Flashback

In 2007 (coinciding with the inaugural year of GI & Hepatology News), the National Institutes of Health launched the initial phase of the Human Microbiome Project (HMP), marking an important milestone in our study and understanding of the gut microbiome. The HMP, which was supported by “only” approximately $20 million of funding in its first year, served as a catalyst for the development of computational tools, clinical protocols, and reference datasets for an emerging field that now approaches nearly $2 billion per year in market value of diagnostics and therapeutics.

Over the past 15 years, many important discoveries about the microbiome have been made, particularly in the fields of gastroenterology, hepatology, and nutrition. The transplantation of gut microbiome from one person to another has been shown to be more than 90% effective in the treatment of recurrent C. difficile infection, disrupting our current therapeutic algorithms of repetitive antibiotics. Other exciting discoveries have included the relationship between the gut microbiome and enteric nervous system, and its roles in the regulation of metabolism and obesity and in the progression of liver fibrosis and cancer.

ChrisChrisW/Getty Images

Looking ahead, several exciting areas related to digestive health and the microbiome are being prioritized, including the role of probiotics in nutrition, the complex relationship of the bidirectional “gut-brain” axis, and further development of analytics to define and deliver precision medicine across a wide range of digestive disorders. Without a doubt, emerging microbiome discoveries will be prominently featured in the pages of GI & Hepatology News over the coming years to keep our readers informed of these cutting-edge findings.

Dr. Rosenberg is medical director of the North Shore Endoscopy Center and director of clinical research at GI Alliance of Illinois in Gurnee, Ill. Dr. Rosenberg is a consultant for Aimmune Therapeutics and performs clinical research with Ferring Pharmaceuticals.

In 2007 (coinciding with the inaugural year of GI & Hepatology News), the National Institutes of Health launched the initial phase of the Human Microbiome Project (HMP), marking an important milestone in our study and understanding of the gut microbiome. The HMP, which was supported by “only” approximately $20 million of funding in its first year, served as a catalyst for the development of computational tools, clinical protocols, and reference datasets for an emerging field that now approaches nearly $2 billion per year in market value of diagnostics and therapeutics.

Over the past 15 years, many important discoveries about the microbiome have been made, particularly in the fields of gastroenterology, hepatology, and nutrition. The transplantation of gut microbiome from one person to another has been shown to be more than 90% effective in the treatment of recurrent C. difficile infection, disrupting our current therapeutic algorithms of repetitive antibiotics. Other exciting discoveries have included the relationship between the gut microbiome and enteric nervous system, and its roles in the regulation of metabolism and obesity and in the progression of liver fibrosis and cancer.

ChrisChrisW/Getty Images

Looking ahead, several exciting areas related to digestive health and the microbiome are being prioritized, including the role of probiotics in nutrition, the complex relationship of the bidirectional “gut-brain” axis, and further development of analytics to define and deliver precision medicine across a wide range of digestive disorders. Without a doubt, emerging microbiome discoveries will be prominently featured in the pages of GI & Hepatology News over the coming years to keep our readers informed of these cutting-edge findings.

Dr. Rosenberg is medical director of the North Shore Endoscopy Center and director of clinical research at GI Alliance of Illinois in Gurnee, Ill. Dr. Rosenberg is a consultant for Aimmune Therapeutics and performs clinical research with Ferring Pharmaceuticals.

In 2007 (coinciding with the inaugural year of GI & Hepatology News), the National Institutes of Health launched the initial phase of the Human Microbiome Project (HMP), marking an important milestone in our study and understanding of the gut microbiome. The HMP, which was supported by “only” approximately $20 million of funding in its first year, served as a catalyst for the development of computational tools, clinical protocols, and reference datasets for an emerging field that now approaches nearly $2 billion per year in market value of diagnostics and therapeutics.

Over the past 15 years, many important discoveries about the microbiome have been made, particularly in the fields of gastroenterology, hepatology, and nutrition. The transplantation of gut microbiome from one person to another has been shown to be more than 90% effective in the treatment of recurrent C. difficile infection, disrupting our current therapeutic algorithms of repetitive antibiotics. Other exciting discoveries have included the relationship between the gut microbiome and enteric nervous system, and its roles in the regulation of metabolism and obesity and in the progression of liver fibrosis and cancer.

ChrisChrisW/Getty Images

Looking ahead, several exciting areas related to digestive health and the microbiome are being prioritized, including the role of probiotics in nutrition, the complex relationship of the bidirectional “gut-brain” axis, and further development of analytics to define and deliver precision medicine across a wide range of digestive disorders. Without a doubt, emerging microbiome discoveries will be prominently featured in the pages of GI & Hepatology News over the coming years to keep our readers informed of these cutting-edge findings.

Dr. Rosenberg is medical director of the North Shore Endoscopy Center and director of clinical research at GI Alliance of Illinois in Gurnee, Ill. Dr. Rosenberg is a consultant for Aimmune Therapeutics and performs clinical research with Ferring Pharmaceuticals.

In the second issue of GI & Hepatology News in February 2007, an article reviewed the disruptive forces to colonoscopy including CT colonography and the colon capsule. The article stated that “colonoscopy is still the preferred method, but the emerging technology could catch up in 3-5 years.”

While this prediction did not come to pass, the field of endoscopy has evolved in remarkable ways over the last 15 years. From the development of high-definition endoscopes to the transformation of interventional endoscopy to include “third space” procedures, previously unimaginable techniques have now become commonplace. This transformation has changed the nature and training of our field and, even more importantly, dramatically improved the care of our patients.

Just as notably, the regulatory and practice environment for endoscopy has also changed in the last 15 years, albeit at a slower pace. In January of 2007, as the first issue of GI & Hepatology News came out, Medicare announced that it would cover all screening procedures without a copay but left a loophole that charged patients if their screening colonoscopy became therapeutic. That loophole was finally fixed this year as GI & Hepatology News celebrates its 15-year anniversary.

If the past 15 years are any indication, endoscopy practice will continue to change at a humbling pace over the next 15 years. I look forward to seeing those changes unfold through the pages of GI & Hepatology News.
 

Dr. Gellad is associate professor of medicine and associate vice chair of ambulatory services at Duke University Medical Center, Durham, N.C. He is also a staff physician with the Durham VA Health Care system. He disclosed ties with Merck, Novo Nordisk, and Higgs Boson Health.

