologists in practice better care for their patients and receive fair reimbursement. Therefore, we were pleased that the budget deal passed by Congress and signed by the president in February included several policy victories that AGA has been working diligently on for many years.

IPAB repeal

AGA, and all of organized medicine, have long opposed the Independent Payment Advisory Board (IPAB) that was created as part of the Affordable Care Act. IPAB is an unelected, unaccountable board whose sole purpose is to cut Medicare spending from providers should Medicare reach a certain threshold of spending. Since hospitals are exempt from their purview, physicians would be particularly vulnerable to cuts. However, repealing IPAB has had bipartisan support over the years, and we applaud Congress for listening to us and the medical community and taking action.

Misvalued codes

AGA and the physician community were also successful in removing a provision that would have extended the misvalued codes initiative for the next two years to reallocate savings from potentially overvalued codes. AGA, the Alliance of Specialty Medicine and the AMA opposed the original provision expanding the misvalued codes initiative and have argued that virtually all codes under the fee schedule, including gastroenterology, have been reevaluated and have already faced significant cuts. In the final agreement, Congress eliminated recapturing savings from the misvalued codes initiative and instead lowered overall updates for physician reimbursement under Medicare by .25 percent for 1 year. Although AGA would prefer this reduction not be included, it is much better than the misvalued codes provision, which disproportionately impacts specialties, like gastroenterology.

Geographic Practice Cost Index

The budget agreement extends the work for the Geographic Practice Cost Index (GPCI) floor for two additional years, which avoids a decrease in Medicare reimbursement for physicians that practice in rural areas. The work GPCI is a variable that Medicare uses to adjust the work component of physician payment based on where they live. A work GPCI floor of 1.0 protects physicians in low-cost, often rural areas, from being paid less for the work they do.

Meaningful use standards

The package addresses electronic health record (EHR) standards and eases requirements for physicians. The language removes the mandate that meaningful use standards become more stringent over time, which is a major financial burden for physician practices. The language also gives physicians more time to submit and receive a hardship exemption from the current EHR standards that would apply to meaningful use and the Quality Payment Program’s advancing care information performance category.

Biosimilars coverage under Medicare Part D

The agreement also levels the playing field between biologics and biosimilars by adding biosimilars to the Medicare Coverage Gap Discount Program. Additionally, by providing the 50 percent discount equally, beneficiary out-of-pocket costs will be reduced and the Medicare program will save money as a result of covering the less expensive medication.

AGA and the medical community have fought long and hard for these provisions and are happy to see them finally being implemented. We thank all of our members who have worked along with us to ensure that the voice of gastroenterology continues to be heard on Capitol Hill.

AGA spends a lot of time on Capitol Hill advocating to help gastroenterologists in practice better care for their patients and receive fair reimbursement. Therefore, we were pleased that the budget deal passed by Congress and signed by the president in February included several policy victories that AGA has been working diligently on for many years.

IPAB repeal

AGA, and all of organized medicine, have long opposed the Independent Payment Advisory Board (IPAB) that was created as part of the Affordable Care Act. IPAB is an unelected, unaccountable board whose sole purpose is to cut Medicare spending from providers should Medicare reach a certain threshold of spending. Since hospitals are exempt from their purview, physicians would be particularly vulnerable to cuts. However, repealing IPAB has had bipartisan support over the years, and we applaud Congress for listening to us and the medical community and taking action.

Misvalued codes

AGA and the physician community were also successful in removing a provision that would have extended the misvalued codes initiative for the next two years to reallocate savings from potentially overvalued codes. AGA, the Alliance of Specialty Medicine and the AMA opposed the original provision expanding the misvalued codes initiative and have argued that virtually all codes under the fee schedule, including gastroenterology, have been reevaluated and have already faced significant cuts. In the final agreement, Congress eliminated recapturing savings from the misvalued codes initiative and instead lowered overall updates for physician reimbursement under Medicare by .25 percent for 1 year. Although AGA would prefer this reduction not be included, it is much better than the misvalued codes provision, which disproportionately impacts specialties, like gastroenterology.

Geographic Practice Cost Index

The budget agreement extends the work for the Geographic Practice Cost Index (GPCI) floor for two additional years, which avoids a decrease in Medicare reimbursement for physicians that practice in rural areas. The work GPCI is a variable that Medicare uses to adjust the work component of physician payment based on where they live. A work GPCI floor of 1.0 protects physicians in low-cost, often rural areas, from being paid less for the work they do.

Meaningful use standards

The package addresses electronic health record (EHR) standards and eases requirements for physicians. The language removes the mandate that meaningful use standards become more stringent over time, which is a major financial burden for physician practices. The language also gives physicians more time to submit and receive a hardship exemption from the current EHR standards that would apply to meaningful use and the Quality Payment Program’s advancing care information performance category.

Biosimilars coverage under Medicare Part D

The agreement also levels the playing field between biologics and biosimilars by adding biosimilars to the Medicare Coverage Gap Discount Program. Additionally, by providing the 50 percent discount equally, beneficiary out-of-pocket costs will be reduced and the Medicare program will save money as a result of covering the less expensive medication.

AGA and the medical community have fought long and hard for these provisions and are happy to see them finally being implemented. We thank all of our members who have worked along with us to ensure that the voice of gastroenterology continues to be heard on Capitol Hill.

AGA spends a lot of time on Capitol Hill advocating to help gastroenterologists in practice better care for their patients and receive fair reimbursement. Therefore, we were pleased that the budget deal passed by Congress and signed by the president in February included several policy victories that AGA has been working diligently on for many years.

IPAB repeal

AGA, and all of organized medicine, have long opposed the Independent Payment Advisory Board (IPAB) that was created as part of the Affordable Care Act. IPAB is an unelected, unaccountable board whose sole purpose is to cut Medicare spending from providers should Medicare reach a certain threshold of spending. Since hospitals are exempt from their purview, physicians would be particularly vulnerable to cuts. However, repealing IPAB has had bipartisan support over the years, and we applaud Congress for listening to us and the medical community and taking action.

Misvalued codes

AGA and the physician community were also successful in removing a provision that would have extended the misvalued codes initiative for the next two years to reallocate savings from potentially overvalued codes. AGA, the Alliance of Specialty Medicine and the AMA opposed the original provision expanding the misvalued codes initiative and have argued that virtually all codes under the fee schedule, including gastroenterology, have been reevaluated and have already faced significant cuts. In the final agreement, Congress eliminated recapturing savings from the misvalued codes initiative and instead lowered overall updates for physician reimbursement under Medicare by .25 percent for 1 year. Although AGA would prefer this reduction not be included, it is much better than the misvalued codes provision, which disproportionately impacts specialties, like gastroenterology.

Geographic Practice Cost Index

The budget agreement extends the work for the Geographic Practice Cost Index (GPCI) floor for two additional years, which avoids a decrease in Medicare reimbursement for physicians that practice in rural areas. The work GPCI is a variable that Medicare uses to adjust the work component of physician payment based on where they live. A work GPCI floor of 1.0 protects physicians in low-cost, often rural areas, from being paid less for the work they do.

