US Gastroenterologists Research Articles

Practice Trends among US Gastroenterologists following the 2020 American Gastroenterological Association Guidelines on Gastric Intestinal Metaplasia: Data from a Tertiary Care Center.

Studies show variability in gastroenterologists' management of gastric intestinal metaplasia (GIM) in the United States. In 2020, the American Gastroenterological Association published GIM guidelines, recommending physician-patient shared decision-making on GIM surveillance based on risk factors. We compared gastroenterologists' communication trends of a GIM finding and surveillance recommendations before and after 2020 and evaluated patient and provider factors associated with a surveillance recommendation. A sample of patients diagnosed with GIM on biopsies from upper endoscopies performed in 2018 (cohort A) and 2021 (cohort B) were included. Logistic regression analysis assessed the association between patient/provider characteristics and surveillance recommendations in the overall cohort and over time. In all, 347 patients were included: 175 in cohort A and 172 in B. Median age was 65.7 (56.0, 73.4), and 54.5% were females. Communication to patients about GIM findings and surveillance recommendations increased from 24.6% <2020 to 50% >2020 (P<0.001) and 20% <2020 to 41.3% >2020 (P<0.001), respectively. Overall, endoscopy >2020, family history of gastric cancer, autoimmune gastritis, female providers, and gastroenterologists with 10 to 20 years of experience were associated with a surveillance recommendation. The effect of family history of gastric cancer and the effect of the patient's female sex on surveillance was significantly different between both cohorts [Odds ratio (OR): 0.13, 95% (Confidence interval) CI: 0.02, 0.97 and OR 3.39, 95% CI: 1.12, 10.2, respectively). Despite a 2-fold increase in surveillance recommendations after 2020, there was no meaningful effect of any of the patients' factors on a recommendation for surveillance over time, which raises the question as to whether surveillance is being offered to both average and high-risk patients without thorough risk stratification.

Burnout Among US Gastroenterologists and Fellows in Training: Identifying Contributing Factors and Offering Solutions.

Consequences of physician burnout include medical errors, higher rate of staff turnover, and decreased patient satisfaction. We examined the prevalence of burnout and identified the contributing factors in gastroenterologists and fellows in training. We performed 3 separate surveys through the American College of Gastroenterology. (1) A national survey of practicing gastroenterologists in the United States that measured burnout and contributing factors, (2) a survey of gastroenterology fellows in training to determine self-identified burnout, as well as mitigating and exacerbating factors, and (3) a follow-up survey of fellows during the COVID-19 pandemic. One thousand and twenty-one persons responded (9.2% response rate) to the first survey, including 756 individuals who completed the Maslach Burnout Inventory survey. Overall, the prevalence of high burnout was 49.3%. Factors associated with high burnout included female sex, younger age, shorter duration in practice, considering the electronic health record non-user-friendly, 2 or more hours of patient-related work at home per day, 8 or more hours of outpatient time per day, 6 or more inpatient consults per day, taking call with procedures 10 or more times per year, and having children at home. With regard to lifestyle factors, taking 20 days or more of vacation time was associated with a lower rate of burnout. The level of burnout for fellows was observed to be high (42.7% in survey 2 and 35.3% in survey 3). Burnout is high in gastroenterologists and fellows in training. Specific contributing factors were both systems based and personal and provide insight into changes that can be made to address burnout.

S1880 Communication and Surveillance Recommendations on Gastric Intestinal Metaplasia by US Gastroenterologists Before and After the 2020 American Gastroenterological Association Guidelines: Data From a Tertiary Care Center

S1880 Communication and Surveillance Recommendations on Gastric Intestinal Metaplasia by US Gastroenterologists Before and After the 2020 American Gastroenterological Association Guidelines: Data From a Tertiary Care Center

P044 A Profile of New Start IBD Patients on Multiple Advanced/Biologic Therapies.

