American College of Gastroenterology (ACG): Annual Scientific Meeting 2011

NATIONAL HARBOR, MD. – Colonoscopy led to significant reductions in colorectal cancers located in both the distal colon and proximal colon, based on a large analysis of Medicare data from 1998 to 2002.

The finding that colonoscopy provided protection in the proximal colon is important because "several recent studies [have] yielded mixed results on the protective effect of colonoscopy in the proximal colon," said Dr. Yize Wang of the Mayo Clinic in Jacksonville, Fla.

To assess the impact of colonoscopy and flexible sigmoidoscopy on colorectal cancer risk, Dr. Wang and colleagues analyzed cancer rates in adults aged 67 to 80 years. The study group included 12,266 patients who had an outpatient colonoscopy, 6,402 who underwent sigmoidoscopy, and 41,410 individuals who did not have a screening procedure and served as controls.

Patients with inflammatory bowel disease, a history of polyps, or a history of colorectal cancer were excluded. The study patients were followed until the end of 2005, or until a diagnosis of colorectal cancer, or death.

A total of 58 colorectal cancers (CRCs) were diagnosed in the colonoscopy group during the follow-up period, compared to 66 CRCs in the patients who underwent flexible sigmoidoscopy and 634 CRCs in the control group.

In a multivariate analysis, colonoscopy was associated with a significant 73% reduction of distal colorectal cancer (hazard ratio, 0.27) and a significant 54% reduction of proximal colorectal cancer (HR, 0.46), compared with unscreened controls.

Sigmoidoscopy was associated with a significant 60% reduction of distal colorectal cancer (HR, 0.40), but no significant reduction in proximal colorectal cancer, compared to unscreened controls; this was expected because the procedure does not examine the entire colon.

A total of 771 (12%) of the patients who first underwent sigmoidoscopy went on to have a colonoscopy within 12 months. When the investigators excluded data from these patients, who had sigmoidoscopy followed by colonoscopy, the study results on cancer risk were essentially unchanged.

The findings were limited by the retrospective nature of the study, as well as the confounding effect of the diagnostic procedure chosen and the selection bias in the use of screening endoscopy, Dr. Wang said.

In addition, the study "does not reflect recent advancements in endoscopy equipment and techniques," he noted.

However, the results from this large study population confirm that colonoscopy remains the preferred screening test for colorectal cancer, said Dr. Wang.

The study was funded by a research grant from the American College of Gastroenterology. The researchers said they had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Colonoscopy led to significant reductions in colorectal cancers located in both the distal colon and proximal colon, based on a large analysis of Medicare data from 1998 to 2002.

The finding that colonoscopy provided protection in the proximal colon is important because "several recent studies [have] yielded mixed results on the protective effect of colonoscopy in the proximal colon," said Dr. Yize Wang of the Mayo Clinic in Jacksonville, Fla.

To assess the impact of colonoscopy and flexible sigmoidoscopy on colorectal cancer risk, Dr. Wang and colleagues analyzed cancer rates in adults aged 67 to 80 years. The study group included 12,266 patients who had an outpatient colonoscopy, 6,402 who underwent sigmoidoscopy, and 41,410 individuals who did not have a screening procedure and served as controls.

Patients with inflammatory bowel disease, a history of polyps, or a history of colorectal cancer were excluded. The study patients were followed until the end of 2005, or until a diagnosis of colorectal cancer, or death.

A total of 58 colorectal cancers (CRCs) were diagnosed in the colonoscopy group during the follow-up period, compared to 66 CRCs in the patients who underwent flexible sigmoidoscopy and 634 CRCs in the control group.

In a multivariate analysis, colonoscopy was associated with a significant 73% reduction of distal colorectal cancer (hazard ratio, 0.27) and a significant 54% reduction of proximal colorectal cancer (HR, 0.46), compared with unscreened controls.

Sigmoidoscopy was associated with a significant 60% reduction of distal colorectal cancer (HR, 0.40), but no significant reduction in proximal colorectal cancer, compared to unscreened controls; this was expected because the procedure does not examine the entire colon.

A total of 771 (12%) of the patients who first underwent sigmoidoscopy went on to have a colonoscopy within 12 months. When the investigators excluded data from these patients, who had sigmoidoscopy followed by colonoscopy, the study results on cancer risk were essentially unchanged.

The findings were limited by the retrospective nature of the study, as well as the confounding effect of the diagnostic procedure chosen and the selection bias in the use of screening endoscopy, Dr. Wang said.

In addition, the study "does not reflect recent advancements in endoscopy equipment and techniques," he noted.

However, the results from this large study population confirm that colonoscopy remains the preferred screening test for colorectal cancer, said Dr. Wang.

The study was funded by a research grant from the American College of Gastroenterology. The researchers said they had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Colonoscopy led to significant reductions in colorectal cancers located in both the distal colon and proximal colon, based on a large analysis of Medicare data from 1998 to 2002.

The finding that colonoscopy provided protection in the proximal colon is important because "several recent studies [have] yielded mixed results on the protective effect of colonoscopy in the proximal colon," said Dr. Yize Wang of the Mayo Clinic in Jacksonville, Fla.

To assess the impact of colonoscopy and flexible sigmoidoscopy on colorectal cancer risk, Dr. Wang and colleagues analyzed cancer rates in adults aged 67 to 80 years. The study group included 12,266 patients who had an outpatient colonoscopy, 6,402 who underwent sigmoidoscopy, and 41,410 individuals who did not have a screening procedure and served as controls.

Patients with inflammatory bowel disease, a history of polyps, or a history of colorectal cancer were excluded. The study patients were followed until the end of 2005, or until a diagnosis of colorectal cancer, or death.

A total of 58 colorectal cancers (CRCs) were diagnosed in the colonoscopy group during the follow-up period, compared to 66 CRCs in the patients who underwent flexible sigmoidoscopy and 634 CRCs in the control group.

In a multivariate analysis, colonoscopy was associated with a significant 73% reduction of distal colorectal cancer (hazard ratio, 0.27) and a significant 54% reduction of proximal colorectal cancer (HR, 0.46), compared with unscreened controls.

Sigmoidoscopy was associated with a significant 60% reduction of distal colorectal cancer (HR, 0.40), but no significant reduction in proximal colorectal cancer, compared to unscreened controls; this was expected because the procedure does not examine the entire colon.

A total of 771 (12%) of the patients who first underwent sigmoidoscopy went on to have a colonoscopy within 12 months. When the investigators excluded data from these patients, who had sigmoidoscopy followed by colonoscopy, the study results on cancer risk were essentially unchanged.

The findings were limited by the retrospective nature of the study, as well as the confounding effect of the diagnostic procedure chosen and the selection bias in the use of screening endoscopy, Dr. Wang said.

In addition, the study "does not reflect recent advancements in endoscopy equipment and techniques," he noted.

However, the results from this large study population confirm that colonoscopy remains the preferred screening test for colorectal cancer, said Dr. Wang.

The study was funded by a research grant from the American College of Gastroenterology. The researchers said they had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Coronary artery disease was significantly more prevalent in patients with hepatitis C virus infection, compared with control subjects, based on a retrospective review. The findings were presented at the annual meeting of the American College of Gastroenterology.

"An association of coronary artery disease [CAD] with hepatitis C has been suggested, but definitive data are still lacking," said Dr. Sanjaya Satapathy, who conducted the study while at Long Island Jewish Medical Center in New Hyde Park, N.Y.

To estimate the prevalence of CAD in hepatitis C patients, Dr. Satapathy and his colleagues reviewed data from 934 individuals with hepatitis C infection who were seen at a single center between May 2002 and December 2008. Of these patients, 63 had undergone coronary angiography. The investigators compared their data with data from 63 matched controls without hepatitis C.

Overall severity of CAD according to the combined Reardon severity score was significantly greater in the hepatitis C virus (HCV) group than in the controls (6.3 vs. 2.6, respectively), suggesting that being HCV-positive increases the severity of, or risk for, CAD, Dr. Satapathy said.

The researchers defined CAD in two different ways for their analysis. CAD defined as stenosis greater than 50% was found in 44 of the HCV cases (70%) compared with 30 controls (48%). CAD defined as stenosis greater than 75% was found in 42 patients with hepatitis C (67%) compared with 29 controls (46%).

In addition, the prevalence of multivessel coronary artery disease was significantly higher in the HCV patients compared with the controls (57% vs. 16%, respectively). The prevalence of single-vessel involvement was greater in the control group.

"HCV seropositive status is a strong predictor for CAD," Dr. Satapathy said. However, "HCV patients are more likely to remain undertreated with antiplatelet and lipid-lowering agents," he noted.

The study was limited by the retrospective design and small sample size, said Dr. Satapathy. However, the findings suggest that CAD is significantly more common and severe in HCV-positive patients, and this should be considered by clinicians treating these patients, he said.