Meaningful use standards

The package addresses electronic health record (EHR) standards and eases requirements for physicians. The language removes the mandate that meaningful use standards become more stringent over time, which is a major financial burden for physician practices. The language also gives physicians more time to submit and receive a hardship exemption from the current EHR standards that would apply to meaningful use and the Quality Payment Program’s advancing care information performance category.

Biosimilars coverage under Medicare Part D

The agreement also levels the playing field between biologics and biosimilars by adding biosimilars to the Medicare Coverage Gap Discount Program. Additionally, by providing the 50 percent discount equally, beneficiary out-of-pocket costs will be reduced and the Medicare program will save money as a result of covering the less expensive medication.

AGA and the medical community have fought long and hard for these provisions and are happy to see them finally being implemented. We thank all of our members who have worked along with us to ensure that the voice of gastroenterology continues to be heard on Capitol Hill.

AGA Legacy Society members share a desire to guarantee long-term support for digestive disease research. Through their foresight and generosity, they help ensure the continued momentum of discovery and patient education that has characterized GI medicine in recent decades. Legacy Society member donations directly support young GI investigators as they establish independent research careers.

Legacy Society members are the most generous individual donors to the AGA Research Foundation. Members of the AGA Legacy Society provide tax-deductible gifts to the AGA Research Foundation of $5,000 or more per year for 5 years ($25,000 total) or $50,000 or more in a planned gift, such as a bequest. All Legacy Society contributions go directly to support research awards.

AGA members support young researchers at a critical decision point in their lives – when many consider giving up their research careers due to a lack of funding. “I am honored to be a recipient of the Research Scholar Award. I would like to thank the foundation for their generous contribution that will fund a crucial transition in my career,” said Jose Saenz, MD, PhD, Washington University School of Medicine and 2017 AGA – Gastric Cancer Foundation Research Scholar Award recipient.

The makings of a grand celebration

Beginning with a memorable gathering at the United States Library of Congress in 2007, the AGA Benefactors’ Dinner has welcomed members of the AGA Legacy Society and other AGA dignitaries to special locations nationwide. The Folger Shakespeare Library will be the location of the 2018 AGA Research Foundation Benefactors Dinner during DDW in Washington, DC. Just steps from the Capitol, the Great Hall and Pastor Reading room are a spectacular setting for an enjoyable evening with friends. Members of the AGA Legacy Society will be among the distinguished honorees at the annual event.

[email protected]

AGA Legacy Society members share a desire to guarantee long-term support for digestive disease research. Through their foresight and generosity, they help ensure the continued momentum of discovery and patient education that has characterized GI medicine in recent decades. Legacy Society member donations directly support young GI investigators as they establish independent research careers.

Legacy Society members are the most generous individual donors to the AGA Research Foundation. Members of the AGA Legacy Society provide tax-deductible gifts to the AGA Research Foundation of $5,000 or more per year for 5 years ($25,000 total) or $50,000 or more in a planned gift, such as a bequest. All Legacy Society contributions go directly to support research awards.

AGA members support young researchers at a critical decision point in their lives – when many consider giving up their research careers due to a lack of funding. “I am honored to be a recipient of the Research Scholar Award. I would like to thank the foundation for their generous contribution that will fund a crucial transition in my career,” said Jose Saenz, MD, PhD, Washington University School of Medicine and 2017 AGA – Gastric Cancer Foundation Research Scholar Award recipient.

The makings of a grand celebration

Beginning with a memorable gathering at the United States Library of Congress in 2007, the AGA Benefactors’ Dinner has welcomed members of the AGA Legacy Society and other AGA dignitaries to special locations nationwide. The Folger Shakespeare Library will be the location of the 2018 AGA Research Foundation Benefactors Dinner during DDW in Washington, DC. Just steps from the Capitol, the Great Hall and Pastor Reading room are a spectacular setting for an enjoyable evening with friends. Members of the AGA Legacy Society will be among the distinguished honorees at the annual event.

[email protected]

AGA Legacy Society members share a desire to guarantee long-term support for digestive disease research. Through their foresight and generosity, they help ensure the continued momentum of discovery and patient education that has characterized GI medicine in recent decades. Legacy Society member donations directly support young GI investigators as they establish independent research careers.

Legacy Society members are the most generous individual donors to the AGA Research Foundation. Members of the AGA Legacy Society provide tax-deductible gifts to the AGA Research Foundation of $5,000 or more per year for 5 years ($25,000 total) or $50,000 or more in a planned gift, such as a bequest. All Legacy Society contributions go directly to support research awards.

AGA members support young researchers at a critical decision point in their lives – when many consider giving up their research careers due to a lack of funding. “I am honored to be a recipient of the Research Scholar Award. I would like to thank the foundation for their generous contribution that will fund a crucial transition in my career,” said Jose Saenz, MD, PhD, Washington University School of Medicine and 2017 AGA – Gastric Cancer Foundation Research Scholar Award recipient.

The makings of a grand celebration

Beginning with a memorable gathering at the United States Library of Congress in 2007, the AGA Benefactors’ Dinner has welcomed members of the AGA Legacy Society and other AGA dignitaries to special locations nationwide. The Folger Shakespeare Library will be the location of the 2018 AGA Research Foundation Benefactors Dinner during DDW in Washington, DC. Just steps from the Capitol, the Great Hall and Pastor Reading room are a spectacular setting for an enjoyable evening with friends. Members of the AGA Legacy Society will be among the distinguished honorees at the annual event.

[email protected]

AGA President Sheila Crowe, MD, FRCPC, FACP, FACG, AGAF, recently spent the day on Capitol Hill meeting with lawmakers to advocate for AGA legislative priorities including increasing funding for NIH and biomedical research, support for the Removing Barriers to Colorectal Cancer Screening Act, and support for the Restoring the Patient’s Voice Act. Dr. Crowe met with eight congressional offices and received helpful feedback on the upcoming agenda in Congress and how it impacts AGA’s priorities.

NIH funding

Removing Barriers to Colorectal Cancer Screening Act

Fixing the current coinsurance problem for Medicare beneficiaries who undergo a screening colonoscopy that becomes therapeutic remains a top AGA priority. Most of the offices that Dr. Crowe met with were cosponsors of the legislation, the Removing Barriers to Colorectal Cancer Screening Act (HR 1017/S.479), that would waive coinsurance payment regardless of the screening outcome. Dr. Crowe shared her experience with patients and the financial burden this places on beneficiaries who need to be screened. Rep. Raul Ruiz, D-CA, and Rep. Scott Peters, D-CA, both members of the House Energy and Commerce Committee and supporters of the bill, will continue to advocate that the bill receive a hearing this year to help move it through Congress. The bill continues to have wide bipartisan support. Read more about the issue and how you can explain it to your patients.

Step therapy

More and more patients are being subject to step therapy protocols, also known as “fail first” under which they are required to try and fail sometimes two or three therapies before receiving coverage of the initial therapy recommended by their physician. With the emergence of new biologics to treat diseases like inflammatory bowel disease, more and more digestive disease patients are being subject to these protocols, which can have adverse effects on their health. Restoring the Patient’s Voice Act (HR 2077) would provide patients and providers with a fair and equitable appeals process when step therapy has been imposed and provides common sense exceptions for the provider to appeal. Dr. Crowe spoke of the impact this policy is having on digestive disease patients and the burden it puts on physician practices that have to take time away from patients to navigate the convoluted insurance appeals process. We are hopeful that many of the offices that we met with will support HR 2077. Read more about the issue.