After analyzing patient chart data from nearly 1,000 recently-initiated biologic/JAK inhibitor inflammatory bowel disease (IBD) patients, it was discovered that 6% are treated with multiple advanced/biologic therapies. This analysis sought to profile those new start patients on a multi-biologic/JAK inhibitor regimen against those treated with a single advanced therapy to determine the type of patient who is typically initiated on more than one advanced/biologic therapy, and why the combination is necessary. An independent market analytics firm collaborated with US gastroenterologists (n=197) to conduct a retrospective chart review of patients with inflammatory bowel disease (IBD) (n=999) who were started on a biologic agent for the first time. Gastroenterologists submitted patient-level data via a HIPAA-compliant audit form which included both clinical and non-clinical data. The data were collected and analyzed in April-June 2021. 7% of ulcerative colitis (UC) and 5% of Crohn's disease (CD) patients are currently treated with more than one biologic/JAK inhibitor. The most common therapy used in combination with another for UC is adalimumab (36%), followed by infliximab brand (18%), and ustekinumab (18%). For CD, the most common combinations involve infliximab brand (35%), followed by vedolizumab (22%), and ustekinumab (13%). The necessity for multiple biologic therapy is clarified when reviewing the IBD patients' comorbidities and medical history. The prevalence of ulcerative proctitis (34% vs. 11%) and gastroduodenal CD (43% vs. 4%) among multi-biologic/JAK inhibitor patients is higher than among those treated with one biologic/JAK inhibitor. Additionally, multi-biologic/JAK inhibitor patients have an increased prevalence of recent bowel perforation (16% vs. 1%) and surgical bowel re-section (10% vs. 3%) compared to those treated with just one advanced therapy. Due to this more severe disease profile, patients treated with more than one advanced/biologic therapy are more likely to report severe impairment in work performance (48% vs. 34%), chronic fatigue comorbidity (23% vs. 5%), more frequent ER visits per year (average= 2.3 vs. 1.1), and more frequent hospitalizations per year (2.0 vs. 0.6). A profile of new start biologic IBD patients ideal for concomitant advanced therapy emerged when reviewing almost 1,000 physician-reported patient records. These patients are more likely to have had gastroduodenal Crohn's disease and or recent bowel perforation or re-section. These patients are more likely to report impaired work performance, chronic fatigue, more frequent ER visits and more frequent hospitalizations.

Knowledge of chronic intestinal failure among US gastroenterologists: Cause for concern and learning opportunity.

Chronic intestinal failure (CIF) is an ultrarare disease, with an estimated national prevalence of ∼25,000 cases. There is a suspicion of widespread lack of expertise in CIF care, but no formal assessment tool or data exist. We developed and validated a knowledge test in CIF and now report our preliminary results from testing CIF knowledge in a cohort of US gastroenterologists. We developed a 20-question knowledge test in CIF, covering four key components of IF. After internal testing, refinement, and revision, we administered the test to a convenience sample of experts and nonexperts in IF. We then deployed the validated test to a cohort of 100 US gastroenterologists. The test had a Cronbach alpha of 0.74, suggesting a reliable test, with a threshold score to discriminate experts and nonexperts of 13.4 (maximum 20) and with a sensitivity of 81.3% and specificity of 86.4%. The overall mean score of 8.2 for the 100 US gastroenterologists was at the level of nonexperts in our convenience sample. The preliminary results of our validated knowledge test in IF among a broad group of US gastroenterologists demonstrate lack of knowledge in IF.

P046 Though Biosimilar Infliximab Prescribing in Inflammatory Bowel Disease Has Increased, Branded Infliximab Continues to Be Prescribed More Often.

