Private Practice Gastroenterologists Research Articles

Probiotics plus vitamin D in irritable bowel syndrome: a prospective multicentric non-interventional study.

Patients with irritable bowel syndrome (IBS) experience recurrent symptoms and anxiety disorders that significantly impact their quality of life (QoL). The aim of the study was to assess in daily practice the benefit of the combination of three probiotic strains (Lactobacillus plantarum CETC 7484 and CETC 7485; Pediococcus acidilactici CECT 7483) plus vitamin D in patients with diarrhea-predominant IBS (IBS-D) or IBS with mixed bowel movements (IBS-M). This was a prospective, multicenter, non-interventional study in adult patients with IBS-D or IBS-M (Rome IV criteria) followed by private-practice gastroenterologists. Patients received daily one sachet of a combination of probiotics (3×109 CFU) and vitamin D (10 μg) for 42 days. The primary endpoint was the responder rate at D42 (≥50% and/or ≥100-point decrease of IBS-Severity Scoring System; IBS-SSS). Gut-related anxiety was measured with the Visceral Sensitivity Index (VSI). The full analysis set population included 246 patients (mean age, 51.2±15.4 years; women, 73.2%; IBS-D, 56.1%; IBS-M, 43.9%). At D42, among the 89 patients with evaluable data, the responder rate was 62.9% with a mean decrease of IBS-SSS of 146.6±125.9 (P<0.0001). Changes of IBS-SSS were significantly correlated with changes of IBS-QoL (r=-0.78; P<0.0001), HAD-anxiety (r=0.46; P<0.0001), HAD-depression (r=0.61; P<0.001) and VSI (r=0.74; P<0.0001). These real-life results are in line with a previous randomized clinical trial demonstrating the benefits of this combination in IBS-D and IBS-M. Symptom relief was associated with improvement of IBS-QoL, anxiety, depression and specifically gut-related anxiety.

Effect of Bifidobacterium longum 35624 on disease severity and quality of life in patients with irritable bowel syndrome.

BACKGROUND Bifidobacterium longum 35624 has shown efficacy in improving irritable bowel syndrome (IBS) symptoms compared with placebo in double-blind randomized studies. However, few data are available from real-life clinical practice or from studies that used Rome IV criteria to diagnose IBS.AIMTo assess the effect of B. longum 35624 on IBS severity and quality of life in a real-life setting. METHODSFrom November 2018 to January 2020, 278 patients with IBS (according to Rome IV criteria) were enrolled in a prospective, open-label, multicenter observational study by private practice gastroenterologists to received one capsule of B. longum 35624 (109 colony-forming units) per day for 30 d. Participation in the study was independently proposed to patients during spontaneous consultations. Disease severity (assessed by the IBS severity scoring system) and patient quality of life (assessed by the IBS quality of life questionnaire) were compared between the inclusion visit (baseline) and the visit at the end of 30 d of treatment. The characteristics of patients were described at baseline. Continuous variables comparisons between inclusion and end-of-treatment visits were performed using the t-test and Kruskal-Wallis test. Categorical variables comparisons were performed using the χ2 test.RESULTSA total of 233 patients, with a mean age of 51.4 years and composed of 71.2% women, were included in the study. Of these patients, 48.1% had moderate IBS and 46.4% had severe IBS. After a 30-d treatment period with one B. longum 35624 capsule per day, a significant decrease in IBS severity was observed compared to baseline (mean ± SD, IBS severity scoring system scores: 208 ± 104 vs 303 ± 81, P < 0.001) and 57% of patients moved to lower severity categories or achieved remission. The quality of life of patients was also improved by the treatment (IBS Quality of Life questionnaire score: 68.8 ± 20.9 vs 60.2 ± 20.5; P < 0.001) and 63.8% of patients were satisfied with the treatment.CONCLUSIONThirty days of treatment with B. longum 35624 reduces disease severity and improves the quality of life of patients with IBS, particularly those with the most severe forms of IBS.