In the second issue of GI & Hepatology News in February 2007, an article reviewed the disruptive forces to colonoscopy including CT colonography and the colon capsule. The article stated that “colonoscopy is still the preferred method, but the emerging technology could catch up in 3-5 years.”

While this prediction did not come to pass, the field of endoscopy has evolved in remarkable ways over the last 15 years. From the development of high-definition endoscopes to the transformation of interventional endoscopy to include “third space” procedures, previously unimaginable techniques have now become commonplace. This transformation has changed the nature and training of our field and, even more importantly, dramatically improved the care of our patients.

Just as notably, the regulatory and practice environment for endoscopy has also changed in the last 15 years, albeit at a slower pace. In January of 2007, as the first issue of GI & Hepatology News came out, Medicare announced that it would cover all screening procedures without a copay but left a loophole that charged patients if their screening colonoscopy became therapeutic. That loophole was finally fixed this year as GI & Hepatology News celebrates its 15-year anniversary.

If the past 15 years are any indication, endoscopy practice will continue to change at a humbling pace over the next 15 years. I look forward to seeing those changes unfold through the pages of GI & Hepatology News.
 

Dr. Gellad is associate professor of medicine and associate vice chair of ambulatory services at Duke University Medical Center, Durham, N.C. He is also a staff physician with the Durham VA Health Care system. He disclosed ties with Merck, Novo Nordisk, and Higgs Boson Health.

In the second issue of GI & Hepatology News in February 2007, an article reviewed the disruptive forces to colonoscopy including CT colonography and the colon capsule. The article stated that “colonoscopy is still the preferred method, but the emerging technology could catch up in 3-5 years.”

While this prediction did not come to pass, the field of endoscopy has evolved in remarkable ways over the last 15 years. From the development of high-definition endoscopes to the transformation of interventional endoscopy to include “third space” procedures, previously unimaginable techniques have now become commonplace. This transformation has changed the nature and training of our field and, even more importantly, dramatically improved the care of our patients.

Just as notably, the regulatory and practice environment for endoscopy has also changed in the last 15 years, albeit at a slower pace. In January of 2007, as the first issue of GI & Hepatology News came out, Medicare announced that it would cover all screening procedures without a copay but left a loophole that charged patients if their screening colonoscopy became therapeutic. That loophole was finally fixed this year as GI & Hepatology News celebrates its 15-year anniversary.

If the past 15 years are any indication, endoscopy practice will continue to change at a humbling pace over the next 15 years. I look forward to seeing those changes unfold through the pages of GI & Hepatology News.
 

Dr. Gellad is associate professor of medicine and associate vice chair of ambulatory services at Duke University Medical Center, Durham, N.C. He is also a staff physician with the Durham VA Health Care system. He disclosed ties with Merck, Novo Nordisk, and Higgs Boson Health.

I was honored to be the third Editor-in-Chief of GIHN, from 2016 through 2021. GIHN is the official newspaper of the American Gastroenterological Association and has the widest readership of any AGA publication and is one that readers told us they read cover to cover. As such, each EIC and their Board of Editors must ensure balanced content that holds the interest of a diverse readership. I was privileged to work with a talented editorial board who reviewed articles, attended leadership meetings, and offered terrific suggestions throughout our tenure. I treasured their support and friendship.

Within each of the 60 monthly issues, we sought to highlight science, practice operations, national trends, and opinions and reviews that would be most important to basic scientists, clinical researchers, and academic and community clinicians, primarily from the United States but also from a worldwide readership. I was given a 300-word section to create editorial comments on pertinent topics that were important to gastroenterologists. Having a background in both community and academic practice, I tried to bring a balanced perspective to areas that often seem worlds apart.

The period between 2016 and 2021 also was a time of political upheaval in this country – something we could not ignore. I attempted to write about current events in a balanced way that kept a focus on patients and AGA’s core constituency. Not always an easy task. Sustainability of the Affordable Care Act was very much in question because of judicial and legislative challenges; had the ACA been overturned, our practices would be very different now.

In 2016, the first private equity–backed practice platform was created in south Florida. Little did we know how much that model would change community practice. Then, on Jan. 21, 2020, the first case of COVID 19 was diagnosed in Seattle (although earlier cases likely occurred). By March, many clinics and practices were closing, and we were altering our care delivery infrastructure in ways that would forever change practice. Trying to keep current with ever-changing science and policies was a challenge.

I will always treasure my time as EIC. I was happy (and proud) to pass this baton to Megan A. Adams MD, JD, MSc, my colleague and mentee at the University of Michigan. The partnership between AGA and Frontline Medical Communications has been successful for 15 years and will continue to be so.

Dr. Allen, now retired, was professor of medicine at the University of Michigan, Ann Arbor. He is secretary/treasurer for the American Gastroenterological Association, and declares no relevant conflicts of interest.

I was honored to be the third Editor-in-Chief of GIHN, from 2016 through 2021. GIHN is the official newspaper of the American Gastroenterological Association and has the widest readership of any AGA publication and is one that readers told us they read cover to cover. As such, each EIC and their Board of Editors must ensure balanced content that holds the interest of a diverse readership. I was privileged to work with a talented editorial board who reviewed articles, attended leadership meetings, and offered terrific suggestions throughout our tenure. I treasured their support and friendship.

Within each of the 60 monthly issues, we sought to highlight science, practice operations, national trends, and opinions and reviews that would be most important to basic scientists, clinical researchers, and academic and community clinicians, primarily from the United States but also from a worldwide readership. I was given a 300-word section to create editorial comments on pertinent topics that were important to gastroenterologists. Having a background in both community and academic practice, I tried to bring a balanced perspective to areas that often seem worlds apart.

The period between 2016 and 2021 also was a time of political upheaval in this country – something we could not ignore. I attempted to write about current events in a balanced way that kept a focus on patients and AGA’s core constituency. Not always an easy task. Sustainability of the Affordable Care Act was very much in question because of judicial and legislative challenges; had the ACA been overturned, our practices would be very different now.

In 2016, the first private equity–backed practice platform was created in south Florida. Little did we know how much that model would change community practice. Then, on Jan. 21, 2020, the first case of COVID 19 was diagnosed in Seattle (although earlier cases likely occurred). By March, many clinics and practices were closing, and we were altering our care delivery infrastructure in ways that would forever change practice. Trying to keep current with ever-changing science and policies was a challenge.

I will always treasure my time as EIC. I was happy (and proud) to pass this baton to Megan A. Adams MD, JD, MSc, my colleague and mentee at the University of Michigan. The partnership between AGA and Frontline Medical Communications has been successful for 15 years and will continue to be so.

