CME Exam 1: Is it a Tumor or a Polyp? A Rare Cause of Adult Ileocecal Intussusception
(Source: Gastroenterology)
Source: Gastroenterology - July 20, 2019 Category: Gastroenterology Tags: Continuing Medical Education (CME)/MOC Activity Source Type: research

CME Exam 2: An 8-Year History of Increased Level of Aspartate Aminotransferase
(Source: Gastroenterology)
Source: Gastroenterology - July 20, 2019 Category: Gastroenterology Tags: Continuing Medical Education (CME)/MOC Activity Source Type: research

CME Exam 3: Model to Calculate Harms and Benefits of Early vs Delayed Liver Transplantation for Patients With Alcohol-Associated Hepatitis
(Source: Gastroenterology)
Source: Gastroenterology - July 20, 2019 Category: Gastroenterology Tags: Continuing Medical Education (CME)/MOC Activity Source Type: research

Cover 1
(Source: Gastroenterology)
Source: Gastroenterology - July 20, 2019 Category: Gastroenterology Source Type: research

Editorial Board
(Source: Gastroenterology)
Source: Gastroenterology - July 20, 2019 Category: Gastroenterology Source Type: research

Table of Contents
(Source: Gastroenterology)
Source: Gastroenterology - July 20, 2019 Category: Gastroenterology Source Type: research

Elsewhere in The AGA Journals
(Source: Gastroenterology)
Source: Gastroenterology - July 20, 2019 Category: Gastroenterology Source Type: research

Information for Authors and Readers
Gastroenterology is the premiere journal in the  field of gastrointestinal disease and is led by an internationally renowned board of editors. As the official journal of the AGA Institute, Gastroenterology delivers up-to-date and authoritative coverage of both basic and clinical gastroenterology and hepatology. Regular features include research and perspectives by leading authorities, reports on the latest technologies for diagnosing and treating digestive diseases, images illustrating important clinical findings, reviews of scholarly media, medical news, meeting summaries, video abstracts, and mon...
Source: Gastroenterology - July 20, 2019 Category: Gastroenterology Source Type: research

Emergencies in an advanced stage Parkinson ’s disease patient
(Source: Gastroenterology)
Source: Gastroenterology - July 18, 2019 Category: Gastroenterology Authors: Konstantinos A. Boulas, Aikaterini Paraskeva, A. Hatzigeorgiadis Source Type: research

An Unusual Case of Esophagitis
(Source: Gastroenterology)
Source: Gastroenterology - July 18, 2019 Category: Gastroenterology Authors: Erick A. Argueta, Jason Pan, Sean Fine Source Type: research

Metabolic Functions of Gut Microbes Associate With Efficacy of Tumor Necrosis Factor Antagonists in Patients with Inflammatory Bowel Diseases
Altered interactions between the mucosal immune system and intestinal microbiota contribute to pathogenesis of inflammatory bowel diseases (IBD). It is not clear how inhibitors of cytokines, such as antagonists of tumor necrosis factor (anti-TNF), affect the intestinal microbiome. We investigated the effects of anti-TNF agents on gut microbe community structure and function in a longitudinal 2-step study of patients with IBD. We correlated our findings with outcomes of treatment and investigated patterns of metabolites in fecal samples before and after anti-TNF therapy. (Source: Gastroenterology)
Source: Gastroenterology - July 18, 2019 Category: Gastroenterology Authors: Konrad Aden, Ateequr Rehman, Silvio Waschina, Wei-Hung Pan, Alesia Walker, Marianna Lucio, Alejandro Mena Nunez, Richa Bharti, Johannes Zimmerman, Johannes Bethge, Berenice Schulte, Dominik Schulte, Andre Franke, Susanna Nikolaus, Johann Oltmann Schroeder Source Type: research