Impact of Covid 19 on endoscopy in Germany

Practices and hospitals are facing great challenges in coping with the COVID-19-pandemic. So far, data on the impact of the pandemic on gastroenterological facilities are lacking, especially on a temporal course. A database is lacking, especially for the outpatient care sector. University Hospital of Augsburg was commissioned to generate data on this as a part of the collaborative project B-FAST of the Network of University Medicine (NUM). Gastroenterological institutions nationwide were surveyed by an online questionnaire. Recruitment was carried out via the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) and the Professional Association of Gastroenterologists in Private Practice (bng). This manuscript provides an overview of data on the use of protective equipment, pre-interventional testing of patients, staff screening and economic impact over the course of the pandemic. 429 facilities answered the questionnaire. Practices tested their patients pre-interventionally significantly less often than clinics (7.8% vs. 82.6%). In clinics, inpatients (93.1%) were tested significantly more often than outpatients (72.2%). The use of personal protective equipment (PPE) increased significantly during the pandemic. It was shown that over 70% of facilities screened their staff for SARS-CoV-2 without cause. Clinics cancelled elective procedures significantly more often than practices in quarter 4/2020. Procedures and turnover decreased in 2020 compared to the previous year. However, fewer facilities were affected by a loss of revenue than expected in previous studies. Our data demonstrate the variable implementation of pre-interventional SARS-CoV-2 testing in outpatient and inpatient care. The use of adequate PPE and staff screening increased during the pandemic.

285 Adherence to Recommending 10-Year Intervals After Normal Screening Colonoscopy in Average-Risk Individuals: A Snapshot of 2017 for Phase 1 of the Michigan CRC Screening Quality Improvement Project

INTRODUCTION: The Michigan CRC Screening Quality Improvement Project (CRC-QIP) is a multi-center, 4-phase project to improve adherence with recommending 10-year intervals after normal screening colonoscopies. Per guidelines, target is 90% adherence with recommended intervals. METHODS: Inclusion criteria: In order to minimize possible confounders, patients were limited to: (a) average-risk, 50–75 year olds; (b) colonoscopy performed in 2017; (c) sole indication-CRC screening; (d) no biopsy, polypectomy, or any abnormal findings on procedure report. Study Setting: In order to minimize confounders when stratifying for specialty and type of practice, only medical centers with (a) GI fellowship program; (b) Hospital-based “open” endoscopy unit (i.e., utilized by private practice gastroenterologists (GIs), colorectal surgeons, and general surgeons). Primary Outcome: Adherence to guideline-consistent intervals defined as repeat colonoscopy in 10 years or discontinue CRC screening due to patient's age when bowel preparation is adequate or &lt;1 year if bowel preparation is inadequate. Primary analysis is frequency of adherence based on endoscopist specialty after adjusting for multiple confounders, including procedure-related factors (e.g., withdrawal time), and endoscopist-related factors (e.g., yrs in practice, solo vs group practice, colonoscopies performed per yr). Hierarchical logistic regression model was used with adherence as the dependent variable with random intercepts for endoscopist performing procedure to account for correlation between endoscopist and site as fixed effects. RESULTS: Among 1,694 eligible patients, mean age was 58.7 ± 6.5, 43% male, and 68% African-American. Adherence was better for academic gastroenterologists with or without GI fellows vs private practice GIs or academic general surgeons (P = 0.04). The latter two groups were adherent in &lt;40% of patients (Table 1). Adherence was significantly better with good/excellent bowel preps compared to all other bowel prep categories (P &lt; 0.05), and patients with poor, fair, or no documentation of prep were adherent &lt;50% (Table 2). CONCLUSION: In this project, adherence did not meet guideline-specified target of 90% among private practice GIs and general surgeons. Phase 2 will include additional analysis to identify factors associated with non-adherence and a mixed methods qualitative study to identify appropriate interventions to improve performance.

Early Initiation of Anti-TNF is Associated with Favourable Long-term Outcome in Crohn's Disease: 10-Year-Follow-up Data from the Swiss IBD Cohort Study.