BACKGROUND: Prescribing of biosimilar infliximab in biologic-naïve, inflammatory bowel disease patients, relative to the reference brand, has grown slightly over the past two years. The rate of physician acceptance of requests from pharmacists and insurance companies, to switch from the reference brand to the biosimilar has increased at a similar rate. In a patient chart study conducted in June 2020, the majority of biologic-naïve patients placed on infliximab were prescribed the reference brand despite the availability of two infliximab biosimilars. Additionally, physicians were not requested to switch the reference brand to a biosimilar in a majority of prescribing situations. A comparison of these trends to an identical study, from two years ago, are presented. METHODS: An independent market analytics firm collaborated with US gastroenterologists (n = 218) to conduct a retrospective chart review of patients with inflammatory bowel disease (IBD) (n = 1,001), who were started on a biologic agent for the first time. Gastroenterologists submitted patient-level data via a HIPAA-compliant audit form which included both clinical and non-clinical data. The collaborating physicians also completed a brief survey about their practices and their opinions regarding IBD patient management. The data were collected and analyzed in June 2020. The data are then compared to a similar study with US gastroenterologists (n = 218) with a retrospective chart review of patients with inflammatory bowel disease (IBD) (n = 1,001) that was collected in 2018. RESULTS: 26% of the patients starting on a biologic for the first time were initiated on infliximab. Of those, 73% were placed on the reference brand, while 27% were placed on a biosimilar. This represents a ten-point increase in biosimilar infliximab prescribing since the last assessment was conducted in 2018 (17%). However, the majority of infliximab prescribing is still for the reference brand. In 82% of the cases where the patient was placed on the reference brand, the physician was not contacted by a pharmacist or insurance company about using a biosimilar in place of the reference brand. This was a decrease of eight points since the last assessment in 2018 (90%). Physicians indicated that if they had been contacted, in 52% of the cases they would have switched to a biosimilar, a nine-point increase from two years ago (43%). Rather than switch, in 39% of the request situations physicians indicated would have pressed to use the reference brand, a twelve-point decrease from two years ago (51%). Finally, in 9% of the request situations physicians would have chosen a non-infliximab alternative, vs switching to a biosimilar or pressing to use the reference brand; only a three-point increase from the data in 2018 (6%). CONCLUSION: While prescribing of infliximab biosimilars has increased slightly over the past two years, use of the reference brand still occurs in the majority of potential substitution situations. Physicians’ receptivity to a requested switch to the biosimilar by a pharmacist or insurance company has increased slightly in the same timeframe.

P047 Awareness and Impact of Recent AGA Guideline Changes for Moderate to Severe Ulcerative Colitis Patients.

BACKGROUND: In January 2020, the American Gastroenterological Association (AGA) released several guideline changes related to the treatment of moderate to severe ulcerative colitis (UC) patients. One of these changes recommended prescribing infliximab or vedolizumab rather than adalimumab for induction of remission in adults with moderate to severe UC who are new to biologic therapy. A second change recommended prescribing ustekinumab or tofacitinib, rather than vedolizumab or adalimumab for induction of remission in UC patients who have been exposed to infliximab and who were not responsive. This research sought to demonstrate the impact that awareness of guideline changes has on use of therapies impacted by each guideline change. METHODS: An independent market analytics firm collaborated with US gastroenterologists (n = 112) to conduct an analysis on the US inflammatory bowel disease (IBD) market. Data collected from the participating gastroenterologists include basic demographics, prescribing behavior, and attitudinal survey responses. Data were collected in April 2020. Responding gastroenterologists were required to predominantly treat adult patients, have at least 50 IBD patients under their management, and spend at least half of their professional time in clinical practice. RESULTS: 66% of gastroenterologists reported awareness of the guideline change recommending the prescribing of infliximab or vedolizumab rather than adalimumab for induction of remission in adult, moderate to severe ulcerative colitis patients who are new to biologic therapy. Using a five point scale, 51% of physicians indicated the guideline change would have some impact (four out of five rating) or a large impact (five out of five rating) on their prescribing of vedolizumab in moderate to severe ulcerative colitis patients. 54% of gastroenterologists reported awareness of the guideline change recommending the prescribing of ustekinumab or tofacitinib rather than vedolizumab or adalimumab for induction of remission in adult, moderate to severe ulcerative colitis patients who have been exposed to infliximab and who were not responsive. Using a five point scale, 63% of physicians indicated the guideline change would have some impact (four out of five rating) or a large impact (five out of five rating) on their prescribing of ustekinumab in these patients, while 32% of gastroenterologists indicated a similar response for their prescribing of tofacitinib in these patients. CONCLUSION: A majority of gastroenterologists have awareness of the AGA guideline changes relative to adult, moderate to severe ulcerative colitis patients new to biologics and that awareness has a positive effect on prescribing of vedolizumab in these patients. Approximately one-half of gastroenterologists are aware of the AGA guideline change relative to adult moderate to severe ulcerative colitis patients who have been exposed to infliximab and who were not responsive. This awareness also had a positive effect on prescribing of ustekinumab, and to a lesser extent, tofacitinib, in these patients.

