Society News

Mark your calendars: the 2020 Vascular Annual Meeting will take place June 17-20 at the Toronto Convention Center in Toronto, Ontario, Canada. All U.S. residents entering Canada will be required to travel with a valid passport. Your passport expiration date may not be within six months of your travel dates. For additional information (including passport requirements for international travelers), please visit the Canada Border Services Agency’s website. Read all future VAM details here.

Mark your calendars: the 2020 Vascular Annual Meeting will take place June 17-20 at the Toronto Convention Center in Toronto, Ontario, Canada. All U.S. residents entering Canada will be required to travel with a valid passport. Your passport expiration date may not be within six months of your travel dates. For additional information (including passport requirements for international travelers), please visit the Canada Border Services Agency’s website. Read all future VAM details here.

Mark your calendars: the 2020 Vascular Annual Meeting will take place June 17-20 at the Toronto Convention Center in Toronto, Ontario, Canada. All U.S. residents entering Canada will be required to travel with a valid passport. Your passport expiration date may not be within six months of your travel dates. For additional information (including passport requirements for international travelers), please visit the Canada Border Services Agency’s website. Read all future VAM details here.

Our website contains many resources that SVS members can use for help with managing a practice, continuing education, patient education materials and much more. The patient resource pages on the site cover a variety of vascular conditions, tests and treatments. Most recently, we’ve added a page for Transcarotid Artery Revascularization (TCAR). This, and most of our pages, can give patients and/or their loved ones a better understanding of their vascular condition, as well as how it’s being tested and treated. Take a look at our pages and share with your patients today.

Our website contains many resources that SVS members can use for help with managing a practice, continuing education, patient education materials and much more. The patient resource pages on the site cover a variety of vascular conditions, tests and treatments. Most recently, we’ve added a page for Transcarotid Artery Revascularization (TCAR). This, and most of our pages, can give patients and/or their loved ones a better understanding of their vascular condition, as well as how it’s being tested and treated. Take a look at our pages and share with your patients today.

Our website contains many resources that SVS members can use for help with managing a practice, continuing education, patient education materials and much more. The patient resource pages on the site cover a variety of vascular conditions, tests and treatments. Most recently, we’ve added a page for Transcarotid Artery Revascularization (TCAR). This, and most of our pages, can give patients and/or their loved ones a better understanding of their vascular condition, as well as how it’s being tested and treated. Take a look at our pages and share with your patients today.

I return to write the Editor’s comments after missing last month because I joined over 700,000 Americans who, this year, will undergo knee replacement surgery.

This month, we feature a couple articles from the 2019 James W. Freston Conference (an annual AGA event that highlights cutting-edge science). Jim was the 89th AGA President (1995) and this conference is a fitting legacy. This year’s topic was “Food at the intersection of gut health and disease.” As usual, the Freston Conference attracted international experts and interested clinicians who want to understand how current research will alter our clinical care in the near future.

Our front-page articles are fascinating. One highlights new advances in the management of celiac disease. Although the only current treatment that reverses intestinal immunological damage is adoption of a gluten-free diet, there is demand for alternative treatments including medical therapies targeting specific steps in the celiac damage pathway. While none are ready for wide-spread adoption, research will continue. Patient self-management with gluten detection-devices were also discussed.

Advances in the genetics of Crohn’s disease are being published at an accelerating rate. This month we highlight an article about how gene expression analysis can predict response to a Crohn’s flare. Evidence-based therapy for inflammatory bowel disease is complex, so clinicians need to stay current. Each year, the premier IBD educational venue is co-produced by the AGA and the Crohn’s & Colitis Foundation. The 2020 Crohn’s and Colitis Congress will be held in Austin, Texas January 23-25. Learn more at: https://www.crohnscolitiscongress.org.

Finally, I want to highlight an article about the risk of venous thromboembolism (VTE) during and after an IBD flare. This risk is underappreciated by many treating physicians but it is real and can be life-threatening. Gastroenterologists must be knowledgeable about current guidelines for VTE in IBD patients (see Gastroenterology 2014;146:835-48).

John I. Allen, MD, MBA, AGAF
Editor in Chief

I return to write the Editor’s comments after missing last month because I joined over 700,000 Americans who, this year, will undergo knee replacement surgery.

This month, we feature a couple articles from the 2019 James W. Freston Conference (an annual AGA event that highlights cutting-edge science). Jim was the 89th AGA President (1995) and this conference is a fitting legacy. This year’s topic was “Food at the intersection of gut health and disease.” As usual, the Freston Conference attracted international experts and interested clinicians who want to understand how current research will alter our clinical care in the near future.

Our front-page articles are fascinating. One highlights new advances in the management of celiac disease. Although the only current treatment that reverses intestinal immunological damage is adoption of a gluten-free diet, there is demand for alternative treatments including medical therapies targeting specific steps in the celiac damage pathway. While none are ready for wide-spread adoption, research will continue. Patient self-management with gluten detection-devices were also discussed.

Advances in the genetics of Crohn’s disease are being published at an accelerating rate. This month we highlight an article about how gene expression analysis can predict response to a Crohn’s flare. Evidence-based therapy for inflammatory bowel disease is complex, so clinicians need to stay current. Each year, the premier IBD educational venue is co-produced by the AGA and the Crohn’s & Colitis Foundation. The 2020 Crohn’s and Colitis Congress will be held in Austin, Texas January 23-25. Learn more at: https://www.crohnscolitiscongress.org.

Finally, I want to highlight an article about the risk of venous thromboembolism (VTE) during and after an IBD flare. This risk is underappreciated by many treating physicians but it is real and can be life-threatening. Gastroenterologists must be knowledgeable about current guidelines for VTE in IBD patients (see Gastroenterology 2014;146:835-48).