Dr. Satapathy said he had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Coronary artery disease was significantly more prevalent in patients with hepatitis C virus infection, compared with control subjects, based on a retrospective review. The findings were presented at the annual meeting of the American College of Gastroenterology.

"An association of coronary artery disease [CAD] with hepatitis C has been suggested, but definitive data are still lacking," said Dr. Sanjaya Satapathy, who conducted the study while at Long Island Jewish Medical Center in New Hyde Park, N.Y.

To estimate the prevalence of CAD in hepatitis C patients, Dr. Satapathy and his colleagues reviewed data from 934 individuals with hepatitis C infection who were seen at a single center between May 2002 and December 2008. Of these patients, 63 had undergone coronary angiography. The investigators compared their data with data from 63 matched controls without hepatitis C.

Overall severity of CAD according to the combined Reardon severity score was significantly greater in the hepatitis C virus (HCV) group than in the controls (6.3 vs. 2.6, respectively), suggesting that being HCV-positive increases the severity of, or risk for, CAD, Dr. Satapathy said.

The researchers defined CAD in two different ways for their analysis. CAD defined as stenosis greater than 50% was found in 44 of the HCV cases (70%) compared with 30 controls (48%). CAD defined as stenosis greater than 75% was found in 42 patients with hepatitis C (67%) compared with 29 controls (46%).

In addition, the prevalence of multivessel coronary artery disease was significantly higher in the HCV patients compared with the controls (57% vs. 16%, respectively). The prevalence of single-vessel involvement was greater in the control group.

"HCV seropositive status is a strong predictor for CAD," Dr. Satapathy said. However, "HCV patients are more likely to remain undertreated with antiplatelet and lipid-lowering agents," he noted.

The study was limited by the retrospective design and small sample size, said Dr. Satapathy. However, the findings suggest that CAD is significantly more common and severe in HCV-positive patients, and this should be considered by clinicians treating these patients, he said.

Dr. Satapathy said he had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Coronary artery disease was significantly more prevalent in patients with hepatitis C virus infection, compared with control subjects, based on a retrospective review. The findings were presented at the annual meeting of the American College of Gastroenterology.

"An association of coronary artery disease [CAD] with hepatitis C has been suggested, but definitive data are still lacking," said Dr. Sanjaya Satapathy, who conducted the study while at Long Island Jewish Medical Center in New Hyde Park, N.Y.

To estimate the prevalence of CAD in hepatitis C patients, Dr. Satapathy and his colleagues reviewed data from 934 individuals with hepatitis C infection who were seen at a single center between May 2002 and December 2008. Of these patients, 63 had undergone coronary angiography. The investigators compared their data with data from 63 matched controls without hepatitis C.

Overall severity of CAD according to the combined Reardon severity score was significantly greater in the hepatitis C virus (HCV) group than in the controls (6.3 vs. 2.6, respectively), suggesting that being HCV-positive increases the severity of, or risk for, CAD, Dr. Satapathy said.

The researchers defined CAD in two different ways for their analysis. CAD defined as stenosis greater than 50% was found in 44 of the HCV cases (70%) compared with 30 controls (48%). CAD defined as stenosis greater than 75% was found in 42 patients with hepatitis C (67%) compared with 29 controls (46%).

In addition, the prevalence of multivessel coronary artery disease was significantly higher in the HCV patients compared with the controls (57% vs. 16%, respectively). The prevalence of single-vessel involvement was greater in the control group.

"HCV seropositive status is a strong predictor for CAD," Dr. Satapathy said. However, "HCV patients are more likely to remain undertreated with antiplatelet and lipid-lowering agents," he noted.

The study was limited by the retrospective design and small sample size, said Dr. Satapathy. However, the findings suggest that CAD is significantly more common and severe in HCV-positive patients, and this should be considered by clinicians treating these patients, he said.

Dr. Satapathy said he had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – "Food is what patients blame for their gastrointestinal symptoms," Dr. Peter Gibson said at the annual meeting of the American College of Gastroenterology.

And patients with functional GI disorders may be on the right track, according to Dr. Gibson, professor of medicine at Monash University in Victoria, Australia. He presented a novel dietary treatment that is not well known in the United States but appears promising as a strategy for managing irritable bowel syndrome (IBS) and other functional GI problems.

(c) Christian Pedant/fotolia.com

Dr. Gibson also said that physicians who want to help their patients manage their symptoms need to understand how foods can interact with the enteric nervous system, which controls most GI functions.

More specifically, certain types of sugars found in many foods are rapidly absorbed and fermented, drawing liquid into the GI tract, which can cause distension and trigger the symptoms of IBS, such as bloating and pain, he said.

The novel dietary approach is known by the acronym FODMAP, which stands for the types of sugars suspected of causing symptoms: fermentable sugars, oligosaccharides, disaccharides, monosaccharides, and polyols (such as sorbitol or mannitol). Thus the regimen designed to reduce symptoms is called a low-FODMAP diet, said Dr. Gibson.

Data are limited, but in theory, a low-FODMAP diet causes less distension of the intestinal lumen and thereby reduces IBS symptoms. His colleague, Susan Shepherd, Ph.D., who is a dietitian, has developed a list of foods that should be included, and others to exclude, when following such a diet.

In a recent study, 82 IBS patients were randomized to receive either standard dietary advice (39 people) or instruction on following a low-FODMAP diet (43 people); the patients were meeting with a dietitian on an outpatient basis (J. Hum. Nutr. Diet 2011;24:487-95).

Composite IBS symptom scores showed that significantly more patients in the low-FODMAP group had overall improvement in their symptoms, compared with the standard care group (86% vs. 49%). In addition, significantly more low-FODMAP patients reported improvements in bloating (82%), abdominal pain (85%), and flatulence (87%), compared with the standard care group (49%, 61%, and 50%, respectively).

More research is needed, but the data support the potential effectiveness of a low-FODMAP diet, Dr. Gibson said.

Some examples of foods to include as part of a low-FODMAP diet are bananas, blueberries, lettuce, potatoes, gluten-free bread or cereal products, rice, oats, hard cheeses, lactose-free milk, sugar, molasses, and most artificial sweeteners with names that do not end in "ol."*

Foods to eliminate when following a low-FODMAP diet include apples, pears, canned fruit in natural juice, high-fructose corn syrup, cows’ milk (which contains lactose), soft cheese, broccoli, cabbage, pasta, bread, or baked goods made from wheat or rye, mushrooms, and sweeteners ending in "ol," such as sorbitol.

A potential limitation of using the low-FODMAP diet is that it requires collaboration with a dietitian who is familiar with the diet, Dr. Gibson noted, and the diet is relatively unknown in the United States.

However, it may catch on, Dr. William D. Chey said in an interview at the meeting. Dr. Chey is a professor of internal medicine and director of the gastrointestinal physiology laboratory at the University of Michigan in Ann Arbor; he is also one of the two editors in chief of the American Journal of Gastroenterology.

"I think doctors are hungry for non-medical interventions" for IBS patients, Dr. Chey said. Although the diet is restrictive, many IBS patients are already on such restricted diets that the low-FODMAP diet actually broadens their food choices, which may promote adherence, he added.

More details about the low-FODMAP diet, including a complete list of foods and a database of knowledgeable dietitians, are available at ibsgroup.org/ibs-diet.

Dr. Gibson said he had no relevant financial disclosures. Dr. Chey has served as a consultant for multiple companies including AstraZeneca, Johnson & Johnson, Salix, and Takeda.

Correction: An earlier version of this story incorrectly named a few items on list of foods that may be consumed on the low-FODMAP diet. The error has been corrected.

NATIONAL HARBOR, MD. – "Food is what patients blame for their gastrointestinal symptoms," Dr. Peter Gibson said at the annual meeting of the American College of Gastroenterology.

And patients with functional GI disorders may be on the right track, according to Dr. Gibson, professor of medicine at Monash University in Victoria, Australia. He presented a novel dietary treatment that is not well known in the United States but appears promising as a strategy for managing irritable bowel syndrome (IBS) and other functional GI problems.

(c) Christian Pedant/fotolia.com

Dr. Gibson also said that physicians who want to help their patients manage their symptoms need to understand how foods can interact with the enteric nervous system, which controls most GI functions.

More specifically, certain types of sugars found in many foods are rapidly absorbed and fermented, drawing liquid into the GI tract, which can cause distension and trigger the symptoms of IBS, such as bloating and pain, he said.

The novel dietary approach is known by the acronym FODMAP, which stands for the types of sugars suspected of causing symptoms: fermentable sugars, oligosaccharides, disaccharides, monosaccharides, and polyols (such as sorbitol or mannitol). Thus the regimen designed to reduce symptoms is called a low-FODMAP diet, said Dr. Gibson.