Epithelial IDO1 Modulates AHR and Notch Signaling to Increase Differentiation of Secretory Cells and Alter Mucus-Associated Microbiota
Inflammation, injury, and infection upregulate expression of the tryptophan metabolizing enzyme indoleamine 2,3-dioxygenase 1 (IDO1) in the intestinal epithelium. We studied the effects of cell-specific IDO1 expression in the epithelium at baseline and during intestinal inflammation in mice. (Source: Gastroenterology)
Source: Gastroenterology - July 17, 2019 Category: Gastroenterology Authors: David M. Alvarado, Baosheng Chen, Micah Iticovici, Ameet I. Thaker, Nattalie Dai, Kelli L. VanDussen, Nurmohammad Shaikh, Chai K. Lim, Gilles J. Guillemin, Phillip I. Tarr, Matthew A. Ciorba Source Type: research

Irritable Bowel Syndrome in Adults (IBS-D)
(Source: Gastroenterology)
Source: Gastroenterology - July 16, 2019 Category: Gastroenterology Authors: American Gastroenterological Association Tags: AGA Section Source Type: research

Cachexia, Colitis, and Cancer
(Source: Gastroenterology)
Source: Gastroenterology - July 16, 2019 Category: Gastroenterology Authors: Arjun R. Sondhi, Luke J. Nayak, Jonathan Mowers Source Type: research

Terminology, Molecular Features, Epidemiology, and Management of Serrated Colorectal Neoplasia
In addition to the adenoma to carcinoma sequence, colorectal carcinogenesis can occur via the serrated pathway. Studies have focused on clarification of categories and molecular features of serrated polyps, as well as endoscopic detection and risk assessment. Guidelines from the World Health Organization propose assigning serrated polyps to categories of hyperplastic polyps, traditional serrated adenomas (TSAs), and sessile serrated lesions (SSLs). TSAs and SSLs are precursors to colorectal cancer. (Source: Gastroenterology)
Source: Gastroenterology - July 16, 2019 Category: Gastroenterology Authors: Seth D. Crockett, Iris Nagtegaal Source Type: research

Canadian Association of Gastroenterology Clinical Practice Guideline for the Medical Management of Pediatric Luminal Crohn's Disease
We aim to provide guidance for medical treatment of luminal Crohn ’s disease in children. (Source: Gastroenterology)
Source: Gastroenterology - July 15, 2019 Category: Gastroenterology Authors: David R. Mack, Eric I. Benchimol, Jeff Critch, Jennifer deBruyn, Frances Tse, Paul Moayyedi, Peter Church, Colette Deslandres, Wael El-Matary, Hien Huynh, Pr évost Jantchou, Sally Lawrence, Anthony Otley, Mary Sherlock, Thomas Walters, Michael D. Kappel Tags: Clinical Practice Guideline Source Type: research

Elevated liver enzymes in a young man with hyperlipidemia
(Source: Gastroenterology)
Source: Gastroenterology - July 15, 2019 Category: Gastroenterology Authors: Benjamin Schmidt, Steven Scaglione, Xianzhong Ding Source Type: research

An uncommon category of polyp lesion in a Western colon
(Source: Gastroenterology)
Source: Gastroenterology - July 15, 2019 Category: Gastroenterology Authors: Vincent Zimmer, Christoph Heinrich Source Type: research

A Rare Case of Dysphagia
(Source: Gastroenterology)
Source: Gastroenterology - July 15, 2019 Category: Gastroenterology Authors: De-feng Li, Ding-guo Zhang, Jun Yao Source Type: research

Overeating and a Wandering Spleen. What is the Link?
(Source: Gastroenterology)
Source: Gastroenterology - July 15, 2019 Category: Gastroenterology Authors: H.D. De ’Ath, J.J. Kelly Source Type: research

Verrucous Plaques of the Buttocks, Perineum, and Umbilicus
(Source: Gastroenterology)
Source: Gastroenterology - July 13, 2019 Category: Gastroenterology Authors: Julie M. Bittar, Kyle Burton, Sahand Rahnama Source Type: research

Case: The little beast that pretended to be a severe Crohn's disease
(Source: Gastroenterology)
Source: Gastroenterology - July 13, 2019 Category: Gastroenterology Authors: Antoine Debourdeau, Lucille Boivineau, Sarah Iltache Source Type: research

Reply to “Tobacco smoking and alcohol drinking: two clinically significant risk factors for esophageal squamous cell carcinoma”
(Source: Gastroenterology)
Source: Gastroenterology - July 13, 2019 Category: Gastroenterology Authors: Mahdi Sheikh, Paul Brennan, Reza Malekzadeh Source Type: research

