Keeping on Top of the Latest in GI – 7 Current Issues

Here are seven current issues and news updates for gastroenterologists to know.

1. Colorectal cancer screening. Colon cancer is the second leading cause of cancer deaths in the United States, but it is also one of the most preventable cancers. In a recent study published in the New England Journal of Medicine, researchers found colonoscopy could prevent 40 percent of colon cancer cases. The study also supported colonoscopy as a colorectal cancer screening tool above sigmoidoscopy.

Despite efforts to promote colon cancer awareness and the benefits of screening, patient participation remains an issue. The Centers for Disease Control and Prevention released a Vital Signs report that reveals one in three adults 50 to 75 years old, a total of 23 million Americans, have not been tested for colorectal cancer.

2. Price and coverage controversy. Though GI physicians and recent studies support colonoscopy as a life-saving tool, the procedure has come into question as overpriced and unnecessary. The New York Times published an article citing colonoscopy as one of the main suspects in the country's high healthcare costs. The article sparked widespread response from the GI community, including a letter to The New York Times from American College of Gastroenterology President Ronald Vender, MD. The American College of Gastroenterology, amongst many in the field, remains convinced of the necessity of colonoscopy.

The Patient Protection and Affordable Care Act has mandated that patients should not have to pay copayments or deductible costs for colonoscopy, but insurers have not quietly stepped up to foot the bill. Many insurers declined to cover the procedure at no cost if a polyp was found, claiming the procedure becomes therapeutic rather than preventative. Though the Obama administration has recently squelched this practice, some payers now deny full coverage for follow-up colonoscopies.

3. Population silence and the burden of GI illness. A recent study found that 72 percent of adults in the U.S. experience at least one gastrointestinal symptom multiple times a month, yet do not seek care from a physician. The symptoms going unreported in this significant segment of the population include stomach pain, gas, bloating, diarrhea, unexplained weight loss, frequent bowel movements and non-specific GI pain.

Though many people are reluctant to come forward with GI symptoms, gastrointestinal illnesses represent a significant burden. In 2007, GI diagnoses in emergency department visits totaled charges of $27.9 billion.

4. New technology. New technology continues to come forward in the field. In October, the FDA granted eight GI-related devices 510(k) clearance. Endochoice and Covidien were among the companies that received clearance for devices.  

5. New clinical guidelines. The American College of Gastroenterology has released updated guidelines for the management of acute pancreatitis and new guidelines for the diagnosis and management of achalasia. Both sets of guidelines appeared in The American Journal of Gastroenterology.
6. C. difficile. Clostridium difficile infections are increasingly becoming a high priority concern in healthcare. Though hesitancy has been associated with fecal microbiota transplants, a recent study has concluded that FMT is a safe, effective treatment for C. difficile infections in all patients, including those with compromised immune systems. For the time being, the FDA has revoked the new drug application requirement for gastroenterologists using FMT. In June, Mayo Clinic opened a clinic specifically for the treatment of C. difficile infections. The clinic offers oral drug therapy, FMT and conducts ongoing research. In October, Thomas Louie, MD, presented the results of a study of FMT repackaged in pill form.

7. Professional Society News. In June, the American Society of Gastrointestinal Endoscopy named Kenneth Wang, MD, its new president and announced its 2013-2014 board members. The American College of Gastroenterology recently elected Harry Eugene Sarles, Jr., MD, as its 2013-2014 president. The ACG also launched the ACG Case Reports Journal in October. The journal, edited by GI fellows, is designed to be an online peer-reviewed, open access journal for GI fellows, clinicians and more.

More Articles on Gastroenterology:
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Physician Endoscopy Receives Cost Management Performance Award
Dr. Steven Brant Awarded $250k for Crohn's Disease Genetic Sequencing Research

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