John I. Allen, MD, MBA, AGAF
Editor in Chief

I return to write the Editor’s comments after missing last month because I joined over 700,000 Americans who, this year, will undergo knee replacement surgery.

This month, we feature a couple articles from the 2019 James W. Freston Conference (an annual AGA event that highlights cutting-edge science). Jim was the 89th AGA President (1995) and this conference is a fitting legacy. This year’s topic was “Food at the intersection of gut health and disease.” As usual, the Freston Conference attracted international experts and interested clinicians who want to understand how current research will alter our clinical care in the near future.

Our front-page articles are fascinating. One highlights new advances in the management of celiac disease. Although the only current treatment that reverses intestinal immunological damage is adoption of a gluten-free diet, there is demand for alternative treatments including medical therapies targeting specific steps in the celiac damage pathway. While none are ready for wide-spread adoption, research will continue. Patient self-management with gluten detection-devices were also discussed.

Advances in the genetics of Crohn’s disease are being published at an accelerating rate. This month we highlight an article about how gene expression analysis can predict response to a Crohn’s flare. Evidence-based therapy for inflammatory bowel disease is complex, so clinicians need to stay current. Each year, the premier IBD educational venue is co-produced by the AGA and the Crohn’s & Colitis Foundation. The 2020 Crohn’s and Colitis Congress will be held in Austin, Texas January 23-25. Learn more at: https://www.crohnscolitiscongress.org.

Finally, I want to highlight an article about the risk of venous thromboembolism (VTE) during and after an IBD flare. This risk is underappreciated by many treating physicians but it is real and can be life-threatening. Gastroenterologists must be knowledgeable about current guidelines for VTE in IBD patients (see Gastroenterology 2014;146:835-48).

John I. Allen, MD, MBA, AGAF
Editor in Chief

Stephen R. Lindemann, PhD, assistant professor of food science and nutrition science, Purdue University, shares four talking points to use when your patients ask about prebiotics.

Explaining prebiotics:

• • Prebiotics serve as food for specific microbes in the gut but their health benefits are likely due to broader changes in the function of communities of microbes.
• • Prebiotics can lead to a durable change in overall function of a gut microbial community with potential for long-term health benefit while probiotics are live microorganisms that when administered in adequate amounts can confer a health benefit even in the short term.
• • Prebiotics ferment to short-chain fatty acids known to positively influence human metabolism and immunity. Commercial prebiotics may be beneficial in some individuals but intolerable in others.
• • Further research is needed to determine the specificity of prebiotics in terms of their biological effects. Other dietary fibers/proteins may have similar health benefits that have not yet been determined.

These tips are from “Prebiotics 101,” the first of a four-part CME series in AGA University, agau.gastro.org, titled, “The Microbiome and Digestive Health: A Look at Prebiotics.” Part two, “Diet vs. Prebiotics” is also available.

Looking for more information on prebiotics?

AGA has educational materials for patients on probiotics (also available in Spanish) at gastro.org/patient.
 

[email protected]

Stephen R. Lindemann, PhD, assistant professor of food science and nutrition science, Purdue University, shares four talking points to use when your patients ask about prebiotics.

Explaining prebiotics:

• • Prebiotics serve as food for specific microbes in the gut but their health benefits are likely due to broader changes in the function of communities of microbes.
• • Prebiotics can lead to a durable change in overall function of a gut microbial community with potential for long-term health benefit while probiotics are live microorganisms that when administered in adequate amounts can confer a health benefit even in the short term.
• • Prebiotics ferment to short-chain fatty acids known to positively influence human metabolism and immunity. Commercial prebiotics may be beneficial in some individuals but intolerable in others.
• • Further research is needed to determine the specificity of prebiotics in terms of their biological effects. Other dietary fibers/proteins may have similar health benefits that have not yet been determined.

These tips are from “Prebiotics 101,” the first of a four-part CME series in AGA University, agau.gastro.org, titled, “The Microbiome and Digestive Health: A Look at Prebiotics.” Part two, “Diet vs. Prebiotics” is also available.

Looking for more information on prebiotics?

AGA has educational materials for patients on probiotics (also available in Spanish) at gastro.org/patient.
 

[email protected]

Stephen R. Lindemann, PhD, assistant professor of food science and nutrition science, Purdue University, shares four talking points to use when your patients ask about prebiotics.

Explaining prebiotics:

• • Prebiotics serve as food for specific microbes in the gut but their health benefits are likely due to broader changes in the function of communities of microbes.
• • Prebiotics can lead to a durable change in overall function of a gut microbial community with potential for long-term health benefit while probiotics are live microorganisms that when administered in adequate amounts can confer a health benefit even in the short term.
• • Prebiotics ferment to short-chain fatty acids known to positively influence human metabolism and immunity. Commercial prebiotics may be beneficial in some individuals but intolerable in others.
• • Further research is needed to determine the specificity of prebiotics in terms of their biological effects. Other dietary fibers/proteins may have similar health benefits that have not yet been determined.

These tips are from “Prebiotics 101,” the first of a four-part CME series in AGA University, agau.gastro.org, titled, “The Microbiome and Digestive Health: A Look at Prebiotics.” Part two, “Diet vs. Prebiotics” is also available.

Looking for more information on prebiotics?

AGA has educational materials for patients on probiotics (also available in Spanish) at gastro.org/patient.
 

