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Tell your patients these four things 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.
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.
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.
AGA urges Medicare to fix CRC screening coinsurance issue
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.
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.
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.
Include the AGA Research Foundation in your estate plan
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 hexcellent@gastro.org.
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 hexcellent@gastro.org.
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 hexcellent@gastro.org.
Update on duodenoscope reprocessing and infection control
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).
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).
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).
8 new insights about diet and gut health
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.
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.
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.
17 fellows advancing GI and patient care
These fellows showcased their commitment to advancing our field through their quality improvement projects presented at DDW® 2019.
Each year during Digestive Disease Week®, AGA hosts a session titled “Advancing Clinical Practice: GI Fellow-Directed Quality-Improvement Projects.” During the 2019 session, 17 quality improvement initiatives were presented — you can review these abstracts in the July issue of Gastroenterology in the “AGA Section,” www.gastrojournal.org/issue/S0016-5085(19)X0009-8. Kudos to the promising fellows featured below, who all served as lead authors for their QI projects.
Manasi Agrawal, MD
Lenox Hill Hospital, New York City
@ManasiAgrawalMD
Jessica Breton, MD
Children’s Hospital of Philadelphia
Adam Faye, MD
Columbia University Medical Center, New York City
@AdamFaye4
Shelly Gurwara, MD
Wake Forest Baptist Health Medical Center, Winston-Salem, N.C.
Afrin Kamal, MD
Stanford University, Calif.
Ani Kardashian, MD
University of California, Los Angeles
@AniKardashianMD
Sonali Palchaudhuri, MD
University of Pennsylvania, Philadelphia
@sopalchaudhuri
Nasim Parsa, MD
University of Missouri Health System, Columbia
Sahil Patel, MD
Drexel University, Philadelphia
@sahilr
Vikram Raghu, MD
Children’s Hospital of Pittsburgh, Pennsylvania
Amit Shah, MD
Children’s Hospital of Philadelphia
Lin Shen, MD
Brigham and Women’s Hospital, Boston
@LinShenMD
Charles Snyder, MD
Icahn School of Medicine at Mount Sinai, New York City
Brian Sullivan, MD
Duke University, Durham, N.C.
Ashley Vachon, MD
University of Colorado Anschutz Medical Campus, Aurora
Ted Walker, MD
Washington University/Barnes Jewish Hospital, St. Louis, Mo.
Xiao Jing Wang, MD
Mayo Clinic, Rochester, Minn.
@IrisWangMD
These fellows showcased their commitment to advancing our field through their quality improvement projects presented at DDW® 2019.
Each year during Digestive Disease Week®, AGA hosts a session titled “Advancing Clinical Practice: GI Fellow-Directed Quality-Improvement Projects.” During the 2019 session, 17 quality improvement initiatives were presented — you can review these abstracts in the July issue of Gastroenterology in the “AGA Section,” www.gastrojournal.org/issue/S0016-5085(19)X0009-8. Kudos to the promising fellows featured below, who all served as lead authors for their QI projects.
Manasi Agrawal, MD
Lenox Hill Hospital, New York City
@ManasiAgrawalMD
Jessica Breton, MD
Children’s Hospital of Philadelphia
Adam Faye, MD
Columbia University Medical Center, New York City
@AdamFaye4
Shelly Gurwara, MD
Wake Forest Baptist Health Medical Center, Winston-Salem, N.C.
Afrin Kamal, MD
Stanford University, Calif.
Ani Kardashian, MD
University of California, Los Angeles
@AniKardashianMD
Sonali Palchaudhuri, MD
University of Pennsylvania, Philadelphia
@sopalchaudhuri
Nasim Parsa, MD
University of Missouri Health System, Columbia
Sahil Patel, MD
Drexel University, Philadelphia
@sahilr
Vikram Raghu, MD
Children’s Hospital of Pittsburgh, Pennsylvania
Amit Shah, MD
Children’s Hospital of Philadelphia
Lin Shen, MD
Brigham and Women’s Hospital, Boston
@LinShenMD
Charles Snyder, MD
Icahn School of Medicine at Mount Sinai, New York City
Brian Sullivan, MD
Duke University, Durham, N.C.