Phosphodiesterase-5 inhibitors and colorectal cancer: A new frontier for prevention?
(Source: Gastroenterology)
Source: Gastroenterology - July 13, 2019 Category: Gastroenterology Authors: Manol Jovani, Andrew T. Chan Source Type: research

In reply to GASTRO-D-18-02777
(Source: Gastroenterology)
Source: Gastroenterology - July 12, 2019 Category: Gastroenterology Authors: Yingchang Lu, Wei Zheng Source Type: research

The transplantation of fecal microbiota for cirrhotic patients
(Source: Gastroenterology)
Source: Gastroenterology - July 12, 2019 Category: Gastroenterology Authors: Gin-Ho Lo Source Type: research

Reply to LTE-19-00260: Improving Clinical Trial Efficiency
(Source: Gastroenterology)
Source: Gastroenterology - July 12, 2019 Category: Gastroenterology Authors: M. Scott Harris, Colin W. Howden Source Type: research

Reply to “Historical Data are not relevant to the diagnostic performance of ultrasound in HCC surveillance”
(Source: Gastroenterology)
Source: Gastroenterology - July 12, 2019 Category: Gastroenterology Authors: Amit G. Singal Source Type: research

Hydrogel spacer for borderline resectable and locally advanced pancreatic cancer: a feasibility human study
(Source: Gastroenterology)
Source: Gastroenterology - July 12, 2019 Category: Gastroenterology Authors: Tossapol Kerdsirichairat, Amol K. Narang, Elizabeth Thompson, Seong-Hun Kim, Avani Rao, Kai Ding, Eun Ji Shin Source Type: research

AGA Guideline on the Laboratory Evaluation of Functional Diarrhea and Diarrhea-Predominant Irritable Bowel Syndrome in Adults (IBS-D)
This document presents the official recommendations of the American Gastroenterological Association (AGA) on the Laboratory Evaluation of Functional Diarrhea and Diarrhea-Predominant Irritable Bowel Syndrome (IBS-D) in Adults. The guideline was developed by the AGA ’s Clinical Practice Guideline Committee and approved by the AGA Governing Board. These Guidelines should expire in 5 years. (Source: Gastroenterology)
Source: Gastroenterology - July 11, 2019 Category: Gastroenterology Authors: Walter Smalley, Corinna Falck-Ytter, Alonso Carrasco-Labra, Sachin Wani, Lyubov Lytvyn, Yngve Falck-Ytter Tags: AGA Section Source Type: research

American Gastroenterological Association Guideline on Mild-to-Moderate Ulcerative Colitis on the Laboratory Evaluation of Functional Diarrhea and Diarrhea-Predominant Irritable Bowel Syndrome in Adults (IBS-D)
This document presents the official recommendations of the American Gastroenterological Association (AGA) on the Laboratory Evaluation of Functional Diarrhea and Diarrhea-Predominant Irritable Bowel Syndrome (IBS-D) in Adults. The guideline was developed by the AGA ’s Clinical Practice Guideline Committee and approved by the AGA Governing Board. These Guidelines should expire in 5 years. (Source: Gastroenterology)
Source: Gastroenterology - July 11, 2019 Category: Gastroenterology Authors: Walter Smalley, Corinna Falck-Ytter, Alonso Carrasco-Labra, Sachin Wani, Lyubov Lytvyn, Yngve Falck-Ytter Tags: AGA Section Source Type: research

Reply to GASTRO-D-19-01131
(Source: Gastroenterology)
Source: Gastroenterology - July 11, 2019 Category: Gastroenterology Authors: Jasmohan S. Bajaj, Patrick M. Gillevet Source Type: research

Development and Validation of Model Consisting of Comorbidity Burden to Calculate Risk of Death Within 6 months for Patients With Suspected Drug-Induced Liver Injury
Patients with drug-induced liver injury (DILI) frequently have comorbid conditions, but the effects of non-liver comorbidities on outcome is not well understood. We investigated the association between co-morbidity burden and outcomes of patients with DILI, and developed and validated a model to calculate risk of death within 6 months. (Source: Gastroenterology)
Source: Gastroenterology - July 11, 2019 Category: Gastroenterology Authors: Marwan Ghabril, Jiezhun Gu, Lindsay Yoder, Laura Corbito, Amit Ringel, Christian D. Beyer, Raj Vuppalanchi, Huiman Barnhart, Paul H. Hayashi, Naga Chalasani Source Type: research