Food is Medicine Working Group

Dr. Crowe also had a productive meeting with Rep. Jim McGovern’s, D-MA, office and learned more about the recently created Food is Medicine Working Group that he has initiated. McGovern is the Ranking Member of the Agriculture Committee’s Subcommittee on Nutrition which is responsible for our nation’s nutrition guidelines and the Supplemental Nutrition Assistance Program. The Working Group will focus on costs related to hunger and the importance of nutrition in treating chronic illness and disease. AGA looks forward to working with McGovern and members of the Working Group on this bipartisan initiative.

Capitol Hill needs to hear the voice of GI

In conjunction with Dr. Crowe’s visit, AGA launched a Virtual Advocacy Day to encourage members to contact their legislators in support of the issues that Dr. Crowe was advocating during her meetings. We thank those members who took time out of their schedules to take action.

AGA President Sheila Crowe, MD, FRCPC, FACP, FACG, AGAF, recently spent the day on Capitol Hill meeting with lawmakers to advocate for AGA legislative priorities including increasing funding for NIH and biomedical research, support for the Removing Barriers to Colorectal Cancer Screening Act, and support for the Restoring the Patient’s Voice Act. Dr. Crowe met with eight congressional offices and received helpful feedback on the upcoming agenda in Congress and how it impacts AGA’s priorities.

NIH funding

Removing Barriers to Colorectal Cancer Screening Act

Fixing the current coinsurance problem for Medicare beneficiaries who undergo a screening colonoscopy that becomes therapeutic remains a top AGA priority. Most of the offices that Dr. Crowe met with were cosponsors of the legislation, the Removing Barriers to Colorectal Cancer Screening Act (HR 1017/S.479), that would waive coinsurance payment regardless of the screening outcome. Dr. Crowe shared her experience with patients and the financial burden this places on beneficiaries who need to be screened. Rep. Raul Ruiz, D-CA, and Rep. Scott Peters, D-CA, both members of the House Energy and Commerce Committee and supporters of the bill, will continue to advocate that the bill receive a hearing this year to help move it through Congress. The bill continues to have wide bipartisan support. Read more about the issue and how you can explain it to your patients.

Step therapy

More and more patients are being subject to step therapy protocols, also known as “fail first” under which they are required to try and fail sometimes two or three therapies before receiving coverage of the initial therapy recommended by their physician. With the emergence of new biologics to treat diseases like inflammatory bowel disease, more and more digestive disease patients are being subject to these protocols, which can have adverse effects on their health. Restoring the Patient’s Voice Act (HR 2077) would provide patients and providers with a fair and equitable appeals process when step therapy has been imposed and provides common sense exceptions for the provider to appeal. Dr. Crowe spoke of the impact this policy is having on digestive disease patients and the burden it puts on physician practices that have to take time away from patients to navigate the convoluted insurance appeals process. We are hopeful that many of the offices that we met with will support HR 2077. Read more about the issue.

Food is Medicine Working Group

Dr. Crowe also had a productive meeting with Rep. Jim McGovern’s, D-MA, office and learned more about the recently created Food is Medicine Working Group that he has initiated. McGovern is the Ranking Member of the Agriculture Committee’s Subcommittee on Nutrition which is responsible for our nation’s nutrition guidelines and the Supplemental Nutrition Assistance Program. The Working Group will focus on costs related to hunger and the importance of nutrition in treating chronic illness and disease. AGA looks forward to working with McGovern and members of the Working Group on this bipartisan initiative.

Capitol Hill needs to hear the voice of GI

In conjunction with Dr. Crowe’s visit, AGA launched a Virtual Advocacy Day to encourage members to contact their legislators in support of the issues that Dr. Crowe was advocating during her meetings. We thank those members who took time out of their schedules to take action.

AGA President Sheila Crowe, MD, FRCPC, FACP, FACG, AGAF, recently spent the day on Capitol Hill meeting with lawmakers to advocate for AGA legislative priorities including increasing funding for NIH and biomedical research, support for the Removing Barriers to Colorectal Cancer Screening Act, and support for the Restoring the Patient’s Voice Act. Dr. Crowe met with eight congressional offices and received helpful feedback on the upcoming agenda in Congress and how it impacts AGA’s priorities.

NIH funding

Removing Barriers to Colorectal Cancer Screening Act

Fixing the current coinsurance problem for Medicare beneficiaries who undergo a screening colonoscopy that becomes therapeutic remains a top AGA priority. Most of the offices that Dr. Crowe met with were cosponsors of the legislation, the Removing Barriers to Colorectal Cancer Screening Act (HR 1017/S.479), that would waive coinsurance payment regardless of the screening outcome. Dr. Crowe shared her experience with patients and the financial burden this places on beneficiaries who need to be screened. Rep. Raul Ruiz, D-CA, and Rep. Scott Peters, D-CA, both members of the House Energy and Commerce Committee and supporters of the bill, will continue to advocate that the bill receive a hearing this year to help move it through Congress. The bill continues to have wide bipartisan support. Read more about the issue and how you can explain it to your patients.

Step therapy

More and more patients are being subject to step therapy protocols, also known as “fail first” under which they are required to try and fail sometimes two or three therapies before receiving coverage of the initial therapy recommended by their physician. With the emergence of new biologics to treat diseases like inflammatory bowel disease, more and more digestive disease patients are being subject to these protocols, which can have adverse effects on their health. Restoring the Patient’s Voice Act (HR 2077) would provide patients and providers with a fair and equitable appeals process when step therapy has been imposed and provides common sense exceptions for the provider to appeal. Dr. Crowe spoke of the impact this policy is having on digestive disease patients and the burden it puts on physician practices that have to take time away from patients to navigate the convoluted insurance appeals process. We are hopeful that many of the offices that we met with will support HR 2077. Read more about the issue.

Food is Medicine Working Group

Dr. Crowe also had a productive meeting with Rep. Jim McGovern’s, D-MA, office and learned more about the recently created Food is Medicine Working Group that he has initiated. McGovern is the Ranking Member of the Agriculture Committee’s Subcommittee on Nutrition which is responsible for our nation’s nutrition guidelines and the Supplemental Nutrition Assistance Program. The Working Group will focus on costs related to hunger and the importance of nutrition in treating chronic illness and disease. AGA looks forward to working with McGovern and members of the Working Group on this bipartisan initiative.

Capitol Hill needs to hear the voice of GI

In conjunction with Dr. Crowe’s visit, AGA launched a Virtual Advocacy Day to encourage members to contact their legislators in support of the issues that Dr. Crowe was advocating during her meetings. We thank those members who took time out of their schedules to take action.

The 2018 Gastrointestinal Cancers Symposium took place Jan. 18-20, 2018, in San Francisco. During the meeting, investigators presented groundbreaking research designed to improve the diagnosis and treatment of GI cancers. Here are some of the most noteworthy headlines from the 2018 meeting.

Promising Results Using Liquid Biopsy to Improve CRC Early Detection

Researchers in Taiwan developed a screening test for early colorectal cancer (CRC) detection that requires a simple blood draw to assess for circulating tumor cells in the blood. The test demonstrates 88% accuracy to detect all stages of colorectal illness, including precancerous lesions. If validated and made commercially available, this test could be readily integrated into a patient’s routine physical exam, thereby increasing CRC screening compliance.