Ashley Vachon, MD
University of Colorado Anschutz Medical Campus, Aurora
Ted Walker, MD
Washington University/Barnes Jewish Hospital, St. Louis, Mo.
Xiao Jing Wang, MD
Mayo Clinic, Rochester, Minn.
@IrisWangMD
These fellows showcased their commitment to advancing our field through their quality improvement projects presented at DDW® 2019.
Each year during Digestive Disease Week®, AGA hosts a session titled “Advancing Clinical Practice: GI Fellow-Directed Quality-Improvement Projects.” During the 2019 session, 17 quality improvement initiatives were presented — you can review these abstracts in the July issue of Gastroenterology in the “AGA Section,” www.gastrojournal.org/issue/S0016-5085(19)X0009-8. Kudos to the promising fellows featured below, who all served as lead authors for their QI projects.
Manasi Agrawal, MD
Lenox Hill Hospital, New York City
@ManasiAgrawalMD
Jessica Breton, MD
Children’s Hospital of Philadelphia
Adam Faye, MD
Columbia University Medical Center, New York City
@AdamFaye4
Shelly Gurwara, MD
Wake Forest Baptist Health Medical Center, Winston-Salem, N.C.
Afrin Kamal, MD
Stanford University, Calif.
Ani Kardashian, MD
University of California, Los Angeles
@AniKardashianMD
Sonali Palchaudhuri, MD
University of Pennsylvania, Philadelphia
@sopalchaudhuri
Nasim Parsa, MD
University of Missouri Health System, Columbia
Sahil Patel, MD
Drexel University, Philadelphia
@sahilr
Vikram Raghu, MD
Children’s Hospital of Pittsburgh, Pennsylvania
Amit Shah, MD
Children’s Hospital of Philadelphia
Lin Shen, MD
Brigham and Women’s Hospital, Boston
@LinShenMD
Charles Snyder, MD
Icahn School of Medicine at Mount Sinai, New York City
Brian Sullivan, MD
Duke University, Durham, N.C.
Ashley Vachon, MD
University of Colorado Anschutz Medical Campus, Aurora
Ted Walker, MD
Washington University/Barnes Jewish Hospital, St. Louis, Mo.
Xiao Jing Wang, MD
Mayo Clinic, Rochester, Minn.
@IrisWangMD
AGA participates in 2019 Alliance of Specialty Medicine Fly In
Thank you to the following members who joined us to advocate for some of the most pressing issues facing gastroenterologists and our patients at the 2019 Alliance of Specialty Medicine Fly In. Our advocates met with House and Senate offices to push for reducing prior authorization burdens and minimizing the strict constraints of step therapy protocols.
• Rotonya M. Carr, MD, University of Pennsylvania Health System
• Peter Kaufman, MD, AGAF, Capital Digestive Care, Bethesda, Md.
• Avinash G. Ketwaroo, MD, Baylor College of Medicine, Houston
• Simon C. Mathews, MD, Johns Hopkins Medicine, Baltimore
Prior authorization
Prior authorization is a tedious process and management tool that requires physicians to obtain preapproval for medical treatments or tests before rendering care to their patients. Patients experience significant barriers to medically necessary care because of prior authorization requirements for services that are eventually routinely approved. H.R. 3107, the Improving Seniors’ Timely Access to Care Act, would increase transparency and accountability and reduce the burdens of prior authorization.
Step therapy
Step therapy treatment, or “fail first,” requires patients to try and fail medications before insurers agree to cover the initial therapy prescribed by their health care provider. While this protocol may initially act as a cost-containment mechanism, it can ultimately lead to more expensive health care costs because of devastating patient complications. H.R. 2279, the Safe Step Act, would provide a clear and timely appeals process when a patient has been subjected to step therapy.