Long-term Risk of Colorectal Cancer After Removal of Conventional Adenomas and Serrated Polyps
Endoscopic screening reduces incidence and mortality of colorectal cancer (CRC) because precursor lesions, such as conventional adenomas or serrated polyps, are removed. Individuals with polypectomies are advised to undergo colonoscopy surveillance to prevent CRC. However, guidelines for surveillance intervals after diagnosis of a precursor lesion, particularly for individuals with serrated polyps, vary widely, and lack sufficient supporting evidence. Consequently, some high-risk patients do not receive enough surveillance and lower-risk subjects receive excessive surveillance. (Source: Gastroenterology)
Source: Gastroenterology - July 11, 2019 Category: Gastroenterology Authors: Xiaosheng He, Dong Hang, Kana Wu, Jennifer Nayor, David A. Drew, Edward L. Giovannucci, Shuji Ogino, Andrew T. Chan, Mingyang Song Source Type: research

Inhibiting PGGT1B Disrupts Function of RHOA, Resulting in T-cell Expression of Integrin α4β7 and Development of Colitis in Mice
It is not clear how regulation of T-cell function is altered during development of inflammatory bowel diseases (IBD). We studied the mechanisms by which geranylgeranyltransferase-mediated prenylation controls T-cell localization to the intestine and chronic inflammation. (Source: Gastroenterology)
Source: Gastroenterology - July 11, 2019 Category: Gastroenterology Authors: Roc ío López-Posadas, Petra Fastancz, Luz del Carmen Martínez-Sánchez, Julia Panteleev-Ivlev, Veronika Thonn, Tatyana Kisseleva, Lukas S. Becker, Anja Schulz-Kuhnt, Sebastian Zundler, Stefan Wirtz, Raja Atreya, Birgitta Carlé, Oliver Friedrich, Sebas Source Type: research

Effects of Ustekinumab on Histologic Disease Activity in Patients with Crohn ’s Disease
Although ustekinumab is an effective therapy for moderate to severe Crohn ’s disease (CD), its effects on the microscopic manifestations of CD are unknown. (Source: Gastroenterology)
Source: Gastroenterology - July 4, 2019 Category: Gastroenterology Authors: Katherine Li, Joshua R. Friedman, Daphne Chan, Paul Pollack, Feifei Yang, Douglas Jacobstein, Carrie Brodmerkel, Christopher Gasink, Brian G. Feagan, William J. Sandborn, Paul Rutgeerts, Gert De Hertogh Source Type: research

Endoscopic, radiologic, and histologic healing with vedolizumab in patients with active Crohn ’s disease
Vedolizumab is a gut-selective monoclonal antibody for the treatment of moderately to severely active Crohn ’s disease (CD). We performed a prospective study of endoscopic, radiologic, and histologic healing in patients with CD who received vedolizumab therapy. (Source: Gastroenterology)
Source: Gastroenterology - July 4, 2019 Category: Gastroenterology Authors: Silvio Danese, William J. Sandborn, Jean-Fr édéric Colombel, Séverine Vermeire, Sarah C. Glover, Jordi Rimola, Jenifer Siegelman, Stephen Jones, Jeffrey Bornstein, Brian G. Feagan Source Type: research

Sigmoid-derived neovaginal hemorrhage in a transgender patient
(Source: Gastroenterology)
Source: Gastroenterology - July 4, 2019 Category: Gastroenterology Authors: Philip J. Riddle, Farzin Rashti, Divya Ahuja Source Type: research

Prevention of biliary cancer with statins: still a long way to go
(Source: Gastroenterology)
Source: Gastroenterology - July 3, 2019 Category: Gastroenterology Authors: Massimo Colombo, Federica Turati, Carlo La Vecchia Source Type: research

43 year old Female presenting with chronic abdominal pain, weight loss and a palpable abdominal mass
(Source: Gastroenterology)
Source: Gastroenterology - July 3, 2019 Category: Gastroenterology Authors: Cosman Camilo Mandujano Bejarano, Louisiana Rivera Valladares, Joseph Vazzana Source Type: research