Dr. Allen, now retired, was professor of medicine at the University of Michigan, Ann Arbor. He is secretary/treasurer for the American Gastroenterological Association, and declares no relevant conflicts of interest.

I was honored to be the third Editor-in-Chief of GIHN, from 2016 through 2021. GIHN is the official newspaper of the American Gastroenterological Association and has the widest readership of any AGA publication and is one that readers told us they read cover to cover. As such, each EIC and their Board of Editors must ensure balanced content that holds the interest of a diverse readership. I was privileged to work with a talented editorial board who reviewed articles, attended leadership meetings, and offered terrific suggestions throughout our tenure. I treasured their support and friendship.

Within each of the 60 monthly issues, we sought to highlight science, practice operations, national trends, and opinions and reviews that would be most important to basic scientists, clinical researchers, and academic and community clinicians, primarily from the United States but also from a worldwide readership. I was given a 300-word section to create editorial comments on pertinent topics that were important to gastroenterologists. Having a background in both community and academic practice, I tried to bring a balanced perspective to areas that often seem worlds apart.

The period between 2016 and 2021 also was a time of political upheaval in this country – something we could not ignore. I attempted to write about current events in a balanced way that kept a focus on patients and AGA’s core constituency. Not always an easy task. Sustainability of the Affordable Care Act was very much in question because of judicial and legislative challenges; had the ACA been overturned, our practices would be very different now.

In 2016, the first private equity–backed practice platform was created in south Florida. Little did we know how much that model would change community practice. Then, on Jan. 21, 2020, the first case of COVID 19 was diagnosed in Seattle (although earlier cases likely occurred). By March, many clinics and practices were closing, and we were altering our care delivery infrastructure in ways that would forever change practice. Trying to keep current with ever-changing science and policies was a challenge.

I will always treasure my time as EIC. I was happy (and proud) to pass this baton to Megan A. Adams MD, JD, MSc, my colleague and mentee at the University of Michigan. The partnership between AGA and Frontline Medical Communications has been successful for 15 years and will continue to be so.

Dr. Allen, now retired, was professor of medicine at the University of Michigan, Ann Arbor. He is secretary/treasurer for the American Gastroenterological Association, and declares no relevant conflicts of interest.

Since the first issue of GI & Hepatology News was published 15 years ago, the field of hepatology has undergone a tremendous transformation.

In the late 2000s, we witnessed revolutionary discoveries and advances in our understanding and management of chronic hepatitis C. Who knew that when IL-28B was first described in 2009, providing a genetic basis for patients’ response to interferon-based therapies, its impact would also be so swiftly supplanted by the introduction of direct acting antivirals a few years later? The pipeline for HCV treatment was feverish for several years, which resulted in a complete transformation of HCV treatment from a long, exhausting, side-effect filled course to a simple 8-to-12-week regimen. Furthermore, we now have established protocols for organ transplantation for patients without active HCV infection to receive HCV-positive organs due to the effectiveness of treatments for HCV. This kind of progress in our field demonstrates how awe-inspiring medical advances can be and how fortunate we are to have witnessed and lived this progress in such a short period of time.

Dr. Jou is associate professor of medicine, division of gastroenterology and hepatology, School of Medicine Fellowship program director, Medicine, Division of Gastroenterology and Hepatology, School of Medicine, Oregon Health and Science University, Portland. She reported no relevant financial conflicts of interest.

Since the first issue of GI & Hepatology News was published 15 years ago, the field of hepatology has undergone a tremendous transformation.

In the late 2000s, we witnessed revolutionary discoveries and advances in our understanding and management of chronic hepatitis C. Who knew that when IL-28B was first described in 2009, providing a genetic basis for patients’ response to interferon-based therapies, its impact would also be so swiftly supplanted by the introduction of direct acting antivirals a few years later? The pipeline for HCV treatment was feverish for several years, which resulted in a complete transformation of HCV treatment from a long, exhausting, side-effect filled course to a simple 8-to-12-week regimen. Furthermore, we now have established protocols for organ transplantation for patients without active HCV infection to receive HCV-positive organs due to the effectiveness of treatments for HCV. This kind of progress in our field demonstrates how awe-inspiring medical advances can be and how fortunate we are to have witnessed and lived this progress in such a short period of time.

Dr. Jou is associate professor of medicine, division of gastroenterology and hepatology, School of Medicine Fellowship program director, Medicine, Division of Gastroenterology and Hepatology, School of Medicine, Oregon Health and Science University, Portland. She reported no relevant financial conflicts of interest.

Since the first issue of GI & Hepatology News was published 15 years ago, the field of hepatology has undergone a tremendous transformation.

In the late 2000s, we witnessed revolutionary discoveries and advances in our understanding and management of chronic hepatitis C. Who knew that when IL-28B was first described in 2009, providing a genetic basis for patients’ response to interferon-based therapies, its impact would also be so swiftly supplanted by the introduction of direct acting antivirals a few years later? The pipeline for HCV treatment was feverish for several years, which resulted in a complete transformation of HCV treatment from a long, exhausting, side-effect filled course to a simple 8-to-12-week regimen. Furthermore, we now have established protocols for organ transplantation for patients without active HCV infection to receive HCV-positive organs due to the effectiveness of treatments for HCV. This kind of progress in our field demonstrates how awe-inspiring medical advances can be and how fortunate we are to have witnessed and lived this progress in such a short period of time.

Dr. Jou is associate professor of medicine, division of gastroenterology and hepatology, School of Medicine Fellowship program director, Medicine, Division of Gastroenterology and Hepatology, School of Medicine, Oregon Health and Science University, Portland. She reported no relevant financial conflicts of interest.

In the 15 years between 2007 and 2022, demographics, treatment options, management and monitoring strategies and even outcomes have dramatically changed in inflammatory bowel diseases (IBD) creating a whole new landscape for the disease.

In 2007, IBD seemed to be primarily a disease of Caucasian and Jewish ancestry. While prevalence of IBD is still highest in the Western world, there is now increasing incidence, even accounting for detection bias, in people of all other ancestries globally. Incidence of IBD in children under the age of 18 years is also rising. Patients with IBD are living longer and, despite the notion that IBD is a disease primarily of younger adults, nearly one-third of Americans with IBD are 60 years and older.