[email protected]

AGA and our sister societies met with Medicare staff in Washington, DC, to voice our opposition to its proposal that would require physicians to inform patients about potential colorectal cancer (CRC) screening costs. Under the proposal, physicians who plan to perform a CRC screening for a Medicare beneficiary must tell the beneficiary in advance that they may have to pay coinsurance under the Medicare program if the screening finds polyps that are removed as part of the screening procedure and document the conversation in the beneficiary’s medical record starting Jan. 1, 2020.

Under the Affordable Care Act, Medicare beneficiaries do not need to pay for screenings that receive an A or B from the U.S. Preventive Services Task Force (USPSTF), such as screening colonoscopy. However, because of Medicare’s interpretation of the coding rules, when a polyp is found and removed during a screening colonoscopy, it is considered a diagnostic procedure and the patient is required to pay the coinsurance. Medicare’s new proposal does not solve the underlying problem — fixing the coinsurance issue for Medicare beneficiaries; instead, it shifts responsibility to notify Medicare beneficiaries to the physician.

The gastroenterology community, together with patient advocates, has been asking CMS since 2011 to use its authority to fix the Medicare screening colonoscopy coinsurance problem. It was never the intention of Congress for polypectomy resulting from the initial screening to be excluded from the screening benefit. The Obama administration provided guidance for commercial plans on this screening benefit and stated that plans should not impose coinsurance since “removal of polyp is integral to the screening” and thus most private insurers recognize the benefit of waiving the coinsurance.

In our meeting with Medicare, we told them that beneficiaries should not be penalized because of the agency’s misinterpretation of Congress’ legislation. We also urged Medicare not to add to physician burden, to take responsibility for notifying patients of its own coverage and payment policies, and to focus on ways to help patients avoid unfair financial penalties resulting from its misinterpretation of Congress’s mandate for free CRC screening.

Medicare needs to hear from you today. Sign our letter on gastro.org/advocacy to let your voice be heard.
 

[email protected]

AGA and our sister societies met with Medicare staff in Washington, DC, to voice our opposition to its proposal that would require physicians to inform patients about potential colorectal cancer (CRC) screening costs. Under the proposal, physicians who plan to perform a CRC screening for a Medicare beneficiary must tell the beneficiary in advance that they may have to pay coinsurance under the Medicare program if the screening finds polyps that are removed as part of the screening procedure and document the conversation in the beneficiary’s medical record starting Jan. 1, 2020.

Under the Affordable Care Act, Medicare beneficiaries do not need to pay for screenings that receive an A or B from the U.S. Preventive Services Task Force (USPSTF), such as screening colonoscopy. However, because of Medicare’s interpretation of the coding rules, when a polyp is found and removed during a screening colonoscopy, it is considered a diagnostic procedure and the patient is required to pay the coinsurance. Medicare’s new proposal does not solve the underlying problem — fixing the coinsurance issue for Medicare beneficiaries; instead, it shifts responsibility to notify Medicare beneficiaries to the physician.

The gastroenterology community, together with patient advocates, has been asking CMS since 2011 to use its authority to fix the Medicare screening colonoscopy coinsurance problem. It was never the intention of Congress for polypectomy resulting from the initial screening to be excluded from the screening benefit. The Obama administration provided guidance for commercial plans on this screening benefit and stated that plans should not impose coinsurance since “removal of polyp is integral to the screening” and thus most private insurers recognize the benefit of waiving the coinsurance.

In our meeting with Medicare, we told them that beneficiaries should not be penalized because of the agency’s misinterpretation of Congress’ legislation. We also urged Medicare not to add to physician burden, to take responsibility for notifying patients of its own coverage and payment policies, and to focus on ways to help patients avoid unfair financial penalties resulting from its misinterpretation of Congress’s mandate for free CRC screening.

Medicare needs to hear from you today. Sign our letter on gastro.org/advocacy to let your voice be heard.
 

[email protected]

AGA and our sister societies met with Medicare staff in Washington, DC, to voice our opposition to its proposal that would require physicians to inform patients about potential colorectal cancer (CRC) screening costs. Under the proposal, physicians who plan to perform a CRC screening for a Medicare beneficiary must tell the beneficiary in advance that they may have to pay coinsurance under the Medicare program if the screening finds polyps that are removed as part of the screening procedure and document the conversation in the beneficiary’s medical record starting Jan. 1, 2020.

Under the Affordable Care Act, Medicare beneficiaries do not need to pay for screenings that receive an A or B from the U.S. Preventive Services Task Force (USPSTF), such as screening colonoscopy. However, because of Medicare’s interpretation of the coding rules, when a polyp is found and removed during a screening colonoscopy, it is considered a diagnostic procedure and the patient is required to pay the coinsurance. Medicare’s new proposal does not solve the underlying problem — fixing the coinsurance issue for Medicare beneficiaries; instead, it shifts responsibility to notify Medicare beneficiaries to the physician.

The gastroenterology community, together with patient advocates, has been asking CMS since 2011 to use its authority to fix the Medicare screening colonoscopy coinsurance problem. It was never the intention of Congress for polypectomy resulting from the initial screening to be excluded from the screening benefit. The Obama administration provided guidance for commercial plans on this screening benefit and stated that plans should not impose coinsurance since “removal of polyp is integral to the screening” and thus most private insurers recognize the benefit of waiving the coinsurance.

In our meeting with Medicare, we told them that beneficiaries should not be penalized because of the agency’s misinterpretation of Congress’ legislation. We also urged Medicare not to add to physician burden, to take responsibility for notifying patients of its own coverage and payment policies, and to focus on ways to help patients avoid unfair financial penalties resulting from its misinterpretation of Congress’s mandate for free CRC screening.