The Impact of Delay Between Biologic Prescription and Therapy Initiation on Clinical Outcomes in Inflammatory Bowel Disease Patients
Biologic therapy for the management of active inflammatory bowel disease (IBD) is expensive and the multi-step process prior to initiation of therapy can be associated with delay. The purpose of this study was to determine if such delay impacts clinical outcomes in IBD patients. (Source: Gastroenterology)
Source: Gastroenterology - June 28, 2019 Category: Gastroenterology Authors: Manasi Agrawal, Adam Tepler, Simon Hong, Rashmi Advani, Dana Lukin Tags: Abstract Source Type: research

Proactive Management of Iron Deficiency and Anemia in Pediatric Inflammatory Bowel Disease —Development of a New Care Pathway
Anemia is a common complication of inflammatory bowel disease (IBD), with studies reporting an even greater prevalence among children (49-70%) than adults (20-39%) at any given time during disease course. In the majority of cases, anemia is a result of iron deficiency (ID), chronic inflammation, or a combination of both. Both anemia and ID itself have been associated with high rates of IBD-related complications, resource utilization, and impaired quality of life. However, ID and anemia remain under-recognized and undertreated. (Source: Gastroenterology)
Source: Gastroenterology - June 28, 2019 Category: Gastroenterology Authors: J. Breton, T. Patel, E. Maxwell, J. Stevenson, J. McDermott, E. Schwab, M. Downing, Y. Zhang, C. Witmer, A. Grossman Tags: Abstract Source Type: research

Hematochezia Decreases Use of Venous Thromboembolism Prophylaxis in Patients With Inflammatory Bowel Disease
Hospitalized patients with inflammatory bowel disease (IBD) have a high risk of venous thromboembolism (VTE). Guidelines therefore suggest pharmacologic prophylaxis in hospitalized IBD patients without major gastrointestinal bleeding (GIB), but prior data has shown poor adherence to this. We assessed the predictors and safety of VTE prophylaxis among IBD patients hospitalized at our institution. (Source: Gastroenterology)
Source: Gastroenterology - June 28, 2019 Category: Gastroenterology Authors: Adam S. Faye, Kenneth Hung, Jon W. Blackett, Adam R. Pont, Garrett Lawlor, Simon Lichtiger, Benjamin Lebwohl, Daniel E. Freedberg Tags: Abstract Source Type: research

Optimizing Outpatient Colorectal Cancer Screening and Surveillance for the Gastroenterologist —A Quality Improvement Project
Colorectal cancer (CRC) is the 2nd most common cancer among men and women in the United States and can be prevented through adequate screening and surveillance by physicians. Gastroenterologists encounter numerous patients in the outpatient setting with a variety of conditions; however, CRC screening and surveillance are not always addressed, especially at new patient visits. The aim of this quality improvement (QI) project was to optimize outpatient CRC screening and surveillance for new outpatients seen by gastroenterology fellows in their continuity clinic. (Source: Gastroenterology)
Source: Gastroenterology - June 28, 2019 Category: Gastroenterology Authors: Shelly Gurwara, Joel Bruggen Tags: Abstract Source Type: research

“Let’s Make Your Clinic Visit a Little Simpler”—Development of a Question Prompt List for Adult Patients With Gastroesophageal Reflux Disease: a Modified Delphi Study
To develop a QPL specific to adults with GERD created by physician experts. (Source: Gastroenterology)
Source: Gastroenterology - June 28, 2019 Category: Gastroenterology Authors: Afrin Kamal, David A. Katzka, Edgar Achkar, Dustin Carlson, John Clarke, Ronnie Fass, C. Prakash Gyawali, Dhyanesh Patel, Roberto Penagini, Ali Rezaie, Sabine Roman, Edoardo Savarino, Nicholas J. Shaheen, George Triadafilopoulos Tags: Abstract Source Type: research

