ACG Magazine | Vol. 9, No. 1 | Spring 2025

ACG MAGAZINE Spring 2025

MEMBERS. MEDICINE. MEANING.

Thriving Beyond Fellowship in Gastroenterology

OCTOBER 24 - 29, 2025 | PHOENIX, ARIZONA

r o f LL A C

OCTOBER 24 - 29, 2025

s t c a r t Abs

OCTOBER 24 - 29, 2025 | PHOENIX, ARIZONA

OCTOBER 24 - 29, 2025

ABSTRACT CATEGORIES • Biliary/Pancreas • IBD • Colon • Infections and Microbiome • Colorectal Cancer 24 - 29, 2025 Prevention OCTOBER • Interventional Endoscopy • Diet, Nutrition, and Obesity • Liver • Endoscopy Video • Pediatrics Forum • Practice • Esophagus Management • Functional Bowel • Small Intestine Disease • Stomach and • General Spleen OCTOBER 24 - 29, 2025 Endoscopy • Clinical Vignettes/ • GI Bleeding Case Reports

Submit Your Abstracts: bit.ly/Abstracts-ACG2025

Call for Abstracts Submission Dates:

MARCH 3 – JUNE 2, 2025

SPRING 2025 // VOLUME 9, NUMBER 1

FEATURED CONTENTS

COVER STORY

THRIVING BEYOND FELLOWSHIP IN GASTROENTEROLOGY GI experts and emerging leaders share their words of wisdom for entering the workforce after fellowship

PAGE 19 ACG PERSPECTIVES ACG's first woman Trustee Dr. Rosemarie Fisher shares how medical education and GI nutrition became key components of her practice

PAGE 31 SAGE ADVICE Dr. Sidney Winawer on the benefits of "showing up" and making an impression professionally and personally

PAGE 40

|1

2025 ACG AWARD NOMINATIONS

Honor Your Colleague with an ACG Award Nomination

The ACG Awards Committee is seeking nominations from all members for the following distinguished awards: Berk/Fise Clinical Achievement Award

This award recognizes an ACG Member who has provided distinguished contributions to clinical gastroenterology, including: (a) clinical medicine, (b) technology application, (c) health care delivery, (d) related factors such as humanism and ethical concern. It is not intended that this award be given in honor of one’s laboratory research accomplishments.

Community Service Award

This award is bestowed upon an ACG Member who has initiated or has been involved in numerous volunteer programs/ activities, or has provided significant volunteer service post-training. The service must have been performed on a completely voluntary basis and not for the completion of training or position requirements.

Distinguished Mentorship and Teaching Award This award recognizes an ACG Member who has provided meaningful and sustained contributions to trainees/colleagues in gastroenterology. Such contributions could include mentorship or teaching to help develop the mentees’ career, clinical practice, research or academic practice.

Distinguished NP/PA Teaching Award

This award recognizes a distinguished nurse practitioner or physician assistant who is an ACG Member and has shown long-standing contributions to educating and mentoring NPs/ PAs in the field of gastroenterology and hepatology (GIH).

Meaningful contributions in teaching include demonstrating mentorship, preceptorship, curricula development and/or other activities that have an impact in educating and developing future NPs/PAs in the field of GIH.

Diversity, Equity and Inclusion Award

This award recognizes an ACG Member whose work in the areas of clinical practice, research, teaching and/or leadership has demonstrated an emerging or sustained commitment to the values of diversity, health equity and inclusion.

International Leadership Award

This award is given to an ACG Member in recognition of outstanding and substantial contributions to gastroenterology, to the College, and to the international gastroenterology community.

Master of the American College of Gastroenterology

Masters of the College of Gastroenterology shall have been ACG Fellows who, because of their recognized stature and achievement in clinical gastroenterology and because of their contribution to the College in service, leadership, and education, have been recommended for designation as Masters.

NP/PA Award for Clinical Excellence

This award recognizes a distinguished nurse practitioner or physician assistant who is an ACG Member and has shown longstanding contributions to advancing clinical practice in the fields of gastroenterology and hepatology. Substantial contributions to GI practice include demonstrated practice expertise, leadership, mentoring and collaborative activities that have an impact at the state, regional, national or international level.

Samuel S. Weiss Award

This award is given to an ACG Fellow or Master in recognition of outstanding service to the American College of Gastroenterology over the course of an individual’s career.

deadline for all nominations: April 15, 2025 Submit your nomination: gi.org/acg-award-nomination-form Nominations for all awards must: • Be accompanied by two letters of recommendation (three for the NP/PA Awards) • Include the nominee’s CV • Conform to the specific nomination requirements • Be unsolicited by the nominee

Nominations must be submitted online: gi.org/acg-award-nomination-form Nomination requirements: gi.org/award-nomination-guidelines

SPRING 2025 // VOLUME 9, NUMBER 1

CONTENTS

“Our aim was to identify opportunities to increase access to diagnostic colonoscopies so that patients could receive high-quality and

­

equitable care irrespective of personal financial access.” — Free Community Clinic and Academic Medical Center Partnership PG 41

6 // MESSAGE FROM THE PRESIDENT Dr. Amy Oxentenko on the way ahead in a season of change

7 // NOVEL & NOTEWORTHY What’s new: College Trustees, GIQuIC President, lectureship at ACG 2025, follow ACG on Bluesky & more

17 // PUBLIC POLICY

31 CONVERSATIONS WITH WOMEN IN GI Dr. Rosemarie Fisher on her career in medical education and establishing a niche in GI nutrition 35 SUMMER SCHOLARS The 2024 ACG Summer Scholars and mentors reflect on their experiences 40 SAGE ADVICE Dr. Sidney Winawer on “showing up” professionally and personally

Dr. Louis Wilson on remaining steadfast and optimistic when advocating in the new administration

41 COMMUNITY CRC SCREENING Students and faculty from Geisel School of Medicine share their model for providing free colonoscopies to under-resourced patients

19 // COVER STORY

45 // INSIDE THE JOURNALS

THRIVING BEYOND FELLOWSHIP IN GI Advice from GI experts and emerging leaders on life after GI fellowship

46 AJG Updated clinical guidelines on EoE by Dellon, et al., from the Inflammation special issue

27 // ACG PERSPECTIVES

46 CTG Use of Biosimilars to Infliximab During Pregnancy in Women with IBD: Results from the PIANO Study by Long, et al.

27 CULINARY CONNECTIONS The section editors share their meetup and cooking class in Philadelphia at ACG 2024

46 ACGCRJ Initial Experience with Safety and Efficacy of Endoscopic Full-Thickness Resection in Patients with Inflammatory Bowel Disease: A Case Series by Khataniar, Desai, and Kochhar, with an accompanying podcast 47 ACG GUIDELINE HIGHLIGHTS: EOSINOPHILIC ESOPHAGITIS A visual summary of ACG's 2024 Clinical Guideline on EoE by Dellon, et al.

48 // REACHING THE CECUM PATIENT HANDOUT: H. PYLORI Information for patients about the treatment of Helicobacter pylori infection

Above: Students from Geisel School of Medicine present their poster on implementing a free colonoscopy community program at ACG 2024 in Philadelphia, PA. (Story on PG 41.)

|3

ACG MAGAZINE MAGAZINE STAFF

CONNECT WITH ACG youtube.com/ACGastroenterology

Executive Director Bradley C. Stillman, JD

facebook.com/AmCollegeGastro Editor in Chief; Vice President, Communications Anne-Louise B. Oliphant

Senior Manager, Communications Becky Abel

Art Director Emily Garel

Senior Graphic Designer Antonella Iseas

BOARD OF TRUSTEES President: Amy S. Oxentenko, MD, FACG President-Elect: William D. Chey, MD, FACG Vice President: Costas H. Kefalas, MD, MMM, FACG Secretary: Neil H. Stollman, MD, FACG Treasurer: Nicholas J. Shaheen, MD, MPH, MACG

x.com/amcollegegastro

@amcollegegastro.bsky.social

bit.ly/ACG-Linked-In

CONTACT IDEAS & FEEDBACK We'd love to hear from you.

Send us your ideas, stories and comments.