Data are limited, but in theory, a low-FODMAP diet causes less distension of the intestinal lumen and thereby reduces IBS symptoms. His colleague, Susan Shepherd, Ph.D., who is a dietitian, has developed a list of foods that should be included, and others to exclude, when following such a diet.

In a recent study, 82 IBS patients were randomized to receive either standard dietary advice (39 people) or instruction on following a low-FODMAP diet (43 people); the patients were meeting with a dietitian on an outpatient basis (J. Hum. Nutr. Diet 2011;24:487-95).

Composite IBS symptom scores showed that significantly more patients in the low-FODMAP group had overall improvement in their symptoms, compared with the standard care group (86% vs. 49%). In addition, significantly more low-FODMAP patients reported improvements in bloating (82%), abdominal pain (85%), and flatulence (87%), compared with the standard care group (49%, 61%, and 50%, respectively).

More research is needed, but the data support the potential effectiveness of a low-FODMAP diet, Dr. Gibson said.

Some examples of foods to include as part of a low-FODMAP diet are bananas, blueberries, lettuce, potatoes, gluten-free bread or cereal products, rice, oats, hard cheeses, lactose-free milk, sugar, molasses, and most artificial sweeteners with names that do not end in "ol."*

Foods to eliminate when following a low-FODMAP diet include apples, pears, canned fruit in natural juice, high-fructose corn syrup, cows’ milk (which contains lactose), soft cheese, broccoli, cabbage, pasta, bread, or baked goods made from wheat or rye, mushrooms, and sweeteners ending in "ol," such as sorbitol.

A potential limitation of using the low-FODMAP diet is that it requires collaboration with a dietitian who is familiar with the diet, Dr. Gibson noted, and the diet is relatively unknown in the United States.

However, it may catch on, Dr. William D. Chey said in an interview at the meeting. Dr. Chey is a professor of internal medicine and director of the gastrointestinal physiology laboratory at the University of Michigan in Ann Arbor; he is also one of the two editors in chief of the American Journal of Gastroenterology.

"I think doctors are hungry for non-medical interventions" for IBS patients, Dr. Chey said. Although the diet is restrictive, many IBS patients are already on such restricted diets that the low-FODMAP diet actually broadens their food choices, which may promote adherence, he added.

More details about the low-FODMAP diet, including a complete list of foods and a database of knowledgeable dietitians, are available at ibsgroup.org/ibs-diet.

Dr. Gibson said he had no relevant financial disclosures. Dr. Chey has served as a consultant for multiple companies including AstraZeneca, Johnson & Johnson, Salix, and Takeda.

Correction: An earlier version of this story incorrectly named a few items on list of foods that may be consumed on the low-FODMAP diet. The error has been corrected.

NATIONAL HARBOR, MD. – "Food is what patients blame for their gastrointestinal symptoms," Dr. Peter Gibson said at the annual meeting of the American College of Gastroenterology.

And patients with functional GI disorders may be on the right track, according to Dr. Gibson, professor of medicine at Monash University in Victoria, Australia. He presented a novel dietary treatment that is not well known in the United States but appears promising as a strategy for managing irritable bowel syndrome (IBS) and other functional GI problems.

(c) Christian Pedant/fotolia.com

Dr. Gibson also said that physicians who want to help their patients manage their symptoms need to understand how foods can interact with the enteric nervous system, which controls most GI functions.

More specifically, certain types of sugars found in many foods are rapidly absorbed and fermented, drawing liquid into the GI tract, which can cause distension and trigger the symptoms of IBS, such as bloating and pain, he said.

The novel dietary approach is known by the acronym FODMAP, which stands for the types of sugars suspected of causing symptoms: fermentable sugars, oligosaccharides, disaccharides, monosaccharides, and polyols (such as sorbitol or mannitol). Thus the regimen designed to reduce symptoms is called a low-FODMAP diet, said Dr. Gibson.

Data are limited, but in theory, a low-FODMAP diet causes less distension of the intestinal lumen and thereby reduces IBS symptoms. His colleague, Susan Shepherd, Ph.D., who is a dietitian, has developed a list of foods that should be included, and others to exclude, when following such a diet.

In a recent study, 82 IBS patients were randomized to receive either standard dietary advice (39 people) or instruction on following a low-FODMAP diet (43 people); the patients were meeting with a dietitian on an outpatient basis (J. Hum. Nutr. Diet 2011;24:487-95).

Composite IBS symptom scores showed that significantly more patients in the low-FODMAP group had overall improvement in their symptoms, compared with the standard care group (86% vs. 49%). In addition, significantly more low-FODMAP patients reported improvements in bloating (82%), abdominal pain (85%), and flatulence (87%), compared with the standard care group (49%, 61%, and 50%, respectively).

More research is needed, but the data support the potential effectiveness of a low-FODMAP diet, Dr. Gibson said.

Some examples of foods to include as part of a low-FODMAP diet are bananas, blueberries, lettuce, potatoes, gluten-free bread or cereal products, rice, oats, hard cheeses, lactose-free milk, sugar, molasses, and most artificial sweeteners with names that do not end in "ol."*

Foods to eliminate when following a low-FODMAP diet include apples, pears, canned fruit in natural juice, high-fructose corn syrup, cows’ milk (which contains lactose), soft cheese, broccoli, cabbage, pasta, bread, or baked goods made from wheat or rye, mushrooms, and sweeteners ending in "ol," such as sorbitol.

A potential limitation of using the low-FODMAP diet is that it requires collaboration with a dietitian who is familiar with the diet, Dr. Gibson noted, and the diet is relatively unknown in the United States.

However, it may catch on, Dr. William D. Chey said in an interview at the meeting. Dr. Chey is a professor of internal medicine and director of the gastrointestinal physiology laboratory at the University of Michigan in Ann Arbor; he is also one of the two editors in chief of the American Journal of Gastroenterology.

"I think doctors are hungry for non-medical interventions" for IBS patients, Dr. Chey said. Although the diet is restrictive, many IBS patients are already on such restricted diets that the low-FODMAP diet actually broadens their food choices, which may promote adherence, he added.

More details about the low-FODMAP diet, including a complete list of foods and a database of knowledgeable dietitians, are available at ibsgroup.org/ibs-diet.

Dr. Gibson said he had no relevant financial disclosures. Dr. Chey has served as a consultant for multiple companies including AstraZeneca, Johnson & Johnson, Salix, and Takeda.

Correction: An earlier version of this story incorrectly named a few items on list of foods that may be consumed on the low-FODMAP diet. The error has been corrected.

NATIONAL HARBOR, MD. – Patients with short-segment Barrett’s esophagus who had additional ablative therapies after endoscopic mucosal resection had no significant improvement in recurrence or mortality rates, compared with patients who did not have additional therapies.

The study of 213 patients was presented at the annual meeting of the American College of Gastroenterology.

"Endoscopic mucosal resection and ablative therapies are now widely used to remove and ablate the Barrett’s mucosa," said Dr. Jianmin Tian of the Mayo Clinic in Rochester, Minn.

However, it is unclear whether additional ablative therapies after endoscopic mucosal resection (EMR) can improve outcomes for patients with short-segment Barrett’s esophagus (SSBE), defined as Barrett’s esophagus less than 3 cm.

To assess the value of additional ablation, Dr. Tian and colleagues conducted a retrospective cohort study of 213 adults with SSBE who were treated in a tertiary referral center. The study population included 93 patients who underwent EMR and 120 patients who underwent EMR plus additional ablative therapies.

The additional ablative therapies included radiofrequency ablation, photodynamic therapy, multipolar/bipolar electrocautery, cryotherapy, and argon plasma coagulation.

The recurrence rate was not significantly different in the EMR-only group, compared with the EMR-plus-ablation group (10% vs. 12%), after control for age, sex, Charlson comorbidity index, and specific condition (either intestinal metaplasia or dysplasia), Dr. Tian said. Similarly, the mortality rate was not significantly different between the two groups (15% vs. 18%, respectively).

The study included patients with SSBE and high-grade dysplasia or early esophageal cancer who had achieved complete remission of their dysplasia or intestinal metaplasia. Patients with a history of esophagectomy were excluded. Recurrence was defined as finding dysplasia or early esophageal cancer after two consecutive negative esophagogastroduodenoscopy exams with complete response.

The findings suggest that ablation of the gastroesophageal junction may not reduce recurrence, said Dr. Tian. The study was limited by its retrospective design and small size. But the study’s strengths include a relatively long follow-up period, the inclusion of two consecutive negative esophagogastroduodenoscopy exams, and systematic surveillance biopsies from the esophagus and the gastroesophageal junction, he noted.