“Adalimumab aids in Crohn’s disease” read the front page of the inaugural issue of GI & Hepatology News in January 2007. The article highlighted the GAIN study, which demonstrated that patients who lost response to infliximab responded to adalimumab, the second anti-tumor necrosis factor (TNF) agent approved for the treatment of Crohn’s disease and subsequently ulcerative colitis. Over the subsequent 15 years, the armamentarium of treatment options for Crohn’s disease and ulcerative colitis have rapidly proliferated: there are now four anti–tumor necrosis factor (TNF) agents, two anti-integrin agents, two anti-interleukin agents, two Janus kinase inhibitors and a sphingosine-1 receptor modulator approved for the treatment of IBD. Many more promising treatment options are in trials. Other mechanisms are under investigation as well, including antimicrobial therapies for ulcerative colitis and stem cell therapeutics for the treatment of refractory perianal fistulizing Crohn’s disease. Perhaps even more novel – dietary therapies are more rigorously under investigation.

“Ulcerative colitis guidelines endorse combined therapy” reads another headline from the inaugural GI & Hepatology News issue. The article discusses the European Crohn’s and Colitis Organisation’s consensus guideline that topical and systemic agents used together are superior to either used alone, referring specifically to mesalamine, both systemic and topical as well as the additional of topical corticosteroid to systemic mesalamine. Combination therapy has a completely new meaning in modern times. With the publication of the SONIC trial in 2010, combination therapy referred to an anti-TNF in combination with an immunomodulator for the ensuing decade. However, in this new era of IBD treatment, combination therapy could also mean a biologic with a small molecule or even combination biologics, for which there is an ongoing randomized controlled trial. On the topic of treatment strategies, one of the biggest shifts in the IBD treatment paradigm is the bottom-up versus top-down approach of treatment, with increasing evidence to suggest that early biologic initiation is more effective, especially in patients with Crohn’s disease. Therapeutic drug monitoring is mainstream. Treat-to-target strategies to achieve more stringent outcomes, such as biomarker, endoscopic and histologic normalization, especially in ulcerative colitis, have evolved to become the norm in 2022.

The combination of increased treatment options, decreased reliance on corticosteroids and stringent treatment strategies have resulted in improved outcomes: IBD-related hospitalizations, surgeries, and even mortality have declined since 2007. The growing recognition and focus on extra-intestinal manifestations, including fatigue, and the gut-brain axis are important steps to improving the overall quality of life of patients with IBD. Beyond treating the disease, we are now learning how to treat the patient. We will be developing personalized strategies to identify the right patient for the right treatment, including patient-level clinical and biologic markers. We need to identify those who are at risk for IBD to prevent the disease at a preclinical phase. Concomitantly, we must continue the quest to cure the disease!

Dr. Kochar is a gastroenterologist and inflammatory bowel disease specialist at Massachusetts General Hospital and a physician investigator in the clinical and translational epidemiology unit at The Mongan Institute, both in Boston. She has no relevant disclosures.

In the 15 years between 2007 and 2022, demographics, treatment options, management and monitoring strategies and even outcomes have dramatically changed in inflammatory bowel diseases (IBD) creating a whole new landscape for the disease.

In 2007, IBD seemed to be primarily a disease of Caucasian and Jewish ancestry. While prevalence of IBD is still highest in the Western world, there is now increasing incidence, even accounting for detection bias, in people of all other ancestries globally. Incidence of IBD in children under the age of 18 years is also rising. Patients with IBD are living longer and, despite the notion that IBD is a disease primarily of younger adults, nearly one-third of Americans with IBD are 60 years and older.

“Adalimumab aids in Crohn’s disease” read the front page of the inaugural issue of GI & Hepatology News in January 2007. The article highlighted the GAIN study, which demonstrated that patients who lost response to infliximab responded to adalimumab, the second anti-tumor necrosis factor (TNF) agent approved for the treatment of Crohn’s disease and subsequently ulcerative colitis. Over the subsequent 15 years, the armamentarium of treatment options for Crohn’s disease and ulcerative colitis have rapidly proliferated: there are now four anti–tumor necrosis factor (TNF) agents, two anti-integrin agents, two anti-interleukin agents, two Janus kinase inhibitors and a sphingosine-1 receptor modulator approved for the treatment of IBD. Many more promising treatment options are in trials. Other mechanisms are under investigation as well, including antimicrobial therapies for ulcerative colitis and stem cell therapeutics for the treatment of refractory perianal fistulizing Crohn’s disease. Perhaps even more novel – dietary therapies are more rigorously under investigation.

“Ulcerative colitis guidelines endorse combined therapy” reads another headline from the inaugural GI & Hepatology News issue. The article discusses the European Crohn’s and Colitis Organisation’s consensus guideline that topical and systemic agents used together are superior to either used alone, referring specifically to mesalamine, both systemic and topical as well as the additional of topical corticosteroid to systemic mesalamine. Combination therapy has a completely new meaning in modern times. With the publication of the SONIC trial in 2010, combination therapy referred to an anti-TNF in combination with an immunomodulator for the ensuing decade. However, in this new era of IBD treatment, combination therapy could also mean a biologic with a small molecule or even combination biologics, for which there is an ongoing randomized controlled trial. On the topic of treatment strategies, one of the biggest shifts in the IBD treatment paradigm is the bottom-up versus top-down approach of treatment, with increasing evidence to suggest that early biologic initiation is more effective, especially in patients with Crohn’s disease. Therapeutic drug monitoring is mainstream. Treat-to-target strategies to achieve more stringent outcomes, such as biomarker, endoscopic and histologic normalization, especially in ulcerative colitis, have evolved to become the norm in 2022.

The combination of increased treatment options, decreased reliance on corticosteroids and stringent treatment strategies have resulted in improved outcomes: IBD-related hospitalizations, surgeries, and even mortality have declined since 2007. The growing recognition and focus on extra-intestinal manifestations, including fatigue, and the gut-brain axis are important steps to improving the overall quality of life of patients with IBD. Beyond treating the disease, we are now learning how to treat the patient. We will be developing personalized strategies to identify the right patient for the right treatment, including patient-level clinical and biologic markers. We need to identify those who are at risk for IBD to prevent the disease at a preclinical phase. Concomitantly, we must continue the quest to cure the disease!

Dr. Kochar is a gastroenterologist and inflammatory bowel disease specialist at Massachusetts General Hospital and a physician investigator in the clinical and translational epidemiology unit at The Mongan Institute, both in Boston. She has no relevant disclosures.