ACGMag@ @gi.org

CONTACT ACG American College of Gastroenterology 11333 Woodglen Drive, Suite 100 North Bethesda, MD 20852 (301) 263-9000 | gi.org

Immediate Past President: Jonathan A. Leighton, MD, FACG Past President: Daniel J. Pambianco, MD, FACG Director, ACG Institute: Neena S. Abraham, MD, MSc, MACG

DIGITAL EDITIONS

Co-Editors, The American Journal of Gastroenterology:

GI.ORG/ACGMAGAZINE

Jasmohan S. Bajaj, MD, MS, FACG Millie D. Long, MD, MPH, FACG Chair, Board of Governors: Sita S. Chokhavatia, MD, MACG Vice Chair, Board of Governors: Harish K. Gagneja, MD, MACG Trustee for Administrative Affairs: Irving M. Pike, MD, FACG

TRUSTEES Brooks D. Cash, MD, FACG Dayna S. Early, MD, FACG Jill K. J. Gaidos, MD, FACG Seth A. Gross, MD, FACG David J. Hass, MD, FACG James C. Hobley, MD, MSc, FACG Vonda G. Reeves, MD, MBA, FACG Aasma Shaukat, MD, MPH, FACG Jay N. Yepuri, MD, MS, FACG Patrick E. Young, MD, FACG

4 | GI.ORG/ACGMAGAZINE

American College of Gastroenterology is an organization with an international membership of over 19,000 individuals from 86 countries.

The College's vision is to be the preeminent organization supporting health care professionals who provide compassionate, equitable, high-quality, state-of-the-art, and personalized care to promote digestive health. The mission of the College is to provide tools, services, and accelerate advances in patient care, education, research, advocacy, practice management, professional development and clinician wellness, enabling our members to improve patients’ digestive health and to build personally fulfilling careers that foster wellbeing, meaning and purpose.

CONTRIBUTING WRITERS Somaya Albhaisi, MBBCh, MPH

Alexander Perelman, DO, MS

Dr. Albhaisi is a GI fellow-in-training at the Keck School of Medicine, University of Southern California.

She is a member of the ACG DEI Committee and the Women in GI Committee.

Dr. Perelman is a gastroenterologist at Vanguard Gastroenterology in New York City. He currently serves on ACG’s Professionalism Committee.

Ahmed M. Al Qady, MD Dr. Al Qady is a first year GI fellow at the University of Florida in Gainesville, FL, and completed his internal medicine residency at Indiana University School of Medicine/Ball Memorial.

Katie A. Dunleavy, MB BCh BAO Dr. Dunleavy is an advanced IBD fellow at Mayo Clinic Rochester. She is editor of the Trainee Hub section of ACG MAGAZINE and is a member of ACG’s Digital Communications and Publications Committee.

Rosemarie L. Fisher, MD, FACG Dr. Fisher is the first woman on the ACG Board of Trustees (1988-1992) and is Professor Emerita of Medicine at Yale School of Medicine.

Jill K.J. Gaidos, MD, FACG Dr. Gaidos is a Trustee of the College and Associate Professor at the Yale School of Medicine Section of Digestive Diseases and Director of Clinical Research for the Yale IBD Program. She is a member of ACG’s Digital Communications and Publications Committee.

Alexandra Goad, BM Alexandra Goad is a member of the 2027 class at the University of Louisville School of Medicine and a 2022 graduate of the Ohio State University with a BM in Flute Performance.

Timothy McAuliffe, BA Timothy McAuliffe is a medical student at the Geisel School of Medicine at Dartmouth in Hanover, NH.

Chioma Owo, MSc Chioma Owo is a medical student at UT Health San Antonio Long School of Medicine and received her Master of Science degree in Global Health from McMaster University in 2021.

Amy S. Oxentenko, MD, FACG ACG President Dr. Amy Oxentenko is Professor of Medicine at Mayo Clinic in Rochester, MN, and is the Vice Dean of Mayo Clinic Practice.

Eric D. Shah, MD, MBA, FACG Dr. Shah is Associate Professor of Medicine in the Division of Gastroenterology and Hepatology at University of Michigan School of Medicine. He is director of the Michigan Medicine GI Physiology Laboratories and a member of ACG’s Legislative & Public Policy Council and Research Committee.

Marquise Soto, BA Marquise Soto is a medical student at the Renaissance School of Medicine at Stony Brook University and a 2021 graduate of Hofstra University with a BA in Chemistry.

Christina A. Tennyson, MD Dr. Tennyson is a gastroenterologist at Augusta Healthcare in Fisherville, VA, with expertise in integrative, lifestyle, and culinary medicine.

Christopher Vélez, MD Dr. Vélez is Associate Program Director of the Advanced Fellowship in Functional and Gastrointestinal Motility Disorders at the Mass General Brigham GI Division. He is a member of the ACG’s DEI and Research Committees.

Lavanya Viswanathan, MD, MS, FACG Dr. Viswanathan is Associate Professor of Medicine in the Department of Gastroenterology Hepatology and Nutrition, University of Texas MD Anderson Cancer Center. She is a member of the College’s Legislative & Public Policy Council.

Louis J. Wilson, MD, FACG Dr. Wilson is an independent private practice gastroenterologist, the managing partner of Wichita Falls Gastroenterology Associates and chair of the ACG Legislation and Public Policy Council.

Sidney Winawer, MD, DSc (Hon), MACG Dr. Winawer is Emeritus Chief, Gastroenterology and Nutrition Service, and Chair, Cancer Prevention Program at Memorial Sloan Kettering. He has been a member of the College since 1971 and served as ACG President, 1979-1980.

Vani Paleti, MD, Dip ACLM, Dip ABOM Dr. Paleti is a gastroenterologist at Baylor, Scott & White Health in Kileen, TX, with a special interest in lifestyle and obesity medicine. She currently serves on ACG’s Professionalism Committee.

|5

THE WEATHER, THE WHITE HOUSE, THE WAY AHEAD Amy S. Oxentenko, MD, FACG

ALTHOUGH 2025 HAS JUST COMMENCED, THE SIGNIFICANT CHANGES FROM 2024 ARE ALREADY EVIDENT. The Weather: As we witness the recent devastation in California due to ongoing wildfires and the hurricane impacts in the South, our hearts go out to all those affected. This is a time of great uncertainty and hardship for many, with lasting effects on families, homes, and communities.

As a society, we stand united in our commitment to support one another, especially during these challenging moments. Whether you are directly impacted by these events or feeling the ripple effects – for yourself, your family, your patients, your friends, your colleagues, or your neighbors – we want you to know that you are not alone. Our ACG community is here to provide a network of support, offering emotional encouragement and practical help where possible.

The White House: As we witness a shift in leadership at the White House, we find ourselves in a period of uncertainty that may bring both challenges and opportunities for healthcare in our nation. The landscape of healthcare policy is often shaped by changes in administration, and this transition is no different. While the full scope of the impact remains to be seen, we will continue to advocate for the issues directly impacting our patients, including access to care, quality of services, and affordability.

As healthcare professionals, we must remain vigilant and adaptable, ready to take action for the needs of patients

“While uncertainty often breeds concern, it also opens the door for innovation and collaboration.”

6 | GI.ORG/ACGMAGAZINE

and the improvement of healthcare delivery. The coming months may bring adjustments in legislation, funding, and regulatory practices, all of which could reshape the environment in which we operate. It’s crucial that we stay informed and engaged, ready to provide insights and expertise where needed.

While uncertainty often breeds concern, it also opens the door for innovation and collaboration. Our society’s commitment to its Vision Statement remains constant, “to be the preeminent organization supporting health care professionals who provide compassionate, equitable, high-quality, state-of-the-art, and personalized care to promote digestive health.” Together, we can continue to ensure that the future of healthcare remains focused on improving the health and well-being of all.

The Way Ahead: The start of the year marks the launch of ACG’s incredibly orchestrated programming for 2025, featuring several exciting changes. Regional courses are in full swing, and this year introduces the inaugural ACG Esophageal School, led by Dr. Felice Schnoll-Sussman and Dr. Evan Dellon. This school was incorporated into the Western Regional Postgraduate Course in Las Vegas and will also be part of the ACG/VGS/ MASGNA Regional Postgraduate Course in September in Williamsburg, VA. Don’t miss the opportunity to learn from leaders in esophageal diseases!

Alongside the ACG/LGS Regional Postgraduate Course in New Orleans, ACG’s Leading with Guts: Women Shaping the Future of Gastroenterology Course, led by Dr. Kara De Felice and Dr. Aasma Shaukat, offers a chance to learn about effective leadership strategies, personal and professional integration, and allyship within GI. As we begin to thaw from the winter season, we can look forward to the sunshine and warmth at ACG 2025 in Phoenix, Arizona! The ACG Annual Scientific Meeting hasn’t been

in Arizona since the year Dr. Chris Surawicz was President in 1999 – what a perfect year to return! #BOOM! Great lectures, research, networking, weather, and adventures await!

