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March 2020 Volume 14 / Number 3

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March 2020 Volume 14 / Number 3 mdedge.com/gihepnews March 2020 Volume 14 / Number 3 INSIDE GALAD score FROM THE AGA JOURNALS predicts USMSTF publishes polypectomy guidance Recommendations aim to NASH-HCC improve complete endoscopic resection More than a year in advance rates. • 6 ENTER C BY WILL PASS sensitivity of ultrasound, Task force on CRC MDedge News reported lead author Jan EDICAL updates colonoscopy M Best, MD, of the University follow-up guidance INAI or patients with Hospital Magdeburg (Ger- -S Few, small adenomas can nonalcoholic steato- many), and colleagues. be treated like none. • 7 EDARS C Fhepatitis (NASH), the “The limitations of ul- Dr. Gil Y. Melmed reported on a quality improvement initiative that GALAD score may accu- trasound surveillance LIVER DISEASE also reduced hospitalizations and opioid use. rately predict hepatocel- alone for early detection Serum keratin 18 lular carcinoma (HCC) as of HCC are particularly early as 560 days before evident in patients with shows injury in AAH IBD quality initiative diagnosis, according to in- NASH,” the investigators Biomarker outperforms vestigators. wrote in Clinical Gastroen- MELD, other measures. The GALAD score, terology and Hepatology. • 18 slashes ED utilization which combines sex, age, “Serum-based biomarkers PRACTICE alpha-fetoprotein-L3 might be more effective, BY RICHARD MARK KIRKNER ment visit rates decline from (AFP-L3), alpha-fetopro- with or without ultra- MANAGEMENT MDedge News 18% to 14%, a 22% relative tein, and des-gamma-car- sound surveillance, for Toolbox: E/M changes decrease, Gil Y. Melmed, MD, boxyprothrombin (DCP), HCC surveillance in NASH coming for 2021 REPORTING FROM CROHN’S & COLITIS CONGRESS AGAF, of Cedars-Sinai Medi- could improve cancer sur- patients, although data in AGA outlines the coding cal Center, Los Angeles, said. veillance among NASH pa- this patient population are updates. • 21 AUSTIN, TEX. – A quality Additionally, the study doc- tients whose obesity limits See NASH-HCC · page 3 improvement initiative aimed umented a similar decrease in the rate of hospitalization, bowel disease (IBD) has re- declining from 14% to 11%, IBD: Inpatient opioids linked ducedat patients emergency with inflammatory department while narcotic utilization visits and hospitalizations by rates declined from 8% to with outpatient use by IBD patients 20% or more and slashed opi- 4%. “We also found decreases oid use by half, according to in special-cause variation in BY WILL PASS rospective analysis of more en’s Hospital, Boston, and study results presented at the other measures of interest, MDedge News than 800 patients. colleagues. Crohn’s & Colitis Congress®, including CT scan utilization Awareness of this “Recent evidence has a partnership of the Crohn’s as well as corticosteroid use, - dose-dependent relation- demonstrated that opi- & Colitis Foundation and the which was reduced 29% Pmatory bowel disease ship and IBD-related risks of oid use is associated with American Gastroenterological during the course of the pro- (IBD)atients who withreceive inflam opioids opioid use should encourage severe infections and in- Association. gram,” he said. while hospitalized are physicians to consider alter- creased mortality among After 15 months, the qual- The quality initiative three times as likely to be native analgesics, according IBD patients,” the inves- ity improvement program was conducted through prescribed opioids after to lead author Rahul S. Dalal, tigators wrote in Clinical showed emergency depart- See Quality · page 13 discharge, based on a ret- MD, of Brigham and Wom- See Opioids · page 13 Register by March 18 and save at least $85. AASLD, AGA, ASGE and SSAT Jan. 15, 2020 members-only registration opens. May 2–5, 2020 Exhibit Dates: May 3–5 Jan. 22, 2020 General registration opens. McCormick Place Register online at www.ddw.org/registration Chicago, IL www.ddw.org Rosemont, IL 60018 IL Rosemont, PERMIT 500 PERMIT Suite 280 Suite HARRISBURG PA HARRISBURG PAID 10255 W Higgins Road, Road, Higgins W 10255 U.S. POSTAGE U.S. GI & Hepatology News Hepatology & GI PRSRT STD PRSRT CHANGE SERVICE REQUESTED SERVICE CHANGE 01_3_4_5_11_12_13_GIHEP20_3.indd 1 2/21/20 3:15 PM NEWS LETTER FROM THE EDITOR: Crohn’s & Colitis Congress has passed, DDW ahead Quick quiz guidance. In our practice manage- Q1. A 45-year-old man has monitoring of the ALT and HBV n late January, the Crohn’s & Coli- ment section, we provide a step-by- recently been diagnosed with DNA. tis Foundation teamed with AGA step guide to changes in evaluation leukemia. The chemotherapeutic to present the Crohn’s & Colitis and management (E/M) coding regimen will include rituximab Q2. An 18-year-old woman I ® Congress in Austin, Tex. Each year, – these changes are the most im- and high-dose steroids. He is presents for evaluation of chronic this is the premier gath- pactful since the Medicare a former IV drug user but has diarrhea, fatigue, and abdominal ering for IBD experts and E/M documentation speci- been sober for 20 years. His lab