Physician sentiment toward artificial intelligence (AI) in colonoscopic practice: a survey of US gastroenterologists.

Background and study aims Early studies have shown that artificial intelligence (AI) has the potential to augment the performance of gastroenterologists during endoscopy. Our aim was to determine how gastroenterologists view the potential role of AI in gastrointestinal endoscopy. Methods In this cross-sectional study, an online survey was sent to US gastroenterologists. The survey included questions about physician level of training, experience, and practice characteristics and physician perception of AI. Descriptive statistics were used to summarize sentiment about AI. Univariate and multivariate analyses were used to assess whether background information about physicians correlated to their sentiment. Results Surveys were emailed to 330 gastroenterologists nationwide. Between December 2018 and January 2019, 124 physicians (38 %) completed the survey. Eighty-six percent of physicians reported interest in AI-assisted colonoscopy; 84.7 % agreed that computer-assisted polyp detection (CADe) would improve their endoscopic performance. Of the respondents, 57.2 % felt comfortable using computer-aided diagnosis (CADx) to support a “diagnose and leave” strategy for hyperplastic polyps. Multivariate analysis showed that post-fellowship experience of fewer than 15 years was the most important factor in determining whether physicians were likely to believe that CADe would lead to more removed polyps (odds ratio = 5.09; P = .01). The most common concerns about implementation of AI were cost (75.2 %), operator dependence (62.8 %), and increased procedural time (60.3 %). Conclusions Gastroenterologists have strong interest in the application of AI to colonoscopy, particularly with regard to CADe for polyp detection. The primary concerns were its cost, potential to increase procedural time, and potential to develop operator dependence. Future developments in AI should prioritize mitigation of these concerns.

From Intention to Action: Operationalizing AGA Diversity Policy to Combat Racism and Health Disparities in Gastroenterology

From Intention to Action: Operationalizing AGA Diversity Policy to Combat Racism and Health Disparities in Gastroenterology

Surveying ADR Knowledge and Practices Among US Gastroenterologists.

The adenoma detection rate (ADR) is of primary importance to the quality of screening colonoscopy. An online survey was conducted to assess knowledge and practices on ADR. Paid questionnaire distributed by email. Eligible respondents were board certified gastroenterologists who perform >80 colonoscopies per month with 3 to 35 years practice after fellowship. There were 250 respondents. In total, 39% were unaware that ADR applies only to screening colonoscopies and 76% incorrectly answered that ADR includes sessile-serrated polyps/adenomas. A total of 51% of respondents incorrectly believe the threshold is set at 25% because 25% is a national ADR average. Many also believe the threshold depends on the patient population (current evidence suggests adjusting ADR for factors other than age and sex is unnecessary). 75% ranked ADR as highly important. 80% reported tracking ADR. A busy practice was the most common reason for not tracking ADR. Caps, chromoendoscopy, and good bowel preparation were viewed as valuable for improving ADR (this is true except for caps). High-definition colonoscopes and education were considered less valuable, despite evidence indicating that both are associated with improved ADR. In total, 57% reported not sharing ADR information with their patients, and 59% reported that no patients in the last 6 months asked for their ADR. The importance of ADR as a quality measure is well understood, but there are misconceptions among gastroenterologists regarding the definition and measurement of ADR, and which methods are proven to increase ADR. Patients are having very little impact on ADR measurement.