It is a true honor to announce the Named Lecturers for ACG 2025, many of whom will speak on aspects of the workforce of the future – a crucial focus for the College in the year ahead. A new change for 2025 is the addition of the ACG Trailblazer Lecture, highlighting someone who has paved the way in the field of gastroenterology. Dr. Rosemarie Fisher is a role model to many, and I cannot wait to share the number of “The first to…” in her introduction, as she blazed the trail for women and those leading in gastroenterology and education. #BOOM! ACG Trailblazer Lecture (formerly David Sun Memorial Lecture) Rosemarie L. Fisher, MD, FACG The American Journal of Gastroenterology Lecture Baharak Moshiree, MD, MSc, FACG J. Edward Berk Distinguished Lecture Corey A. Siegel, MD, MS Emily Couric Memorial Lecture Lewis R. Roberts, MB, ChB, PhD, FACG David Y. Graham Lecture Dayna S. Early, MD, FACG As we embark on 2025, I am filled with optimism and confidence in our collective ability to achieve great things. Challenges we face will strengthen our resolve and prepare us for the opportunities that lie ahead.

Together, we will continue to innovate, collaborate, and excel, driving ACG to new heights. Let us embrace 2025 with enthusiasm, determination, and a shared commitment to our mission. I look forward to witnessing the remarkable accomplishments we will achieve together.

Note hy wor t LEARN MORE ABOUT the new ACG Trustees, Harish K. Gagneja, MD, MACG; Jay N. Yepuri, MD, MS, FACG; and Vonda G. Reeves, MD, MBA, FACG. GIQuIC has a new President, Colleen R. Schmitt, MD, MHS, FACG, MASGE, who has broad experiences with both ACG and ASGE, the two collaborating societies sponsoring the registry.

Rosemarie L. Fisher, MD, FACG, the first woman to serve as an ACG Trustee (1988 to 1992), will deliver the new ACG Trailblazer Lecture at ACG 2025.

The College’s oldest member, Irwin M. Arias, MD, and the first Medical Student Member, Matthew Hill of the University of Illinois College of Medicine, represent the far ends of the career spectrum and we celebrate them both in N & N. Finally, all are welcome to follow ACG on Bluesky, a social media platform that relies upon following trusted peers instead of algorithm-driven content.

Novel & Noteworthy | 7

N&N GI EYE: ARTWORK FROM ACG MEMBERS

A ROYAL SYMPHONY OF ART AND GOLD Ahmed M. Al Qady, MD

THE GALERIE D’APOLLON, THE LOUVRE, PARIS, FRANCE

About the Location Nestled within the iconic Louvre Museum in Paris, the Galerie d’Apollon is a breathtaking hall renowned for its stunning baroque architecture and opulent décor. Originally designed in the 17th century, this gallery was a masterpiece of Charles Le Brun and later restored by Eugène Delacroix after a devastating fire. Its gilded ceiling and magnificent frescoes are inspired by the myth of Apollo, the Greek god of the sun, light, and the arts, making it a symbol of royal grandeur and artistic excellence.

Equipment iPhone 14 Pro Max What Captured My Attention The Galerie d’Apollon captured my attention in ways I hadn't expected. The light reflecting off the gold ceiling created a stunning visual, almost as if the room itself were alive.

Everywhere I looked, I saw the seamless blend of history and art, carefully curated and arranged in perfect symmetry. Each piece seemed to tell a story, not just of the artists who created them, but of the people who worked and walked through this space over the centuries. The weight of that history, the lives touched by this place, and the sheer beauty of the surroundings made it a truly unforgettable experience.

Technical Challenges Indoor photography presents its own set of challenges, especially when dealing with the uncontrollable light streaming through windows. This can cause uneven lighting and make it difficult to capture the full essence of a scene. Adding to the difficulty, the Galerie d’Apollon was filled with hundreds of people, which made it harder to control the surroundings and find the perfect angle

8 | GI.ORG/ACGMAGAZINE

for the shot. Photographing art is another delicate task—it’s important not to diminish the piece's true beauty or essence in the process. At the same time, the artwork should not overpower the composition, creating a balance between capturing the art and the overall atmosphere of the space.

Personal Significance of Photography Photography, especially while traveling, holds profound personal significance for me. It’s more than just capturing images; it’s about preserving the stories of the places I visit and sharing those moments with others who weren't there. Through

photography, I have the chance to freeze time, allowing me to relive these experiences, reflect on them, and reconnect with the emotions tied to those moments.

Though I still consider myself a beginner, with much to learn, I see photography as an evolving art that I hope to master one day. It’s a form of expression that lets me share how

I see the world, offering a perspective that others may not have access to.

As physicians, we should hone the art of storytelling—yet in the rush of our daily routines, it’s easy to forget how valuable it can be to pause, reflect, and capture the essence of a moment, whether through a camera or in our interactions with patients.

About Ahmed M. Al Qady, MD is a first-year GI fellow at the University of Florida in Gainesville, FL. He completed his internal medicine residency at Indiana University School of Medicine/Ball Memorial and was Chief Resident from 2023-2024. He is a 2016 graduate of the Cairo University School of Medicine.

Novel & Noteworthy | 9

// N&N

[WELCOME]

MEET NEW MEMBERS OF ACG’S BOARD OF TRUSTEES Vonda G. Reeves, MD, MBA, FACG Current Affiliation: GI Alliance, Flowood, Mississippi Best of ACG: My most personally rewarding experiences with ACG have been twofold. I have loved sharing my experience with the Practice Management Summit.

The ability to lecture and connect with others has been amazing. Second, I have had the opportunity to advocate for gastroenterologists and our patients in Washington, DC, as a Governor for my state.

Fun Fact: I am a small-scale timber and cattle farmer.

ACG Member Since: 1994 ACG Activities: Governor for Mississippi (2019-2024), Legislative & Public Policy Council (2024-2027); Diversity, Equity & Inclusion Committee (2022-2025); Nominating Committee (2023-2024); Practice Management Committee (20182024); Membership Committee (19992024). Course Co-Director, ACG Practice Management Summit (2021 and 2022).

Jay N. Yepuri, MD, MS, FACG Current Affiliation: GI Alliance/Digestive Health Associates of Texas, Dallas, Texas; Physician Executive Board Member and Vice Chairman, Central Division Clinical Governance Board.

Best of ACG: It has been a privilege to serve as ACG Governor for Northern Texas and I’m excited to continue my service to the College as Vice President of GIQuIC. Fun Fact: I am a huge professional soccer fan (particularly the English Premier League) and try to get to matches there at least once a year.

ACG Member Since: 2004 ACG Activities: Governor for Northern Texas (2018-2024); Awards Committee (2020-2024)’ Nominating Committee (2022-2024); Innovation & Technology Committee (2018-2020); Practice Management Committee (2013-2019).

Harish K. Gagneja, MD, MACG Current Affiliation: Physician Executive, Austin Gastroenterology, P.A.; Member, Physician Executive Board, GI Alliance.

Best of ACG: I have enjoyed advocating for our patients, practices, and colleagues during ACG’s Board of Governors Fly-in in Washington, DC, for the last eight years, consecutively, including virtual advocacy in 2020.

Fun Fact: I love food and enjoy dining at hard to get a reservation Michelin star restaurants. Recently, I flew to Kyoto just to eat at Noma Kyoto and was there only for two nights.

ACG Member Since: 1998 ACG Activities: Vice Chair, Board of Governors (2024-2026); Governor for Southern Texas (2017-2024); Legislative and Public Policy Council (2024-2028); Membership Committee (2024-2026), Chair (2024-2026); Educational Affairs Committee (2018-2024); Practice Management Committee (2013-2020); Credentials Committee (2016-2018).

Dr. Yepuri and his family. Left to Right: Sons Neil and Evan, mother Prema, and brother Hirsha.

The children of Dr. Reeves, Left to Right: Royce, Jaren, Peryn, and Galen.

[GIQUIC NEWS]

Colleen R. Schmitt, MD, MHS, FACG, MASGE, has been appointed President of the GI Quality Improvement Consortium, Inc. (GIQuIC), a national endoscopic registry and clinical benchmarking tool for gastroenterologists that is jointly managed by ACG and the American Society for Gastrointestinal Endoscopy (ASGE).