Areas for further research include validation of the study findings in a randomized, controlled trial; data collection from patients with long-segment Barrett’s esophagus; and investigation of the clinical significance of recurrence at the gastroesophageal junction, Dr. Tian said.

Dr. Tian had no financial conflicts to disclose. Several study coauthors disclosed financial relationships with companies including Olympus, Fujinon, and Barrx.

NATIONAL HARBOR, MD. – Patients with short-segment Barrett’s esophagus who had additional ablative therapies after endoscopic mucosal resection had no significant improvement in recurrence or mortality rates, compared with patients who did not have additional therapies.

The study of 213 patients was presented at the annual meeting of the American College of Gastroenterology.

"Endoscopic mucosal resection and ablative therapies are now widely used to remove and ablate the Barrett’s mucosa," said Dr. Jianmin Tian of the Mayo Clinic in Rochester, Minn.

However, it is unclear whether additional ablative therapies after endoscopic mucosal resection (EMR) can improve outcomes for patients with short-segment Barrett’s esophagus (SSBE), defined as Barrett’s esophagus less than 3 cm.

To assess the value of additional ablation, Dr. Tian and colleagues conducted a retrospective cohort study of 213 adults with SSBE who were treated in a tertiary referral center. The study population included 93 patients who underwent EMR and 120 patients who underwent EMR plus additional ablative therapies.

The additional ablative therapies included radiofrequency ablation, photodynamic therapy, multipolar/bipolar electrocautery, cryotherapy, and argon plasma coagulation.

The recurrence rate was not significantly different in the EMR-only group, compared with the EMR-plus-ablation group (10% vs. 12%), after control for age, sex, Charlson comorbidity index, and specific condition (either intestinal metaplasia or dysplasia), Dr. Tian said. Similarly, the mortality rate was not significantly different between the two groups (15% vs. 18%, respectively).

The study included patients with SSBE and high-grade dysplasia or early esophageal cancer who had achieved complete remission of their dysplasia or intestinal metaplasia. Patients with a history of esophagectomy were excluded. Recurrence was defined as finding dysplasia or early esophageal cancer after two consecutive negative esophagogastroduodenoscopy exams with complete response.

The findings suggest that ablation of the gastroesophageal junction may not reduce recurrence, said Dr. Tian. The study was limited by its retrospective design and small size. But the study’s strengths include a relatively long follow-up period, the inclusion of two consecutive negative esophagogastroduodenoscopy exams, and systematic surveillance biopsies from the esophagus and the gastroesophageal junction, he noted.

Areas for further research include validation of the study findings in a randomized, controlled trial; data collection from patients with long-segment Barrett’s esophagus; and investigation of the clinical significance of recurrence at the gastroesophageal junction, Dr. Tian said.

Dr. Tian had no financial conflicts to disclose. Several study coauthors disclosed financial relationships with companies including Olympus, Fujinon, and Barrx.

NATIONAL HARBOR, MD. – Patients with short-segment Barrett’s esophagus who had additional ablative therapies after endoscopic mucosal resection had no significant improvement in recurrence or mortality rates, compared with patients who did not have additional therapies.

The study of 213 patients was presented at the annual meeting of the American College of Gastroenterology.

"Endoscopic mucosal resection and ablative therapies are now widely used to remove and ablate the Barrett’s mucosa," said Dr. Jianmin Tian of the Mayo Clinic in Rochester, Minn.

However, it is unclear whether additional ablative therapies after endoscopic mucosal resection (EMR) can improve outcomes for patients with short-segment Barrett’s esophagus (SSBE), defined as Barrett’s esophagus less than 3 cm.

To assess the value of additional ablation, Dr. Tian and colleagues conducted a retrospective cohort study of 213 adults with SSBE who were treated in a tertiary referral center. The study population included 93 patients who underwent EMR and 120 patients who underwent EMR plus additional ablative therapies.

The additional ablative therapies included radiofrequency ablation, photodynamic therapy, multipolar/bipolar electrocautery, cryotherapy, and argon plasma coagulation.

The recurrence rate was not significantly different in the EMR-only group, compared with the EMR-plus-ablation group (10% vs. 12%), after control for age, sex, Charlson comorbidity index, and specific condition (either intestinal metaplasia or dysplasia), Dr. Tian said. Similarly, the mortality rate was not significantly different between the two groups (15% vs. 18%, respectively).

The study included patients with SSBE and high-grade dysplasia or early esophageal cancer who had achieved complete remission of their dysplasia or intestinal metaplasia. Patients with a history of esophagectomy were excluded. Recurrence was defined as finding dysplasia or early esophageal cancer after two consecutive negative esophagogastroduodenoscopy exams with complete response.

The findings suggest that ablation of the gastroesophageal junction may not reduce recurrence, said Dr. Tian. The study was limited by its retrospective design and small size. But the study’s strengths include a relatively long follow-up period, the inclusion of two consecutive negative esophagogastroduodenoscopy exams, and systematic surveillance biopsies from the esophagus and the gastroesophageal junction, he noted.

Areas for further research include validation of the study findings in a randomized, controlled trial; data collection from patients with long-segment Barrett’s esophagus; and investigation of the clinical significance of recurrence at the gastroesophageal junction, Dr. Tian said.

Dr. Tian had no financial conflicts to disclose. Several study coauthors disclosed financial relationships with companies including Olympus, Fujinon, and Barrx.

NATIONAL HARBOR, MD. – Prophylactic use of probiotics appeared to reduce the odds of developing antibiotic-associated diarrhea by 60%, based on data from a meta-analysis of more than 3,000 patients. The findings were presented at the annual meeting of the American College of Gastroenterology.

The incidence and severity of antibiotic-associated diarrhea (AAD) are increasing in the United States, with major financial and clinical implications, said Dr. Steven Shamah, a resident in Internal Medicine at Maimonides Medical Center in Brooklyn, N.Y.

"Given the enormous cost, morbidity, and mortality associated with this [disorder], it is important to identify those at-risk populations and institute preventative measures," Dr. Shamah said. The most common type of AAD is Clostridium difficile–associated diarrhea (CDAD), he said.

Several studies have examined the effectiveness of daily treatment with probiotics to prevent antibiotic-associated diarrhea, but results have been mixed, he noted. Dr. Shamah and colleagues reviewed data from 22 studies including 3,096 patients, 63% of which were adults. A total of 53% of the study subjects were from outpatient settings and 47% were hospitalized patients.

The researchers conducted a chi square analysis of patients who had successful and failed probiotic treatments. Overall, patients who took probiotics had significantly reduced odds of developing AAD (odds ratio, 0.39). The probiotic treatment periods ranged from 5 days to 3 weeks, with an average treatment duration of 1.5 weeks, Dr. Shamah said.

"This analysis clearly demonstrates that probiotics offer protective benefit in the prevention of [AAD]," said Dr. Shamah. All patients who are at high risk for AAD should receive probiotic prophylaxis, he added. Risk factors for AAD include recent antibiotics use, old age, recent hospitalization, low albumin, and immunosuppression.

However, additional prospective studies are needed to determine the most effective dose, duration, and specific species of probiotics to prevent AAD and CDAD in these patients, he noted.

Dr. Shamah said he had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Prophylactic use of probiotics appeared to reduce the odds of developing antibiotic-associated diarrhea by 60%, based on data from a meta-analysis of more than 3,000 patients. The findings were presented at the annual meeting of the American College of Gastroenterology.

The incidence and severity of antibiotic-associated diarrhea (AAD) are increasing in the United States, with major financial and clinical implications, said Dr. Steven Shamah, a resident in Internal Medicine at Maimonides Medical Center in Brooklyn, N.Y.

"Given the enormous cost, morbidity, and mortality associated with this [disorder], it is important to identify those at-risk populations and institute preventative measures," Dr. Shamah said. The most common type of AAD is Clostridium difficile–associated diarrhea (CDAD), he said.

Several studies have examined the effectiveness of daily treatment with probiotics to prevent antibiotic-associated diarrhea, but results have been mixed, he noted. Dr. Shamah and colleagues reviewed data from 22 studies including 3,096 patients, 63% of which were adults. A total of 53% of the study subjects were from outpatient settings and 47% were hospitalized patients.

The researchers conducted a chi square analysis of patients who had successful and failed probiotic treatments. Overall, patients who took probiotics had significantly reduced odds of developing AAD (odds ratio, 0.39). The probiotic treatment periods ranged from 5 days to 3 weeks, with an average treatment duration of 1.5 weeks, Dr. Shamah said.

"This analysis clearly demonstrates that probiotics offer protective benefit in the prevention of [AAD]," said Dr. Shamah. All patients who are at high risk for AAD should receive probiotic prophylaxis, he added. Risk factors for AAD include recent antibiotics use, old age, recent hospitalization, low albumin, and immunosuppression.