Opioid Prescription Patterns Among US Gastroenterologists From 2013 to 2017

Opioid Prescription Patterns Among US Gastroenterologists From 2013 to 2017

489 Opioid and Neuromodulator Prescription Patterns Among U.S. Gastroenterologists

INTRODUCTION: The opioid epidemic has garnered significant national attention and is responsible for $78.5 billion in annual economic costs. Best practices encourage the use of alternatives to opioids such as neuromodulators to treat pain. This study characterizes opioid and neuromodulator prescription patterns among US gastroenterologists. METHODS: Medicare Part D Prescriber Data from 15,172 gastroenterologists between 2013 and 2017 were analyzed to calculate prescription metrics for opioids and neuromodulators. Neuromodulators include tricyclic antidepressants (TCAs), SSRIs, SNRIs and antispasmodics. Linear temporal trends were assessed using a Cochran-Armitage test. Multivariable logistic regression was used to examine the association between provider characteristics and &gt;10 opioid prescriptions or &gt;10 neuromodulator prescriptions annually. RESULTS: 59% of gastroenterologists prescribed opioids at least once in 2017. However only 15% wrote more than 10 opioid prescriptions. In comparison, 57% of gastroenterologists wrote more than 10 neuromodulator prescriptions. During the 5-year study period, the trend of gastroenterologists who prescribed at least one opioid (P &lt; 0.001) or &gt;10 opioids (P &lt; 0.001) decreased, while the overall trend of those who prescribed &gt;10 neuromodulators (P &lt; 0.001) increased, predominantly due to antispasmodics and TCAs. Among gastroenterologists who prescribed more than 10 opioids, there was a decrease from 2013 to 2017 in opioid prescriptions, opioid prescriptions per physician, % of patients prescribed opioids, and opioid prescriber rates compared to all prescriptions written. Female gastroenterologists were associated with decreased odds of prescribing opioids (OR 0.45, 95% CI 0.39–0.53), while practice in the South (OR 1.65, 95% CI 1.48–1.83) increased odds. Patient populations with higher percentages of female, whites and patients who received Medicare low-income subsidies were also associated with opioid prescriptions. Similar features of physicians were associated with neuromodulator prescriptions. CONCLUSION: The most recent opioid epidemic began in 2013. Since then, opioid prescriptions by gastroenterologists have decreased while neuromodulator prescriptions have increased for Medicare patients. Gastroenterologists are more likely to prescribe neuromodulators than opioids, both of which are used to treat abdominal pain. Compared to family medicine physicians (6%) and surgical subspecialties (37%), gastroenterologists (3%) had lower opioid prescription rates.

P104 Branded infliximab still predominantly used over biosimilars in patients with IBD

BACKGROUND: Despite the availability of 2 infliximab biosimilars in the US market, the vast majority of bio-naïve patients being placed on infliximab are prescribed the reference brand. METHODS: In April 2018, we conducted a retrospective patient chart audit of 1,005 patients with IBD who were started on a biologic agent for the first time. 209 US gastroenterologists submitted patient-level data via a HIPAA-compliant audit form which included both clinical and non-clinical data. The collaborating physicians also completed a brief survey about their practices and their opinions regarding IBD patient management. The data were collected and analyzed in SPSS. RESULTS: 30% of the patients starting on a biologic for the first time were initiated on infliximab. Of those, 16% were placed on a biosimilar and 84% were placed on the reference brand. When presented with the statement, “I trust that infliximab biosimilars are clinically comparable to the reference brand,” 46% of the physicians expressed agreement, 36% were neutral, and 18% disagreed. In 90% of the cases where the patient was placed on the reference brand, the physician was not contacted by a pharmacist or insurance company about using a biosimilar in place of the reference brand. If they had been contacted, in 43% of the cases they would have switched to a biosimilar, in 51% they would have pressed to use the reference brand, and in 6% they would have chosen a non-infliximab alternative. CONCLUSION(S): Until gastroenterologists are encouraged or mandated to use biosimilars, use of the reference brand is anticipated to remain dominant. Based on physician feedback, about half appear to be very willing to use biosimilars, but despite this, continue to prescribe the more familiar reference brand.