The optimal timing of treatment escalation in Crohn's disease [CD] remains a challenging issue, and very little is known about its long-term development following early versus late administration of anti-TNF antibodies. The long-term outcome of Swiss CD patients was comparatively assessed in an up to 10-year follow-up, using patients participating in the Swiss Inflammatory Bowel Disease Cohort Study [SIBDCS]. Prospectively collected SIBDCS patient data, including disease history, baseline characteristics at enrolment, and course of disease, were analysed in patients with early versus late [<24 versus ≥24 months after diagnosis] and no anti-TNF treatment. A reduced risk of developing bowel stenosis was found in patients who received early anti-TNF treatment. This association was seen in patients overall and also in the subgroups of CD patients without pre-existing complications [Log-rank test: p < 0.001].Furthermore, osteoporosis and anaemia were observed significantly less frequently in patients who received early anti-TNF treatment, compared with either patients who received treatment late [p < 0.001 and p = 0.046, respectively] or were never [p < 0.001 for both] treated with anti-TNF antibodies. Patients with early anti-TNF administration sought medical consultations significantly less often, including gastroenterologists in private practice [p = 0.017], ambulatory [outpatient] hospital visits [p = 0.038], and a composite of any medical visits [p = 0.001]. The percentage of patients unable to work was lowest for early-anti-TNF-treated patients, in comparison with patients who were treated late or never [3.6% vs 8.8% vs 3.7%, p = 0.016]. In CD patients within the SIBDCS, early anti-TNF administration was found to be associated with several indicators of a more favourable long-term outcome.

Scope of Burnout Among Young Gastroenterologists and Practical Solutions from Gastroenterology and Other Disciplines.

Burnout is a critical issue among physicians, including gastroenterologists. Up to 50% of gastroenterologists have reported symptoms of burnout in national assessments, leading to increased recognition of the burden of burnout among subspecialty societies. Particularly alarming in these assessments of burnout is the suggestion of increased rates of burnout among trainees and early career gastroenterologists. In this article, we describe the scope of burnout among young gastroenterologists and the risk factors that contribute. In addition, we will offer practical solutions to reduce burnout based on insights developed from multidisciplinary approaches, including relevant burnout literature, organizational approaches within academic medical centers, and training programs, as well as interviews with successful private practice gastroenterologists, and leaders in the fields of business and education.

Are Gastroenterologists Willing to Implement the "Predict, Resect, and Discard" Management Strategy for Diminutive Colorectal Polyps?: Results From a National Survey.

To determine whether gastroenterologists would be willing to accept the "predict, resect, and discard" strategy for diminutive colorectal polyps and identify potential barriers to implementation in clinical practice. The ASGE recently published a Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) document on managing diminutive colorectal polyps using the "predict, resect, and discard" strategy. However, there is no data on whether gastroenterologists would accept this paradigm shift. We performed a random survey of gastroenterologists at a national meeting. Awareness of and willingness to adopt the "predict, resect, and discard" practice, reasons for not utilizing it, and whether a financial incentive would be persuasive in implementing the practice were assessed. A total of 105 gastroenterologists were surveyed. Seventy-six (72%) were aware of the PIVI statement and 64 (61%) stated they would be willing to implement this in practice. Medical-legal concerns (85%) and lack of financial incentives (32%) were the 2 most commonly cited barriers to implementation. Greater than 50% of those resistant to performing the service would be willing do so if given a financial incentive, with ∼50% of gastroenterologists who cited an appropriate incentive preferring >$75 to do so. Of these, private practice gastroenterologists and those who had financial interest in sending polyps to pathology were the most likely to request this amount. Approximately two-thirds of gastroenterologists are willing to adopt the "predict, resect, and discard" strategy for managing diminutive colon polyps. Medical-legal concerns and lack of financial incentives are the primary barriers to implementation.

Pricing Practices of Gastroenterologists in New York

There is growing awareness of the price disparities for equivalent services in healthcare. We aimed to characterize regional variations in fees charged by gastroenterologists in Manhattan, NY. All private practice gastroenterologists in Manhattan were contacted and asked what they charge fee-paying patients for initial consultations for nonspecific gastrointestinal symptoms. Cost information was obtained from 89 offices, and practices were classified on the basis of location in Manhattan. We observed significant regional variation; gastroenterologists on the Upper East Side (1.20-fold the overall mean) charged more than twice as those on the Upper West Side (0.58-fold the mean) and 50% more than gastroenterologists in South Manhattan (0.76-fold the mean). The coefficient of variation was 46%; the most expensive gastroenterologist charged 14-fold more than the least expensive. We provide evidence for significant regional variation in prices for medical services. Future studies are needed to characterize regional price variations in other aspects of healthcare.