— @CongressmanRuiz from Cali combats #steptherapy with the bipartisan Safe Step Act (H.R. 2279). #Patients should be given a clear, equitable & transparent appeals process concerning step therapy. Urge your member of Congress to take action:https://t.co/q4ljhuMO9X#specialtydocs pic.twitter.com/B2zvRT6mG5
— AGA (@AmerGastroAssn) July 16, 2019
“Thank you, GI docs. I had colon cancer and a GI surgeon saved my life.” Thank you, @RepMarkGreen, for supporting reducing prior authorization. https://t.co/kc9fWnA8XB #specialtydocs
— AGA (@AmerGastroAssn) July 17, 2019
The Alliance of Specialty Medicine is a coalition of national medical societies representing specialty physicians in the United States.
This conference took place July 15-17, 2019, at the Liaison Washington Capitol Hill in Washington, DC.
Thank you to the following members who joined us to advocate for some of the most pressing issues facing gastroenterologists and our patients at the 2019 Alliance of Specialty Medicine Fly In. Our advocates met with House and Senate offices to push for reducing prior authorization burdens and minimizing the strict constraints of step therapy protocols.
• Rotonya M. Carr, MD, University of Pennsylvania Health System
• Peter Kaufman, MD, AGAF, Capital Digestive Care, Bethesda, Md.
• Avinash G. Ketwaroo, MD, Baylor College of Medicine, Houston
• Simon C. Mathews, MD, Johns Hopkins Medicine, Baltimore
Prior authorization
Prior authorization is a tedious process and management tool that requires physicians to obtain preapproval for medical treatments or tests before rendering care to their patients. Patients experience significant barriers to medically necessary care because of prior authorization requirements for services that are eventually routinely approved. H.R. 3107, the Improving Seniors’ Timely Access to Care Act, would increase transparency and accountability and reduce the burdens of prior authorization.
Step therapy
Step therapy treatment, or “fail first,” requires patients to try and fail medications before insurers agree to cover the initial therapy prescribed by their health care provider. While this protocol may initially act as a cost-containment mechanism, it can ultimately lead to more expensive health care costs because of devastating patient complications. H.R. 2279, the Safe Step Act, would provide a clear and timely appeals process when a patient has been subjected to step therapy.
— @CongressmanRuiz from Cali combats #steptherapy with the bipartisan Safe Step Act (H.R. 2279). #Patients should be given a clear, equitable & transparent appeals process concerning step therapy. Urge your member of Congress to take action:https://t.co/q4ljhuMO9X#specialtydocs pic.twitter.com/B2zvRT6mG5
— AGA (@AmerGastroAssn) July 16, 2019
“Thank you, GI docs. I had colon cancer and a GI surgeon saved my life.” Thank you, @RepMarkGreen, for supporting reducing prior authorization. https://t.co/kc9fWnA8XB #specialtydocs
— AGA (@AmerGastroAssn) July 17, 2019
The Alliance of Specialty Medicine is a coalition of national medical societies representing specialty physicians in the United States.
This conference took place July 15-17, 2019, at the Liaison Washington Capitol Hill in Washington, DC.
Thank you to the following members who joined us to advocate for some of the most pressing issues facing gastroenterologists and our patients at the 2019 Alliance of Specialty Medicine Fly In. Our advocates met with House and Senate offices to push for reducing prior authorization burdens and minimizing the strict constraints of step therapy protocols.
• Rotonya M. Carr, MD, University of Pennsylvania Health System
• Peter Kaufman, MD, AGAF, Capital Digestive Care, Bethesda, Md.
• Avinash G. Ketwaroo, MD, Baylor College of Medicine, Houston
• Simon C. Mathews, MD, Johns Hopkins Medicine, Baltimore
Prior authorization
Prior authorization is a tedious process and management tool that requires physicians to obtain preapproval for medical treatments or tests before rendering care to their patients. Patients experience significant barriers to medically necessary care because of prior authorization requirements for services that are eventually routinely approved. H.R. 3107, the Improving Seniors’ Timely Access to Care Act, would increase transparency and accountability and reduce the burdens of prior authorization.