In the 15 years between 2007 and 2022, demographics, treatment options, management and monitoring strategies and even outcomes have dramatically changed in inflammatory bowel diseases (IBD) creating a whole new landscape for the disease.

In 2007, IBD seemed to be primarily a disease of Caucasian and Jewish ancestry. While prevalence of IBD is still highest in the Western world, there is now increasing incidence, even accounting for detection bias, in people of all other ancestries globally. Incidence of IBD in children under the age of 18 years is also rising. Patients with IBD are living longer and, despite the notion that IBD is a disease primarily of younger adults, nearly one-third of Americans with IBD are 60 years and older.

“Adalimumab aids in Crohn’s disease” read the front page of the inaugural issue of GI & Hepatology News in January 2007. The article highlighted the GAIN study, which demonstrated that patients who lost response to infliximab responded to adalimumab, the second anti-tumor necrosis factor (TNF) agent approved for the treatment of Crohn’s disease and subsequently ulcerative colitis. Over the subsequent 15 years, the armamentarium of treatment options for Crohn’s disease and ulcerative colitis have rapidly proliferated: there are now four anti–tumor necrosis factor (TNF) agents, two anti-integrin agents, two anti-interleukin agents, two Janus kinase inhibitors and a sphingosine-1 receptor modulator approved for the treatment of IBD. Many more promising treatment options are in trials. Other mechanisms are under investigation as well, including antimicrobial therapies for ulcerative colitis and stem cell therapeutics for the treatment of refractory perianal fistulizing Crohn’s disease. Perhaps even more novel – dietary therapies are more rigorously under investigation.

“Ulcerative colitis guidelines endorse combined therapy” reads another headline from the inaugural GI & Hepatology News issue. The article discusses the European Crohn’s and Colitis Organisation’s consensus guideline that topical and systemic agents used together are superior to either used alone, referring specifically to mesalamine, both systemic and topical as well as the additional of topical corticosteroid to systemic mesalamine. Combination therapy has a completely new meaning in modern times. With the publication of the SONIC trial in 2010, combination therapy referred to an anti-TNF in combination with an immunomodulator for the ensuing decade. However, in this new era of IBD treatment, combination therapy could also mean a biologic with a small molecule or even combination biologics, for which there is an ongoing randomized controlled trial. On the topic of treatment strategies, one of the biggest shifts in the IBD treatment paradigm is the bottom-up versus top-down approach of treatment, with increasing evidence to suggest that early biologic initiation is more effective, especially in patients with Crohn’s disease. Therapeutic drug monitoring is mainstream. Treat-to-target strategies to achieve more stringent outcomes, such as biomarker, endoscopic and histologic normalization, especially in ulcerative colitis, have evolved to become the norm in 2022.

The combination of increased treatment options, decreased reliance on corticosteroids and stringent treatment strategies have resulted in improved outcomes: IBD-related hospitalizations, surgeries, and even mortality have declined since 2007. The growing recognition and focus on extra-intestinal manifestations, including fatigue, and the gut-brain axis are important steps to improving the overall quality of life of patients with IBD. Beyond treating the disease, we are now learning how to treat the patient. We will be developing personalized strategies to identify the right patient for the right treatment, including patient-level clinical and biologic markers. We need to identify those who are at risk for IBD to prevent the disease at a preclinical phase. Concomitantly, we must continue the quest to cure the disease!

Dr. Kochar is a gastroenterologist and inflammatory bowel disease specialist at Massachusetts General Hospital and a physician investigator in the clinical and translational epidemiology unit at The Mongan Institute, both in Boston. She has no relevant disclosures.

It was a pleasure to serve as editor-in-chief (EIC) of GI & Hepatology News from 2011 to 2016. As the second EIC of the newspaper, I was preceded by Dr. Charles Lightdale – big shoes to fill! I was fortunate to attract a strong group of associate editors who covered many key areas of interest for the paper’s readership. With the enthusiastic support of American Gastroenterological Association staff members, we published once-monthly and received generally positive feedback from readers – predominantly U.S.-based AGA members.

Serving as EIC was also a learning opportunity for me. A number of potentially newsworthy items were brought to my attention – some of which I would not otherwise have seen. Although not all were of direct relevance to the readership, I believe that most of those we published were of value.

One rewarding aspect of the editorship was the opportunity to liaise with those experts from whom I solicited commentaries on some of our featured items. These busy individuals were consistently generous with their time and expertise, and I believe that their contributions added to the paper’s overall appeal.

I initiated the inclusion of two DDSEP questions per edition, and am pleased that this feature continues. One less successful venture was the attempt at a Correspondence section, which ultimately proved too cumbersome to maintain.

I congratulate the AGA on the 15th anniversary of GIHN, and I wish the current EIC, Dr. Megan Adams, and her editorial colleagues continued success in providing this benefit to AGA members.

Colin W. Howden, MD, AGAF, is professor emeritus in the division of gastroenterology, department of medicine, at the University of Tennessee, Memphis. He is a consultant for Allakos, Ironwood, Phathom, and RedHill Biopharma. He is a member of speakers’ bureaus for Alnylam, RedHill Biopharma, and Sanofi/Genzyme. He owns stock in Antibe Therapeutics.

It was a pleasure to serve as editor-in-chief (EIC) of GI & Hepatology News from 2011 to 2016. As the second EIC of the newspaper, I was preceded by Dr. Charles Lightdale – big shoes to fill! I was fortunate to attract a strong group of associate editors who covered many key areas of interest for the paper’s readership. With the enthusiastic support of American Gastroenterological Association staff members, we published once-monthly and received generally positive feedback from readers – predominantly U.S.-based AGA members.

Serving as EIC was also a learning opportunity for me. A number of potentially newsworthy items were brought to my attention – some of which I would not otherwise have seen. Although not all were of direct relevance to the readership, I believe that most of those we published were of value.

One rewarding aspect of the editorship was the opportunity to liaise with those experts from whom I solicited commentaries on some of our featured items. These busy individuals were consistently generous with their time and expertise, and I believe that their contributions added to the paper’s overall appeal.

I initiated the inclusion of two DDSEP questions per edition, and am pleased that this feature continues. One less successful venture was the attempt at a Correspondence section, which ultimately proved too cumbersome to maintain.

I congratulate the AGA on the 15th anniversary of GIHN, and I wish the current EIC, Dr. Megan Adams, and her editorial colleagues continued success in providing this benefit to AGA members.