Gastroenterology: A Field With Endless Career Opportunities for Physicians and Scientists

Gastroenterology is an exciting and burgeoning field that provides an extraordinary number of career opportunities for physicians and scientists. The unique blend of intellectual and procedural-based clinical practice coupled with the excite

314l: Improved Adenoma Detection Rates At an Academic Gastroenterology Unit Following Department Colonoscopy Assessment

There is a clear association between colonoscopic withdrawal time and adenoma detection rates. Furthermore, there is a wide variation in the withdrawal times, as well as, adenoma detection rates among academic and private practice gastroenterologists.

S1037 Detection Bias Influences Increasing Rates of Microscopic Colitis: A Population Based Study

Background and Aim: Anemia is a common complication of inflammatory bowel disease (IBD) in both Crohn's disease (CD) and ulcerative colitis (UC). Studies on anemia in patients with IBD are usually conducted in tertiary referral centers. Unfortunately, data from private clinical practice is missing. The aim of the present study was to investigate the occurrence of anemia in IBD patients from University Hospitals and from private practices and to compare those results to healthy blood donor candidates. Methods: Data (such as age, gender, hemoglobine level, disease severity) was acquired prospectively from patients included in the Swiss IBD Cohort Study. The control population consisted of healthy first-time blood donor candidates at the blood transfusion center, Swiss Red Cross, Basel. IBD activity was measured in CD by the Crohn's disease activity index (CDAI) and in UC by the modified Truelove and Witts activity index (MTWAI). Anemia was defined as haemoglobin level ≤ 120 g/l in women and ≤ 130 g/l in men. Iron deficiency anemia was defined by a ferritin level 150, MTWAI >3) was defined as iron deficiency anemia in combination with anemia of chronic disease. Results: 125 patients from University Hospitals (66 CD and 59 UC) and 116 patients from private practices (71 CD and 45 UC) were included and compared to a control population (6074 blood donor candidates). In women from University Hospitals, anemia was significantly more frequent than in women from private practice and healthy female blood donors (30.4% vs. 11.9% vs 4.0%, p< 0.0001). In men anemia was less pronounced but reached statistical significance (27.8% vs. 14.3% vs. 2.8%, p< 0.001). CDAI was significantly higher in University Hospitals as compared to private practice (97.1± 72.4 vs. 64.7± 58.8, p=0.006) whereas the MTWAI was comparable (5.4 ± 4.5 vs. 3.9 ± 3.9, p=0.07). Anemia caused by iron deficiency was found in 60% of the IBD-patients from tertiary centers with anemia, but just in 18% of the IBD patients from private practice with anemia (p= 0.025). Supplementation therapy with iron/folic acid/vitamin B12 was applied more often in private practice than in University Hospitals (42% vs. 27%, p=0.01). Conclusions: Frequency of anemia in IBD patients is high in both tertiary referral centers and in private practice but is more pronounced in tertiary referral centers. The anemia is mainly caused by iron deficiency indicating that private practice gastroenterologists are more aware of potential iron deficiency and subsequent substitution therapy.

S1036 Anemia in Inflammatory Bowel Disease: Differences Between Private Practice and University Hospital: A Prospective Study

Background and Aim: Anemia is a common complication of inflammatory bowel disease (IBD) in both Crohn's disease (CD) and ulcerative colitis (UC). Studies on anemia in patients with IBD are usually conducted in tertiary referral centers. Unfortunately, data from private clinical practice is missing. The aim of the present study was to investigate the occurrence of anemia in IBD patients from University Hospitals and from private practices and to compare those results to healthy blood donor candidates. Methods: Data (such as age, gender, hemoglobine level, disease severity) was acquired prospectively from patients included in the Swiss IBD Cohort Study. The control population consisted of healthy first-time blood donor candidates at the blood transfusion center, Swiss Red Cross, Basel. IBD activity was measured in CD by the Crohn's disease activity index (CDAI) and in UC by the modified Truelove and Witts activity index (MTWAI). Anemia was defined as haemoglobin level ≤ 120 g/l in women and ≤ 130 g/l in men. Iron deficiency anemia was defined by a ferritin level 150, MTWAI >3) was defined as iron deficiency anemia in combination with anemia of chronic disease. Results: 125 patients from University Hospitals (66 CD and 59 UC) and 116 patients from private practices (71 CD and 45 UC) were included and compared to a control population (6074 blood donor candidates). In women from University Hospitals, anemia was significantly more frequent than in women from private practice and healthy female blood donors (30.4% vs. 11.9% vs 4.0%, p< 0.0001). In men anemia was less pronounced but reached statistical significance (27.8% vs. 14.3% vs. 2.8%, p< 0.001). CDAI was significantly higher in University Hospitals as compared to private practice (97.1± 72.4 vs. 64.7± 58.8, p=0.006) whereas the MTWAI was comparable (5.4 ± 4.5 vs. 3.9 ± 3.9, p=0.07). Anemia caused by iron deficiency was found in 60% of the IBD-patients from tertiary centers with anemia, but just in 18% of the IBD patients from private practice with anemia (p= 0.025). Supplementation therapy with iron/folic acid/vitamin B12 was applied more often in private practice than in University Hospitals (42% vs. 27%, p=0.01). Conclusions: Frequency of anemia in IBD patients is high in both tertiary referral centers and in private practice but is more pronounced in tertiary referral centers. The anemia is mainly caused by iron deficiency indicating that private practice gastroenterologists are more aware of potential iron deficiency and subsequent substitution therapy.