Step therapy
Step therapy treatment, or “fail first,” requires patients to try and fail medications before insurers agree to cover the initial therapy prescribed by their health care provider. While this protocol may initially act as a cost-containment mechanism, it can ultimately lead to more expensive health care costs because of devastating patient complications. H.R. 2279, the Safe Step Act, would provide a clear and timely appeals process when a patient has been subjected to step therapy.
— @CongressmanRuiz from Cali combats #steptherapy with the bipartisan Safe Step Act (H.R. 2279). #Patients should be given a clear, equitable & transparent appeals process concerning step therapy. Urge your member of Congress to take action:https://t.co/q4ljhuMO9X#specialtydocs pic.twitter.com/B2zvRT6mG5
— AGA (@AmerGastroAssn) July 16, 2019
“Thank you, GI docs. I had colon cancer and a GI surgeon saved my life.” Thank you, @RepMarkGreen, for supporting reducing prior authorization. https://t.co/kc9fWnA8XB #specialtydocs
— AGA (@AmerGastroAssn) July 17, 2019
The Alliance of Specialty Medicine is a coalition of national medical societies representing specialty physicians in the United States.
This conference took place July 15-17, 2019, at the Liaison Washington Capitol Hill in Washington, DC.
‘No Surprises Act’ clears House committee
In welcomed news, the House Energy and Commerce Committee approved legislation that would address surprise bills by protecting patients when they access care and aren’t aware that a provider is outside of their insurance network.
The No Surprises Act, H.R. 3630, would allow providers to appeal a federal benchmark payment to an arbiter in cases when the median in-network payment to physicians or hospitals exceeds $1,250. This arbitration provision was included in the bill at the last minute by Reps. Raul Ruiz, D-Calif., and Larry Buschon, R-Ind., to address provider concerns. Without an option for arbitration, physicians would be at a severe disadvantage when negotiating contracts with insurers. AGA supports and will continue to advocate for provisions that give physicians an opportunity to go to arbitration similar to the effective New York state model.
The No Surprises Act also requires the Department of Health and Human Services to study the impact of the legislation, including the adequacy of provider networks, and to establish an audit process for medical contracted rates.
Addressing surprise medical bills and protecting patients has been a priority on Capitol Hill and one that has strong bipartisan support in both chambers of Congress and from President Trump. Since this new House bill also has jurisdiction from the Ways and Means Committee and the Education and Labor Committee, both committees will need to address the bill before it can advance. AGA will keep you updated on the status of this important legislation.
In welcomed news, the House Energy and Commerce Committee approved legislation that would address surprise bills by protecting patients when they access care and aren’t aware that a provider is outside of their insurance network.
The No Surprises Act, H.R. 3630, would allow providers to appeal a federal benchmark payment to an arbiter in cases when the median in-network payment to physicians or hospitals exceeds $1,250. This arbitration provision was included in the bill at the last minute by Reps. Raul Ruiz, D-Calif., and Larry Buschon, R-Ind., to address provider concerns. Without an option for arbitration, physicians would be at a severe disadvantage when negotiating contracts with insurers. AGA supports and will continue to advocate for provisions that give physicians an opportunity to go to arbitration similar to the effective New York state model.
The No Surprises Act also requires the Department of Health and Human Services to study the impact of the legislation, including the adequacy of provider networks, and to establish an audit process for medical contracted rates.
Addressing surprise medical bills and protecting patients has been a priority on Capitol Hill and one that has strong bipartisan support in both chambers of Congress and from President Trump. Since this new House bill also has jurisdiction from the Ways and Means Committee and the Education and Labor Committee, both committees will need to address the bill before it can advance. AGA will keep you updated on the status of this important legislation.
In welcomed news, the House Energy and Commerce Committee approved legislation that would address surprise bills by protecting patients when they access care and aren’t aware that a provider is outside of their insurance network.
The No Surprises Act, H.R. 3630, would allow providers to appeal a federal benchmark payment to an arbiter in cases when the median in-network payment to physicians or hospitals exceeds $1,250. This arbitration provision was included in the bill at the last minute by Reps. Raul Ruiz, D-Calif., and Larry Buschon, R-Ind., to address provider concerns. Without an option for arbitration, physicians would be at a severe disadvantage when negotiating contracts with insurers. AGA supports and will continue to advocate for provisions that give physicians an opportunity to go to arbitration similar to the effective New York state model.