However, additional prospective studies are needed to determine the most effective dose, duration, and specific species of probiotics to prevent AAD and CDAD in these patients, he noted.

Dr. Shamah said he had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Prophylactic use of probiotics appeared to reduce the odds of developing antibiotic-associated diarrhea by 60%, based on data from a meta-analysis of more than 3,000 patients. The findings were presented at the annual meeting of the American College of Gastroenterology.

The incidence and severity of antibiotic-associated diarrhea (AAD) are increasing in the United States, with major financial and clinical implications, said Dr. Steven Shamah, a resident in Internal Medicine at Maimonides Medical Center in Brooklyn, N.Y.

"Given the enormous cost, morbidity, and mortality associated with this [disorder], it is important to identify those at-risk populations and institute preventative measures," Dr. Shamah said. The most common type of AAD is Clostridium difficile–associated diarrhea (CDAD), he said.

Several studies have examined the effectiveness of daily treatment with probiotics to prevent antibiotic-associated diarrhea, but results have been mixed, he noted. Dr. Shamah and colleagues reviewed data from 22 studies including 3,096 patients, 63% of which were adults. A total of 53% of the study subjects were from outpatient settings and 47% were hospitalized patients.

The researchers conducted a chi square analysis of patients who had successful and failed probiotic treatments. Overall, patients who took probiotics had significantly reduced odds of developing AAD (odds ratio, 0.39). The probiotic treatment periods ranged from 5 days to 3 weeks, with an average treatment duration of 1.5 weeks, Dr. Shamah said.

"This analysis clearly demonstrates that probiotics offer protective benefit in the prevention of [AAD]," said Dr. Shamah. All patients who are at high risk for AAD should receive probiotic prophylaxis, he added. Risk factors for AAD include recent antibiotics use, old age, recent hospitalization, low albumin, and immunosuppression.

However, additional prospective studies are needed to determine the most effective dose, duration, and specific species of probiotics to prevent AAD and CDAD in these patients, he noted.

Dr. Shamah said he had no financial conflicts to disclose.

NATIONAL HARBOR, MD – Fecal microbiota transplants showed long-term effectiveness in eliminating recurrent Clostridium difficile infections, based on data from 77 patients.

The findings were presented at the annual meeting of the American College of Gastroenterology.

C. difficile is responsible for approximately 500,000 infections and 15,000 deaths annually in the United States, said Dr. Mark Mellow, medical director of the digestive health center at INTEGRIS Baptist Medical Center in Oklahoma City. In addition, recurrence rates after an initial infection range from 15% to 25%, and the rate of recurrence after a recurrent infection ranges from 40% to 50%.

The fecal microbiota transplant (FMT) procedure has shown success in treating C. difficile, but long-term follow-up data are limited, Dr. Mellow said.

In this study, Dr. Mellow and his colleagues contacted patients who underwent colonoscopic FMT for recurrent C. difficile infections at least 3 months previously, via a mail or phone questionnaire. The patient population came from five different centers and included 56 women and 21 men. The patients ranged in age from 22 to 87 years, with a mean age of 65 years and an average illness duration of 11 months.

Pre-FMT data included health status, duration of infection, previous treatments, risk factors, and characteristics of the fecal donor. Post-FMT data included the effect of FMT on symptoms, time to improvement, and, in some cases, follow-up stool testing.

The average time to resolution of diarrhea after FMT was 6 days overall. Time to resolution was 3 days or less in 57 patients. Fatigue resolved in an average of 4 weeks overall, and in 1 week or less in 51 patients, Dr. Mellow said.

After an average of 17 months’ follow-up, 70 patients (91%) reported no recurrence of C. difficile.

"Despite lengthy illness before FMT, the response to FMT was rapid and sustained," and no patient developed a recurrent infection that did not receive subsequent antibiotic treatment for other infections, Dr. Mellow said.

Of the seven patients who failed an initial FMT treatment, four were successfully treated with a 2-week course of vancomycin alone or in combination with Florastor, Alinia, and kefir. Another two were treated successfully with a second FMT after failing a 2-week course of vancomycin, and one patient was not treated and died after spending time in hospice care.

The FMT procedure was well received in this patient population, most of whom had suffered with recurrent infection and failed multiple courses of standard treatments, Dr. Mellow noted. When patients were asked about their preferred treatment if their C. difficile infections were to recur, 53% said they would have a second FMT as their first choice for therapy, he said.

The findings were similar across all five centers, and support the effectiveness of FMT as a treatment option for patients with at least two prior bouts of C. difficile, Dr. Mellow said.

Dr. Mellow had no financial conflicts to disclose.

NATIONAL HARBOR, MD – Fecal microbiota transplants showed long-term effectiveness in eliminating recurrent Clostridium difficile infections, based on data from 77 patients.

The findings were presented at the annual meeting of the American College of Gastroenterology.

C. difficile is responsible for approximately 500,000 infections and 15,000 deaths annually in the United States, said Dr. Mark Mellow, medical director of the digestive health center at INTEGRIS Baptist Medical Center in Oklahoma City. In addition, recurrence rates after an initial infection range from 15% to 25%, and the rate of recurrence after a recurrent infection ranges from 40% to 50%.

The fecal microbiota transplant (FMT) procedure has shown success in treating C. difficile, but long-term follow-up data are limited, Dr. Mellow said.

In this study, Dr. Mellow and his colleagues contacted patients who underwent colonoscopic FMT for recurrent C. difficile infections at least 3 months previously, via a mail or phone questionnaire. The patient population came from five different centers and included 56 women and 21 men. The patients ranged in age from 22 to 87 years, with a mean age of 65 years and an average illness duration of 11 months.

Pre-FMT data included health status, duration of infection, previous treatments, risk factors, and characteristics of the fecal donor. Post-FMT data included the effect of FMT on symptoms, time to improvement, and, in some cases, follow-up stool testing.

The average time to resolution of diarrhea after FMT was 6 days overall. Time to resolution was 3 days or less in 57 patients. Fatigue resolved in an average of 4 weeks overall, and in 1 week or less in 51 patients, Dr. Mellow said.

After an average of 17 months’ follow-up, 70 patients (91%) reported no recurrence of C. difficile.

"Despite lengthy illness before FMT, the response to FMT was rapid and sustained," and no patient developed a recurrent infection that did not receive subsequent antibiotic treatment for other infections, Dr. Mellow said.

Of the seven patients who failed an initial FMT treatment, four were successfully treated with a 2-week course of vancomycin alone or in combination with Florastor, Alinia, and kefir. Another two were treated successfully with a second FMT after failing a 2-week course of vancomycin, and one patient was not treated and died after spending time in hospice care.

The FMT procedure was well received in this patient population, most of whom had suffered with recurrent infection and failed multiple courses of standard treatments, Dr. Mellow noted. When patients were asked about their preferred treatment if their C. difficile infections were to recur, 53% said they would have a second FMT as their first choice for therapy, he said.

The findings were similar across all five centers, and support the effectiveness of FMT as a treatment option for patients with at least two prior bouts of C. difficile, Dr. Mellow said.

Dr. Mellow had no financial conflicts to disclose.

NATIONAL HARBOR, MD – Fecal microbiota transplants showed long-term effectiveness in eliminating recurrent Clostridium difficile infections, based on data from 77 patients.

The findings were presented at the annual meeting of the American College of Gastroenterology.

C. difficile is responsible for approximately 500,000 infections and 15,000 deaths annually in the United States, said Dr. Mark Mellow, medical director of the digestive health center at INTEGRIS Baptist Medical Center in Oklahoma City. In addition, recurrence rates after an initial infection range from 15% to 25%, and the rate of recurrence after a recurrent infection ranges from 40% to 50%.

The fecal microbiota transplant (FMT) procedure has shown success in treating C. difficile, but long-term follow-up data are limited, Dr. Mellow said.

In this study, Dr. Mellow and his colleagues contacted patients who underwent colonoscopic FMT for recurrent C. difficile infections at least 3 months previously, via a mail or phone questionnaire. The patient population came from five different centers and included 56 women and 21 men. The patients ranged in age from 22 to 87 years, with a mean age of 65 years and an average illness duration of 11 months.

Pre-FMT data included health status, duration of infection, previous treatments, risk factors, and characteristics of the fecal donor. Post-FMT data included the effect of FMT on symptoms, time to improvement, and, in some cases, follow-up stool testing.

The average time to resolution of diarrhea after FMT was 6 days overall. Time to resolution was 3 days or less in 57 patients. Fatigue resolved in an average of 4 weeks overall, and in 1 week or less in 51 patients, Dr. Mellow said.

After an average of 17 months’ follow-up, 70 patients (91%) reported no recurrence of C. difficile.