10 | GI.ORG/ACGMAGAZINE

Dr. Gagneja and his family hiking in Mombacho Volcano in Nicaragua. With wife Sunena Gagneja, front; son Nihar; and daughter Mehek.

Dr. Schmitt has served on the GIQuIC Board of Directors since 2015. She is Past President of the ASGE and a Trustee and Vice-Chair for the ASGE Foundation. Dr. Schmitt previously served on the College’s Practice Parameters, National Affairs, and Publications Committees. She is a past president of the Tennessee Society for Gastrointestinal Endoscopy, serves on the Board of Directors for the Chattanooga Hamilton County Medical Society, and

is active with the Tennessee Medical Association. She is a founding physician for Volunteers in Medicine, and a volunteer for Project Access, an organization that provides healthcare for the uninsured. Dr. Schmitt recently retired from the gastrointestinal specialty arm of Galen Medical Group in Chattanooga, TN, where she served as its President.

[TRAILBLAZER]

[NEW TO ACG]

Rosemarie L. Fisher, MD, FACG has been invited to deliver the newly named ACG Trailblazer Lecture. Dr. Fisher was the first woman to serve as a Trustee of the College from 1988 to 1992. She is Professor Emerita of Medicine at Yale School of Medicine.

Matthew Hill, BA, of the University of Illinois College of Medicine is the College’s first Medical Student Member. The Board of Trustees approved a Bylaws change for this new membership category in October, 2024.

“During my first year and a half of medical school, I have explored the field of gastroenterology by spending time with doctors and fellows in the GI clinic, engaging in GI research, and ultimately presenting research at ACG 2024. I then decided to join the College as a medical student member to learn more about GI, stay involved, and seek mentorship as I progress in my education and training.”

Fun fact: Matthew Hill has visited 45 of the 50 states and enjoys skiing as he travels.

Next on his list is the Pacific Northwest.

[LEADERSHIP]

The ACG Institute and its Center for Leadership, Ethics and Equity supports four distinct leadership programs, with each program being tailored to a distinct career stage: [EMERITUS]

Irwin M. Arias, MD, a hepatologist, is the oldest ACG member. Born in 1926, Dr. Arias joined the College in 1971. He is a founder of the American Liver Foundation (ALF) and served as a member of their national Board of Directors. Dr. Arias is Emeritus Professor of Medicine, Albert Einstein College of Medicine; Emeritus Professor of Physiology and Medicine, Tufts University School of Medicine; and Senior Scientist at the National Institutes of Health where he continues to teach. In 1991, ALF established the Annual Irwin M. Arias Symposium in his honor. Now in its 34th year, the session brings together leading biomedical scientists and physicians at the Broad Institute of MIT and Harvard for plenary talks that bridge basic science and clinical care for liver disease. As recently as September 2024, at age 98, Dr. Arias presented at the Georgetown University Distinguished Scientist series.

• Emerging Leadership Program (3rd & 4th year GI fellows) • Early Career Leadership Program (1-5 years post-fellowship completion) • Advanced Leadership Program (10-20 years post-fellowship completion) • Clinical Research Leadership Program (2-15 years post-fellowship completion with grant funding as a PI/Co-PI in the last 10 years) In a new initiative, Leadership YOU, participants in these programs will convene over one weekend, June 6-8, 2025, in Washington, DC. Leadership YOU will provide an opportunity for all four cohorts to network and engage in shared learning sessions in addition to cohort-specific professional development.

See members of all four ACG Leadership cohorts: gi.org/introducing-the-2025-acg-institute-leadership-you-cohorts

[BLUER SKIES]

In November 2024, the College launched a Bluesky account that now has more than 2,000 followers. (bsky.app/profile/amcollegegastro.bsky.social) Bluesky is similar to Twitter/X, but users opt in to follow each other, creating “neighborhoods” with similar interests. Instead of algorithm-driven content, Bluesky aggregates posts using hashtags, in the case of GI and medicine: #GastroSky #LiverSky #EndoscopySky and #MedSky. ACG has pulled together a “Starter Pack” which is a list of Bluesky users in one place that makes it easy for newcomers to identify trusted peers and follow each other. go.bsky.app/5iTZwFW

Novel & Noteworthy | 11

// N&N [BOOK REVIEW]

ACG GUIDE TO THE GUIDELINES VOLUME 2 Authors: Brennan M. R. Spiegel, MD, MSHS, FACG, and Hetal A. Karsan, MD, FACG

Reviewed by Brian E. Lacy, MD, PhD, FACG “We are drowning in information while starving for wisdom.” – E.O. Wilson (American biologist, entomologist, ecologist; 1929-2021) Over 1.8 million scientific articles are published each year in approximately 28,000 peer-reviewed journals. More than 150 journals focus on gastroenterology and hepatology. It has been estimated that the average clinician needs to read one scientific article each day simply to stay abreast of clinically important changes. We are clearly awash in information but most of us do not have the time or resources to gather critically important data that will enable us to provide exceptional patient care. That is where clinical guidelines come in.

Clinical practice guidelines, many of which are published in The American Journal of Gastroenterology, are written with the intent of providing evidence-based recommendations to clinicians, improving the quality of patient care, reducing variations in clinical care, and discouraging therapies with limited utility.

Staying on top of the guidelines can be difficult, however, for a busy health care provider. The American College of Gastroenterology alone has published over 75 comprehensive guidelines for example. This is why the publication of the exceptional second volume of the “ACG Guide to the Guidelines” series

by Dr. Brennan Spiegel and Dr. Hetal Karsan is so welcome. Following the format of the successful first volume of Guide to the Guidelines, the second installation contains three broad chapters. Chapter 1 focuses on “The Inflamed Pathways” summarizing guidelines on Crohn’s disease, ulcerative colitis, and celiac disease. Chapter 2 (“The Unwelcome Guests”) reviews gastrointestinal infections including Helicobacter pylori, Clostridioides difficile, and other enteric infections. Chapter 3 (“When the River Runs Red”) covers the guidelines on upper and lower gastrointestinal bleeding, the critical topics of how to manage anticoagulants and antiplatelet medications during an acute event (and after), as well as ischemic disorders of the GI tract.

Each chapter is filled with clinical cases used to highlight specific recommendations made within each guideline. For example, the authors highlight the broad differential diagnosis required for a patient presenting with terminal ileitis with specific references to the ACG guideline on diagnostic testing for patients with suspected Crohn’s disease. Similar to the first volume, Dr. Spiegel and Dr. Karsan make use of clever mnemonics to assist the reader in remembering differential diagnoses, pathophysiology, and treatment options (i.e., TRIGGER to remember triggers for an IBD flare). Cases will appeal to clinicians at all levels of training as they are practical and represent commonly encountered scenarios. For example, appropriate triage of a patient with a likely NSAID-induced ulcer is covered in Chapter 3 with a succinct review of the Glasgow-Blatchford score. Chapters are visually appealing with “call out” boxes highlighting key teaching points.

A nice addition at the end of each chapter is a short quiz with multiple-choice questions. As noted by the authors, these quizzes can be taken in advance of reading the chapter to assess possible deficiencies, or after reading the chapter, to evaluate retention. Guidelines and other key references are complete, up to date, and listed towards the end of the book (for example, the updated ACG H. pylori guideline discussed was published in 2024). Many of the cases include images; tables and charts throughout the book are clear, precise, and concise.

Overall, I would recommend this new edition to the Guide to the Guidelines series for any practicing gastroenterologist or health care provider who evaluates and treats patients with gastrointestinal disorders. Trainees will find the book easy to read with information that can be used that day in clinic. Experienced providers can use the book for teaching purposes or to brush up on areas outside their realm of expertise. Simply put, this should be on everyone’s bookshelf. I am already looking forward to the third Guide to the Guidelines.

12 | GI.ORG/ACGMAGAZINE

ERGONOMICS FOR ENDOSCOPY: OPTIMAL PREPARATION, PERFORMANCE, AND RECOVERY by Gyanprakash Ketwaroo, MD, FACG; Kalpesh Patel, MD; and Amandeep K. Shergill, MD, MS.