The No Surprises Act also requires the Department of Health and Human Services to study the impact of the legislation, including the adequacy of provider networks, and to establish an audit process for medical contracted rates.
Addressing surprise medical bills and protecting patients has been a priority on Capitol Hill and one that has strong bipartisan support in both chambers of Congress and from President Trump. Since this new House bill also has jurisdiction from the Ways and Means Committee and the Education and Labor Committee, both committees will need to address the bill before it can advance. AGA will keep you updated on the status of this important legislation.
Top AGA Community patient cases
Physicians with difficult patient scenarios regularly bring their questions to the AGA Community to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Combination therapy with Entyvio – The GI community shared their experiences with combination therapy of Entyvio and immunomodulators in patients with ulcerative colitis who have developed antibodies to anti-TNF therapy.
2. Small bowel ulcerations in anemic patient with rheumatoid arthritis – Read an update on this patient with rheumatoid arthritis who was experiencing recurrent abdominal pain associated with iron-deficiency anemia diagnosed with multiple small bowel ulcers.
3. When losing weight is too difficult – How do you approach NAFLD patients who have a difficult time committing to a weight-loss treatment plan?
Access these clinical cases and more discussions at https://community.gastro.org/discussions.
Physicians with difficult patient scenarios regularly bring their questions to the AGA Community to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Combination therapy with Entyvio – The GI community shared their experiences with combination therapy of Entyvio and immunomodulators in patients with ulcerative colitis who have developed antibodies to anti-TNF therapy.
2. Small bowel ulcerations in anemic patient with rheumatoid arthritis – Read an update on this patient with rheumatoid arthritis who was experiencing recurrent abdominal pain associated with iron-deficiency anemia diagnosed with multiple small bowel ulcers.
3. When losing weight is too difficult – How do you approach NAFLD patients who have a difficult time committing to a weight-loss treatment plan?
Access these clinical cases and more discussions at https://community.gastro.org/discussions.
Physicians with difficult patient scenarios regularly bring their questions to the AGA Community to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Combination therapy with Entyvio – The GI community shared their experiences with combination therapy of Entyvio and immunomodulators in patients with ulcerative colitis who have developed antibodies to anti-TNF therapy.
2. Small bowel ulcerations in anemic patient with rheumatoid arthritis – Read an update on this patient with rheumatoid arthritis who was experiencing recurrent abdominal pain associated with iron-deficiency anemia diagnosed with multiple small bowel ulcers.
3. When losing weight is too difficult – How do you approach NAFLD patients who have a difficult time committing to a weight-loss treatment plan?
Access these clinical cases and more discussions at https://community.gastro.org/discussions.
Prior authorization and step therapy: My visit to Capitol Hill
As an early-career gastroenterologist, I have become increasingly aware of the impact of advocacy in championing legislation important to our patients. Initially naive about health care advocacy, I owe much to AGA in preparing and arranging for opportunities to speak with elected officials and their staff on GI-related priorities and bills. As a member of the AGA Congressional Advocates Program, I received training and support in visiting Capitol Hill, discussing specific legislation and upcoming bills, writing op-eds, and hosting site visits.
Most recently, AGA sponsored my attendance at the Alliance of Specialty Medicine Annual Advocacy Fly In. With colleagues from around the country – in specialties ranging from ophthalmology to dermatology – we listened to invited congressional representatives and senators on important bills that can directly affect the care we provide to our patients. We had the opportunity to ask questions of these legislators, many of whom were fellow physicians, and gain advice on effective advocacy, as well as build camaraderie with our colleagues in other specialties who face similar issues.