"Despite lengthy illness before FMT, the response to FMT was rapid and sustained," and no patient developed a recurrent infection that did not receive subsequent antibiotic treatment for other infections, Dr. Mellow said.

Of the seven patients who failed an initial FMT treatment, four were successfully treated with a 2-week course of vancomycin alone or in combination with Florastor, Alinia, and kefir. Another two were treated successfully with a second FMT after failing a 2-week course of vancomycin, and one patient was not treated and died after spending time in hospice care.

The FMT procedure was well received in this patient population, most of whom had suffered with recurrent infection and failed multiple courses of standard treatments, Dr. Mellow noted. When patients were asked about their preferred treatment if their C. difficile infections were to recur, 53% said they would have a second FMT as their first choice for therapy, he said.

The findings were similar across all five centers, and support the effectiveness of FMT as a treatment option for patients with at least two prior bouts of C. difficile, Dr. Mellow said.

Dr. Mellow had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Treating patients with both rosacea and small intestinal bacterial overgrowth with the drug rifaximin was associated with improved rosacea symptoms in some patients, in a small, preliminary study. The findings were presented at the annual meeting of the American College of Gastroenterology.

Previous studies have shown a relationship between gastrointestinal bacteria and various skin disorders such as scleroderma, and a small case series showed that rosacea improved when patients with small intestinal bacterial overgrowth (SIBO) were treated with rifaximin, said Dr. Leonard B. Weinstock of Specialists in Gastroenterology in St. Louis.

Dr. Weinstock identified 63 patients with rosacea; the average age of the patients was 56 years. Most of them, 57 patients, had been diagnosed with facial rosacea by a dermatologist, and 4 had been diagnosed with ocular rosacea by an ophthalmologist. The rosacea patients were compared to 30 healthy controls and 30 general population controls. All study participants underwent lactulose breath testing to determine whether they had SIBO.

Overall, SIBO was significantly more common in the rosacea patients (50%) than in the general population controls (23%) or the healthy controls (10%). All four patients with ocular rosacea had SIBO.

A total of 32 rosacea patients were positive for SIBO, and 28 of these (including all ocular rosacea patients) received 1200 mg/day of rifaximin (two 200-mg tablets 3 times daily) for 10 days. Of the treated patients, 46% showed clearance of, or marked improvement in, rosacea symptoms, while another 25% showed moderate improvement.

"All four patients with ocular rosacea and SIBO reported marked improvement in conjunctivitis, sclera erythema, and dry eyes following treatment with rifaximin," Dr. Weinstock noted.

A large, randomized clinical trial is underway to further explore the possible benefits of rifaximin in patients with rosacea and SIBO, Dr. Weinstock added.

The study was supported by a grant from Salix Pharmaceuticals, maker of rifaximin.

NATIONAL HARBOR, MD. – Treating patients with both rosacea and small intestinal bacterial overgrowth with the drug rifaximin was associated with improved rosacea symptoms in some patients, in a small, preliminary study. The findings were presented at the annual meeting of the American College of Gastroenterology.

Previous studies have shown a relationship between gastrointestinal bacteria and various skin disorders such as scleroderma, and a small case series showed that rosacea improved when patients with small intestinal bacterial overgrowth (SIBO) were treated with rifaximin, said Dr. Leonard B. Weinstock of Specialists in Gastroenterology in St. Louis.

Dr. Weinstock identified 63 patients with rosacea; the average age of the patients was 56 years. Most of them, 57 patients, had been diagnosed with facial rosacea by a dermatologist, and 4 had been diagnosed with ocular rosacea by an ophthalmologist. The rosacea patients were compared to 30 healthy controls and 30 general population controls. All study participants underwent lactulose breath testing to determine whether they had SIBO.

Overall, SIBO was significantly more common in the rosacea patients (50%) than in the general population controls (23%) or the healthy controls (10%). All four patients with ocular rosacea had SIBO.

A total of 32 rosacea patients were positive for SIBO, and 28 of these (including all ocular rosacea patients) received 1200 mg/day of rifaximin (two 200-mg tablets 3 times daily) for 10 days. Of the treated patients, 46% showed clearance of, or marked improvement in, rosacea symptoms, while another 25% showed moderate improvement.

"All four patients with ocular rosacea and SIBO reported marked improvement in conjunctivitis, sclera erythema, and dry eyes following treatment with rifaximin," Dr. Weinstock noted.

A large, randomized clinical trial is underway to further explore the possible benefits of rifaximin in patients with rosacea and SIBO, Dr. Weinstock added.

The study was supported by a grant from Salix Pharmaceuticals, maker of rifaximin.

NATIONAL HARBOR, MD. – Treating patients with both rosacea and small intestinal bacterial overgrowth with the drug rifaximin was associated with improved rosacea symptoms in some patients, in a small, preliminary study. The findings were presented at the annual meeting of the American College of Gastroenterology.

Previous studies have shown a relationship between gastrointestinal bacteria and various skin disorders such as scleroderma, and a small case series showed that rosacea improved when patients with small intestinal bacterial overgrowth (SIBO) were treated with rifaximin, said Dr. Leonard B. Weinstock of Specialists in Gastroenterology in St. Louis.

Dr. Weinstock identified 63 patients with rosacea; the average age of the patients was 56 years. Most of them, 57 patients, had been diagnosed with facial rosacea by a dermatologist, and 4 had been diagnosed with ocular rosacea by an ophthalmologist. The rosacea patients were compared to 30 healthy controls and 30 general population controls. All study participants underwent lactulose breath testing to determine whether they had SIBO.

Overall, SIBO was significantly more common in the rosacea patients (50%) than in the general population controls (23%) or the healthy controls (10%). All four patients with ocular rosacea had SIBO.

A total of 32 rosacea patients were positive for SIBO, and 28 of these (including all ocular rosacea patients) received 1200 mg/day of rifaximin (two 200-mg tablets 3 times daily) for 10 days. Of the treated patients, 46% showed clearance of, or marked improvement in, rosacea symptoms, while another 25% showed moderate improvement.

"All four patients with ocular rosacea and SIBO reported marked improvement in conjunctivitis, sclera erythema, and dry eyes following treatment with rifaximin," Dr. Weinstock noted.

A large, randomized clinical trial is underway to further explore the possible benefits of rifaximin in patients with rosacea and SIBO, Dr. Weinstock added.

The study was supported by a grant from Salix Pharmaceuticals, maker of rifaximin.

NATIONAL HARBOR, MD. – Polyp detection rates were significantly higher among endoscopists who completed a quality-improvement training program, compared with rates of those who did not in a randomized, controlled trial of 15 endoscopists and 2,400 procedures. The findings were presented at the annual meeting of the American College of Gastroenterology.

Adenoma detection rate is a key quality indicator for colonoscopy, and previous studies have shown associations between physicians’ behavior (such as looking behind folds, and the time spent inspecting the colon) and rates of adenoma detection, said Dr. Susan Coe of the Mayo Clinic in Jacksonville, Fla.

However, attempts at improving polyp detection rates, including discussions with low-performing physicians, required withdrawal times, and financial penalties, have proven unsuccessful, she said.

Dr. Coe and her colleagues, including senior investigator Dr. Michael B. Wallace, designed a prospective, randomized educational intervention to determine whether targeted endoscopist training would increase polyp detection rates.

"This is the first study to our knowledge to prospectively show that adenoma detection rate can be significantly improved through an intensive, structured endoscopist training program," Dr. Coe said.

In the first phase of the study, the endoscopists performed 1,200 colonoscopies to determine their baseline detection rates. The average baseline rate was 36% among endoscopists randomized to both the training and non-training groups.

In the second phase of the study, the endoscopists performed another 1,200 colonoscopies after half of them had completed the training program. Among endoscopists in the training group, the average adenoma detection rate increased significantly to 47%, compared to 35% in the non-training group.

The Endoscopic Quality Improvement Program consisted of two 1-hour small group sessions. The first session included literature, photo, and video examples of polyps, explanations of techniques from high-detecting endoscopists, and information about subtle lesions such as flat and serrated polyps.

The second session consisted of a validated surface pattern recognition exercise. The participants in the training program received monthly feedback on their adenoma detection rates, withdrawal times, and group averages after completing the program.

The baseline characteristics of the endoscopists who underwent training and those who did not were similar overall. Median age in the trained and untrained groups was 45 years and 50 years, respectively.

Dr. Coe noted that the findings were limited by the small number of endoscopists and the single setting, but the study is ongoing to see whether the improvements associated with training persist. Larger studies are also planned, she said.

Dr. Coe said she had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Polyp detection rates were significantly higher among endoscopists who completed a quality-improvement training program, compared with rates of those who did not in a randomized, controlled trial of 15 endoscopists and 2,400 procedures. The findings were presented at the annual meeting of the American College of Gastroenterology.

