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Incorporating Psych Care in Management of Chronic Digestive VOL. 12 NO. 4 APRIL 2018 ® Incorporating psych INSIDE NEWS care in management Commentary Some AGA wins in Congressional of chronic digestive budget. • 5 FROM THE AGA IEGEL diseases JOURNALS A. S Opioids linked to BY CHHAVI JAIN of patients across the spec- OREY mortality in IBD . C Frontline Medical News trum of disease to brain-gut R Prescriptions for opioids D psychotherapies is crucial. sychogastroenterol- In a review by Laurie have increased in the OURTESY past 20 years. • 9 C ogy is the science of Keefer, PhD and her co- Disease severity indexes were created for each severity attribute on Papplying psychological authors, published in the a 100-point scale, reported Dr. Corey A. Siegel. principles and techniques April issue of Gastroenter- IBD AND INTESTINAL to alleviate the burden of ology, provided a clinical DISORDERS chronic digestive diseases. update on the structure Tofacitinib approved New study establishes This burden includes diges- and efficacy of two major for UC tive symptoms and disease classes of psychogastro- FDA panel adds severity, as well as patients’ enterology – cognitive- indication. • 21 IBD severity index ability to cope with them. behavioral therapy (CBT) Chronic digestive diseases, and gut-directed hyp- BY MADHU RAJARAMAN ysis found that, in Crohn’s such as irritable bowel syn- notherapy (HYP). The ENDOSCOPY Frontline Medical News disease, mucosal lesions, drome, gastroesophageal review discussed the Nonendoscopic fistulas, and abscesses were reflux disease, and inflam- effects of these therapies nonmalignant polyp xperts have established the greatest contributors to matory bowel diseases, can- on GI symptoms and the surgery up a severity index for disease severity at 15.8%, not be disentangled from patients’ ability to im- This procedure is not Einflammatory bowel 10.9%, and 9.7%, respec- their psychosocial context. prove coping, resilience, recommended, disease (IBD), according tively. In ulcerative colitis, In this regard, the role of and self-regulation. The however. • 24 to results of an analysis 18.1% of disease severity gastroenterologists in pro- review also provided a published in the journal was attributed to mucosal moting best practices for framework to understand Gut (doi: 10.1136/gut- lesions, 14% to impact on the assessment and referral See Psych care · page 21 jnl-2016-312648). daily activities, and 11.2% The index, conceived by a to C-reactive protein, wrote panel of IBD specialists from Corey A. Siegel, MD, MS, of NASH rapidly overtaking hepatitis C the International Organiza- the Dartmouth-Hitchcock tion for the Study of Inflam- Medical Center in Lebanon, matory Bowel Diseases, is a N.H., and his coauthors. as cause of liver cancer step toward the standardiza- Investigators used a BY BIANCA NOGRADY cancer in the United States. Journal of Clinical and Ex- tion of disease severity defi- PubMed literature search to Frontline Medical News Researchers reported perimental Hepatology. nitions in ulcerative colitis identify three broad elements on their analysis of past The analysis, based on and Crohn’s disease. of disease severity: impact of onalcoholic steatohep- prevalence of HCV, NASH, data from the National The panel determined disease symptoms on daily Natitis (NASH) is rapidly and alcoholic cirrhosis and Health and Nutrition Ex- 16 severity attributes for activities, inflammatory bur- eclipsing hepatitis C virus prediction of future trends amination Survey and the Crohn’s disease and 13 for den, and disease course. (HCV) infection as the and their effect on hepato- Organ Procurement and ulcerative colitis. The anal- See Index · page 20 leading contributor to liver cellular carcinoma in the See NASH · page 22 2018 AGA Saturday, June 2, 2018 8:15 a.m.–5:30 p.m. Sunday, June 3, 2018 8:30 a.m.–12:35 p.m. Learn more at pgcourse.gastro.org. FROM ABSTRACT TO REALITY Plainview, NY 11803-1709 NY Plainview, A PROGRAM OF THE AGA INSTITUTERegister by April 18, 2018, and save $75 . Lebanon Jct. KY Jct. Lebanon Suite 2, 2, Suite Permit No. 384 No. Permit PAID 151 Fairchild Ave., Ave., Fairchild 151 U.S. Postage U.S. Presorted Standard Presorted CHANGE SERVICE REQUESTED SERVICE CHANGE 2200-080EDU_17-20 GI & Hepatology News Hepatology & GI POSTGRADUATE COURSE 2 NEWS APRIL 2018 • GI & HEPATOLOGY NEWS LETTER FROM THE EDITOR: Hope, hepatology, and social determinants of health elcome to the April edition effectiveness of new IBD drugs. You Economic pressures are leading to massive consolidations of GI & Hepatology News. can also read about incorporating WApril has always been a psychological care in the manage- within the health care delivery system. month in which we have a sense ment of chronic diseases – a topic of renewal and becoming more important as we 340-B funding, continued transition integrations now have supplanted hope. For those expand our focus beyond just the from commercial to government horizontal integrations as the indus- of us living in