With colleagues from Texas, and assisted by Kathleen Teixeira, AGA vice president, government affairs, we visited the offices of our congressional representatives and senators throughout the afternoon. During our meetings with congressional staff, we stressed the importance of making changes to current prior authorization and step-therapy approaches to make it easier for our patients to access the right treatments as soon as possible. We also discussed the importance of supporting graduate medical education to ensure we have a future cohort of gastroenterologists and other specialists to meet the rising demands of our population. We were well received, and the briefs prepared by the alliance and AGA, as well as tips on effectively communicating our positions, made the whole process seamless. Discussing our own personal experiences and sharing patient stories, we found our meetings to be productive and insightful.
Now, I hope to host my congresswoman, Rep. Lizzie Fletcher, D-Tex., for a site visit locally at Baylor, after a successful meeting with her aide on Capitol Hill.
None of this would have been possible without AGA’s support in arranging these presentations, meetings, and physically supporting us throughout the process. I encourage all of you to utilize AGA in advocating for our patients. It is fun, high impact, and incredibly insightful!
How to get involved in advocacy
Interested in advocacy but not sure how or whether you have time in your busy schedule? AGA has an array of options for how you can be active in advocacy. Some take as little as 5 minutes.
Letter writing. AGA uses GovPredict, an online advocacy platform that allows members to contact their member of Congress with just a few clicks. AGA develops messages on significant pieces of legislation, key efforts in Congress or on issues being advanced by federal agencies that have a great effect on gastroenterology. AGA’s ongoing letter writing campaigns can always be found on gastro.org, but be sure to keep an eye out for advocacy emails, AGA eDigest, and social media, so you do not miss your opportunity to take action on timely issues. AGA encourages its members to share letter writing campaigns with their colleagues, as well as posting them on social media.
Meetings with your member of Congress. In-person meetings are an excellent opportunity to share with your member of Congress, or their staff, how the issues that affect gastroenterology affect you, your patients, and your practice. AGA has a plethora of resources to help you set up a meeting with your member of Congress, including up-to-date issue briefs, tips and tricks for productive meetings, and webinars on how to host an on-site visit. AGA staff is always more than happy to help you arrange a meeting either in Washington, DC, or your home state. If you are interested in arranging a meeting with your member of Congress, please contact AGA Public Policy Coordinator, Jonathan Sollish, at jsollish@gastro.org or 240-482-3228.
AGA PAC. AGA PAC is a voluntary, nonpartisan political organization affiliated with and supported by AGA. The only political action committee supported by a national gastroenterology society, its mission is to give gastroenterologists a greater presence on Capitol Hill and a more effective voice in policy discussions. AGA PAC supports candidates who support our policy priorities, such as fair reimbursement, cutting regulatory red tape, supporting patient protections and access to specialty care, and sustained federal funding of digestive disease research. If you are interested in learning more, contact AGA Government and Political Affairs Manager, Navneet Buttar, at nbuttar@gastro.org or 240-482-3221.
Congressional Advocates Program. This grassroots program is aimed at establishing a stronger foundation for our current and future advocacy initiatives by creating state teams to work on advocacy on the local, state, and national levels. Participation can include a wide variety of activities, ranging from creating educational posts on social media to meeting with members of Congress. Members of the Congressional Advocates Program are mentored and receive advocacy training by AGA leadership and staff. Participating members receive an AGA Congressional Advocate Program Certificate, a Digestive Disease Week® (DDW) badge ribbon, policy badge on the AGA Community, and recognition on AGA’s website. Applications for the next cycle will be released in 2019.
ginews@gastro.org
As an early-career gastroenterologist, I have become increasingly aware of the impact of advocacy in championing legislation important to our patients. Initially naive about health care advocacy, I owe much to AGA in preparing and arranging for opportunities to speak with elected officials and their staff on GI-related priorities and bills. As a member of the AGA Congressional Advocates Program, I received training and support in visiting Capitol Hill, discussing specific legislation and upcoming bills, writing op-eds, and hosting site visits.
Most recently, AGA sponsored my attendance at the Alliance of Specialty Medicine Annual Advocacy Fly In. With colleagues from around the country – in specialties ranging from ophthalmology to dermatology – we listened to invited congressional representatives and senators on important bills that can directly affect the care we provide to our patients. We had the opportunity to ask questions of these legislators, many of whom were fellow physicians, and gain advice on effective advocacy, as well as build camaraderie with our colleagues in other specialties who face similar issues.