Variability in the diagnosis and management of adenoma-like and non-adenoma-like dysplasia-associated lesions or masses in inflammatory bowel disease: an Internet-based study

Dysplasia-associated lesions or masses (DALMs) in inflammatory bowel disease (IBD) are a heterogeneous group of tumors with different natural histories. Our purpose was to determine the ability of gastroenterologists (GE) to distinguish adenoma-like (ALD) from non-adenoma-like DALMs (NALD) in patients with ulcerative colitis (UC) and to evaluate management practices with regard to these lesions. Randomly chosen academic and private practice members of the American Society for Gastrointestinal Endoscopy and a group of IBD experts. All GEs answered a series of questions related to UC-associated DALMs and were asked to classify 13 digitally transmitted endoscopic images (5 ALD, 5 NALD, and 3 inflammatory polyps [IP]). Internet-based survey. Not applicable. Not applicable. Percentage of respondents who answered management questions and classified endoscopic images correctly. ALD, NALD, and IP were correctly diagnosed by 68%, 75%, and 82% of IBD experts; 58%, 56%, and 57% of academic gastroenterologists; and 60%, 73%, and 60% of private practice GEs, respectively. Overall, there were no significant differences in rates of correct diagnosis for the 3 types of polyps (P=.603). IBD experts showed a significantly higher correct diagnosis rate (P=.048) and interobserver agreement (P<.01) compared with the other two GE groups. Many GEs were not aware of the currently recommended management guidelines for patients with IBD with DALMs. Only a single endoscopic image was used in this study. The response rate was 32%. These data suggest that academic GEs and private practice GEs have more difficulty than IBD experts do in distinguishing between and managing DALMs in patients with UC.

579 Effectiveness of antiviral therapy in patients with chronic hepatitis C treated by gastroenterologists in private practice

579 Effectiveness of antiviral therapy in patients with chronic hepatitis C treated by gastroenterologists in private practice

Effektivität der antiviralen Behandlung von Patienten mit chronischer Hepatitis C in der gastroenterologischen Facharztpraxis

The standard treatment for patients with chronic hepatitis C consists of pegylated interferon (PegIFN) alpha in combination with ribavirin. Information on treatment effectiveness outside clinical trials is sparse. To study community-based health care, a regional network supported by the German network of competence for hepatitis (Hep-Net) was created between gastroenterologists in private practice and a tertiary referral centre. A treatment register containing evidence-based guidelines was established and 212 consecutive patients who were treated with either PegIF Nalpha 2a/ribavirin (n = 126) or PegIFNalpha2b/ribavirin (n = 86) for 24 weeks (HCV genotype 2, 3) and 48 weeks (HCV genotype 1, 4, 5), respectively, were included and followed prospectively. Twenty-four weeks after cessation of antiviral treatment a sustained virological response was achieved in 54 % of the patients. By univariate analyses, infection with HCV genotypes 2 or 3 (p < 0.0001), younger age (p < 0.0001), normal gamma-glutamyltransferase levels before initiation of treatment (p = 0.003), and absence of language communication problems (p = 0.023) were associated with a sustained virological response. The presence of liver cirrhosis in patients with HCV genotype 1, 4, 5 infection was associated with lower sustained response rates (p = 0.025). Patients infected with HCV genotype 1 in whom the PegIFNalpha dose was reduced had higher virological relapse rates (p = 0.049). With regard to the treating physician, sustained virological response rates ranged from 26 - 67 % in patients infected with HCV genotype 1. Our study shows that virological response rates similar to those in international randomised clinical trials can be achieved by private practice gastroenterologists. The presented network allows characterization of the treatment outcome in chronic hepatitis C not only with regard to virus- and host-related factors but also on an individual physician basis.