Adenoma detection rate is a key quality indicator for colonoscopy, and previous studies have shown associations between physicians’ behavior (such as looking behind folds, and the time spent inspecting the colon) and rates of adenoma detection, said Dr. Susan Coe of the Mayo Clinic in Jacksonville, Fla.

However, attempts at improving polyp detection rates, including discussions with low-performing physicians, required withdrawal times, and financial penalties, have proven unsuccessful, she said.

Dr. Coe and her colleagues, including senior investigator Dr. Michael B. Wallace, designed a prospective, randomized educational intervention to determine whether targeted endoscopist training would increase polyp detection rates.

"This is the first study to our knowledge to prospectively show that adenoma detection rate can be significantly improved through an intensive, structured endoscopist training program," Dr. Coe said.

In the first phase of the study, the endoscopists performed 1,200 colonoscopies to determine their baseline detection rates. The average baseline rate was 36% among endoscopists randomized to both the training and non-training groups.

In the second phase of the study, the endoscopists performed another 1,200 colonoscopies after half of them had completed the training program. Among endoscopists in the training group, the average adenoma detection rate increased significantly to 47%, compared to 35% in the non-training group.

The Endoscopic Quality Improvement Program consisted of two 1-hour small group sessions. The first session included literature, photo, and video examples of polyps, explanations of techniques from high-detecting endoscopists, and information about subtle lesions such as flat and serrated polyps.

The second session consisted of a validated surface pattern recognition exercise. The participants in the training program received monthly feedback on their adenoma detection rates, withdrawal times, and group averages after completing the program.

The baseline characteristics of the endoscopists who underwent training and those who did not were similar overall. Median age in the trained and untrained groups was 45 years and 50 years, respectively.

Dr. Coe noted that the findings were limited by the small number of endoscopists and the single setting, but the study is ongoing to see whether the improvements associated with training persist. Larger studies are also planned, she said.

Dr. Coe said she had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Polyp detection rates were significantly higher among endoscopists who completed a quality-improvement training program, compared with rates of those who did not in a randomized, controlled trial of 15 endoscopists and 2,400 procedures. The findings were presented at the annual meeting of the American College of Gastroenterology.

Adenoma detection rate is a key quality indicator for colonoscopy, and previous studies have shown associations between physicians’ behavior (such as looking behind folds, and the time spent inspecting the colon) and rates of adenoma detection, said Dr. Susan Coe of the Mayo Clinic in Jacksonville, Fla.

However, attempts at improving polyp detection rates, including discussions with low-performing physicians, required withdrawal times, and financial penalties, have proven unsuccessful, she said.

Dr. Coe and her colleagues, including senior investigator Dr. Michael B. Wallace, designed a prospective, randomized educational intervention to determine whether targeted endoscopist training would increase polyp detection rates.

"This is the first study to our knowledge to prospectively show that adenoma detection rate can be significantly improved through an intensive, structured endoscopist training program," Dr. Coe said.

In the first phase of the study, the endoscopists performed 1,200 colonoscopies to determine their baseline detection rates. The average baseline rate was 36% among endoscopists randomized to both the training and non-training groups.

In the second phase of the study, the endoscopists performed another 1,200 colonoscopies after half of them had completed the training program. Among endoscopists in the training group, the average adenoma detection rate increased significantly to 47%, compared to 35% in the non-training group.

The Endoscopic Quality Improvement Program consisted of two 1-hour small group sessions. The first session included literature, photo, and video examples of polyps, explanations of techniques from high-detecting endoscopists, and information about subtle lesions such as flat and serrated polyps.

The second session consisted of a validated surface pattern recognition exercise. The participants in the training program received monthly feedback on their adenoma detection rates, withdrawal times, and group averages after completing the program.

The baseline characteristics of the endoscopists who underwent training and those who did not were similar overall. Median age in the trained and untrained groups was 45 years and 50 years, respectively.

Dr. Coe noted that the findings were limited by the small number of endoscopists and the single setting, but the study is ongoing to see whether the improvements associated with training persist. Larger studies are also planned, she said.

Dr. Coe said she had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – A screening colonoscopy can provide a convenient opportunity to simultaneously test older adults for hepatitis, based on a study of 500 patients, 75% of whom agreed to blood tests for hepatitis A, B, and C.

Adults aged 50-65 years (the "baby boomers") represent a high-risk population for hepatitis, and hepatitis C in particular, because of possible exposure to high-risk activities in their teens and twenties, said Dr. Dawn Sears of Scott & White Hospital in Temple, Tex. The findings were presented at the annual meeting of the American College of Gastroenterology.

Men make up 70% of chronic hepatitis cases, and they are less likely to see a doctor regularly than women, she noted. "Colorectal cancer screenings are often the only physician encounter for men aged 50 to 60 years," she said.

To increase hepatitis screening in older adults, Dr. Sears and her colleagues tested whether combining hepatitis testing with routine colonoscopy appointments would be effective.

Patients were mailed information about hepatitis along with their instructions for colonoscopy preparation. On the day of their colonoscopies, patients met with a research nurse, signed a consent form, and completed a patient risk form. Blood was drawn for hepatitis screening when the IV was placed prior to the colonoscopy.

A total of 376 of 500 patients (75%) undergoing colonoscopies agreed to hepatitis testing. The study population was 42% male and 58% female. Risk factors in the patients’ histories included high-risk sexual activity, getting a tattoo prior to the year 2000, injecting or snorting drugs, having a blood transfusion before 1992, having a sexual partner with known hepatitis, being a health care worker who had been stuck with a needle, and spending at least 2 days in jail.

None of the patients had hepatitis B surface antigens, and 77% did not have antibodies against hepatitis A and B. Four patients had results suggesting previously undiagnosed hepatitis C, and all four complied with the recommended follow-up polymerase chain reaction (PCR) testing. One patient had a positive PCR follow-up, and that patient is beginning triple therapy, Dr. Sears said. All patients who were found to have hepatitis C antibodies had risk factors for hepatitis C infection, she noted.

"We should ask about risk factors and consider screening for hepatitis B and C," Dr. Sears said. "Gastroenterologists see most baby boomers at least once. We understand the [test] results, and this provides the highest quality, most efficient health care for our patients."

Dr. Sears said she had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – A screening colonoscopy can provide a convenient opportunity to simultaneously test older adults for hepatitis, based on a study of 500 patients, 75% of whom agreed to blood tests for hepatitis A, B, and C.

Adults aged 50-65 years (the "baby boomers") represent a high-risk population for hepatitis, and hepatitis C in particular, because of possible exposure to high-risk activities in their teens and twenties, said Dr. Dawn Sears of Scott & White Hospital in Temple, Tex. The findings were presented at the annual meeting of the American College of Gastroenterology.

Men make up 70% of chronic hepatitis cases, and they are less likely to see a doctor regularly than women, she noted. "Colorectal cancer screenings are often the only physician encounter for men aged 50 to 60 years," she said.

To increase hepatitis screening in older adults, Dr. Sears and her colleagues tested whether combining hepatitis testing with routine colonoscopy appointments would be effective.

Patients were mailed information about hepatitis along with their instructions for colonoscopy preparation. On the day of their colonoscopies, patients met with a research nurse, signed a consent form, and completed a patient risk form. Blood was drawn for hepatitis screening when the IV was placed prior to the colonoscopy.

A total of 376 of 500 patients (75%) undergoing colonoscopies agreed to hepatitis testing. The study population was 42% male and 58% female. Risk factors in the patients’ histories included high-risk sexual activity, getting a tattoo prior to the year 2000, injecting or snorting drugs, having a blood transfusion before 1992, having a sexual partner with known hepatitis, being a health care worker who had been stuck with a needle, and spending at least 2 days in jail.

None of the patients had hepatitis B surface antigens, and 77% did not have antibodies against hepatitis A and B. Four patients had results suggesting previously undiagnosed hepatitis C, and all four complied with the recommended follow-up polymerase chain reaction (PCR) testing. One patient had a positive PCR follow-up, and that patient is beginning triple therapy, Dr. Sears said. All patients who were found to have hepatitis C antibodies had risk factors for hepatitis C infection, she noted.

"We should ask about risk factors and consider screening for hepatitis B and C," Dr. Sears said. "Gastroenterologists see most baby boomers at least once. We understand the [test] results, and this provides the highest quality, most efficient health care for our patients."

Dr. Sears said she had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – A screening colonoscopy can provide a convenient opportunity to simultaneously test older adults for hepatitis, based on a study of 500 patients, 75% of whom agreed to blood tests for hepatitis A, B, and C.

