1978 —
35th Anniversary — 2013
gastroendonews.com
The Independent Monthly Newspaper for Gastroenterologists
DDW 2013
Endoscopy Spares Some From PPIs BY TED BOSWORTH ORLANDO, FLA.—Data on two endoscopic procedures for treating gastroesophageal reflux disease (GERD) show that the procedures are capable of eliminating, or greatly reducing, dependence on proton pump inhibitor (PPI) therapy. Findings were presented at the 2013 Digestive Disease Week meeting. see Antireflux Procedures, page 16
For IBD, ‘Decade of Immunomonitoring’ BY DAVID WILD ORLANDO, FLA.—An increasing number of studies indicate that a triad of measurable variables—including serum drug levels, levels of antibodies to certain drugs and mucosal healing—can help clinicians optimize the safety and efficacy of biologic treatments in patients with inflammatory bowel disease (IBD). see Immunomonitoring, page 13
Prevalence of Celiac Disease Not Reflected in Diagnosis Rate BY MONICA J. SMITH NEW YORK K—Despite a reputation for rampant medical testing in the United States, the diagnosis rate for celiac disease is far lower than the disease’s estimated prevalence. “The fact of the matter is that most U.S. patients with celiac disease are undiagnosed,” said Benjamin Lebwohl, MD, MS, who spoke on the topic at the Intestinal Immune-Based Inflammatory Diseases Symposium, held at Columbia University Medical Center, New York City, in March. “We know from multiple seroprevalence studies that 0.7% to 1% of individuals in this country have celiac disease. Yet, from the studies that also ask patients, ‘do you have a diagnosis of celiac disease,’ the majority was not diagnosed.” Dr. Lebwohl, who is assistant professor of clinical medicine and epidemiology at the Celiac Disease Center, Columbia University, New York City, discussed
several aspects surrounding celiac disease that he and his colleagues have been studying that may shed some light on why some diagnoses are missed.
Falling Short on Biopsy Specimens The diagnosis of celiac disease requires an see Diagnosis, page 10
I N S I D E
Patient Satisfaction and Loyalty Key To Maintaining Competitive Practice
EXPERTS’ PICKS The Best of Digestive Disease Week (DDW): Part 3 Experts share their favorite abstracts from the 2013 DDW meeting .............................................................................................. page 20
BY MONICA J. SMITH BOSTON—At this year’s annual GI Roundtable meeting, held in Boston in March, approximately 250 gastroenterologists, gastroenterology nurses and practice managers gathered to explore issues surrounding health care reform and the future of gastroenterology. The meeting’s roster included a bevy of speakers, but a talk that seemed especially
Ronnie Fass, MD
Benjamin Lebwohl, MD, MS
Randy S. Longman, MD, PhD
see Patient Satisfaction, page 30 PRINTER-FRIENDLY VERSION AVAILABLE AT WEBSITE.COM
Endoscopic Eradication Therapy for
CLINICAL REVIEW
Barrett’s Esophagus SHREYAS SALIGRAM MD, MRCPA,B (1, 2) PRASHANTH VENNALAGANTI MDA (1) PRATEEK SHARMA MDA,B (1, 2)
see insert between pages 18 and 19
a
Department of Veterans Affairs Medical Center Kansas City, Kansas b University of Kansas School of Medicine Kansas City, Kansas
B
arrett’s esophagus is the precursor lesion to esophageal
Endoscopic Eradicationn Therapy in Barrett’s Esophagus
adenocarcinoma, which if diagnosed at an invasive stage is associated with
a significant morbidity and mortality. Surgery was the mainstay of treatment
for patients with Barrett’s associated high grade dysplasia and adenocarcinoma; however, surgery in itself carries significant morbidity. There has been tremendous progress in the minimally invasive treatment of Barrett’s esophagus in the last decade.
By Shreyas Saligram, MD, MRCP, Prashanth Vennalaganti, MD, and Prateek Sharma, MD
The premise to be aggressive in treating high grade dysplastic Barrett’s esophagus and early stage of adenocarcinoma is to prevent progression to advanced stage of cancer. Most interventional endoscopists are comfortable in treating high grade dysplasia and intra-mucosal esophageal cancer. Recently there has been emerging data in treating early sub-mucosal cancer in Barrett’s esophagus at one end and low grade dysplasia at the other. New techniques in treating Barrett’s esophagus are constantly evolving with renewed interest in arresting the slide of the fastest growing cancer in the western world. The aim of this article is to review the different modes and strategies on endoscopic treatment of Barrett’s esophagus with emphasis on newer techniques.
Introduction Barrett’s esophagus is defined as displacement of squamocolumnar junction by intestinal metaplasia (goblet cells) proximal to gastro esophageal junction.
The overall population prevalence is estimated at 1.6% 1 with an annual incidence of 62 per100,000. 2 In patients with Barrett’s esophagus, the annual incidence of esophageal adenocarcinoma is reported to be between 0.12 and 0.5%. 3-6 Intestinal metaplasia can have a histological transformation from no dysplasia to low grade dysplasia (LGD), high grade dysplasia (HGD) and eventually to esophageal adenocarcinoma. 7Patients with HGD have the highest tendency to progress to esophageal adenocarcinoma. Therefore, endoscopic eradication therapy is increasingly used to treat HGD and early esophageal adenocarcinoma to decrease the progression to invasive disease. The data extraction from national cancer institute’s surveillance, epidemiology, and end results suggested a six fold increase in incidence of esophageal adenocarcinoma in 2001 and is considered as the fastest rising cancer in USA. 8 The aim of this article is to review the current modalities of endoscopic eradication
G AST R O E N T E R O LO GY & E N D O S CO PY N E WS • S E P T E M B E R 2 0 1 3
1