Colin W. Howden, MD, AGAF, is professor emeritus in the division of gastroenterology, department of medicine, at the University of Tennessee, Memphis. He is a consultant for Allakos, Ironwood, Phathom, and RedHill Biopharma. He is a member of speakers’ bureaus for Alnylam, RedHill Biopharma, and Sanofi/Genzyme. He owns stock in Antibe Therapeutics.

It was a pleasure to serve as editor-in-chief (EIC) of GI & Hepatology News from 2011 to 2016. As the second EIC of the newspaper, I was preceded by Dr. Charles Lightdale – big shoes to fill! I was fortunate to attract a strong group of associate editors who covered many key areas of interest for the paper’s readership. With the enthusiastic support of American Gastroenterological Association staff members, we published once-monthly and received generally positive feedback from readers – predominantly U.S.-based AGA members.

Serving as EIC was also a learning opportunity for me. A number of potentially newsworthy items were brought to my attention – some of which I would not otherwise have seen. Although not all were of direct relevance to the readership, I believe that most of those we published were of value.

One rewarding aspect of the editorship was the opportunity to liaise with those experts from whom I solicited commentaries on some of our featured items. These busy individuals were consistently generous with their time and expertise, and I believe that their contributions added to the paper’s overall appeal.

I initiated the inclusion of two DDSEP questions per edition, and am pleased that this feature continues. One less successful venture was the attempt at a Correspondence section, which ultimately proved too cumbersome to maintain.

I congratulate the AGA on the 15th anniversary of GIHN, and I wish the current EIC, Dr. Megan Adams, and her editorial colleagues continued success in providing this benefit to AGA members.

Colin W. Howden, MD, AGAF, is professor emeritus in the division of gastroenterology, department of medicine, at the University of Tennessee, Memphis. He is a consultant for Allakos, Ironwood, Phathom, and RedHill Biopharma. He is a member of speakers’ bureaus for Alnylam, RedHill Biopharma, and Sanofi/Genzyme. He owns stock in Antibe Therapeutics.

Fifteen years is a lifetime for the advancement of medical research. This seems particularly true for upper GI tract disorders.

In 2007, eosinophilic esophagitis was a rare disease; limited clinical data were available describing the symptoms, demographic characteristics, and endoscopic findings. Treatment was guided mostly by uncontrolled patient series for topical steroids and comprehensive diet exclusion therapy. Today, the molecular, genetic, and evolving microbiome’s contributions to EoE are being elucidated. EoE is recognized as one of the most common diseases in our practice, and rigorously performed controlled trials of steroids and biologics (including Food and Drug Administration–approved dupilumab) guide our treatment. Diet has also become easier with the identification of a single food antigen as the cause in 40% of EoE patients. The most pressing need is for a test that’s reliable and less invasive than endoscopy to assess and monitor treatment.

Dr. Katzka is professor of medicine at Columbia University, New York. He reports consulting for Takeda and Celgene.

This article was updated July 7, 2022.

Fifteen years is a lifetime for the advancement of medical research. This seems particularly true for upper GI tract disorders.

In 2007, eosinophilic esophagitis was a rare disease; limited clinical data were available describing the symptoms, demographic characteristics, and endoscopic findings. Treatment was guided mostly by uncontrolled patient series for topical steroids and comprehensive diet exclusion therapy. Today, the molecular, genetic, and evolving microbiome’s contributions to EoE are being elucidated. EoE is recognized as one of the most common diseases in our practice, and rigorously performed controlled trials of steroids and biologics (including Food and Drug Administration–approved dupilumab) guide our treatment. Diet has also become easier with the identification of a single food antigen as the cause in 40% of EoE patients. The most pressing need is for a test that’s reliable and less invasive than endoscopy to assess and monitor treatment.

Dr. Katzka is professor of medicine at Columbia University, New York. He reports consulting for Takeda and Celgene.

This article was updated July 7, 2022.

Fifteen years is a lifetime for the advancement of medical research. This seems particularly true for upper GI tract disorders.

In 2007, eosinophilic esophagitis was a rare disease; limited clinical data were available describing the symptoms, demographic characteristics, and endoscopic findings. Treatment was guided mostly by uncontrolled patient series for topical steroids and comprehensive diet exclusion therapy. Today, the molecular, genetic, and evolving microbiome’s contributions to EoE are being elucidated. EoE is recognized as one of the most common diseases in our practice, and rigorously performed controlled trials of steroids and biologics (including Food and Drug Administration–approved dupilumab) guide our treatment. Diet has also become easier with the identification of a single food antigen as the cause in 40% of EoE patients. The most pressing need is for a test that’s reliable and less invasive than endoscopy to assess and monitor treatment.

Dr. Katzka is professor of medicine at Columbia University, New York. He reports consulting for Takeda and Celgene.

This article was updated July 7, 2022.

The demographics of the American Gastroenterological Association have changed markedly since the first issue of GI and Hepatology News (GIHN) was published in 2007. GIHN’s first editorial team published news that was reliable and informative.

The first GIHN editor in chief, Dr. Charles J. Lightdale, described GIHN as “irresistible reading for all those seeking comprehensive, current, authoritative information in the field.” Today, GIHN continues the tradition of publishing news that is “irresistible,” “comprehensive,” and “authoritative.” However, GIHN’s board of editors looks quite different in 2022 than it did in 2007. The current board comprises people from both academic and private practice settings; we are from diverse ethnic and racial backgrounds. Finally, Dr. Megan A. Adams is the first woman to serve as editor in chief of the publication.

The last 15 years have seen an increase in the number of women and underrepresented minorities in gastroenterology. This, in turn, has changed the demographics of the AGA, and more women and underrepresented minorities are assuming leadership roles within the organization. The AGA values diversity and inclusion in its membership, but more importantly in its leadership. 

Next, Dr. John M. Carethers spoke about the importance of diversity and leadership. That afternoon, I sat on a panel with Dr. Anna S. Lok and Dr. Guadalupe Garcia-Tsao. The panel was asked to speak about mentoring across practice settings. As I sat there, I became acutely aware of the diversity represented on the panel and in the audience. The panelists were all women, and women of color. The future leaders of the AGA are from diverse backgrounds.

The physicians participating in that meeting came from academia and private practice – young men and women leaders from various racial and ethnic backgrounds. It was so uplifting to witness how the AGA is evolving. I am proud to be a member of an organization that values having different voices at the table. This diversity will make our organization stronger as we face the challenges in our profession today and in the future.