CELESTIAL Results May Lead to Cabozantinib Approval in Second-Line HCC

The phase III CELESTIAL trial met its primary endpoint by demonstrating a survival advantage with cabozantinib in patients with advanced hepatocellular carcinoma (HCC) that progressed following prior systemic therapy. Other outcomes included improvements in progression-free survival and objective response rate, as well as an acceptable safety profile, thus positioning cabozantinib for potential approval in the second-line setting in HCC.

RAINFALL Meets Primary Endpoint, But Ramucirumab Will Not Be Pursued for a First-Line Indication in G-GEJ Cancer

Results of the global, randomized, double-blind, placebo-controlled, phase III RAINFALL trial established the statistical benefit of ramucirumab, a monoclonal antibody targeting VEGFR-2, added to standard chemotherapy for patients with previously untreated metastatic gastric or gastroesophageal junction (G-GEJ) adenocarcinoma. The findings revealed a significant 25% reduction in the risk of disease progression or death for the primary endpoint of progression-free survival (PFS). However, the reduction corresponded to only a 9-day improvement in median PFS, so the clinical benefit of frontline ramucirumab is debatable.

The Gastrointestinal Cancers Symposium is cosponsored by AGA, the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO) and the Society of Surgical Oncology (SSO).

More news from the 2018 Gastrointestinal Cancers Symposium is available at gicasym.org/daily-news.

[email protected]

The 2018 Gastrointestinal Cancers Symposium took place Jan. 18-20, 2018, in San Francisco. During the meeting, investigators presented groundbreaking research designed to improve the diagnosis and treatment of GI cancers. Here are some of the most noteworthy headlines from the 2018 meeting.

Promising Results Using Liquid Biopsy to Improve CRC Early Detection

Researchers in Taiwan developed a screening test for early colorectal cancer (CRC) detection that requires a simple blood draw to assess for circulating tumor cells in the blood. The test demonstrates 88% accuracy to detect all stages of colorectal illness, including precancerous lesions. If validated and made commercially available, this test could be readily integrated into a patient’s routine physical exam, thereby increasing CRC screening compliance.

CELESTIAL Results May Lead to Cabozantinib Approval in Second-Line HCC

The phase III CELESTIAL trial met its primary endpoint by demonstrating a survival advantage with cabozantinib in patients with advanced hepatocellular carcinoma (HCC) that progressed following prior systemic therapy. Other outcomes included improvements in progression-free survival and objective response rate, as well as an acceptable safety profile, thus positioning cabozantinib for potential approval in the second-line setting in HCC.

RAINFALL Meets Primary Endpoint, But Ramucirumab Will Not Be Pursued for a First-Line Indication in G-GEJ Cancer

Results of the global, randomized, double-blind, placebo-controlled, phase III RAINFALL trial established the statistical benefit of ramucirumab, a monoclonal antibody targeting VEGFR-2, added to standard chemotherapy for patients with previously untreated metastatic gastric or gastroesophageal junction (G-GEJ) adenocarcinoma. The findings revealed a significant 25% reduction in the risk of disease progression or death for the primary endpoint of progression-free survival (PFS). However, the reduction corresponded to only a 9-day improvement in median PFS, so the clinical benefit of frontline ramucirumab is debatable.

The Gastrointestinal Cancers Symposium is cosponsored by AGA, the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO) and the Society of Surgical Oncology (SSO).

More news from the 2018 Gastrointestinal Cancers Symposium is available at gicasym.org/daily-news.

[email protected]

The 2018 Gastrointestinal Cancers Symposium took place Jan. 18-20, 2018, in San Francisco. During the meeting, investigators presented groundbreaking research designed to improve the diagnosis and treatment of GI cancers. Here are some of the most noteworthy headlines from the 2018 meeting.

Promising Results Using Liquid Biopsy to Improve CRC Early Detection

Researchers in Taiwan developed a screening test for early colorectal cancer (CRC) detection that requires a simple blood draw to assess for circulating tumor cells in the blood. The test demonstrates 88% accuracy to detect all stages of colorectal illness, including precancerous lesions. If validated and made commercially available, this test could be readily integrated into a patient’s routine physical exam, thereby increasing CRC screening compliance.

CELESTIAL Results May Lead to Cabozantinib Approval in Second-Line HCC

The phase III CELESTIAL trial met its primary endpoint by demonstrating a survival advantage with cabozantinib in patients with advanced hepatocellular carcinoma (HCC) that progressed following prior systemic therapy. Other outcomes included improvements in progression-free survival and objective response rate, as well as an acceptable safety profile, thus positioning cabozantinib for potential approval in the second-line setting in HCC.

RAINFALL Meets Primary Endpoint, But Ramucirumab Will Not Be Pursued for a First-Line Indication in G-GEJ Cancer

Results of the global, randomized, double-blind, placebo-controlled, phase III RAINFALL trial established the statistical benefit of ramucirumab, a monoclonal antibody targeting VEGFR-2, added to standard chemotherapy for patients with previously untreated metastatic gastric or gastroesophageal junction (G-GEJ) adenocarcinoma. The findings revealed a significant 25% reduction in the risk of disease progression or death for the primary endpoint of progression-free survival (PFS). However, the reduction corresponded to only a 9-day improvement in median PFS, so the clinical benefit of frontline ramucirumab is debatable.

The Gastrointestinal Cancers Symposium is cosponsored by AGA, the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO) and the Society of Surgical Oncology (SSO).

More news from the 2018 Gastrointestinal Cancers Symposium is available at gicasym.org/daily-news.

[email protected]

2017 was a busy year in the AGA Community, our member-only discussion forum. Some of our favorite discussions included challenging clinical cases you shared, remembering your colleague Dr. Marv Sleisenger and first-hand recaps of AGA’s Advocacy Day experiences.

Thank you to everyone who contributed to the conversations in 2017, making the AGA Community a hub for collaboration to ever-expand the field of GI.

Tied for the title of top contributor in 2017 were Dmitriy Kedrin, MD, PhD, of Elliot Hospital in Manchester, N.H., and Sunanda Kane, MD, MSPH, AGAF, of Mayo Clinic in Rochester, MN.

Both are key influencers in the forum, especially with helping colleagues manage challenging patient cases. Learn more about each contributor and why keeping up with the Community is an important part of their regular routines in this brief Q&A.

Thanks for being such an active member of the AGA Community! Why do you contribute?

Dr. Kane: “You are welcome! I contribute because I feel I have helpful suggestions and recommendations for managing difficult patient scenarios as well as for professional issues.”

Dr. Kedrin: “I think it is important for GI docs to be a part of a larger community, stay informed on latest guidelines, research publications and approaches to difficult cases, where more than one road can be taken. I feel that it is a great forum for someone like me, relatively junior gastroenterologist.”

Why do you enjoy being part of the AGA Community?

Kane: “I feel engaged with my colleagues who I otherwise do not see on a regular basis, and get to ‘meet’ new ones.”

Kedrin: “I find the case discussions informative. I learn a great deal about current trends and opinions on important topics in the GI world.”

What do you like to do in your free time?