With colleagues from Texas, and assisted by Kathleen Teixeira, AGA vice president, government affairs, we visited the offices of our congressional representatives and senators throughout the afternoon. During our meetings with congressional staff, we stressed the importance of making changes to current prior authorization and step-therapy approaches to make it easier for our patients to access the right treatments as soon as possible. We also discussed the importance of supporting graduate medical education to ensure we have a future cohort of gastroenterologists and other specialists to meet the rising demands of our population. We were well received, and the briefs prepared by the alliance and AGA, as well as tips on effectively communicating our positions, made the whole process seamless. Discussing our own personal experiences and sharing patient stories, we found our meetings to be productive and insightful.
Now, I hope to host my congresswoman, Rep. Lizzie Fletcher, D-Tex., for a site visit locally at Baylor, after a successful meeting with her aide on Capitol Hill.
None of this would have been possible without AGA’s support in arranging these presentations, meetings, and physically supporting us throughout the process. I encourage all of you to utilize AGA in advocating for our patients. It is fun, high impact, and incredibly insightful!
How to get involved in advocacy
Interested in advocacy but not sure how or whether you have time in your busy schedule? AGA has an array of options for how you can be active in advocacy. Some take as little as 5 minutes.
Letter writing. AGA uses GovPredict, an online advocacy platform that allows members to contact their member of Congress with just a few clicks. AGA develops messages on significant pieces of legislation, key efforts in Congress or on issues being advanced by federal agencies that have a great effect on gastroenterology. AGA’s ongoing letter writing campaigns can always be found on gastro.org, but be sure to keep an eye out for advocacy emails, AGA eDigest, and social media, so you do not miss your opportunity to take action on timely issues. AGA encourages its members to share letter writing campaigns with their colleagues, as well as posting them on social media.
Meetings with your member of Congress. In-person meetings are an excellent opportunity to share with your member of Congress, or their staff, how the issues that affect gastroenterology affect you, your patients, and your practice. AGA has a plethora of resources to help you set up a meeting with your member of Congress, including up-to-date issue briefs, tips and tricks for productive meetings, and webinars on how to host an on-site visit. AGA staff is always more than happy to help you arrange a meeting either in Washington, DC, or your home state. If you are interested in arranging a meeting with your member of Congress, please contact AGA Public Policy Coordinator, Jonathan Sollish, at jsollish@gastro.org or 240-482-3228.
AGA PAC. AGA PAC is a voluntary, nonpartisan political organization affiliated with and supported by AGA. The only political action committee supported by a national gastroenterology society, its mission is to give gastroenterologists a greater presence on Capitol Hill and a more effective voice in policy discussions. AGA PAC supports candidates who support our policy priorities, such as fair reimbursement, cutting regulatory red tape, supporting patient protections and access to specialty care, and sustained federal funding of digestive disease research. If you are interested in learning more, contact AGA Government and Political Affairs Manager, Navneet Buttar, at nbuttar@gastro.org or 240-482-3221.
Congressional Advocates Program. This grassroots program is aimed at establishing a stronger foundation for our current and future advocacy initiatives by creating state teams to work on advocacy on the local, state, and national levels. Participation can include a wide variety of activities, ranging from creating educational posts on social media to meeting with members of Congress. Members of the Congressional Advocates Program are mentored and receive advocacy training by AGA leadership and staff. Participating members receive an AGA Congressional Advocate Program Certificate, a Digestive Disease Week® (DDW) badge ribbon, policy badge on the AGA Community, and recognition on AGA’s website. Applications for the next cycle will be released in 2019.
ginews@gastro.org
As an early-career gastroenterologist, I have become increasingly aware of the impact of advocacy in championing legislation important to our patients. Initially naive about health care advocacy, I owe much to AGA in preparing and arranging for opportunities to speak with elected officials and their staff on GI-related priorities and bills. As a member of the AGA Congressional Advocates Program, I received training and support in visiting Capitol Hill, discussing specific legislation and upcoming bills, writing op-eds, and hosting site visits.