P105 Biologic/JAK preference in different IBD patient types

BACKGROUND: The IBD market is rapidly evolving as new biologic and small molecule agents are being approved such as ustekinumab in Crohn's disease and tofacitinib in ulcerative colitis (UC). This study sought to understand gastroenterologists' product preferences for certain patient types and to understand any shifts in preference with new agents to consider. METHODS: Each quarter, an independent healthcare agency surveys approximately 100 US gastroenterologists about the evolving treatment of IBD. To qualify, gastroenterologists must spend the majority of time in clinical practice, must be managing a minimum of 50 patients with IBD, and must be in practice between 2 and 35 years. Regional and practice setting quotas are applied in order to obtain a representative sample. The survey is administered online and respondents are compensated for their participation. The data are collected and analyzed in SPSS. RESULTS: Gastroenterologists describe over half of their UC patients as being “young, with active lifestyles”. This patient type has historically been strongly associated with adalimumab over other biologic agents, with 64% (n = 100) of respondents surveyed in April 2018 indicating that they would be most likely to use adalimumab for this patient category. However, with the availability of tofacitinib, which was approved in June 2018, preference for this large patient segment is changing. In the July 2018 wave of the survey, nearly one-quarter (23%) of gastroenterologists selected the new, oral JAK inhibitor as their most likely agent of choice for young, active patients, with adalimumab preference dipping to 54%. Tofacitinib was also selected by 16% of the gastroenterologists as being the drug of choice in patients with secondary TNF failures (waning efficacy), though the majority still prefer vedolizumab in this scenario (58%). When directly comparing adalimumab with tofacitinib in UC, gastroenterologists view adalimumab outperforming tofacitinib on all attributes associated with length of time in the market, but tofacitinib is already matching, or outpacing, adalimumab on many key attributes for treatment success including efficacy, adherence, tolerability, and sustained response. Analysis of the most recent prescription patterns, as assessed by physician allocation of their last 5 biologic/JAK prescriptions between April 2018 and July 2018 shows declining use of adalimumab (34% to 30%) with an increase of tofacitinib (0% to 5%). CONCLUSION(S): Adalimumab has long been the preferred biologic agent for the treatment of UC in younger, active patients, relatively unchallenged by any of the other biologics for this large patient sub-type. Early use of tofacitinib suggests that the advent of an oral advanced therapy option may soon rival adalimumab for preference in younger, active patients.

Radiation Training, Radiation Protection, and Fluoroscopy Utilization Practices Among US Therapeutic Endoscopists.

Fluoroscopy use during ERCP exposes patients and providers to deleterious effects of radiation. Formal training in fluoroscopy/radiation protection is not widely emphasized during therapeutic endoscopy training, and radiation use during GI endoscopy has not previously been characterized in the USA. In this study, we evaluated radiation training, fluoroscopy use patterns, and radiation protection practices among US therapeutic endoscopists. An anonymous electronic survey was distributed to US therapeutic endoscopists, and responses were analyzed using descriptive statistics. State-specific requirements for fluoroscopy utilization were determined from state radiologic health branches. A total of 159 endoscopists (response rate 67.8%) predominantly those working in university hospitals (69.2%) with > 5years of experience performing ERCP (74.9%) completed the questionnaire. Although the majority of endoscopists (61.6%) reported that they personally controlled fluoroscopy during ERCP, most (56.6%) had not received training on operating their fluoroscopy system. Only a minority (18-31%) of all respondents reported consistently utilizing modifiable fluoroscopy system parameters that minimize patient radiation exposure (pulsed fluoroscopy, frame rate modification or collimation). Endoscopists appear to undertake adequate personal radiation protective measures although use of a dosimeter was not consistent in half of respondents. The majority of states (56.8%) do not have any stated requirement for certification of non-radiologist physicians who intend to operate fluoroscopy. Most US gastroenterologists performing ERCP have not received formal training in operating their fluoroscopy system or in minimizing radiation exposure to themselves and to their patients. Such formal training should be included in all therapeutic endoscopy training programs, and fluoroscopy system-specific training should be offered at all hospitals.