Kane: “I enjoy cooking and binge-watching Netflix.”

Kedrin: “I bake bread and run a gastroenterology literature review podcast called ‘GI Pearls.’”

What’s your approach to handling a difficult patient case you come across in your practice?

Kane: “I reach out to as many of my colleagues as I think appropriate who may have some experience or thoughts about how to help a difficult patient.”

Kedrin: “I often seek advice of other clinicians, some with more expertise in a particular area. I also go to the literature and try to learn more that way, help expand my differential as well as figure out the best therapeutic approach.”

Was there a conversation in the AGA Community in 2017 that was your favorite?

Kane: “All conversations have merit, none stick out as a favorite.”

Kedrin: “Oh, there are several. I recall a patient case where there were several thought leaders in the field who had a disagreement about the best approach to treatment. The work-life balance conversation [Early Career Group members only] was also very good. I also enjoyed reading about different opinions regarding the values of randomized versus observational trials that happened a while back.”

View the top discussions and contributors from 2017 on the AGA Community homepage, for a limited time.

[email protected]

2017 was a busy year in the AGA Community, our member-only discussion forum. Some of our favorite discussions included challenging clinical cases you shared, remembering your colleague Dr. Marv Sleisenger and first-hand recaps of AGA’s Advocacy Day experiences.

Thank you to everyone who contributed to the conversations in 2017, making the AGA Community a hub for collaboration to ever-expand the field of GI.

Tied for the title of top contributor in 2017 were Dmitriy Kedrin, MD, PhD, of Elliot Hospital in Manchester, N.H., and Sunanda Kane, MD, MSPH, AGAF, of Mayo Clinic in Rochester, MN.

Both are key influencers in the forum, especially with helping colleagues manage challenging patient cases. Learn more about each contributor and why keeping up with the Community is an important part of their regular routines in this brief Q&A.

Thanks for being such an active member of the AGA Community! Why do you contribute?

Dr. Kane: “You are welcome! I contribute because I feel I have helpful suggestions and recommendations for managing difficult patient scenarios as well as for professional issues.”

Dr. Kedrin: “I think it is important for GI docs to be a part of a larger community, stay informed on latest guidelines, research publications and approaches to difficult cases, where more than one road can be taken. I feel that it is a great forum for someone like me, relatively junior gastroenterologist.”

Why do you enjoy being part of the AGA Community?

Kane: “I feel engaged with my colleagues who I otherwise do not see on a regular basis, and get to ‘meet’ new ones.”

Kedrin: “I find the case discussions informative. I learn a great deal about current trends and opinions on important topics in the GI world.”

What do you like to do in your free time?

Kane: “I enjoy cooking and binge-watching Netflix.”

Kedrin: “I bake bread and run a gastroenterology literature review podcast called ‘GI Pearls.’”

What’s your approach to handling a difficult patient case you come across in your practice?

Kane: “I reach out to as many of my colleagues as I think appropriate who may have some experience or thoughts about how to help a difficult patient.”

Kedrin: “I often seek advice of other clinicians, some with more expertise in a particular area. I also go to the literature and try to learn more that way, help expand my differential as well as figure out the best therapeutic approach.”

Was there a conversation in the AGA Community in 2017 that was your favorite?

Kane: “All conversations have merit, none stick out as a favorite.”

Kedrin: “Oh, there are several. I recall a patient case where there were several thought leaders in the field who had a disagreement about the best approach to treatment. The work-life balance conversation [Early Career Group members only] was also very good. I also enjoyed reading about different opinions regarding the values of randomized versus observational trials that happened a while back.”

View the top discussions and contributors from 2017 on the AGA Community homepage, for a limited time.

[email protected]

2017 was a busy year in the AGA Community, our member-only discussion forum. Some of our favorite discussions included challenging clinical cases you shared, remembering your colleague Dr. Marv Sleisenger and first-hand recaps of AGA’s Advocacy Day experiences.

Thank you to everyone who contributed to the conversations in 2017, making the AGA Community a hub for collaboration to ever-expand the field of GI.

Tied for the title of top contributor in 2017 were Dmitriy Kedrin, MD, PhD, of Elliot Hospital in Manchester, N.H., and Sunanda Kane, MD, MSPH, AGAF, of Mayo Clinic in Rochester, MN.

Both are key influencers in the forum, especially with helping colleagues manage challenging patient cases. Learn more about each contributor and why keeping up with the Community is an important part of their regular routines in this brief Q&A.

Thanks for being such an active member of the AGA Community! Why do you contribute?

Dr. Kane: “You are welcome! I contribute because I feel I have helpful suggestions and recommendations for managing difficult patient scenarios as well as for professional issues.”

Dr. Kedrin: “I think it is important for GI docs to be a part of a larger community, stay informed on latest guidelines, research publications and approaches to difficult cases, where more than one road can be taken. I feel that it is a great forum for someone like me, relatively junior gastroenterologist.”

Why do you enjoy being part of the AGA Community?

Kane: “I feel engaged with my colleagues who I otherwise do not see on a regular basis, and get to ‘meet’ new ones.”

Kedrin: “I find the case discussions informative. I learn a great deal about current trends and opinions on important topics in the GI world.”

What do you like to do in your free time?

Kane: “I enjoy cooking and binge-watching Netflix.”

Kedrin: “I bake bread and run a gastroenterology literature review podcast called ‘GI Pearls.’”

What’s your approach to handling a difficult patient case you come across in your practice?

Kane: “I reach out to as many of my colleagues as I think appropriate who may have some experience or thoughts about how to help a difficult patient.”

Kedrin: “I often seek advice of other clinicians, some with more expertise in a particular area. I also go to the literature and try to learn more that way, help expand my differential as well as figure out the best therapeutic approach.”

Was there a conversation in the AGA Community in 2017 that was your favorite?

Kane: “All conversations have merit, none stick out as a favorite.”

Kedrin: “Oh, there are several. I recall a patient case where there were several thought leaders in the field who had a disagreement about the best approach to treatment. The work-life balance conversation [Early Career Group members only] was also very good. I also enjoyed reading about different opinions regarding the values of randomized versus observational trials that happened a while back.”

View the top discussions and contributors from 2017 on the AGA Community homepage, for a limited time.

[email protected]

General registration and housing for Digestive Disease Week^® (DDW) 2018 are now open. Registering during the early-bird period (until April 18) guarantees a savings of at least $80 on your registration.

Why DDW?

Just as monumental as this year’s host city, Washington, D.C., DDW is the premier meeting for GI professionals. Come to DDW 2018, taking place June 2-5, to:

• • Choose from an extensive program of high-quality education presented in a variety of learning formats.
• • Explore research unveiled in more than 4,000 poster presentations and over 1,000 abstract presentations.
• • Network and share capital ideas with more than 14,000 other attendees from around the world.
• • Browse an extensive Exhibit Hall featuring the latest products and services in gastroenterology and related fields.

Whether your area of expertise is in patient care, research, education, or administration, DDW has something for you. Register today

[email protected]

General registration and housing for Digestive Disease Week^® (DDW) 2018 are now open. Registering during the early-bird period (until April 18) guarantees a savings of at least $80 on your registration.

Why DDW?