The traditional 15th-year anniversary gift is crystal, which symbolizes clarity and durability. On GIHN’s 15th-year anniversary, the path before us looks bright. The changing demographics of GI and of our organization brings together unfamiliar faces, fresh perspectives and new ideas that will help the organization build a clear and resilient path forward. Our future is bright!

Kimberly M. Persley, MD, AGAF, is a partner with Texas Digestive Disease Consultants/GI Alliance in Dallas, is on the medical staff of Texas Health Presbyterian Hospital, and is an associate editor of GI & Hepatology News. She has no relevant conflicts of interest.

The demographics of the American Gastroenterological Association have changed markedly since the first issue of GI and Hepatology News (GIHN) was published in 2007. GIHN’s first editorial team published news that was reliable and informative.

The first GIHN editor in chief, Dr. Charles J. Lightdale, described GIHN as “irresistible reading for all those seeking comprehensive, current, authoritative information in the field.” Today, GIHN continues the tradition of publishing news that is “irresistible,” “comprehensive,” and “authoritative.” However, GIHN’s board of editors looks quite different in 2022 than it did in 2007. The current board comprises people from both academic and private practice settings; we are from diverse ethnic and racial backgrounds. Finally, Dr. Megan A. Adams is the first woman to serve as editor in chief of the publication.

The last 15 years have seen an increase in the number of women and underrepresented minorities in gastroenterology. This, in turn, has changed the demographics of the AGA, and more women and underrepresented minorities are assuming leadership roles within the organization. The AGA values diversity and inclusion in its membership, but more importantly in its leadership. 

Next, Dr. John M. Carethers spoke about the importance of diversity and leadership. That afternoon, I sat on a panel with Dr. Anna S. Lok and Dr. Guadalupe Garcia-Tsao. The panel was asked to speak about mentoring across practice settings. As I sat there, I became acutely aware of the diversity represented on the panel and in the audience. The panelists were all women, and women of color. The future leaders of the AGA are from diverse backgrounds.

The physicians participating in that meeting came from academia and private practice – young men and women leaders from various racial and ethnic backgrounds. It was so uplifting to witness how the AGA is evolving. I am proud to be a member of an organization that values having different voices at the table. This diversity will make our organization stronger as we face the challenges in our profession today and in the future.

The traditional 15th-year anniversary gift is crystal, which symbolizes clarity and durability. On GIHN’s 15th-year anniversary, the path before us looks bright. The changing demographics of GI and of our organization brings together unfamiliar faces, fresh perspectives and new ideas that will help the organization build a clear and resilient path forward. Our future is bright!

Kimberly M. Persley, MD, AGAF, is a partner with Texas Digestive Disease Consultants/GI Alliance in Dallas, is on the medical staff of Texas Health Presbyterian Hospital, and is an associate editor of GI & Hepatology News. She has no relevant conflicts of interest.

The demographics of the American Gastroenterological Association have changed markedly since the first issue of GI and Hepatology News (GIHN) was published in 2007. GIHN’s first editorial team published news that was reliable and informative.

The first GIHN editor in chief, Dr. Charles J. Lightdale, described GIHN as “irresistible reading for all those seeking comprehensive, current, authoritative information in the field.” Today, GIHN continues the tradition of publishing news that is “irresistible,” “comprehensive,” and “authoritative.” However, GIHN’s board of editors looks quite different in 2022 than it did in 2007. The current board comprises people from both academic and private practice settings; we are from diverse ethnic and racial backgrounds. Finally, Dr. Megan A. Adams is the first woman to serve as editor in chief of the publication.

The last 15 years have seen an increase in the number of women and underrepresented minorities in gastroenterology. This, in turn, has changed the demographics of the AGA, and more women and underrepresented minorities are assuming leadership roles within the organization. The AGA values diversity and inclusion in its membership, but more importantly in its leadership. 

Next, Dr. John M. Carethers spoke about the importance of diversity and leadership. That afternoon, I sat on a panel with Dr. Anna S. Lok and Dr. Guadalupe Garcia-Tsao. The panel was asked to speak about mentoring across practice settings. As I sat there, I became acutely aware of the diversity represented on the panel and in the audience. The panelists were all women, and women of color. The future leaders of the AGA are from diverse backgrounds.

The physicians participating in that meeting came from academia and private practice – young men and women leaders from various racial and ethnic backgrounds. It was so uplifting to witness how the AGA is evolving. I am proud to be a member of an organization that values having different voices at the table. This diversity will make our organization stronger as we face the challenges in our profession today and in the future.

The traditional 15th-year anniversary gift is crystal, which symbolizes clarity and durability. On GIHN’s 15th-year anniversary, the path before us looks bright. The changing demographics of GI and of our organization brings together unfamiliar faces, fresh perspectives and new ideas that will help the organization build a clear and resilient path forward. Our future is bright!

Kimberly M. Persley, MD, AGAF, is a partner with Texas Digestive Disease Consultants/GI Alliance in Dallas, is on the medical staff of Texas Health Presbyterian Hospital, and is an associate editor of GI & Hepatology News. She has no relevant conflicts of interest.

I had an early attraction to newspapers. As a child growing up in Jersey City, N.J., I delivered them door-to-door. I was editor-in-chief of my high school newspaper and worked as a copy boy and sports reporter on the daily Jersey Journal. At Princeton, I joined the University Press Club, working as a string reporter for the New York Herald Tribune, Philadelphia Inquirer, and Associated Press.

I thought I might become a journalist, but medicine was too strong a calling. During my GI elective as a senior medical resident at New York Hospital, I was able to work with some of the first commercial fiberoptic instruments, which presaged my academic career in endoscopic innovation. I was editor-in-chief of Gastrointestinal Endoscopy from 1988 to 1996, and have been the consulting editor for GI Endoscopy Clinics of North America since 1997.

As the first editor-in-chief of GI & Hepatology News, I had the opportunity to combine a background in peer review with my early newspaper experience. My vision for the new publication was to provide information curated and vetted by experts, in contrast to the torrent pouring down from the Internet that was (pertinent to our specialty) “indigestible.” I put in much effort selecting stories provided by Elsevier Global Medical News, especially in constructing the front page. AGA Institute provided strong support, allowing me to choose an editorial board covering all subspecialties. I wanted to highlight the excitement of researchers balanced by expert review and commentary. The digital version added search features, and I tried to promote the “browse factor” that would also encourage advertising, critical to the success of any newspaper. At the end of my term, I felt I had laid a strong foundation, and have been delighted to see the publication continue to thrive.
 