Evaluation der ambulanten gastroenterologischen Betreuung von HNPCC-Patienten und deren Familien

The differential diagnostic assignment of patients with hereditary non-polyposis colorectal cancer among patients with non-familial colorectal carcinoma is difficult but essential to provide early sufficient cancer screening. In order to analyze the actual situation of outpatients, 36 gastroenterologists in private practice have been interviewed with respect to their experience concerning outpatients. The interview data revealed that care for patients with colorectal cancer is a fundamental component of their work. A third of the gastroenterologists deal with patients suffering from colorectal cancer before 45 years of age. Yet these gastroenterologists did not report a single HNPCC patient. Especially gastroenterologists with long lasting experience in private practice did not mention HNPCC patients at all. These results may indicate that identifying the cases at risk for HNPCC is difficult in daily routine work. The possibility of genetic diagnostics (and counselling) should be taken into consideration in individual cases. In consequence comprehensive screening programs can be initiated for patients and their families.

The Role of Endoscopy in the Management of Inflammatory Bowel Disease in French Gastro Enterological Private Practice: A Study Based on a Sample of 1175 Patients

Aim: The aim of this study was to evaluate the use of endoscopy for the management of inflammatory bowel disease (IBD) in private practice in France. Methods: The entire group of 2,039 French gastro enterologists in private practice were invited by mail to take part in this study. They had to collect data from all patients with Crohn's disease (CD), ulcerative colitis (UC) or indeterminate colitis (IC) between the 13th and the 25th of October 2003. Results: 375 practitioners (18,4%) invited to take part in this study participated actively; 1175 files were collected of which 1065 were fully exploitable which corresponded to 533 CD (50%), 498 UC (47%) and 34 IC (3%). Almost all patients (96%) had had a colonoscopy. Sigmoïdoscopy was performed for 333 patients (31%), more often in UC and IC than in CD (respectively 50%, 29% and 13%). Colonoscopies were performed for diagnosis. The average was 1,79 colonoscopies per patient (1,59 for UC, 1,97 for CD, 1,56 for IC). Half of them had had only one colonoscopy. An upper endoscopy was performed in 294 CD (55%). From the 1065 IBD, 881 (82%) had a colonic localisation of their disease. Among them 427 (48%) had a left colitis, 59 (7%) a pancolitis. Three hundred and seventy seven patients (35%) had suffered from the disease for more than 8 years. A colonoscopy was used to research dysplasia for 166 patients (105 UC, 55 CD, 6 IC). Forty five per cent of this group had 1 colonoscopy for screening dysplasia, 20% had 2, 12% had 3 and 22% more than 3. Endoscopic dialatations for benign strictures were performed for 17 patients (4 UC, 12CD, 1 IC): 9 once and only one more than three times. Conclusion: Considering the methodology of this survey and the significant number of patients examined, two facts can be stressed out: in France, colonoscopy is mainly used for diagnosis (with a low number of therapeutic colonoscopies) and this examination is rarely done more than twice during the disease. There is a lack of surveillance colonoscopies for screening dysplasia among patients with long duration disease. Aim: The aim of this study was to evaluate the use of endoscopy for the management of inflammatory bowel disease (IBD) in private practice in France. Methods: The entire group of 2,039 French gastro enterologists in private practice were invited by mail to take part in this study. They had to collect data from all patients with Crohn's disease (CD), ulcerative colitis (UC) or indeterminate colitis (IC) between the 13th and the 25th of October 2003. Results: 375 practitioners (18,4%) invited to take part in this study participated actively; 1175 files were collected of which 1065 were fully exploitable which corresponded to 533 CD (50%), 498 UC (47%) and 34 IC (3%). Almost all patients (96%) had had a colonoscopy. Sigmoïdoscopy was performed for 333 patients (31%), more often in UC and IC than in CD (respectively 50%, 29% and 13%). Colonoscopies were performed for diagnosis. The average was 1,79 colonoscopies per patient (1,59 for UC, 1,97 for CD, 1,56 for IC). Half of them had had only one colonoscopy. An upper endoscopy was performed in 294 CD (55%). From the 1065 IBD, 881 (82%) had a colonic localisation of their disease. Among them 427 (48%) had a left colitis, 59 (7%) a pancolitis. Three hundred and seventy seven patients (35%) had suffered from the disease for more than 8 years. A colonoscopy was used to research dysplasia for 166 patients (105 UC, 55 CD, 6 IC). Forty five per cent of this group had 1 colonoscopy for screening dysplasia, 20% had 2, 12% had 3 and 22% more than 3. Endoscopic dialatations for benign strictures were performed for 17 patients (4 UC, 12CD, 1 IC): 9 once and only one more than three times. Conclusion: Considering the methodology of this survey and the significant number of patients examined, two facts can be stressed out: in France, colonoscopy is mainly used for diagnosis (with a low number of therapeutic colonoscopies) and this examination is rarely done more than twice during the disease. There is a lack of surveillance colonoscopies for screening dysplasia among patients with long duration disease.