Just as monumental as this year’s host city, Washington, D.C., DDW is the premier meeting for GI professionals. Come to DDW 2018, taking place June 2-5, to:

• • Choose from an extensive program of high-quality education presented in a variety of learning formats.
• • Explore research unveiled in more than 4,000 poster presentations and over 1,000 abstract presentations.
• • Network and share capital ideas with more than 14,000 other attendees from around the world.
• • Browse an extensive Exhibit Hall featuring the latest products and services in gastroenterology and related fields.

Whether your area of expertise is in patient care, research, education, or administration, DDW has something for you. Register today

[email protected]

General registration and housing for Digestive Disease Week^® (DDW) 2018 are now open. Registering during the early-bird period (until April 18) guarantees a savings of at least $80 on your registration.

Why DDW?

Just as monumental as this year’s host city, Washington, D.C., DDW is the premier meeting for GI professionals. Come to DDW 2018, taking place June 2-5, to:

• • Choose from an extensive program of high-quality education presented in a variety of learning formats.
• • Explore research unveiled in more than 4,000 poster presentations and over 1,000 abstract presentations.
• • Network and share capital ideas with more than 14,000 other attendees from around the world.
• • Browse an extensive Exhibit Hall featuring the latest products and services in gastroenterology and related fields.

Whether your area of expertise is in patient care, research, education, or administration, DDW has something for you. Register today

[email protected]

The AGA Fecal Microbiota Transplantation (FMT) National Registry is officially underway! The first patient enrolled in the FMT National Registry received a fecal transplant through the Gastroenterology Center of Connecticut/Medical Research Center of Connecticut by Paul Feuerstadt, MD. The patient being treated had experienced multiple recurrences of C. difficile infection. As part of the registry, Dr. Feuerstadt will follow up with the patient four times over the next 2 years and report back on the patient’s health post-FMT. The patient will also provide yearly reports for up to 10 years.

The AGA FMT National Registry, a program of the AGA Center for Gut Microbiome Research and Education, was established in August 2016 after receiving funding from the National Institute of Allergy and Infectious Diseases (NIAID) of the NIH (award number R24AI118629). The registry aims to enroll 75 sites and track 4,000 patients for 5-10 years after their FMT procedure. The data collected from this registry will guide physicians in determining when to use FMT on their patients and will provide much-needed information on the potential risks associated with stool transplants.

If you’re interested in participating in the registry, email [email protected].
 

New registry collaborators

AGA will collaborate with the American Gut Project – an academic effort run by the laboratory of Rob Knight, PhD, professor and director of the Center for Microbiome Innovation at the University of California, San Diego – to build a biobank of stool samples from participants in the FMT National Registry. American Gut will receive stool samples from registry participants before and after their FMT. The microbiota will be sequenced in each sample, and remaining material will be frozen to be made available for future research. Eventually, this information could help doctors screen and select the best donor samples for individual patients.

AGA will also collaborate with OpenBiome, a public stool bank and nonprofit research organization that provides clinicians with rigorously screened, ready-to-use stool preparations for fecal transplant procedures. As the only public stool bank in the country, OpenBiome serves as the source of stool preparations for nearly 1,000 clinical partners performing FMT across the U.S. For patients enrolled in the registry who receive OpenBiome FMT material, OpenBiome will provide screening information and samples to support the registry’s research analyses. Learn more at www.gastro.org/FMTRegistry.

[email protected]

The AGA Fecal Microbiota Transplantation (FMT) National Registry is officially underway! The first patient enrolled in the FMT National Registry received a fecal transplant through the Gastroenterology Center of Connecticut/Medical Research Center of Connecticut by Paul Feuerstadt, MD. The patient being treated had experienced multiple recurrences of C. difficile infection. As part of the registry, Dr. Feuerstadt will follow up with the patient four times over the next 2 years and report back on the patient’s health post-FMT. The patient will also provide yearly reports for up to 10 years.

The AGA FMT National Registry, a program of the AGA Center for Gut Microbiome Research and Education, was established in August 2016 after receiving funding from the National Institute of Allergy and Infectious Diseases (NIAID) of the NIH (award number R24AI118629). The registry aims to enroll 75 sites and track 4,000 patients for 5-10 years after their FMT procedure. The data collected from this registry will guide physicians in determining when to use FMT on their patients and will provide much-needed information on the potential risks associated with stool transplants.

If you’re interested in participating in the registry, email [email protected].
 

New registry collaborators

AGA will collaborate with the American Gut Project – an academic effort run by the laboratory of Rob Knight, PhD, professor and director of the Center for Microbiome Innovation at the University of California, San Diego – to build a biobank of stool samples from participants in the FMT National Registry. American Gut will receive stool samples from registry participants before and after their FMT. The microbiota will be sequenced in each sample, and remaining material will be frozen to be made available for future research. Eventually, this information could help doctors screen and select the best donor samples for individual patients.

AGA will also collaborate with OpenBiome, a public stool bank and nonprofit research organization that provides clinicians with rigorously screened, ready-to-use stool preparations for fecal transplant procedures. As the only public stool bank in the country, OpenBiome serves as the source of stool preparations for nearly 1,000 clinical partners performing FMT across the U.S. For patients enrolled in the registry who receive OpenBiome FMT material, OpenBiome will provide screening information and samples to support the registry’s research analyses. Learn more at www.gastro.org/FMTRegistry.

[email protected]

The AGA Fecal Microbiota Transplantation (FMT) National Registry is officially underway! The first patient enrolled in the FMT National Registry received a fecal transplant through the Gastroenterology Center of Connecticut/Medical Research Center of Connecticut by Paul Feuerstadt, MD. The patient being treated had experienced multiple recurrences of C. difficile infection. As part of the registry, Dr. Feuerstadt will follow up with the patient four times over the next 2 years and report back on the patient’s health post-FMT. The patient will also provide yearly reports for up to 10 years.

The AGA FMT National Registry, a program of the AGA Center for Gut Microbiome Research and Education, was established in August 2016 after receiving funding from the National Institute of Allergy and Infectious Diseases (NIAID) of the NIH (award number R24AI118629). The registry aims to enroll 75 sites and track 4,000 patients for 5-10 years after their FMT procedure. The data collected from this registry will guide physicians in determining when to use FMT on their patients and will provide much-needed information on the potential risks associated with stool transplants.

If you’re interested in participating in the registry, email [email protected].
 

New registry collaborators

AGA will collaborate with the American Gut Project – an academic effort run by the laboratory of Rob Knight, PhD, professor and director of the Center for Microbiome Innovation at the University of California, San Diego – to build a biobank of stool samples from participants in the FMT National Registry. American Gut will receive stool samples from registry participants before and after their FMT. The microbiota will be sequenced in each sample, and remaining material will be frozen to be made available for future research. Eventually, this information could help doctors screen and select the best donor samples for individual patients.

AGA will also collaborate with OpenBiome, a public stool bank and nonprofit research organization that provides clinicians with rigorously screened, ready-to-use stool preparations for fecal transplant procedures. As the only public stool bank in the country, OpenBiome serves as the source of stool preparations for nearly 1,000 clinical partners performing FMT across the U.S. For patients enrolled in the registry who receive OpenBiome FMT material, OpenBiome will provide screening information and samples to support the registry’s research analyses. Learn more at www.gastro.org/FMTRegistry.