Medicare needs to hear from you today. Sign our letter on gastro.org/advocacy to let your voice be heard.
 

[email protected]

Gifts to charitable organizations, such as the AGA Research Foundation, in your future plans ensure your support for our mission continues even after your lifetime. Review these goals to turn financial aspiration into charitable action to achieve your philanthropic vision.

Goal: Take care of those you love

Use your will or living trust to clearly communicate your intentions for how you would like to provide for your loved ones and favorite causes, including the AGA Research Foundation. You can feel secure knowing you will maintain control of your assets until after your lifetime and that your gifts are revocable so you can change your mind at any time.

Goal: Eliminate capital gains tax on stocks

When you donate appreciated securities – that is, stocks you’ve owned for more than 1 year that are now worth more than you originally paid for them – you can benefit yourself and the AGA Research Foundation. You can reduce or even eliminate federal capital gains taxes on the stock transfer, and you may be entitled to a federal income tax charitable deduction.

Tip: There are a number of ways to give appreciated securities, such as outright giving or funding a charitable gift annuity or a charitable remainder trust.
 

Goal: Conserve today’s finances

Save critical funds now by naming the AGA Research Foundation as the beneficiary of all or a percentage (1%-100%) of your IRA. Leaving all or part of your IRA to charity after your lifetime dramatically lowers future taxes for your beneficiaries. Naming a charity, like the AGA Research Foundation, as a beneficiary can eliminate federal income taxes that could consume a substantial portion of your account.

Want to learn more about including a gift to the AGA Research Foundation in your future plans? Visit our website at https://gastro.planmylegacy.org or contact Harmony Excellent at 301-272-1602 or [email protected].

[email protected]

Gifts to charitable organizations, such as the AGA Research Foundation, in your future plans ensure your support for our mission continues even after your lifetime. Review these goals to turn financial aspiration into charitable action to achieve your philanthropic vision.

Goal: Take care of those you love

Use your will or living trust to clearly communicate your intentions for how you would like to provide for your loved ones and favorite causes, including the AGA Research Foundation. You can feel secure knowing you will maintain control of your assets until after your lifetime and that your gifts are revocable so you can change your mind at any time.

Goal: Eliminate capital gains tax on stocks

When you donate appreciated securities – that is, stocks you’ve owned for more than 1 year that are now worth more than you originally paid for them – you can benefit yourself and the AGA Research Foundation. You can reduce or even eliminate federal capital gains taxes on the stock transfer, and you may be entitled to a federal income tax charitable deduction.

Tip: There are a number of ways to give appreciated securities, such as outright giving or funding a charitable gift annuity or a charitable remainder trust.
 

Goal: Conserve today’s finances

Save critical funds now by naming the AGA Research Foundation as the beneficiary of all or a percentage (1%-100%) of your IRA. Leaving all or part of your IRA to charity after your lifetime dramatically lowers future taxes for your beneficiaries. Naming a charity, like the AGA Research Foundation, as a beneficiary can eliminate federal income taxes that could consume a substantial portion of your account.

Want to learn more about including a gift to the AGA Research Foundation in your future plans? Visit our website at https://gastro.planmylegacy.org or contact Harmony Excellent at 301-272-1602 or [email protected].

[email protected]

Gifts to charitable organizations, such as the AGA Research Foundation, in your future plans ensure your support for our mission continues even after your lifetime. Review these goals to turn financial aspiration into charitable action to achieve your philanthropic vision.

Goal: Take care of those you love

Use your will or living trust to clearly communicate your intentions for how you would like to provide for your loved ones and favorite causes, including the AGA Research Foundation. You can feel secure knowing you will maintain control of your assets until after your lifetime and that your gifts are revocable so you can change your mind at any time.

Goal: Eliminate capital gains tax on stocks

When you donate appreciated securities – that is, stocks you’ve owned for more than 1 year that are now worth more than you originally paid for them – you can benefit yourself and the AGA Research Foundation. You can reduce or even eliminate federal capital gains taxes on the stock transfer, and you may be entitled to a federal income tax charitable deduction.

Tip: There are a number of ways to give appreciated securities, such as outright giving or funding a charitable gift annuity or a charitable remainder trust.
 

Goal: Conserve today’s finances

Save critical funds now by naming the AGA Research Foundation as the beneficiary of all or a percentage (1%-100%) of your IRA. Leaving all or part of your IRA to charity after your lifetime dramatically lowers future taxes for your beneficiaries. Naming a charity, like the AGA Research Foundation, as a beneficiary can eliminate federal income taxes that could consume a substantial portion of your account.

Want to learn more about including a gift to the AGA Research Foundation in your future plans? Visit our website at https://gastro.planmylegacy.org or contact Harmony Excellent at 301-272-1602 or [email protected].

[email protected]

Infection transmission from duodenoscopes is a serious and complex issue for our patients and our practices.

As previously shared with our members late last year, the U.S. Food and Drug Administration (FDA) reported on preliminary data from manufacturer testing of duodenoscopes following reprocessing (cleaning). The report showed that, in about 5% of cases, samples tested positive for “high concern” bacteria after the scopes had been reprocessed as recommended. According to FDA, these are bacteria that are more often associated with disease. The final results and more granular detail are expected later this year.

This is a serious and complex issue for our patients and our practices. Duodenoscopes are necessary for performing endoscopic retrograde cholangiopancreatography (ERCP). This minimally invasive procedure is typically performed in patients with diseases of the liver, pancreas, and gallbladder and obviates the necessity for more morbid surgical and radiologic procedures.