Charles Lightdale, MD, is professor of medicine at Columbia University Medical Center in New York. He disclosed having no conflicts of interest.

I had an early attraction to newspapers. As a child growing up in Jersey City, N.J., I delivered them door-to-door. I was editor-in-chief of my high school newspaper and worked as a copy boy and sports reporter on the daily Jersey Journal. At Princeton, I joined the University Press Club, working as a string reporter for the New York Herald Tribune, Philadelphia Inquirer, and Associated Press.

I thought I might become a journalist, but medicine was too strong a calling. During my GI elective as a senior medical resident at New York Hospital, I was able to work with some of the first commercial fiberoptic instruments, which presaged my academic career in endoscopic innovation. I was editor-in-chief of Gastrointestinal Endoscopy from 1988 to 1996, and have been the consulting editor for GI Endoscopy Clinics of North America since 1997.

As the first editor-in-chief of GI & Hepatology News, I had the opportunity to combine a background in peer review with my early newspaper experience. My vision for the new publication was to provide information curated and vetted by experts, in contrast to the torrent pouring down from the Internet that was (pertinent to our specialty) “indigestible.” I put in much effort selecting stories provided by Elsevier Global Medical News, especially in constructing the front page. AGA Institute provided strong support, allowing me to choose an editorial board covering all subspecialties. I wanted to highlight the excitement of researchers balanced by expert review and commentary. The digital version added search features, and I tried to promote the “browse factor” that would also encourage advertising, critical to the success of any newspaper. At the end of my term, I felt I had laid a strong foundation, and have been delighted to see the publication continue to thrive.
 

Charles Lightdale, MD, is professor of medicine at Columbia University Medical Center in New York. He disclosed having no conflicts of interest.

I had an early attraction to newspapers. As a child growing up in Jersey City, N.J., I delivered them door-to-door. I was editor-in-chief of my high school newspaper and worked as a copy boy and sports reporter on the daily Jersey Journal. At Princeton, I joined the University Press Club, working as a string reporter for the New York Herald Tribune, Philadelphia Inquirer, and Associated Press.

I thought I might become a journalist, but medicine was too strong a calling. During my GI elective as a senior medical resident at New York Hospital, I was able to work with some of the first commercial fiberoptic instruments, which presaged my academic career in endoscopic innovation. I was editor-in-chief of Gastrointestinal Endoscopy from 1988 to 1996, and have been the consulting editor for GI Endoscopy Clinics of North America since 1997.

As the first editor-in-chief of GI & Hepatology News, I had the opportunity to combine a background in peer review with my early newspaper experience. My vision for the new publication was to provide information curated and vetted by experts, in contrast to the torrent pouring down from the Internet that was (pertinent to our specialty) “indigestible.” I put in much effort selecting stories provided by Elsevier Global Medical News, especially in constructing the front page. AGA Institute provided strong support, allowing me to choose an editorial board covering all subspecialties. I wanted to highlight the excitement of researchers balanced by expert review and commentary. The digital version added search features, and I tried to promote the “browse factor” that would also encourage advertising, critical to the success of any newspaper. At the end of my term, I felt I had laid a strong foundation, and have been delighted to see the publication continue to thrive.
 

Charles Lightdale, MD, is professor of medicine at Columbia University Medical Center in New York. He disclosed having no conflicts of interest.

For the final installment of this series, we “flashback” to our April 2016 issue, which featured a study examining 30-day complications among commercially insured adults undergoing colonoscopy with and without anesthesia-assisted sedation using Marketscan data (2008-2011).

Several letters to the editor challenged the methods used in this systematic review/meta-analysis, such that this question remains largely unresolved. What is clear is that we continue to lack an adequate understanding of which patients are most likely to benefit from anesthesia-assisted sedation, whether due to increased risk of failing standard sedation or increased risk of complications with standard sedation. This lack of clarity, as manifested in poorly specified guidelines, has fueled likely inappropriate allocation of monitored anesthesia care to low risk-patients (driven by a complex interplay of patient, provider, organizational, and economic factors), which has contributed to ballooning health care costs

Megan A. Adams, MS, JD, MSc, is a clinical lecturer in the division of gastroenterology at the University of Michigan, a gastroenterologist at the Ann Arbor Mich, VA, and an investigator in the VA Ann Arbor Center for Clinical Management Research. She is an associate editor of GI & Hepatology News.

For the final installment of this series, we “flashback” to our April 2016 issue, which featured a study examining 30-day complications among commercially insured adults undergoing colonoscopy with and without anesthesia-assisted sedation using Marketscan data (2008-2011).

Several letters to the editor challenged the methods used in this systematic review/meta-analysis, such that this question remains largely unresolved. What is clear is that we continue to lack an adequate understanding of which patients are most likely to benefit from anesthesia-assisted sedation, whether due to increased risk of failing standard sedation or increased risk of complications with standard sedation. This lack of clarity, as manifested in poorly specified guidelines, has fueled likely inappropriate allocation of monitored anesthesia care to low risk-patients (driven by a complex interplay of patient, provider, organizational, and economic factors), which has contributed to ballooning health care costs

Megan A. Adams, MS, JD, MSc, is a clinical lecturer in the division of gastroenterology at the University of Michigan, a gastroenterologist at the Ann Arbor Mich, VA, and an investigator in the VA Ann Arbor Center for Clinical Management Research. She is an associate editor of GI & Hepatology News.

For the final installment of this series, we “flashback” to our April 2016 issue, which featured a study examining 30-day complications among commercially insured adults undergoing colonoscopy with and without anesthesia-assisted sedation using Marketscan data (2008-2011).

Several letters to the editor challenged the methods used in this systematic review/meta-analysis, such that this question remains largely unresolved. What is clear is that we continue to lack an adequate understanding of which patients are most likely to benefit from anesthesia-assisted sedation, whether due to increased risk of failing standard sedation or increased risk of complications with standard sedation. This lack of clarity, as manifested in poorly specified guidelines, has fueled likely inappropriate allocation of monitored anesthesia care to low risk-patients (driven by a complex interplay of patient, provider, organizational, and economic factors), which has contributed to ballooning health care costs

Megan A. Adams, MS, JD, MSc, is a clinical lecturer in the division of gastroenterology at the University of Michigan, a gastroenterologist at the Ann Arbor Mich, VA, and an investigator in the VA Ann Arbor Center for Clinical Management Research. She is an associate editor of GI & Hepatology News.