[email protected]

The way we diagnose and treat patients is thanks to years of research. Decades of research and discoveries by dedicated investigators have revolutionized the care of many digestive disease patients. As the charitable arm of the American Gastroenterological Association (AGA), the AGA Research Foundation contributes to this tradition of discovery.

Federal research funding is at risk. Promising early-stage investigators find it increasingly difficult to secure funding and many leave the field because they are unable to sustain a research career. The foundation provides a key source of funding at a critical juncture in a young investigator’s career.

“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.”

By joining others in donating to the AGA Research Foundation, you can help fill the funding gap and protect the next generation of investigators.

[email protected]

The way we diagnose and treat patients is thanks to years of research. Decades of research and discoveries by dedicated investigators have revolutionized the care of many digestive disease patients. As the charitable arm of the American Gastroenterological Association (AGA), the AGA Research Foundation contributes to this tradition of discovery.

Federal research funding is at risk. Promising early-stage investigators find it increasingly difficult to secure funding and many leave the field because they are unable to sustain a research career. The foundation provides a key source of funding at a critical juncture in a young investigator’s career.

“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.”

By joining others in donating to the AGA Research Foundation, you can help fill the funding gap and protect the next generation of investigators.

[email protected]

The way we diagnose and treat patients is thanks to years of research. Decades of research and discoveries by dedicated investigators have revolutionized the care of many digestive disease patients. As the charitable arm of the American Gastroenterological Association (AGA), the AGA Research Foundation contributes to this tradition of discovery.

Federal research funding is at risk. Promising early-stage investigators find it increasingly difficult to secure funding and many leave the field because they are unable to sustain a research career. The foundation provides a key source of funding at a critical juncture in a young investigator’s career.

“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.”

By joining others in donating to the AGA Research Foundation, you can help fill the funding gap and protect the next generation of investigators.

[email protected]

AGA’s member-only online networking platform, the AGA Community, was the hub for clinical case scenarios in 2017. About 100 deidentified patient cases were submitted to the forum, generating over 475 private and public responses from your peers.

Here is a summary of the three cases that sparked the most discussion among AGA members. You can view all discussions in the forum at community.gastro.org/discussions.
 

#3 “Esophageal hyperkeratosis” (February 2017)

Patient scenario: Patient was having dysphagia. EGD showed circumferential thickening of esophageal lining in the lower half of the esophagus causing partial obstruction; lumen diameter was 7 mm (scope was able to pass with mild resistance). Human papillomavirus (HPV) stain was negative. Multiple biopsies were negative for malignancy, so the practice did not recommend esophagectomy and believed the symptoms were consistent with hyperkeratosis of esophagus. Endoscopic cryotherapy was being considered.

Question: Has anyone come across a case like this?
 

#2 Thickened stomach (May 2017)

Patient scenario: A 74-year-old male presented early satiety, anemia, and dyspepsia. EGD showed diffuse moderate erythema of the stomach sparing the antrum, and two small superficial duodenal ulcers. Biopsies showed mild chronic inflammation, duodenitis, and negative for H. pylori. The patient was started on a proton pump inhibitor (PPI).

One month later, patient reported early satiety, a 40-pound weight loss over last few months, nausea and vomiting, with minimal improvement while using the PPI. A CT scan of the abdomen and pelvis showed diffuse thickening of the stomach, but was otherwise unremarkable.

One month after that, a repeated EGD showed moderate erythema with enlarged gastric folds, cobblestone of mucosa, again all sparing the antrum. The colonoscopy results were unremarkable. Gastric biopsies showed mild chronic inflammation. Endoscopic ultrasound showed a thickened gastric wall to 14 mm (normal 5 mm) and fine needle aspiration showed normal gastric foveolar epithelium. The patient received a PEG-J tube to maintain nutrition, and then had a laparoscopic assisted full thickness gastric biopsy, which showed benign hypertrophic gastric smooth muscle tissue.

Serum protein electrophoresis and urine protein electrophoresis test results were normal, with total IgG and IgA normal, total IgM low at 31 (normal 60-265), albumin low, other proteins normal, and immunofixation negative. Prealbumin was low at 5 (normal 15-45). Albumin initially normal and over a couple of days low at 2.6 (normal 3.4-5.0). Total protein initially normal and over a couple of days was low at 6.3 (normal 6.8-8.8). Gastrin level was insignificant on the PPI, in the 400s. Zollinger Ellison gastrin not impressive, and the patient is HIV negative.

Question: With a negative biopsy and other test results, Menetrier’s, malignancy, sarcoidosis, eosinophilic gastroenteritis, and amyloidosis can be ruled out. What could the diagnosis be?
 

#1 IBD and prior hep B (July 2017)

Patient scenario: A 53-year-old male diagnosed with ulcerative colitis (UC) at outside hospital after presenting with abdominal pain, perforation of sigmoid colon. He underwent total colectomy with ileostomy, which showed he has remnant rectum, and the path of colon showed UC with sigmoid stricture. There is no malignancy or dysplasia, and the terminal ileum included in the resection was normal. He had complicated post-op course with enterocutaneous fistula.

He underwent takedown of ileostomy, small bowel resection and ileostomy revision. Path showed segmental small bowel showing viable mucosa with acute serositis and serial adhesions. Ileal mucosa was normal. Rectum has inflammation, and he has symptoms of mucus, urgency, and blood. He had rectal burning and did not tolerate CANASA^® suppository. He did not seem to improve with hydrocortisone suppository either.

In trying to decipher next treatment step, hepatitis panel was done, which showed positive hepatitis B core antibody (IgM). Hepatitis B viral load was undetectable. Hepatitis B surface antibody test (HBsAb) quantitative was 6 (not quite the range for immunity of greater than 10). Hepatitis B “e” antigen (HBeAg) negative and hepatitis B “e” antibody (HBeAb) positive. This patient’s hep B core total was positive and hep B surface antigen was negative.

Question: How would you treat this patient? Would you use Imuran?

Share your difficult patient case for the GI community to help you solve at community.gastro.org/quickpost.
 

[email protected]

AGA’s member-only online networking platform, the AGA Community, was the hub for clinical case scenarios in 2017. About 100 deidentified patient cases were submitted to the forum, generating over 475 private and public responses from your peers.

Here is a summary of the three cases that sparked the most discussion among AGA members. You can view all discussions in the forum at community.gastro.org/discussions.
 

#3 “Esophageal hyperkeratosis” (February 2017)

Patient scenario: Patient was having dysphagia. EGD showed circumferential thickening of esophageal lining in the lower half of the esophagus causing partial obstruction; lumen diameter was 7 mm (scope was able to pass with mild resistance). Human papillomavirus (HPV) stain was negative. Multiple biopsies were negative for malignancy, so the practice did not recommend esophagectomy and believed the symptoms were consistent with hyperkeratosis of esophagus. Endoscopic cryotherapy was being considered.

Question: Has anyone come across a case like this?
 

#2 Thickened stomach (May 2017)

Patient scenario: A 74-year-old male presented early satiety, anemia, and dyspepsia. EGD showed diffuse moderate erythema of the stomach sparing the antrum, and two small superficial duodenal ulcers. Biopsies showed mild chronic inflammation, duodenitis, and negative for H. pylori. The patient was started on a proton pump inhibitor (PPI).