Endoscopy and dyspepsia: From theory to practical use, a cregg study involving a national representative sample of private practice gastroenterologists

Endoscopy and dyspepsia: From theory to practical use, a cregg study involving a national representative sample of private practice gastroenterologists

Characteristics of best gastroenterology practices.

As health care costs continue to rise, competition among providers is increasing. Although this competition is currently based on price, quality of care will become an increasingly important issue. One popular method to assess quality is by comparing physicians' performance with that of a representative group of physicians, in a process called benchmarking. The purpose of this study was to survey private practice gastroenterologists to identify the practice characteristics, so-called "best practices," associated with high-quality health care delivery to provide data for use as benchmarks. Three hundred randomly selected gastroenterology practices were surveyed regarding practice demographics, administration, financial management, and use of outcomes techniques by mail questionnaire. Analogous questionnaires were completed by representatives of the gastroenterology practices comprising the Gastroenterology Practice Management Group, LLC (GMPG). One hundred and eighty-two (61%) of the 300 eligible practices responded to the questionnaire. Increasing differences between survey and benchmark GPMG practices were observed as the complexity of quality measures increased. Among structure measures, the groups were similar. By contrast, significant differences were observed between survey and benchmark groups with regards to outcomes measures such as the use of practice guidelines, continuous quality improvement, and outcomes assessment. These results provide a snapshot of gastroenterology practices across the country and can be used as a benchmark for quality assessment purposes to compare with one's practice, suggesting areas for change or improvement. It seems clear that the defining characteristic of best gastroenterology practices is the demonstration of quality patient care. It also appears that many practices' efforts in this regard could be increased.

Characteristics of best gastroenterology practices

OBJECTIVE: As health care costs continue to rise, competition among providers is increasing. Although this competition is currently based on price, quality of care will become an increasingly important issue. One popular method to assess quality is by comparing physicians’ performance with that of a representative group of physicians, in a process called benchmarking. The purpose of this study was to survey private practice gastroenterologists to identify the practice characteristics, so-called “best practices,” associated with high-quality health care delivery to provide data for use as benchmarks. METHODS: Three hundred randomly selected gastroenterology practices were surveyed regarding practice demographics, administration, financial management, and use of outcomes techniques by mail questionnaire. Analogous questionnaires were completed by representatives of the gastroenterology practices comprising the Gastroenterology Practice Management Group, LLC (GMPG). RESULTS: One hundred and eighty-two (61%) of the 300 eligible practices responded to the questionnaire. Increasing differences between survey and benchmark GPMG practices were observed as the complexity of quality measures increased. Among structure measures, the groups were similar. By contrast, significant differences were observed between survey and benchmark groups with regards to outcomes measures such as the use of practice guidelines, continuous quality improvement, and outcomes assessment. CONCLUSIONS: These results provide a snapshot of gastroenterology practices across the country and can be used as a benchmark for quality assessment purposes to compare with one’s practice, suggesting areas for change or improvement. It seems clear that the defining characteristic of best gastroenterology practices is the demonstration of quality patient care. It also appears that many practices’ efforts in this regard could be increased.