biology of disease and into social payers, a tightening labor market, try trend. This situation will affect northern climes, determinants of health as we con- and relentless increases in overhead many of our independent gastroen- both the dis- tinue our transition to value-based expenses, all combine to reduce terology practices as demand-side tinct change in reimbursement. Another topic financial margins of both academic management by large national cor- daylight and the included this month (and to which and nonacademic health systems. porations increases. melting of the several DDW sessions are dedicat- Economic pressures are leading to snow (finally) ed) is the devastating impact of opi- massive consolidations within the John I. Allen, MD, MBA, AGAF both lift us from ates on our patients. health care delivery system. Vertical Editor in Chief the doldrums DR. ALLEN We have included a number of of winter dark- hepatology articles this month, DATA WATCH ness. such as the front-page story on In just over 2 months, we will NASH and its relationship with Prevalence of chronic conditions by IBD status gather in Washington for Digestive hepatocellular cancer. Pioglitazone Disease Week.® I have seen a pre- benefits NASH patients with and view of AGA plenary sessions (basic without type 2 diabetes, and bio- Arthritis science and clinical). They will be markers may predict liver trans- terrific. We will hear about advanc- plant failures. There are selected Respiratory disease es in areas such as the microbiome, articles about Barrett’s esophagus IBD-related inflammatory path- progression and risk stratification Ulcer ways, new insights into functional for colorectal cancer. bowel disorders, and a myriad of From Washington, we have re- Cardiovascular disease new therapeutics (both medical ceived some good news. Please see Adults with IBD and device) for us to share with our the AGA commentary on the pro- Cancer patients. posed budget. We were reminded Adults without IBD In this month’s issue, we touch recently about how federal politics Diabetes* on themes that will carry into DDW. can impact U.S. medicine. With EWS Substantial work is being done to the (very late) reauthorization of 0 5% 10% 15% 20% 25% 30% 35% 40% N better define an IBD severity index. the Children’s Health Insurance EDICAL *Difference is not signicant These metrics are of critical impor- Plan (CHIP), we saw how political M Note: Based on data from the National Health Interview Survey, 2015 and 2016. tance for clinical researchers to use dysfunction can impact millions of Source: MMWR. 2018;67(6):190-5 RONTLINE as we investigate the efficacy and American family’s lives. Changes in F EDITOR IN CHIEF GI & HEPATOLOGY NEWS is the ofcial newspaper of the American FRONTLINE MEDICAL COMMUNICATIONS SOCIETY PARTNERS John I. Allen, MD, MBA, AGAF Gastroenterological Association (AGA) Institute and provides the VP/Group Publisher; Director, FMC Society Partners Mark Branca ASSOCIATE EDITORS gastroenterologist with timely and relevant news and commentary about Editor in Chief Mary Jo M. Dales clinical developments and about the impact of health care policy. Content for Megan A. Adams, MD, JD, MSc Executive Editors Denise Fulton, Kathy Scarbeck GI & HEPATOLOGY NEWS is developed through a partnership of the newspaper’s Editor Lora T. McGlade Ziad Gellad, MD, MPH, AGAF medical board of editors (Editor in Chief and Associate Editors), Frontline Kim L. Isaacs, MD, PhD, AGAF Creative Director Louise A. Koenig Medical Communications Inc. and the AGA Institute Staff. “News from the Bryson Katona, MD, PhD AGA” is provided exclusively by the AGA, AGA Institute, and AGA Research Director, Production/Manufacturing Rebecca Slebodnik Gyanprakash A. Ketwaroo, MD, MSc Foundation. All content is reviewed by the medical board of editors for National Account Manager Artie Krivopal, 973-206-2326, Larry R. Kosinski, MD, MBA, AGAF accuracy, timeliness, and pertinence. To add clarity and context to important cell 973-202-5402, [email protected] Sonia S. Kupfer, MD developments in the eld, select content is reviewed by and commented on by Digital Account Manager Rey Valdivia, 973-206-8094, Wajahat Mehal, MD, PhD external experts selected by the board of editors. [email protected] Senior Director of Classied Sales Tim LaPella, 484-921-5001, [email protected] EDITORS EMERITUS The ideas and opinions expressed in GI & HEPATOLOGY NEWS do not Colin W. Howden, MD, AGAF necessarily reect those of the AGA Institute or the Publisher. The AGA Advertising Ofces 7 Century Drive, Suite 302, Parsippany, NJ 07054-4609 973-206-3434, fax 973-206-9378 Charles J. Lightdale, MD, AGAF Institute and Frontline Medical Communications Inc. will not assume MEDICAL COMMUNICATIONS AGA INSTITUTE STAFF responsibility for damages, loss, or claims of any kind arising from or related FRONTLINE to the information contained in this publication, including any claims related GI & HEPATOLOGY NEWS, Vice President, Marketing & Customer Managing Editor, Brook A. 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