A recent article in The New York Times reviewing this issue largely understated the value of duodenoscopes and the procedure for which they are used. This is a potentially life-saving procedure for nearly 700,000 patients each year in the United States. When a doctor recommends ERCP, it often is because the patient is seriously ill, and the benefits of the procedure far outweigh the risks. ERCPs also spare patients more invasive alternatives, including surgery. Withdrawal of these instruments from the marketplace is simply not feasible and would be a major step backward in our ability to treat common and complex disease in the most beneficial manner.

We do agree and support the identification and development of safe and effective solutions that eliminate risk of infection transmission as a top priority. This cannot happen overnight: We cannot adopt new technologies, such as disposable duodenoscopes, without first understanding the new and unintentional risks we may be introducing to our patients such as an increased risk of procedural failure, perforation, or pancreatitis.

The GI societies have been working closely with FDA and industry to identify and properly vet potential solutions. FDA has already reviewed and cleared new reprocessing and sterilization technologies and revised designs for some duodenoscopes; all are intended to enhance ease of cleaning and reprocessing, thereby improving safety from transmitted infection. Other redesigns and new technologies for endoscope reprocessing, as well as single-use instruments, are in the pipeline. All of these options, and others, will likely enter the marketplace in the coming months and years after FDA vetting and approval and with postmarketing studies to ensure the efficacy of the technology and patient safety.

AGA is currently seeking feedback from AGA members to provide to FDA for consideration as they make upcoming review and approval decisions. If you are concerned about losing access to ERCP, a valuable procedure, please share your comments in the AGA Community. We will be sharing these comments with FDA to ensure their decisions reflect the needs of our members.

Since it was discovered several years ago that cases of infection transmission associated with duodenoscopes had been experienced by hospitals in the United States and Europe, health care organizations across the board recognized the need to escalate infection control efforts and to swiftly identify and disseminate best practices. FDA, the Centers for Disease Control and Prevention, state and local health departments, scope manufacturers, and medical societies have collaborated continuously to determine best practices for identifying and reporting sources of infection and effectively cleaning equipment.

Since this problem was identified, vigilance has been raised and infection rates have improved. As with all medical procedures, physicians should discuss the risks and benefits with their patients who require ERCP.

This article was developed in collaboration with American Society for Gastrointestinal Endoscopy (ASGE) and the Society of Gastroenterology Nurses and Associates (SGNA).

[email protected]

Infection transmission from duodenoscopes is a serious and complex issue for our patients and our practices.

As previously shared with our members late last year, the U.S. Food and Drug Administration (FDA) reported on preliminary data from manufacturer testing of duodenoscopes following reprocessing (cleaning). The report showed that, in about 5% of cases, samples tested positive for “high concern” bacteria after the scopes had been reprocessed as recommended. According to FDA, these are bacteria that are more often associated with disease. The final results and more granular detail are expected later this year.

This is a serious and complex issue for our patients and our practices. Duodenoscopes are necessary for performing endoscopic retrograde cholangiopancreatography (ERCP). This minimally invasive procedure is typically performed in patients with diseases of the liver, pancreas, and gallbladder and obviates the necessity for more morbid surgical and radiologic procedures.

A recent article in The New York Times reviewing this issue largely understated the value of duodenoscopes and the procedure for which they are used. This is a potentially life-saving procedure for nearly 700,000 patients each year in the United States. When a doctor recommends ERCP, it often is because the patient is seriously ill, and the benefits of the procedure far outweigh the risks. ERCPs also spare patients more invasive alternatives, including surgery. Withdrawal of these instruments from the marketplace is simply not feasible and would be a major step backward in our ability to treat common and complex disease in the most beneficial manner.

We do agree and support the identification and development of safe and effective solutions that eliminate risk of infection transmission as a top priority. This cannot happen overnight: We cannot adopt new technologies, such as disposable duodenoscopes, without first understanding the new and unintentional risks we may be introducing to our patients such as an increased risk of procedural failure, perforation, or pancreatitis.

The GI societies have been working closely with FDA and industry to identify and properly vet potential solutions. FDA has already reviewed and cleared new reprocessing and sterilization technologies and revised designs for some duodenoscopes; all are intended to enhance ease of cleaning and reprocessing, thereby improving safety from transmitted infection. Other redesigns and new technologies for endoscope reprocessing, as well as single-use instruments, are in the pipeline. All of these options, and others, will likely enter the marketplace in the coming months and years after FDA vetting and approval and with postmarketing studies to ensure the efficacy of the technology and patient safety.

AGA is currently seeking feedback from AGA members to provide to FDA for consideration as they make upcoming review and approval decisions. If you are concerned about losing access to ERCP, a valuable procedure, please share your comments in the AGA Community. We will be sharing these comments with FDA to ensure their decisions reflect the needs of our members.

Since it was discovered several years ago that cases of infection transmission associated with duodenoscopes had been experienced by hospitals in the United States and Europe, health care organizations across the board recognized the need to escalate infection control efforts and to swiftly identify and disseminate best practices. FDA, the Centers for Disease Control and Prevention, state and local health departments, scope manufacturers, and medical societies have collaborated continuously to determine best practices for identifying and reporting sources of infection and effectively cleaning equipment.

Since this problem was identified, vigilance has been raised and infection rates have improved. As with all medical procedures, physicians should discuss the risks and benefits with their patients who require ERCP.

This article was developed in collaboration with American Society for Gastrointestinal Endoscopy (ASGE) and the Society of Gastroenterology Nurses and Associates (SGNA).

[email protected]

Infection transmission from duodenoscopes is a serious and complex issue for our patients and our practices.