Physician attitudes about non-medical switching to biosimilars: results from an online physician survey in the United States

Objective: This study was designed to understand the level of familiarity of US rheumatologists, gastroenterologists and dermatologists with biosimilar therapies, their experience with non-medical switching (switching medications for reasons unrelated to patient health) of patients between biologics and their attitudes towards switching from a biologic to a biosimilar.Methods: A total of 297 US physicians who currently prescribe biologics for their patients completed a 15-minute online survey. Rheumatologists, dermatologists and gastroenterologists were included.Results: The majority of physicians (84%) did not want stable patients undergoing a non-medical switch to a biosimilar. While 60% of physicians believed non-medical switching to biosimilars may have a positive impact on healthcare system costs, multiple negative impacts were also expected. A majority of physicians anticipated a negative impact on patient mental health (59%), treatment efficacy (57%), patient safety (53%) and physician office management (60%).Conclusions: The majority of physicians had concerns regarding non-medical switching to biosimilars and the impact such switching would have on patient care and physician practice.

Management of eosinophilic esophagitis is often discordant with guidelines and not patient-centered: results of a survey of gastroenterologists.

Published guidelines for the management of eosinophilic esophagitis (EoE) recommend an initial trial of proton pump inhibitors (PPI), histologic assessment for response to therapy, and tailoring treatments to patient needs and provider resources. Effectiveness studies directly comparing therapies are lacking, leaving a situation ripe for shared decision making. We aimed to assess gastroenterologists' adherence to guidelines and how they respond to EoE patients' preferences regarding management. We administered a web-based survey to practicing US gastroenterologists, assessing knowledge, and practice patterns in the management of EoE, including comfort with alternative treatments to steroids. Ninety-two providers responded, including 55% in private practice. Nearly half (47%) reported spending≤10 minutes on initial education and counseling and 48% recommended PPI monotherapy prior to other strategies. Of those who did not start with PPI monotherapy, 55% chose topical steroids± PPI and 26% dietary elimination± PPI. Despite this, 90% felt comfortable allowing a patient to start dietary elimination instead of steroids, but less comfortable with dilation alone (39%) or no treatment (30%). Upon symptomatic resolution, 72% of academic providers recommended endoscopy with biopsies to demonstrate histologic response to treatment, compared to 27% in private practice. There are substantial variations in adherence to guidelines regarding PPI use and assessing response to therapy. Gastroenterologists prefer topical steroids over other treatment modalities and most spend little time educating and counseling, which may limit informed decision making. Strategies aimed at decreasing these variations in management and promoting shared decision making in EoE are needed.

Surveying ADR knowledge and practices among US gastroenterologists

Background: &#x0D; The adenoma detection rate (ADR) is of primary importance to the quality of screening colonoscopy. An online survey was conducted to assess knowledge and practices on ADR. &#x0D; Methods: &#x0D; Paid questionnaire distributed by email. Eligible respondents were board certified gastroenterologists who perform &gt;80 colonoscopies per month with 3 to 35 years after fellowship. &#x0D; Results: &#x0D; 39% were unaware that ADR applies only to screening colonoscopies and 76% incorrectly answered that ADR includes sessile serrated polyps/adenomas. 51% of respondents incorrectly believe the threshold is set at 25% because 25% is a national ADR average. Many also believe the threshold depends on the patient population (current evidence suggests adjusting ADR for factors other than age and sex is unnecessary). 75% ranked ADR as highly important. 80% reported tracking ADR. A busy practice was the most common reason for not tracking ADR. Caps, chromoendoscopy, and good bowel preparation were viewed as valuable for improving ADR (this is true except for caps). HD colonoscopes and education were considered less valuable (although evidence suggests HD and education are associated with improved ADR). 57% reported not sharing ADR information with their patients, and 59% reported no patients in the past 6 months asking for their ADR.&#x0D; Conclusion: &#x0D; The importance of ADR as a validated quality measure is well understood, but there are misconceptions among gastroenterologists regarding the definition and measurement of ADR and which methods are proven to increase ADR. Patients are having very little impact on ADR measurement.