One month later, patient reported early satiety, a 40-pound weight loss over last few months, nausea and vomiting, with minimal improvement while using the PPI. A CT scan of the abdomen and pelvis showed diffuse thickening of the stomach, but was otherwise unremarkable.

One month after that, a repeated EGD showed moderate erythema with enlarged gastric folds, cobblestone of mucosa, again all sparing the antrum. The colonoscopy results were unremarkable. Gastric biopsies showed mild chronic inflammation. Endoscopic ultrasound showed a thickened gastric wall to 14 mm (normal 5 mm) and fine needle aspiration showed normal gastric foveolar epithelium. The patient received a PEG-J tube to maintain nutrition, and then had a laparoscopic assisted full thickness gastric biopsy, which showed benign hypertrophic gastric smooth muscle tissue.

Serum protein electrophoresis and urine protein electrophoresis test results were normal, with total IgG and IgA normal, total IgM low at 31 (normal 60-265), albumin low, other proteins normal, and immunofixation negative. Prealbumin was low at 5 (normal 15-45). Albumin initially normal and over a couple of days low at 2.6 (normal 3.4-5.0). Total protein initially normal and over a couple of days was low at 6.3 (normal 6.8-8.8). Gastrin level was insignificant on the PPI, in the 400s. Zollinger Ellison gastrin not impressive, and the patient is HIV negative.

Question: With a negative biopsy and other test results, Menetrier’s, malignancy, sarcoidosis, eosinophilic gastroenteritis, and amyloidosis can be ruled out. What could the diagnosis be?
 

#1 IBD and prior hep B (July 2017)

Patient scenario: A 53-year-old male diagnosed with ulcerative colitis (UC) at outside hospital after presenting with abdominal pain, perforation of sigmoid colon. He underwent total colectomy with ileostomy, which showed he has remnant rectum, and the path of colon showed UC with sigmoid stricture. There is no malignancy or dysplasia, and the terminal ileum included in the resection was normal. He had complicated post-op course with enterocutaneous fistula.

He underwent takedown of ileostomy, small bowel resection and ileostomy revision. Path showed segmental small bowel showing viable mucosa with acute serositis and serial adhesions. Ileal mucosa was normal. Rectum has inflammation, and he has symptoms of mucus, urgency, and blood. He had rectal burning and did not tolerate CANASA^® suppository. He did not seem to improve with hydrocortisone suppository either.

In trying to decipher next treatment step, hepatitis panel was done, which showed positive hepatitis B core antibody (IgM). Hepatitis B viral load was undetectable. Hepatitis B surface antibody test (HBsAb) quantitative was 6 (not quite the range for immunity of greater than 10). Hepatitis B “e” antigen (HBeAg) negative and hepatitis B “e” antibody (HBeAb) positive. This patient’s hep B core total was positive and hep B surface antigen was negative.

Question: How would you treat this patient? Would you use Imuran?

Share your difficult patient case for the GI community to help you solve at community.gastro.org/quickpost.
 

[email protected]

AGA’s member-only online networking platform, the AGA Community, was the hub for clinical case scenarios in 2017. About 100 deidentified patient cases were submitted to the forum, generating over 475 private and public responses from your peers.

Here is a summary of the three cases that sparked the most discussion among AGA members. You can view all discussions in the forum at community.gastro.org/discussions.
 

#3 “Esophageal hyperkeratosis” (February 2017)

Patient scenario: Patient was having dysphagia. EGD showed circumferential thickening of esophageal lining in the lower half of the esophagus causing partial obstruction; lumen diameter was 7 mm (scope was able to pass with mild resistance). Human papillomavirus (HPV) stain was negative. Multiple biopsies were negative for malignancy, so the practice did not recommend esophagectomy and believed the symptoms were consistent with hyperkeratosis of esophagus. Endoscopic cryotherapy was being considered.

Question: Has anyone come across a case like this?
 

#2 Thickened stomach (May 2017)

Patient scenario: A 74-year-old male presented early satiety, anemia, and dyspepsia. EGD showed diffuse moderate erythema of the stomach sparing the antrum, and two small superficial duodenal ulcers. Biopsies showed mild chronic inflammation, duodenitis, and negative for H. pylori. The patient was started on a proton pump inhibitor (PPI).

One month later, patient reported early satiety, a 40-pound weight loss over last few months, nausea and vomiting, with minimal improvement while using the PPI. A CT scan of the abdomen and pelvis showed diffuse thickening of the stomach, but was otherwise unremarkable.

One month after that, a repeated EGD showed moderate erythema with enlarged gastric folds, cobblestone of mucosa, again all sparing the antrum. The colonoscopy results were unremarkable. Gastric biopsies showed mild chronic inflammation. Endoscopic ultrasound showed a thickened gastric wall to 14 mm (normal 5 mm) and fine needle aspiration showed normal gastric foveolar epithelium. The patient received a PEG-J tube to maintain nutrition, and then had a laparoscopic assisted full thickness gastric biopsy, which showed benign hypertrophic gastric smooth muscle tissue.

Serum protein electrophoresis and urine protein electrophoresis test results were normal, with total IgG and IgA normal, total IgM low at 31 (normal 60-265), albumin low, other proteins normal, and immunofixation negative. Prealbumin was low at 5 (normal 15-45). Albumin initially normal and over a couple of days low at 2.6 (normal 3.4-5.0). Total protein initially normal and over a couple of days was low at 6.3 (normal 6.8-8.8). Gastrin level was insignificant on the PPI, in the 400s. Zollinger Ellison gastrin not impressive, and the patient is HIV negative.

Question: With a negative biopsy and other test results, Menetrier’s, malignancy, sarcoidosis, eosinophilic gastroenteritis, and amyloidosis can be ruled out. What could the diagnosis be?
 

#1 IBD and prior hep B (July 2017)

Patient scenario: A 53-year-old male diagnosed with ulcerative colitis (UC) at outside hospital after presenting with abdominal pain, perforation of sigmoid colon. He underwent total colectomy with ileostomy, which showed he has remnant rectum, and the path of colon showed UC with sigmoid stricture. There is no malignancy or dysplasia, and the terminal ileum included in the resection was normal. He had complicated post-op course with enterocutaneous fistula.

He underwent takedown of ileostomy, small bowel resection and ileostomy revision. Path showed segmental small bowel showing viable mucosa with acute serositis and serial adhesions. Ileal mucosa was normal. Rectum has inflammation, and he has symptoms of mucus, urgency, and blood. He had rectal burning and did not tolerate CANASA^® suppository. He did not seem to improve with hydrocortisone suppository either.

In trying to decipher next treatment step, hepatitis panel was done, which showed positive hepatitis B core antibody (IgM). Hepatitis B viral load was undetectable. Hepatitis B surface antibody test (HBsAb) quantitative was 6 (not quite the range for immunity of greater than 10). Hepatitis B “e” antigen (HBeAg) negative and hepatitis B “e” antibody (HBeAb) positive. This patient’s hep B core total was positive and hep B surface antigen was negative.

Question: How would you treat this patient? Would you use Imuran?

Share your difficult patient case for the GI community to help you solve at community.gastro.org/quickpost.
 

[email protected]