As previously shared with our members late last year, the U.S. Food and Drug Administration (FDA) reported on preliminary data from manufacturer testing of duodenoscopes following reprocessing (cleaning). The report showed that, in about 5% of cases, samples tested positive for “high concern” bacteria after the scopes had been reprocessed as recommended. According to FDA, these are bacteria that are more often associated with disease. The final results and more granular detail are expected later this year.

This is a serious and complex issue for our patients and our practices. Duodenoscopes are necessary for performing endoscopic retrograde cholangiopancreatography (ERCP). This minimally invasive procedure is typically performed in patients with diseases of the liver, pancreas, and gallbladder and obviates the necessity for more morbid surgical and radiologic procedures.

A recent article in The New York Times reviewing this issue largely understated the value of duodenoscopes and the procedure for which they are used. This is a potentially life-saving procedure for nearly 700,000 patients each year in the United States. When a doctor recommends ERCP, it often is because the patient is seriously ill, and the benefits of the procedure far outweigh the risks. ERCPs also spare patients more invasive alternatives, including surgery. Withdrawal of these instruments from the marketplace is simply not feasible and would be a major step backward in our ability to treat common and complex disease in the most beneficial manner.

We do agree and support the identification and development of safe and effective solutions that eliminate risk of infection transmission as a top priority. This cannot happen overnight: We cannot adopt new technologies, such as disposable duodenoscopes, without first understanding the new and unintentional risks we may be introducing to our patients such as an increased risk of procedural failure, perforation, or pancreatitis.

The GI societies have been working closely with FDA and industry to identify and properly vet potential solutions. FDA has already reviewed and cleared new reprocessing and sterilization technologies and revised designs for some duodenoscopes; all are intended to enhance ease of cleaning and reprocessing, thereby improving safety from transmitted infection. Other redesigns and new technologies for endoscope reprocessing, as well as single-use instruments, are in the pipeline. All of these options, and others, will likely enter the marketplace in the coming months and years after FDA vetting and approval and with postmarketing studies to ensure the efficacy of the technology and patient safety.

AGA is currently seeking feedback from AGA members to provide to FDA for consideration as they make upcoming review and approval decisions. If you are concerned about losing access to ERCP, a valuable procedure, please share your comments in the AGA Community. We will be sharing these comments with FDA to ensure their decisions reflect the needs of our members.

Since it was discovered several years ago that cases of infection transmission associated with duodenoscopes had been experienced by hospitals in the United States and Europe, health care organizations across the board recognized the need to escalate infection control efforts and to swiftly identify and disseminate best practices. FDA, the Centers for Disease Control and Prevention, state and local health departments, scope manufacturers, and medical societies have collaborated continuously to determine best practices for identifying and reporting sources of infection and effectively cleaning equipment.

Since this problem was identified, vigilance has been raised and infection rates have improved. As with all medical procedures, physicians should discuss the risks and benefits with their patients who require ERCP.

This article was developed in collaboration with American Society for Gastrointestinal Endoscopy (ASGE) and the Society of Gastroenterology Nurses and Associates (SGNA).

[email protected]

Three experts share their takeaways from the 2019 James W. Freston Conference: Food at the Intersection of Gut Health and Disease.

During your 4 years of medical school, you likely received only 4 hours of nutrition training. Yet we know diet is integral to the care of GI patients. That’s why AGA focused the 2019 James W. Freston Conference on the topic of food.

Our course directors William Chey, MD, AGAF, Sheila E. Crowe, MD, AGAF, and Gerard E. Mullin, MD, AGAF, share eight points from the meeting that stuck with them and can help all practicing GIs as they consider dietary treatments for their patients.

• 1. Personalized nutrition is important. Genetic differences lead to differences in health outcomes. One size or recommendation does not fit all. This is why certain diets only work on certain people. There is no one diet for all and for all disease states. Genetic tests can be helpful, but they rely on reporting that isn’t readily available yet.

• 2. Dietary therapy is key to managing eosinophilic esophagitis (EoE). EoE is becoming more and more prevalent. Genes can’t change that fast, but epigenetic factors can, and the evidence seems to be in food. EoE is not an IgE-mediated disease and therefore most allergy tests will not prove useful; however, food is often the trigger — most common, dairy. Dietary therapy is likely the best way to manage. You want to reduce the number of eliminated foods by way of a reintroduction protocol. The six-food elimination diet is standard, though some are moving to a four-food elimination diet (dairy, wheat, egg and soy).

• 3. There has been a reported increase in those with food allergies, sensitivities, celiac disease, and other adverse reactions to food. Many of the food allergy tests available are not helpful. In addition, many afflicted patients are conducting self-imposed diets rather than working with a GI, allergist, or dietitian. This needs to change.

• 4. There is currently insufficient evidence to support a gluten-free diet for irritable bowel syndrome (IBS). It is possible that fructans, more than gluten, are causing the GI issues. Typically, the low-FODMAP diet is beneficial to IBS patients if done correctly with the guidance of a dietitian; however, not everyone with IBS improves on it. All the steps are important though, including reintroduction and maintenance.

•5. When working with patients on the low-FODMAP or other restrictive diets, it is important to know their food and eating history. Avoidance/Restrictive Food Intake Disorder (ARFID) is something we need to be aware of when it comes to patients with a history or likelihood to develop disordered eating/eating disorders. The patient team may need to include an eating disorder therapist.

•6. The general population in the U.S. has increased the adoption of a gluten-free diet although the number of cases of celiac disease has not increased. Many have self-reported gluten sensitivities. Those that have removed gluten following trends are more at risk of bowel irregularity (low fiber), weight gain, and disordered eating. Celiac disease is not a do-it-yourself disease, patients will be best served working with a dietitian and GI.