Review by Brian C. Jacobson, MD, MPH, FACG Associate Professor of Medicine, Harvard Medical School; Director of Program Development for GI, Massachusetts General Hospital Endoscopy-related injuries are extremely common, impacting between 60% and 90% of endoscopists. Fortunately, there is a burgeoning awareness of this issue, particularly as we come to understand that many injuries can be mitigated in severity or avoided altogether. Ergonomics for Endoscopy: Optimal Preparation, Performance, and Recovery, a multi-author book edited by Gyanprakash Ketwaroo, Kalpesh Patel and Amandeep Shergill, is a welcome compendium providing comprehensive guidance for clinicians and endoscopy unit leadership.

The book is a collection of 11 chapters with topics ranging from the principles of ergonomics, endoscopy unit layout, personal protective equipment, ways to improve the ergonomic performance of endoscopy, and how to recover from injury. The editors have done an excellent job making the material inclusive and thorough. For example, there is a chapter devoted to ergonomic considerations for nurses and technicians.

Another chapter focuses on the performance of endoscopy during pregnancy, providing specific recommendations to address common problems like wrist pain, back pain and lower extremity edema.

Fellowship program directors will be glad to see a chapter providing suggestions for incorporating ergonomics into endoscopy training, highlighting that attention to these issues early in one’s career is one of the most effective ways to prevent long-term musculoskeletal injuries.

There is some repetition of information (e.g., the proper positioning of a monitor relative to the endoscopist’s gaze appears in three chapters).

However, such repetition is necessary as some readers will likely use this book as a reference, returning to specific chapters when needed. I believe this book will prove helpful for anyone looking for ways to protect themselves, and their colleagues, from many of the common injuries seen ERGONOMICS regularly in busy endoscopy FOR ENDOSCOP Y units. It can also spark muchneeded conversations about programmatic approaches to better health and wellbeing.

Optimal Preparation

, Performance,

GYANPRAKASH KETWAROO KALPESH PATEL

A M E R I C A N CO

LLEGE OF G

and Recovery

AMANDEEP K. SHERGILL

AST R O E N T E

R O LO GY

ACG PRACTICE MANAGEMENT

Toolbox

Members Only

ACG’S Billing & Coding FORUM ACG members and GI practices continue to face mounting financial and reimbursement pressures. Complex coding and documentation requirements only add to these burdens. The ACG Practice Management Committee is pleased to announce the new member benefit: professional coding and documentation assistance for ACG members, tailored to your individual practice’s questions and needs.

HAVE A QUESTION? Email coding@gi.org

Arlene Morrow, CPC, CMM, CMSCS, is now available to answer your questions!

ACG members will receive an answer and guidance within a few business days.

Start Building Success Today gi.org/practice-management

Novel & Noteworthy | 13

// N&N

[CRC AWARENESS SNAPSHOT]

SANKALP DWIVEDI, MD, CHAMPIONS CRC AWARENESS To address patient-centered challenges for colon cancer screening such as lack of awareness about colon cancer, and fear of discomfort from the bowel preparation and the colonoscopy procedure, Sankalp Dwivedi, MD, and his colleagues at Ascension Medical Group in Menasha, WI, organize creative community education efforts.

They have also implemented several changes in their endoscopy unit to improve the quality of endoscopic exams as well and now take a more tailored approach to bowel preps based on patient needs.

Dr. Dwivedi commented, “I have been passionate about colon cancer eradication since my early years of training. Our department is blessed to have a dedicated GI coordinator, Shannon Rucynski, who is also a specialized GI nurse. Before she was a nurse, she was a GI tech for more than 10 years. Her dedication for GI and commitment to the community is extraordinary. I am fortunate to have another exemplary and dedicated physician in my practice, Dr. Sudeep Sodhi, and together with Shannon we collaborate on ways to address and overcome various challenges for colon cancer screening.” He added, “The best part of our work on these creative CRC awareness initiatives is to brainstorm the ideas each year. On the day of these events, it is fun to dress up and get ready as a motivated GI team for the photoshoots.”

When asked why he loves what he does, Dr. Dwivedi shared, “When I identify a large precancerous polyp and remove it at the same colonoscopy, it gives me immense motivation and joy that I have made a difference in decreasing the incidence of colon cancer in my community and in the life of my patient.”

Some fun examples of CRC Awareness initiatives by Dr. Sankalp Dwivedi and his team at Ascension Medical Group in Menasha, WI. (bottom right) Sankalp Dwivedi, MD, in “Dunk the Doctor” at the Rock Cancer event.

14 | GI.ORG/ACGMAGAZINE

PUBLIC POLICY

SUN TZU, THE FIFTH-CENTURY BC CHINESE PHILOSOPHER, is credited with a quote that

Advocacy in the Midst of Chaos A preview of this year’s advocacy day and healthcare policy efforts Louis J. Wilson, MD, FACG

summarizes my attitude heading into this year’s ACG Advocacy Day: “In the midst of chaos, there is also opportunity.”

As we approach our annual April visit to the nation’s capital, Washington, DC, is experiencing massive change. Like any new administration, new leadership at HHS and CMS will bring its own agenda and policy priorities, amid broader efforts to cut costs and bring “efficiency” to government.

The effect of these changes on our legislative priorities is anyone’s guess, but allow me to explain why I'm embracing an optimistic spirit for the College’s advocacy in 2025.

I’ll be the first to admit things currently look rather bleak. Congress is struggling to pass a budget with persistent threats of a government shutdown looming. Meanwhile, dramatic efforts to cut “waste, fraud, and abuse” seem to make any legislation that increases government spending an uphill battle. But our priorities to protect access

Public Policy | 17

// PUBLIC POLICY to care, expand patient choice, and improve the value of healthcare have broad bipartisan support. Therefore, ACG remains unashamedly laserfocused on the important issues impacting on our practices.

These priorities include: Supporting GI patient care issues and increasing access to GI services, like colorectal cancer screening, preventive care, clinical trials, and telehealth reimbursement. We also expect to renew our fight in Congress and with HHS to require insurers to cover surveillance colonoscopy as the preventive service that it is.

Adopting Medicare physician fee schedule reforms, because inaction is harming patient access to care, accelerating practice consolidation, and exacerbating workforce challenges. The latest estimates suggest that, adjusted for inflation, Medicare physician reimbursement has plummeted by 33% since 2001.

In April, ACG’s advocates will push Congress to avoid the annual ‘doc

fix’ emergencies and adopt sustainable, longer-term reforms.

Reducing administrative burdens and improving productivity through popular, bipartisan reforms to prior authorization and step therapy. We look forward to having new conversations about physician autonomy and productivity. We must reduce the regulatory burdens of MIPS participation and Medicare quality reporting, because we all know our time is best spent treating patients instead of handling data entry.

There is also a promising opportunity to reform antiquated rules on self-referral and physician-ownership, where decades-old rules stifle innovation and productivity.

We were all looking for Congress to address at least some of these challenges in last year’s lame duck session, but our allies in House and Senate remain committed to moving their respective chambers towards legislative solutions.

Looking at the bigger picture, as Chair of the Legislative and Public Policy Council, I believe ACG’s approach of ‘focus, framing, and flexibility’ is evergreen, helping us build stronger relationships and deliver results – even in the current political upheaval.

This means that although those priorities remain our focus, we will be continuously adapting our messages and adjusting how we frame them. For some Members of Congress, that might mean spending more time on local stories and the importance of independent GI practices; for others, maybe it’s health equity or the financial bottomline. But in all cases, it means keeping patients at the core of our priorities and reiterating the sanctity of the physicianpatient relationship.

For decades, ACG has excelled at the balancing act of advancing our own policy priorities while being flexible

Clockwise: In December 2024, Louis Wilson, MD, FACG, met with several Members of Congress and their staff to discuss critical Medicare reimbursement reforms and other legislative solutions to protect patient access to GI services. Louis Wilson, MD, FACG, and James Hobley, MD, FACG, meet with Speaker of the House Mike Johnson (R-LA) before ACG's 2024 Advocacy Day. Former President Jonathan Leighton, MD, FACG, former Rep. Brad Wenstrup, MD (R-OH) [retired after the 118th Congress], Rep. Gregory Murphy, MD (R-NC), and Louis Wilson, MD, FACG, at the Doctor's Caucus meeting before ACG's 2024 Advocacy Day.

18 | GI.ORG/ACGMAGAZINE

to meet the demands of an everchanging Congress and presidential administration. In fact, I’m encouraged to see emerging areas of agreement, including an increased focus on chronic illness, ‘food as medicine’ initiatives, and meaningfully tackling healthcare workforce challenges. We look forward to collaborating with the Trump Administration on these and any other opportunities that advance digestive health.