P055 IMPACT OF NEW BIOLOGIC AGENT APPROVAL FOR ULCERATIVE COLITIS ON TUMOR NECROSIS FACTOR INHIBITOR (TNF) PRESCRIBING: RESULTS FROM A NATIONAL PATIENT CHART AUDIT

TNF-inhibitor (TNF) therapy was approved for use in moderately active ulcerative colitis (UC) in 2005. We were interested in studying to what extent newly approved biologics with a different mechanism of action (MOA) had on utilization. An independent market analytics firm collaborated with US gastroenterologists (n=187) to conduct a retrospective chart review of patients with either ulcerative colitis (UC) (n=475) or Crohn’s disease (CD) (n=566), who had switched from one biologic therapy to another in the prior 12wks. Gastroenterologists could submit up to seven charts. Data were collected in April 2017 and included clinical and non-clinical patient demographics, as well as physician demographic and attitudinal survey responses. 75% of participating gastroenterologists reported recent changes to UC patient management, predominantly citing more aggressive use of biologics and increased use of vedolizumab. Use of infliximab as a first-line biologic in UC has decreased significantly over time (50% of first-line patients initiated > 24mths prior to study vs. 37% of patients initiated within 12mths prior to the study.) Over the same time, first-line use of adalimumab remained consistent and vedolizumab use increased slightly (0% to 7%)(Fig 1). Patients initiated on infliximab as their first-line biologic were significantly more likely to be switched to a second TNF inhibitor compared to patients initiated on adalimumab first-line (77% vs. 54%, respectively.) Use of vedolizumab as a second-line agent was twice as likely for patients initially started on adalimumab vs. those started on infliximab (37% vs. 19%, respectively.) (Fig 2) TNF therapy dominates biologic treatment for UC, however, vedolizumab is being used more and used earlier. Infliximab use for new patients has steadily decreased, however adalimumab use has stayed constant. Which TNF is used first appears to have an influence on subsequent treatment with vedolizumab.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Gastroenterologists Attitudes About Maintenance of Certification: A Multi-practice National Survey

Introduction: To determine gastroenterologist opinions of current maintenance of certification (MOC) activities and to investigate if perceptions differ across practice settings and demographics. Methods: We conducted an electronic survey amongst a random sample of licensed US gastroenterologists from February 2017 through March 2017. The questionnaire included 8 items regarding date of initial board certification, current and proposed MOC satisfaction, and practice demographic variables. Results: Of 489 potential respondents, we received 88 responses (response rate 18%), reflecting the distribution of US gastroenterologists. The date of initial GI board certification ranged from 1952 to 2017. The practice settings were: 27% private practice, 62% training institution, 3.4% Veterans Administration, and 6.8% “other.” While 65.9% did not maintain their core internal medicine (IM) certification, 78% of respondents were required to maintain certification by either their practice setting (84%) or insurance companies (8.4%). While only 4% of states reportedly had passed legislation prohibiting MOC as a condition of employment or payment, 42% (see described responses) said they would still maintain board certification even if not required. Ninety-two percent were not satisfied with the most recent American Board of Internal Medicine (ABIM) proposal for recertification and biannual MOC testing, and 86% would petition their institution to utilize an alternative non-ABIM MOC pathway, if available. There were 97% of respondents who would enroll in an independent American College of Gastroenterology (ACG)-approved MOC pathway, assuming it was recognized by their institution. There was no relationship of attitudes toward MOC with certification status, practice type, compensation model, time since initial certification.Figure: Date of Initial GI Board Certification.Figure: Are you satisfied with the most recent ABIM proposal for recertification testing and MOC?Conclusion: There is significant dissatisfaction with the current and proposed ABIM MOC program amongst US gastroenterologists, regardless of certification longevity or practice setting. There is also a distinct perception that an alternative MOC pathway is needed and broad grass roots support for such a pathway.