Adults aged 50-65 years (the "baby boomers") represent a high-risk population for hepatitis, and hepatitis C in particular, because of possible exposure to high-risk activities in their teens and twenties, said Dr. Dawn Sears of Scott & White Hospital in Temple, Tex. The findings were presented at the annual meeting of the American College of Gastroenterology.

Men make up 70% of chronic hepatitis cases, and they are less likely to see a doctor regularly than women, she noted. "Colorectal cancer screenings are often the only physician encounter for men aged 50 to 60 years," she said.

To increase hepatitis screening in older adults, Dr. Sears and her colleagues tested whether combining hepatitis testing with routine colonoscopy appointments would be effective.

Patients were mailed information about hepatitis along with their instructions for colonoscopy preparation. On the day of their colonoscopies, patients met with a research nurse, signed a consent form, and completed a patient risk form. Blood was drawn for hepatitis screening when the IV was placed prior to the colonoscopy.

A total of 376 of 500 patients (75%) undergoing colonoscopies agreed to hepatitis testing. The study population was 42% male and 58% female. Risk factors in the patients’ histories included high-risk sexual activity, getting a tattoo prior to the year 2000, injecting or snorting drugs, having a blood transfusion before 1992, having a sexual partner with known hepatitis, being a health care worker who had been stuck with a needle, and spending at least 2 days in jail.

None of the patients had hepatitis B surface antigens, and 77% did not have antibodies against hepatitis A and B. Four patients had results suggesting previously undiagnosed hepatitis C, and all four complied with the recommended follow-up polymerase chain reaction (PCR) testing. One patient had a positive PCR follow-up, and that patient is beginning triple therapy, Dr. Sears said. All patients who were found to have hepatitis C antibodies had risk factors for hepatitis C infection, she noted.

"We should ask about risk factors and consider screening for hepatitis B and C," Dr. Sears said. "Gastroenterologists see most baby boomers at least once. We understand the [test] results, and this provides the highest quality, most efficient health care for our patients."

Dr. Sears said she had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Endoscopists using the water-infusion method of screening colonoscopy found significantly more adenomas if they added indigo dye, compared with the water method alone, a new study has shown.

"Indigo carmine enhances any surface irregularities" when used as part of screening colonoscopies, Dr. Joseph W. Leung said in a late-breaking abstract session at the annual meeting of the American College of Gastroenterology.

Indigo carmine is used to enhance adenoma detection in chromoendoscopy, which is a more cumbersome process than the water method, Dr. Leung said. He and his colleagues conducted a randomized, controlled trial to assess the value of adding indigo carmine to the water method. The protocol was to add 10 mL 0.8% indigo carmine per 1 liter of water (0.008% indigo carmine).

A total of 84 patients were randomized to screening colonoscopies via the water method alone, and another 84 were randomized to the water method with indigo carmine. The mean age of the patients was 58 years, and more than 75% of patients in each group were men. Body mass index and family history of colon cancer were similar in the two groups, but the indigo carmine group included significantly more smokers than the water-method-only group.

Overall, the adenoma detection rate was 62% in the water-plus-indigo carmine group, compared with 44% in the water-only group, and this difference was statistically significant (P = .03). One cancer was detected in each group.

The colonoscopies were performed by two endoscopists who had experience with both methods, noted Dr. Leung of the Sacramento VA Medical Center in Mather, Calif. Patients were blinded as to which procedure they had, and all patients underwent intravenous conscious sedation.

In both groups, air was suctioned out of the rectum when a high-resolution colonoscope was inserted. Water was infused, and any residual stool or cloudiness was suctioned out, followed by another infusion of clear water. "Water infusion and suction was done in rapid sequence," Dr. Leung said.

"Upon seeing the appendix opening under water, water was suctioned and air was insufflated to facilitate inspection on scope withdrawal," he added.

Dr. Leung offered several possible explanations for the increased adenoma detection rate when indigo carmine was added to the water method.

"The water exchange minimizes residual water and allows undistracted examination during withdrawal," he said. The addition of indigo carmine dye enhances the contrast between a lesion and the surrounding mucosa, which improves polyp detection, he noted. Also, the water method offers improved visualization, and the warm water may reduce spasm in the colon, he added.

The study was supported in part by clinical research grants from the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology. Dr. Leung had no personal financial disclosures.

NATIONAL HARBOR, MD. – Endoscopists using the water-infusion method of screening colonoscopy found significantly more adenomas if they added indigo dye, compared with the water method alone, a new study has shown.

"Indigo carmine enhances any surface irregularities" when used as part of screening colonoscopies, Dr. Joseph W. Leung said in a late-breaking abstract session at the annual meeting of the American College of Gastroenterology.

Indigo carmine is used to enhance adenoma detection in chromoendoscopy, which is a more cumbersome process than the water method, Dr. Leung said. He and his colleagues conducted a randomized, controlled trial to assess the value of adding indigo carmine to the water method. The protocol was to add 10 mL 0.8% indigo carmine per 1 liter of water (0.008% indigo carmine).

A total of 84 patients were randomized to screening colonoscopies via the water method alone, and another 84 were randomized to the water method with indigo carmine. The mean age of the patients was 58 years, and more than 75% of patients in each group were men. Body mass index and family history of colon cancer were similar in the two groups, but the indigo carmine group included significantly more smokers than the water-method-only group.

Overall, the adenoma detection rate was 62% in the water-plus-indigo carmine group, compared with 44% in the water-only group, and this difference was statistically significant (P = .03). One cancer was detected in each group.

The colonoscopies were performed by two endoscopists who had experience with both methods, noted Dr. Leung of the Sacramento VA Medical Center in Mather, Calif. Patients were blinded as to which procedure they had, and all patients underwent intravenous conscious sedation.

In both groups, air was suctioned out of the rectum when a high-resolution colonoscope was inserted. Water was infused, and any residual stool or cloudiness was suctioned out, followed by another infusion of clear water. "Water infusion and suction was done in rapid sequence," Dr. Leung said.

"Upon seeing the appendix opening under water, water was suctioned and air was insufflated to facilitate inspection on scope withdrawal," he added.

Dr. Leung offered several possible explanations for the increased adenoma detection rate when indigo carmine was added to the water method.

"The water exchange minimizes residual water and allows undistracted examination during withdrawal," he said. The addition of indigo carmine dye enhances the contrast between a lesion and the surrounding mucosa, which improves polyp detection, he noted. Also, the water method offers improved visualization, and the warm water may reduce spasm in the colon, he added.

The study was supported in part by clinical research grants from the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology. Dr. Leung had no personal financial disclosures.

NATIONAL HARBOR, MD. – Endoscopists using the water-infusion method of screening colonoscopy found significantly more adenomas if they added indigo dye, compared with the water method alone, a new study has shown.

"Indigo carmine enhances any surface irregularities" when used as part of screening colonoscopies, Dr. Joseph W. Leung said in a late-breaking abstract session at the annual meeting of the American College of Gastroenterology.

Indigo carmine is used to enhance adenoma detection in chromoendoscopy, which is a more cumbersome process than the water method, Dr. Leung said. He and his colleagues conducted a randomized, controlled trial to assess the value of adding indigo carmine to the water method. The protocol was to add 10 mL 0.8% indigo carmine per 1 liter of water (0.008% indigo carmine).

A total of 84 patients were randomized to screening colonoscopies via the water method alone, and another 84 were randomized to the water method with indigo carmine. The mean age of the patients was 58 years, and more than 75% of patients in each group were men. Body mass index and family history of colon cancer were similar in the two groups, but the indigo carmine group included significantly more smokers than the water-method-only group.

Overall, the adenoma detection rate was 62% in the water-plus-indigo carmine group, compared with 44% in the water-only group, and this difference was statistically significant (P = .03). One cancer was detected in each group.

The colonoscopies were performed by two endoscopists who had experience with both methods, noted Dr. Leung of the Sacramento VA Medical Center in Mather, Calif. Patients were blinded as to which procedure they had, and all patients underwent intravenous conscious sedation.

In both groups, air was suctioned out of the rectum when a high-resolution colonoscope was inserted. Water was infused, and any residual stool or cloudiness was suctioned out, followed by another infusion of clear water. "Water infusion and suction was done in rapid sequence," Dr. Leung said.

"Upon seeing the appendix opening under water, water was suctioned and air was insufflated to facilitate inspection on scope withdrawal," he added.

Dr. Leung offered several possible explanations for the increased adenoma detection rate when indigo carmine was added to the water method.

"The water exchange minimizes residual water and allows undistracted examination during withdrawal," he said. The addition of indigo carmine dye enhances the contrast between a lesion and the surrounding mucosa, which improves polyp detection, he noted. Also, the water method offers improved visualization, and the warm water may reduce spasm in the colon, he added.

The study was supported in part by clinical research grants from the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology. Dr. Leung had no personal financial disclosures.