I also firmly believe this flexibility means Washington, DC, doesn’t have to be – and perhaps, shouldn’t be – the sole focus of our work.

Last year, the ACG Board of Governors and hundreds of ACG members from across the country channeled their frustration with federal gridlock into advocacy for meaningful state reforms. These new laws are substantial achievements that improved access and reduced financial barriers to colorectal cancer screenings in five states and reigned in prior authorization and step therapy requirements in another seven. I know there are more state wins to come in 2025 and look forward to updating you about them soon.

It’s easy to be frustrated by the many challenges of our country’s broken healthcare system. At times, we assume our voices have been drowned out by better-resourced stakeholders that benefit from the status quo. But when I see how active and engaged our membership has remained through it all, I am filled with a great deal of resolve and optimism.

As our public policy leaders advocate vigorously in Washington, DC, this spring, remember that your voice matters, too.

So, in the spirit of Sun Tzu, I hope you will find opportunity in the chaos and join our advocacy efforts by visiting the ACG Legislative Action Center today at gi.org/public-policy/ legislative-action-center.

About Louis J. Wilson, MD, FACG Dr. Wilson is an independent private practice gastroenterologist, the managing partner of Wichita Falls Gastroenterology Associates, and chair of the ACG Legislation and Public Policy Council.

Thriving Beyond Fellowship in Gastroenterology Katie A. Dunleavy, MB BCh BAO

T // COVER STORY

THE TRANSITION FROM GASTROENTEROLOGY FELLOWSHIP TO ATTENDING PHYSICIAN is one of the most exciting—and challenging—times in a medical career. While medical school, residency, and fellowship provide the advanced training and clinical experience needed, stepping into the role of an attending gastroenterologist brings with it new responsibilities, expectations, and opportunities for growth. As I prepare to graduate from my Advanced Inflammatory Bowel Disease fellowship, I’ve gathered some expert insights and tips to help newly graduated fellows navigate this next chapter of their careers. I hope that others will benefit from exploring the answers to my questions by some inspiring leaders in GI. — Katie A. Dunleavy, MB BCh BAO

GRADUATING GI FELLOWS FACE THE FUTURE: QUESTIONS FROM DR. KATIE DUNLEAVY How should fellows make the most of the time between graduation and starting their first job?

Amy Oxentenko: “To make the most of the time, take the most time! The time between fellowship graduation and starting your first job is a sacred time and should be treated as such. While some may need to start working shortly after graduation to keep earning a paycheck, this is the one time that you can take any length of time off without having to dip into a finite vacation bucket.”

Katie Hutchins: “Enjoy your time, but plan for your upcoming board exams. Avoid waiting until you start your job to begin the final push for studying. It is possible to both enjoy your time off and study between the last day of fellowship and first day of your attending job.”

Tauseef Ali: “Get Familiar: Understand the practice’s structure, patients, and workflows to hit the ground running. Learn the Business: Master billing, coding, and financial basics to navigate private practice smoothly. Set Clear Goals: Reflect on your career path and break down your long-term

dreams into actionable steps.”

Andrew Moon: “One of the best ways to maximize time between graduation and starting one’s first job is speaking to young faculty members. Ask them about obstacles they face and solutions to difficult issues in clinic, endoscopy, inpatient service, and balancing home life.”

Carl Kay: “Relax in June and July.

There’s no need to stress about boards right away. Begin structured studying in August with a clear plan.”

Sumana Moole: “Disconnect, reflect, and organize your priorities. Sign off the beeper, take off the ID badge, and go on a month-long (or longer) sabbatical to help guide you in the right direction. Remember, you’ve climbed the mountain; now take a moment to enjoy the view before scaling the next peak.”

Looking back, what do you wish you had known before beginning your first year as an attending gastroenterologist?

Amy Oxentenko: “It is 100% OK (and expected) to ask for help. The first year of practice is still a steep learning curve, so do not hesitate to run a tough case by a colleague or ask someone to come into the endoscopy suite if you are struggling or unsure of how to manage a finding. Don’t be afraid that people will judge you for that, as we all did it!”

Joshua Steinberg: “No one has all the right answers for when you’re starting your career – but you should never feel ashamed or afraid to ask a colleague, superior, or mentor for guidance during this transitional period. Open communication with your colleagues and staff is key to a successful first year.”

Loren Rabinowitz: “I wish I had known how happy I would be to have control over my time and care of patients

“It is 100% OK (and expected) to ask for help. The first year of practice is still a steep learning curve, so do not hesitate to run a tough case by a colleague...”

20 | GI.ORG/ACGMAGAZINE

after finally completing many years of training. Getting to know and learning from my patients (and having the time to do so!) is a joy. I think I might have been more excited and less anxious prior to starting if I knew how much fun I would have being a gastroenterologist.”

Tauseef Ali: “The Learning Curve is Real: Fellowship gives you a solid foundation, but real-world practice throws curveballs—stay humble and keep learning! Teamwork Makes the Dream Work: Your nurses, techs, and admin? They’re your MVPs—build those relationships! Talk the Talk: Patients remember how you make them feel.

Master the art of clear, compassionate communication—it’s as crucial as your technical skills. Give Yourself Grace: You won’t have it all figured out on day one. Mistakes are part of the journey— embrace the process!”

Mohammad Bilal: “Knowledge is of course key to success, but even more helpful are the non-technical skills or the cognitive skills. These include how do you train your nurses, communicate with your referring physicians, and develop your workflow, etc.”

Carl Kay: “Learn to advocate for what you want while maintaining collaborative relationships. The book Never Split the Difference: Negotiating As If Your Life Depended On It by Chris Voss is a game-changer. It teaches practical techniques such as tactical empathy and calibrated questions to help you negotiate confidently and effectively. Practice these skills in everyday interactions—negotiation is everywhere – as small wins build confidence for bigger conversations.”

What strategies have you found effective for managing both the clinical demands of the role and the learning curve associated with new responsibilities?

Katie Hutchins: “To manage both clinical demands and the learning curve of new responsibilities, I focus on prioritizing tasks, delegating when possible, and setting aside dedicated time for learning. Breaking down new skills into manageable steps, seeking

mentorship, and using available resources such as training programs or clinical support tools can enhance efficiency. Regular feedback and self-reflection are key to preventing burnout. Focusing on small, achievable goals and celebrating progress helps keep motivation high while balancing clinical duties with continued professional development.”

Joshua Steinberg: “Try not to say ‘yes’ to too much upfront, give yourself some grace and allow yourself to get your feet wet the first six or so months; your patients and your practice are your #1 priority – building your career and CV can wait. If you wouldn’t say ‘yes’ to doing something (such as a research project, article, etc.) if it were to happen tomorrow – don’t say ‘yes’ at all!”

Andrew Moon: “An effective strategy I’ve used is keeping my senior colleagues on speed dial. Working in a place with highly knowledgeable and approachable colleagues has always been a huge perk and we continually learn from each other by discussing difficult clinical cases.”

Cassandra Sanossian: “Knowing it’s OK to ask questions - from your coworkers, former mentors and cofellows. You won’t know even close to everything and that's OK. Sometimes seeking guidance from someone who has years of experience is more valuable.”

Carl Kay: “I wish I would have found principles from the book Getting Things Done by David Allen earlier.

This framework has revolutionized how I manage immediate and longterm goals in personal, academic, and clinical arenas. One of two apps can be used to integrate these time management principles: Things 3 (my favorite) or Google Tasks.”

Sumana Moole: “Remember, you’re not just a doctor; you’re the CEO of your own well-being.”

How do you ensure a smooth patient flow during a busy clinic day, especially when faced with unexpected delays or urgent situations?

“There will always be unanticipated events, but the more prepared you are for the day, the more you will be able to navigate the unexpected. Don’t walk into clinic unprepared – it will feel like walking into a dark forest without a flashlight.”

Amy Oxentenko: “Prepping for clinic is key. I have a goal to finish every patient encounter before I move onto the next one. This forces me to maintain efficiency and allows me to go home and not bring clinic work with me. There will always be unanticipated events, but the more prepared you are for the day, the more you will be able to navigate the unexpected.

Don’t walk into clinic unprepared – it will feel like walking into a dark forest without a flashlight.”