Quality Gaps in Preventative Care Provided to Outpatients With Cirrhosis at a High-Volume Tertiary Care Liver Transplant Center
High quality preventative care has the potential to improve health outcomes in patients with cirrhosis; however, most quality improvement initiatives focus on hospitalized patients. We aimed to evaluate the quality of care (QOC) provided by gastroenterology (GI) and hepatology providers to patients with cirrhosis by measuring eleven evidence-based quality indicators (QIs) focusing on outpatient preventative care and the factors associated with higher QOC. (Source: Gastroenterology)
Source: Gastroenterology - June 28, 2019 Category: Gastroenterology Authors: Ani Kardashian, Arpan A. Patel, Elizabeth S. Aby, Sean Delshad, Camille Soroudi, Vivy Tran, Liu Yang, Folasade P. May Tags: Abstract Source Type: research

Utilizing a QI Time Series Study to Inform QI Initiatives for Improving Inpatient Endoscopy Workflow
Inpatient endoscopy workflow is complex due to the need for multidisciplinary care coordination and on-demand scheduling. At our facility, weekday inpatient procedures are performed in dedicated operating rooms (ORs) with anesthesia support, with staff resource changes after 17:00. Delays result in unpredictable schedules and extended work days, negatively impacting patient care and both patient and provider dissatisfaction. This initiative sought to find targetable opportunities to streamline endoscopy workflow and minimize time between cases by utilizing a time-series study, with the goal to decrease days with cases exte...
Source: Gastroenterology - June 28, 2019 Category: Gastroenterology Authors: Sonali Palchaudhuri, Sara Attalla, Jaime Gilbo, Mark S. Weiss, Shivan J. Mehta, Jan-Michael A. Klapproth, Gregory G. Ginsberg, David C. Metz, Michael L. Kochman, Nuzhat A. Ahmad, Shazia M. Siddique Tags: Abstract Source Type: research

New Patient Access in a Gastroenterology Clinic: A Quality Improvement Initiative
Subspecialty access is an important aspect of the healthcare system, especially in gastroenterology. Given that gastroenterologists ’ time is divided between endoscopy and clinic and not solely clinic, it is difficult to accommodate the clinic demand, especially for new patients. In our institution, our demand for new patients overwhelms our supply. Therefore, we performed a quality improvement project within the Division of G astroenterology at the University of Missouri-Columbia (MU-GI) with the aim of improving new patient access in our gastroenterology clinics (patients scheduled within 10 business days) by 10% o...
Source: Gastroenterology - June 28, 2019 Category: Gastroenterology Authors: Nasim Parsa, Michelle L. Matteson, Sami Samiullah, Matthew L. Bechtold Tags: Abstract Source Type: research

Improving First-Case Start Delays in a Tertiary Care Academic Endoscopy Unit
Increasing emphasis on quality of care, as well as performance-based reimbursement have placed the spotlight on improving healthcare efficiency. As demand for GI procedures continues to increase, resources like physical space and personnel remain unchanged. Despite this, the literature is sparse with regard to improving efficiency in the endoscopy unit. First-case start delay is a known endoscopy efficiency metric. In our study, we look at the impact of implementing a patient check-in protocol on first-case start delays in our hospital-based endoscopy unit. (Source: Gastroenterology)
Source: Gastroenterology - June 28, 2019 Category: Gastroenterology Authors: Sahil R. Patel, Anand R. Kumar, Asyia Ahmad Tags: Abstract Source Type: research

Implementation of an Acute Care Clinical Pathway for the Management of Pediatric Constipation Improves Process Control
Constipation accounts for approximately 3% of all pediatric visits. The role of providing care for children with constipation has expanded from the outpatient offices to include providers in the emergency department (ED) and inpatient settings. At UPMC Children ’s Hospital of Pittsburgh, approximately 100 children are seen monthly in the ED for constipation, with nearly 10% being admitted for further management. We aimed to collect baseline data on the management of constipation at our hospital, use these data to develop a clinical pathway for constipati on management, and assess the pathway’s effect on utiliza...
Source: Gastroenterology - June 28, 2019 Category: Gastroenterology Authors: Vikram K. Raghu, Katherine E. Gaughan, Cecilia Verner, Tracy A. Pasek, Gabriella A. Butler, Jeffrey A. Rudolph, Arvind I. Srinath, Andrew R. Buchert Tags: Abstract Source Type: research