cramping. She was recently in the rest of us to catch work is as follows: ALT 25 U/L, Puerto Rico for 6 months visiting up on the substantial We have 2 months left HAV total antibody positive, HBs family and returned a few weeks progress we are making beforefications Digestive first appeared. Disease antibody positive, HBs antigen in treating patients with Week® (DDW). Each negative, HBc total positive, HCV a hemoglobin of 11 g/L with an IBD. This month, we year, DDW marks the antibody positive, HCV RNA un- MCVago. Her of 109 labs fL. are Her significant albumin foris 3.6 highlight a number of ar- end of our AGA Institute detected. g/dL. She had stool studies which ticles from the Congress, President’s term and the ruled out infection, including including results show- beginning of another’s Which of the following is true? parasites. TtG IgA and total IgA ing how a focused IBD Dr. Allen epoch. Hashem B. El-Se- A. The patient is at risk of HCV were within normal limits. EGD quality initiative reduced rag will pass the gavel to reactivation because of prior with multiple duodenal biopsies emergency department visits, an Bishr Omary – both great friends exposure. showed villous blunting with article about the effects of IBD on and great gastroenterologists. I B. The patient should receive increased intraepithelial lympho- fertility, and the link between stress am happy to see that Gail Hecht prophylaxis against HBV re- cytes. follows me as this year’s AGA Ju- verse seroconversion through these articles are worth reading, lius Friedenwald Medal recipient his chemotherapy. What is the preferred treatment sinceand ulcerative they can helpcolitis our flares. care All of pa-of (AGA’s highest honor). She, too, is C. The patient should receive pro- for this patient? tients. On agau.gastro.org, you can a great friend and role model for phylaxis against HBV reverse A. Gluten-free diet access slides from the Congress. me and many others. DDW returns seroconversion through his B. Ceftriaxone IV followed by Bac- Several more articles deserve to Chicago in early May, and once chemotherapy and for 12-18 trim PO mention. Three articles from the again will be the world’s best gath- months afterward. C. Low FODMAP diet AGA journals highlight new infor- ering of physicians and scientists D. The HBV reactivation is not a D. Tetracycline and folic acid mation about colorectal cancer pre- dedicated to digestive diseases. concern in this patient. E. Rifaxmin vention and the U.S. Multi-Society E. A watchful waiting approach Task Force on Colorectal Cancer John I. Allen, MD, MBA, AGAF is reasonable with q 3-month The answers are on page 6. has updated colonoscopy follow-up Editor in Chief mdedge.com/gihepnews EDITOR IN CHIEF, GI & HEPATOLOGY NEWS GI & HEPATOLOGY NEWS is the official newspaper of the American FRONTLINE MEDICAL COMMUNICATIONS SOCIETY PARTNERS John I. Allen, MD, MBA, AGAF Gastroenterological Association (AGA) Institute and provides the Executive Editor Kathy Scarbeck EDITOR IN CHIEF, THE NEW GASTROENTEROLOGIST gastroenterologist with timely and relevant news and commentary about Editor Lora T. McGlade Vijaya L. Rao, MD clinical developments and about the impact of health care policy. Content for Creative Director Louise A. Koenig ASSOCIATE EDITORS GI & HEPATOLOGY NEWS is developed through a partnership of the newspaper’s Megan A. Adams, MD, JD, MSc medical board of editors (Editor in Chief and Associate Editors), Frontline Director, Production/Manufacturing Rebecca Slebodnik Ziad Gellad, MD, MPH, AGAF Medical Communications Inc. and the AGA Institute Staff. “News from the National Account Manager Artie Krivopal, 973-290-8218, Kim L. Isaacs, MD, PhD, AGAF AGA” is provided exclusively by the AGA, AGA Institute, and AGA Research cell 973-202-5402, [email protected] Gyanprakash A. Ketwaroo, MD, MSc Foundation. All content is reviewed by the medical board of editors for Digital Account Manager Rey Valdivia, 973-206-8094, Larry R. Kosinski, MD, MBA, AGAF accuracy, timeliness, and pertinence. To add clarity and context to important [email protected] Sonia S. Kupfer, MD developments in the field, select content is reviewed by and commented on by Wajahat Mehal, MD, PhD external experts selected by the board of editors. Senior Director of Classified Sales Tim LaPella, 484-921-5001, [email protected] The ideas and opinions expressed in GI & HEPATOLOGY NEWS do not EDITORS EMERITUS, GI & HEPATOLOGY NEWS necessarily reflect those of the AGA Institute or the Publisher. The AGA Advertising Offices 7 Century Drive, Suite 302, Parsippany, Colin W. Howden, MD, AGAF Institute and Frontline Medical Communications Inc. will not assume NJ 07054-4609 973-206-3434, fax 973-206-9378 Charles J. Lightdale, MD, AGAF responsibility for damages, loss, or claims of any kind arising from or related Editorial Offices 2275 Research Blvd, Suite 400, Rockville, MD 20850, EDITOR EMERITUS, THE NEW GASTROENTEROLOGIST Bryson Katona, MD, PhD to the information contained in this publication, including any claims related 240-221-2400, fax 240-221-2548 to the products, drugs, or services mentioned herein.
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