Loren Rabinowitz: “Building seams into your day is helpful (for example, holding a dedicated slot for urgent follow-ups to avoid double-booking). I also find it useful to set expectations when meeting new patients that emergencies are a part of every clinic. Sometimes, you will be the patient that I spend extra time with and sometimes you will be the patient that needs to wait a bit to see me – but I promise that I will give you my full effort and attention and do my very best to respect your time.”

Tauseef Ali: “Delegate like a pro: Empower your team to take care of non-clinical tasks so you can focus on patient care. It’s all about teamwork! Use your time wisely: Tackle straightforward issues quickly and flag follow-ups for more in-depth conversations. Efficiency is the name of the game! Reflect & Improve: At the end of the day, look for bottlenecks and chat with your team about how to keep patient flow smooth. Always be refining!”

Mohammad Bilal: “I would like to quote former ACG President Dr. Mark Pochapin here: ‘Interruptions are part of the job’ – we have to remind ourselves of our ‘why’ and why we are here.”

Cassandra Sanossian: “Sometimes (often), delays happen, but trying to defer other tasks to the end of the day (finishing a

note or returning a non-urgent phone call from a patient) can help mitigate delays. Thanking the patient for waiting (or apologizing for the delay) acknowledges the patient’s time, and may relieve some of the frustration associated with the longer wait.”

Sumana Moole: “Make sure your schedule is set up so that you only have one responsibility at a time. If unexpected delays occur, have your office inform patients in advance so they can manage their own schedule.”

What were some of the key challenges you encountered in your first year, and how did you address them?

Amy Oxentenko: “My challenges were largely related to balancing parenthood and work. Within three months of starting my first job, I delivered our third child, and had three kids ages three and younger. I was forced to learn efficiency skills, as I had to pump throughout the day, stay on time in clinic, and pick up kids before the doors to daycare closed.

Then there were all the childhood illnesses and sick calls from daycare to contend with! While this was so stressful at the time, I am certain my efficiency and organization skills were directly born out of necessity and have served me well ever since.”

Katie Hutchins: “Despite being well trained, the first year of practice is intimidating at times. I recognized the importance of understanding my limits and avoided taking unnecessary risks.

I focused on seeking guidance when needed and collaborating with more experienced colleagues to ensure the best outcomes for patients.”

Joshua Steinberg: “Creating a priority

Cover Story | 21

// COVER STORY

“Friendships and mentorship are like plants – they need to be tended to with some regularity in order to grow and flourish.” list of desired goals is extremely helpful, and having a ‘mission statement’ to stay true to will help guide your decision making in the short and long term.”

Loren Rabinowitz: “The learning curve (clinically and procedurally) is very steep during the first year. This is especially true if you find yourself in a new practice setting. Be kind to everyone you meet – techs, RNs, admins, fellows, colleagues, and patients. They will be vital in helping you navigate a new environment.”

Tauseef Ali: “Lean on your team and trust yourself—you’re more ready than you think!”

Andrew Moon: “As a young clinician and researcher, publishing and preparing grant applications were essential tasks that are time consuming and often derailed by clinical responsibilities. Identifying times when I do my best thinking and writing (the morning for me) and keeping these times blocked off was essential to making progress on research-oriented activities.”

Mohammad Bilal: “I think the biggest challenge was the need for validation.

It’s important to remember we are not alone and being vulnerable, too, is a strength.”

Carl Kay: “As part of the military, I had no control over my first postfellowship assignment. The location and practice environment were not ideal as it removed me from my passion for graduate medical education (GME). Additionally, the move was not aligned with my family’s preferences; this created personal and professional challenges.

Despite being removed from a GME environment, I made a deliberate effort to remain engaged with military GI fellowship programs, offering

22 | GI.ORG/ACGMAGAZINE

mentorship, and teaching as much as possible. I joined the ACG subcommittee and Army GI leadership to advocate for the optimal utilization of early-career Army gastroenterologists. I worked to influence policies and opportunities for others in similar positions, leveraging my experiences to help improve the system.”

Sumana Moole: “Do it even if you’re afraid, and slowly you’ll grow into your role! The first time I had to make a critical decision without backup, I realized that fear is just courage waiting to be discovered.”

How did you establish a strong network of colleagues, mentors, and peers during your first year in practice?

Amy Oxentenko: “You need to dedicate the time to establish a strong network of colleagues. Attend as many internal work conferences and social events as you can in order to get to know your colleagues and allow them to get to know you (particularly if you are new to the practice or institution). The same is true when attending GI meetings outside of your practice or institution to develop a network of colleagues elsewhere who can serve as an excellent sounding board.

Mentorship can start with an invitation for someone to join you for coffee and see if your interests align. Friendships and mentorship are like plants – they need to be tended to with some regularity in order to grow and flourish.”

Katie Hutchins: “Communication is key. When establishing a strong network of colleagues and peers, I can’t overemphasize the value of picking up the phone to have a direct conversation.”

Loren Rabinowitz: “Firstly, selecting the right environment to begin with is important. Secondly, having an organized approach to network-building can be useful, especially with a very busy first year attending schedule. Finding time for coffee or introductory meetings over Zoom

can feel overwhelming if you are not intentional about blocking out time for these efforts. At the end of each meeting, ask ‘who else do you suggest I reach out to?’ and then follow up on those suggestions.”

Tauseef Ali: “Be Proactive: Don't wait for connections to come to you—introduce yourself to specialists, primary care doctors, and administrators. Early relationships pay off! Go National: Join organizations like ACG to access a wider network of experts and peers who can elevate your practice. Social media: LinkedIn, BlueSky, and X aren’t just for memes—use them to connect with professionals in your field and expand your network. Be Approachable: Show genuine interest in your colleagues’ work, lend a hand, and remember that strong networks are built on collaboration and support!”

Mohammad Bilal: “This is possibly one of the most critical things that can help us succeed. Find your tribe – your mentors, sponsors, and peermentors. I used my network through ACG involvement (ACG Institute Young Physician Leadership Scholars Program, ACG Mentoring Program), people I trained with and worked on committees, etc., with to be my tribe.”

Carl Kay: “Make attending your first ACG conference post-graduation a priority. Use this opportunity to reconnect with fellowship mentors, meet peers in your region, and engage with thought leaders.”

How did you navigate work-life balance during your first year, and how has it contributed to your success?

Amy Oxentenko: “Over time and as my kids got older, I have learned to prioritize the things that are most important to me, such as family, exercise, sleep, and reading. These things are not found on one’s Outlook calendar, but they should be, as they need to be factored in with the regularity needed to feel sustained and nourished. I often hear the excuse, ‘I do not have time.’ Everyone has the same 24 hours in a day – it is how

you choose to spend those hours that differs among us. Choose wisely!”

Katie Hutchins: “I view work-life balance as an ever-fluctuating system with demands that wax and wane.

There are times when life demands override work and vice versa. That said, there are certain ‘can’t miss’ life events that I won’t sacrifice for work. Remain loyal to those ‘can’t miss’ moments.”

Andrew Moon: “Navigating work-life balance remains incredibly hard. I have a very hard time not working on evenings and weekends, and still struggle with this. Rather than leaving the weekend up to last minute planning, I try to schedule exciting outings or date nights with my spouse to ensure I spend quality time with loved ones and provide me with something to look forward to.”

Mohammad Bilal: “As physicians, we always put patients first, as we should, but we are also humans. Therefore, it is essential to maintain a healthy work-life balance, because if we are happy in our personal lives, this will translate into our professional lives and vice versa.”

Carl Kay: “Communicate availability to colleagues and patients early to establish expectations. Engage in a consistent physical activity. For me, training for my first marathon and improving my VO2 max provided structure, stress relief, and a sense of accomplishment beyond work. Take proactive steps to schedule time off before the calendar fills up.”

Sumana Moole: “Strong priorities before you enter the workforce are key. For me, it was time with family and getting home in time to see my kids get off the school bus. This gave me a clear vision of the type of jobs I accepted and the structure of my current practice. Find your North Star.”

How did you identify and connect with mentors during your first year, and what role did mentorship play in your professional development?

Amy Oxentenko: “The first time you approach a potential mentor, remember that it is precisely that – one with potential, but it is not a

given. Request a coffee meetup with someone who you think could serve as a useful research or career mentor. In that first meeting, explore common interests, and if it goes well, it may then lead to another, and another, and so on. I would never recommend going up to someone you have never met and ask if they will be your mentor – that is like asking them to marry you when you are just meeting on a first date – you may scare folks away!