• 7. Food can induce symptoms in patients with inflammatory bowel disease (IBD). It can also trigger gut inflammation resulting in incident or relapse. There is experimental plausibility for some factors of the relationship to be causal and we may be able to modify the diet to prevent and manage IBD.

• 8. The focus on nutrition education must continue! Nutrition should be a required part of continuing medical education for physicians. And physicians should work with dietitians to improve the care of GI patients.

For resources to help your patients understand how diet and nutrition can affect their digestive health, visit the AGA GI Patient Center, gastro.org/patient. Each disease-based resource provides tips from leading experts on the role of diet in managing GI health.

The 2019 James W. Freston Single Topic Conference took place Aug. 9 and 10 in Chicago. The Freston conference is the only conference organized by the AGA Institute Council in which the agenda is determined through an open call for proposals from AGA membership. The purpose of the conference is to focus on scientific dialogue, present opportunities for scientific collaboration, and explore new ideas that may lead to enhanced patient therapies or potential opportunities for cures of digestive diseases. The 2019 conference was sponsored by the AGA Institute Council Obesity, Metabolism & Nutrition Section. Vice chair of the section, Dr. Gerard Mullin, served as co-course director.

[email protected]

Three experts share their takeaways from the 2019 James W. Freston Conference: Food at the Intersection of Gut Health and Disease.

During your 4 years of medical school, you likely received only 4 hours of nutrition training. Yet we know diet is integral to the care of GI patients. That’s why AGA focused the 2019 James W. Freston Conference on the topic of food.

Our course directors William Chey, MD, AGAF, Sheila E. Crowe, MD, AGAF, and Gerard E. Mullin, MD, AGAF, share eight points from the meeting that stuck with them and can help all practicing GIs as they consider dietary treatments for their patients.

• 1. Personalized nutrition is important. Genetic differences lead to differences in health outcomes. One size or recommendation does not fit all. This is why certain diets only work on certain people. There is no one diet for all and for all disease states. Genetic tests can be helpful, but they rely on reporting that isn’t readily available yet.

• 2. Dietary therapy is key to managing eosinophilic esophagitis (EoE). EoE is becoming more and more prevalent. Genes can’t change that fast, but epigenetic factors can, and the evidence seems to be in food. EoE is not an IgE-mediated disease and therefore most allergy tests will not prove useful; however, food is often the trigger — most common, dairy. Dietary therapy is likely the best way to manage. You want to reduce the number of eliminated foods by way of a reintroduction protocol. The six-food elimination diet is standard, though some are moving to a four-food elimination diet (dairy, wheat, egg and soy).

• 3. There has been a reported increase in those with food allergies, sensitivities, celiac disease, and other adverse reactions to food. Many of the food allergy tests available are not helpful. In addition, many afflicted patients are conducting self-imposed diets rather than working with a GI, allergist, or dietitian. This needs to change.

• 4. There is currently insufficient evidence to support a gluten-free diet for irritable bowel syndrome (IBS). It is possible that fructans, more than gluten, are causing the GI issues. Typically, the low-FODMAP diet is beneficial to IBS patients if done correctly with the guidance of a dietitian; however, not everyone with IBS improves on it. All the steps are important though, including reintroduction and maintenance.

•5. When working with patients on the low-FODMAP or other restrictive diets, it is important to know their food and eating history. Avoidance/Restrictive Food Intake Disorder (ARFID) is something we need to be aware of when it comes to patients with a history or likelihood to develop disordered eating/eating disorders. The patient team may need to include an eating disorder therapist.

•6. The general population in the U.S. has increased the adoption of a gluten-free diet although the number of cases of celiac disease has not increased. Many have self-reported gluten sensitivities. Those that have removed gluten following trends are more at risk of bowel irregularity (low fiber), weight gain, and disordered eating. Celiac disease is not a do-it-yourself disease, patients will be best served working with a dietitian and GI.

• 7. Food can induce symptoms in patients with inflammatory bowel disease (IBD). It can also trigger gut inflammation resulting in incident or relapse. There is experimental plausibility for some factors of the relationship to be causal and we may be able to modify the diet to prevent and manage IBD.

• 8. The focus on nutrition education must continue! Nutrition should be a required part of continuing medical education for physicians. And physicians should work with dietitians to improve the care of GI patients.

For resources to help your patients understand how diet and nutrition can affect their digestive health, visit the AGA GI Patient Center, gastro.org/patient. Each disease-based resource provides tips from leading experts on the role of diet in managing GI health.

The 2019 James W. Freston Single Topic Conference took place Aug. 9 and 10 in Chicago. The Freston conference is the only conference organized by the AGA Institute Council in which the agenda is determined through an open call for proposals from AGA membership. The purpose of the conference is to focus on scientific dialogue, present opportunities for scientific collaboration, and explore new ideas that may lead to enhanced patient therapies or potential opportunities for cures of digestive diseases. The 2019 conference was sponsored by the AGA Institute Council Obesity, Metabolism & Nutrition Section. Vice chair of the section, Dr. Gerard Mullin, served as co-course director.

[email protected]

Three experts share their takeaways from the 2019 James W. Freston Conference: Food at the Intersection of Gut Health and Disease.

During your 4 years of medical school, you likely received only 4 hours of nutrition training. Yet we know diet is integral to the care of GI patients. That’s why AGA focused the 2019 James W. Freston Conference on the topic of food.

Our course directors William Chey, MD, AGAF, Sheila E. Crowe, MD, AGAF, and Gerard E. Mullin, MD, AGAF, share eight points from the meeting that stuck with them and can help all practicing GIs as they consider dietary treatments for their patients.