Most recently, AGA sponsored my attendance at the Alliance of Specialty Medicine Annual Advocacy Fly In. With colleagues from around the country – in specialties ranging from ophthalmology to dermatology – we listened to invited congressional representatives and senators on important bills that can directly affect the care we provide to our patients. We had the opportunity to ask questions of these legislators, many of whom were fellow physicians, and gain advice on effective advocacy, as well as build camaraderie with our colleagues in other specialties who face similar issues.
With colleagues from Texas, and assisted by Kathleen Teixeira, AGA vice president, government affairs, we visited the offices of our congressional representatives and senators throughout the afternoon. During our meetings with congressional staff, we stressed the importance of making changes to current prior authorization and step-therapy approaches to make it easier for our patients to access the right treatments as soon as possible. We also discussed the importance of supporting graduate medical education to ensure we have a future cohort of gastroenterologists and other specialists to meet the rising demands of our population. We were well received, and the briefs prepared by the alliance and AGA, as well as tips on effectively communicating our positions, made the whole process seamless. Discussing our own personal experiences and sharing patient stories, we found our meetings to be productive and insightful.
Now, I hope to host my congresswoman, Rep. Lizzie Fletcher, D-Tex., for a site visit locally at Baylor, after a successful meeting with her aide on Capitol Hill.
None of this would have been possible without AGA’s support in arranging these presentations, meetings, and physically supporting us throughout the process. I encourage all of you to utilize AGA in advocating for our patients. It is fun, high impact, and incredibly insightful!
How to get involved in advocacy
Interested in advocacy but not sure how or whether you have time in your busy schedule? AGA has an array of options for how you can be active in advocacy. Some take as little as 5 minutes.
Letter writing. AGA uses GovPredict, an online advocacy platform that allows members to contact their member of Congress with just a few clicks. AGA develops messages on significant pieces of legislation, key efforts in Congress or on issues being advanced by federal agencies that have a great effect on gastroenterology. AGA’s ongoing letter writing campaigns can always be found on gastro.org, but be sure to keep an eye out for advocacy emails, AGA eDigest, and social media, so you do not miss your opportunity to take action on timely issues. AGA encourages its members to share letter writing campaigns with their colleagues, as well as posting them on social media.
Meetings with your member of Congress. In-person meetings are an excellent opportunity to share with your member of Congress, or their staff, how the issues that affect gastroenterology affect you, your patients, and your practice. AGA has a plethora of resources to help you set up a meeting with your member of Congress, including up-to-date issue briefs, tips and tricks for productive meetings, and webinars on how to host an on-site visit. AGA staff is always more than happy to help you arrange a meeting either in Washington, DC, or your home state. If you are interested in arranging a meeting with your member of Congress, please contact AGA Public Policy Coordinator, Jonathan Sollish, at jsollish@gastro.org or 240-482-3228.
AGA PAC. AGA PAC is a voluntary, nonpartisan political organization affiliated with and supported by AGA. The only political action committee supported by a national gastroenterology society, its mission is to give gastroenterologists a greater presence on Capitol Hill and a more effective voice in policy discussions. AGA PAC supports candidates who support our policy priorities, such as fair reimbursement, cutting regulatory red tape, supporting patient protections and access to specialty care, and sustained federal funding of digestive disease research. If you are interested in learning more, contact AGA Government and Political Affairs Manager, Navneet Buttar, at nbuttar@gastro.org or 240-482-3221.
Congressional Advocates Program. This grassroots program is aimed at establishing a stronger foundation for our current and future advocacy initiatives by creating state teams to work on advocacy on the local, state, and national levels. Participation can include a wide variety of activities, ranging from creating educational posts on social media to meeting with members of Congress. Members of the Congressional Advocates Program are mentored and receive advocacy training by AGA leadership and staff. Participating members receive an AGA Congressional Advocate Program Certificate, a Digestive Disease Week® (DDW) badge ribbon, policy badge on the AGA Community, and recognition on AGA’s website. Applications for the next cycle will be released in 2019.
ginews@gastro.org