• 1. Personalized nutrition is important. Genetic differences lead to differences in health outcomes. One size or recommendation does not fit all. This is why certain diets only work on certain people. There is no one diet for all and for all disease states. Genetic tests can be helpful, but they rely on reporting that isn’t readily available yet.

• 2. Dietary therapy is key to managing eosinophilic esophagitis (EoE). EoE is becoming more and more prevalent. Genes can’t change that fast, but epigenetic factors can, and the evidence seems to be in food. EoE is not an IgE-mediated disease and therefore most allergy tests will not prove useful; however, food is often the trigger — most common, dairy. Dietary therapy is likely the best way to manage. You want to reduce the number of eliminated foods by way of a reintroduction protocol. The six-food elimination diet is standard, though some are moving to a four-food elimination diet (dairy, wheat, egg and soy).

• 3. There has been a reported increase in those with food allergies, sensitivities, celiac disease, and other adverse reactions to food. Many of the food allergy tests available are not helpful. In addition, many afflicted patients are conducting self-imposed diets rather than working with a GI, allergist, or dietitian. This needs to change.

• 4. There is currently insufficient evidence to support a gluten-free diet for irritable bowel syndrome (IBS). It is possible that fructans, more than gluten, are causing the GI issues. Typically, the low-FODMAP diet is beneficial to IBS patients if done correctly with the guidance of a dietitian; however, not everyone with IBS improves on it. All the steps are important though, including reintroduction and maintenance.

•5. When working with patients on the low-FODMAP or other restrictive diets, it is important to know their food and eating history. Avoidance/Restrictive Food Intake Disorder (ARFID) is something we need to be aware of when it comes to patients with a history or likelihood to develop disordered eating/eating disorders. The patient team may need to include an eating disorder therapist.

•6. The general population in the U.S. has increased the adoption of a gluten-free diet although the number of cases of celiac disease has not increased. Many have self-reported gluten sensitivities. Those that have removed gluten following trends are more at risk of bowel irregularity (low fiber), weight gain, and disordered eating. Celiac disease is not a do-it-yourself disease, patients will be best served working with a dietitian and GI.

• 7. Food can induce symptoms in patients with inflammatory bowel disease (IBD). It can also trigger gut inflammation resulting in incident or relapse. There is experimental plausibility for some factors of the relationship to be causal and we may be able to modify the diet to prevent and manage IBD.

• 8. The focus on nutrition education must continue! Nutrition should be a required part of continuing medical education for physicians. And physicians should work with dietitians to improve the care of GI patients.

For resources to help your patients understand how diet and nutrition can affect their digestive health, visit the AGA GI Patient Center, gastro.org/patient. Each disease-based resource provides tips from leading experts on the role of diet in managing GI health.

The 2019 James W. Freston Single Topic Conference took place Aug. 9 and 10 in Chicago. The Freston conference is the only conference organized by the AGA Institute Council in which the agenda is determined through an open call for proposals from AGA membership. The purpose of the conference is to focus on scientific dialogue, present opportunities for scientific collaboration, and explore new ideas that may lead to enhanced patient therapies or potential opportunities for cures of digestive diseases. The 2019 conference was sponsored by the AGA Institute Council Obesity, Metabolism & Nutrition Section. Vice chair of the section, Dr. Gerard Mullin, served as co-course director.

[email protected]

If you are a young vascular surgeon from outside North America, consider applying for the International Scholars Program. Recipients of the award will receive a $5,000 stipend, spend two weeks in the U.S, visiting universities and clinics, and attend the 2020 VAM in Toronto. Scholars will work with a mentor to schedule various vascular program visits, including clinical, teaching and research programs. Apply before Oct. 7 to be considered. Learn more here.

If you are a young vascular surgeon from outside North America, consider applying for the International Scholars Program. Recipients of the award will receive a $5,000 stipend, spend two weeks in the U.S, visiting universities and clinics, and attend the 2020 VAM in Toronto. Scholars will work with a mentor to schedule various vascular program visits, including clinical, teaching and research programs. Apply before Oct. 7 to be considered. Learn more here.

If you are a young vascular surgeon from outside North America, consider applying for the International Scholars Program. Recipients of the award will receive a $5,000 stipend, spend two weeks in the U.S, visiting universities and clinics, and attend the 2020 VAM in Toronto. Scholars will work with a mentor to schedule various vascular program visits, including clinical, teaching and research programs. Apply before Oct. 7 to be considered. Learn more here.

The Affinity Program of expanded benefits is available to SVS members and can connect them with individual disability plans. These plans – available through Principal Life Insurance Company, Securian and Lloyds of London – provide tax-free benefits and can protect hundreds of thousands of dollars.

If interested in learning more about your disability insurance options, contact Mark Blocker at [email protected] or at 949-554- 9936; he is available after-hours and on weekends. Learn more here.

The Affinity Program of expanded benefits is available to SVS members and can connect them with individual disability plans. These plans – available through Principal Life Insurance Company, Securian and Lloyds of London – provide tax-free benefits and can protect hundreds of thousands of dollars.

If interested in learning more about your disability insurance options, contact Mark Blocker at [email protected] or at 949-554- 9936; he is available after-hours and on weekends. Learn more here.

The Affinity Program of expanded benefits is available to SVS members and can connect them with individual disability plans. These plans – available through Principal Life Insurance Company, Securian and Lloyds of London – provide tax-free benefits and can protect hundreds of thousands of dollars.

If interested in learning more about your disability insurance options, contact Mark Blocker at [email protected] or at 949-554- 9936; he is available after-hours and on weekends. Learn more here.