Mentorships are relationships that develop over time, and you can have a number of different mentors to help guide in different aspects of your career and life.”

What methods do you use to stay current with the latest research and evidence-based practices in gastroenterology?

Amy Oxentenko: “I always peruse the table of contents of the GI journals each month, ensuring I read the latest guidelines, clinical reviews, and topics related to my personal areas of interest. And a plug for ACG’s Postgraduate Course and Annual Scientific Meeting!!!”

Katie Hutchins: “One of my greatest regrets was not connecting with mentors during my first year in practice. When I reflect on this, I did not know who to ask during that first year. The ACG provides a great resource to connect with a mentor. I highly recommend early career gastroenterologists to consider the ACG Mentoring Program. Mentorship has been instrumental in helping me to focus on my mission, develop professionally, and the added perk of building my network (and friendtors).”

Joshua Steinberg: “I really enjoy listening to GI podcasts (such as ACG, IBD Drive Time).”

Loren Rabinowitz: “Coachability is incredibly important as a mentee – showing your mentors that you take feedback well and are eager to learn from them makes them more engaged and invested in your career success (because they are also successes for your mentor!).”

Joshua Steinberg: “A ‘friendtor’ is an invaluable person to have in your corner – someone you feel comfortable with to share what’s on your mind to, in turn, receive sound advice for your personal and professional growth!”

Carl Kay: “Being in an isolated practice with one other Army gastroenterologist made mentorship crucial. Thankfully, the military naturally connects us, and my colleague became an invaluable mentor.

I rely heavily on previous co-fellows and attendings for guidance and expertise.”

Sumana Moole: “Initially, I had no mentors.

However, mentors can be found virtually through books, podcasts, and admired individuals. Your mentors don’t have to be in the same room—they can be in your headphones or on your bookshelf.”

Katie Hutchins: “ACG Virtual Grand Rounds (recorded for viewing later, if needed).”

Loren Rabinowitz: “Joining national societies such as the ACG and accessing their app/guideline updates can help routinize continuing education in GI after fellowship.”

Tauseef Ali: “Use PubMed or Google Scholar to get real-time updates on topics like IBD, liver cancer, and advanced endoscopy. Knowledge is delivered to your inbox while you sip your coffee!”

Andrew Moon: “To stay current with the literature, I try to follow a highly tailored group of educational profiles on social media, browse the tables of contents for top GI/hepatology journals, and attend all our divisional GI journal clubs.”

Mohammad Bilal: “For me as an advanced endoscopist, following video publications for navigating complex endoscopic challenges has been an excellent way to keep up to date.”

Carl Kay: “Twitter (X) is a powerful tool when tactfully curated. Tip: Mute non-relevant content to maintain focus on lifelong learning.”

What steps did you take to familiarize yourself with the business aspects of private practice, including billing, contracts, and financial management?

Tauseef Ali: “Ask the Right Questions: Don't hesitate to chat with your practice admin and colleagues about workflows and finances. They’ve

Cover Story | 23

// PERSPECTIVES

got the know-how that’ll save you time! Get Your Financial GPS: The ACG Practice Management Course is your roadmap for mastering billing, contracts, and financial management in private practice. Level Up with Resources: Check out the ACG Practice Management Resources at gi.org — it’s like a cheat code for boosting your business skills!”

Sumana Moole: “Speaking to private practice physicians in the area you wish to practice, get some basics, check if there are CINs in your area, make some strong initial hires, and hire on the basis of attitude – most skills can be learnt.”

Joshua Steinberg: “Nothing in training can fully prepare you for this, and it takes time. Ask your practice to dedicate time during your onboarding for you to understand the inner workings of your practice, how to code/bill, and connect yourself with a financial advisor who specializes in working with physicians – this will be critical to your personal and financial success.”

How did you go about building your patient base during your first year, and which marketing or networking strategies proved most effective?

Sumana Moole: “Take time, don’t rush. In-person visits to local doctors’ offices, good work, a basic website, and Google ads are effective. Word of mouth and referrals increase by the second year. A handshake and a smile during office visits worked wonders. My patient base grew faster than I expected, proving that personal connections still matter.”

Tauseef Ali: “Word-of-Mouth Wins: Satisfied patients are your best marketers. Let them spread the word and watch your patient base grow.

Build Relationships: Introduce yourself to local practices. Networking with fellow providers is key to a thriving, steady patient flow!”

Joshua Steinberg: “I became involved with the local Crohn’s and Colitis Foundation chapter (Rocky Mountain)

24 | GI.ORG/ACGMAGAZINE

and started the Colorado IBD Consortium – a group of GI and CRS providers to meet over dinner and discuss journal articles, complex cases, and network – this could be replicated anywhere! Becoming involved with industry (pharma, etc.) can also help bolster your profile with consulting and educational speaking engagements that will reinforce your expertise in the field.”

How do you balance the responsibility of teaching residents or medical students while continuing to refine your own clinical and procedural skills?

Amy Oxentenko: “Working with trainees keeps you honest – they will ask questions that you will not know, and it is important to be candid and learn together. They can present a few pearls on something they saw in clinic with you the day before, or you can give them a topic to read and informally discuss the next day. There is no better way to learn material than to have to teach it to someone else. In terms of procedural skills, I strongly suggest being very comfortable in your own skills before being assigned to work with trainees. Teaching a technical skill is not easy, and learning the nuances of how to do this well is important.”

Katie Hutchins: “This is challenging and rewarding. First, I ask residents and medical students what they want to learn.

This helps to guide my approach. My goal when working with residents or students is to identify teaching points for the day.”

Loren Rabinowitz: “I find that teaching complex concepts helps to crystallize my own learning. I love to have trainees in my clinic because it forces me to articulate my clinical thought processes, which makes it easier to relay those thoughts to our patients. Preparing for every patient prior to clinic (i.e., creating a checklist of anticipated ‘to-dos’ for visits) helps to streamline the day, increasing dedicated teaching time while ensuring that patient care remains prioritized.”

Andrew Moon: “Whenever a question comes up on rounds, we search the relevant primary literature or guidelines and find the answer together. As the saying goes, if you teach the trainee to fish, you feed her for a lifetime.”

Mohammad Bilal: “To me, this is the most fun and rewarding part of being in academic medicine. I think you have to figure out what skills you are comfortable in and what skills you need to refine. The skills you are comfortable with are excellent opportunities to allow the trainees to learn and for you to teach them. I believe setting these expectations up front with fellows you are scoping with on what you want them to learn and which skills you want to focus on in your growth. Trainees will appreciate it if you set these expectations explicitly prior to the rotation, etc., and will allow you to teach them but also let you learn new skills.”

Sumana Moole: “During a particularly challenging scope session, I realized the importance of patience and clear communication. Those moments of struggle became our best teaching points.”

How do you manage the administrative duties, such as grant writing, research approvals, or committee work, alongside your clinical responsibilities?

Amy Oxentenko: “As I mentioned before, it all comes down to efficiency, organizational skills, and knowing when to say yes versus no. The most important part of this equation is knowing how full your plate is, and if you are being offered a new opportunity, you need to ensure you have room on your plate – if not, you either need to say no, or remove something on your plate to make it fit. Much of this work falls outside of the regular hours of a workday, so you should ensure you are passionate about this work and that you have the time to dedicate to it.”

Katie Hutchins: “When I have nonclinical time, I am intentional about scheduling specific tasks into my calendar. I use time blocking and do my best to stick to the plan. It feels good to be asked to be on a committee or task force. Before accepting, ensure that you have the time and interest to commit.

Overcommitting and failing to fulfill

obligations can reflect poorly and interfere with future invitations (that you might want)!”

Loren Rabinowitz: “For any physician, patient care comes first – but this can make it challenging to sufficiently prioritize other academic work, including research and grant writing.

Finding a cohort of peers (both within your institution and outside of it) with similar academic goals can be helpful in keeping you motivated and on-task. Additionally, writing teams, a concept I learned about during an ACG leadership course led by Neena Abraham, can be invaluable and help ‘supercharge’ academic productivity.

As Dr. Abraham says, ‘work smarter!’”

Andrew Moon: “I have an incredible team of research managers and clinical research coordinators who can address research approvals and support grant writing activities. Negotiating for coordinator time or asking mentors about sharing resources may make this feasible while you build your own research funding portfolio.”

Mohammad Bilal: “I suggest first figuring out what you are passionate about. I feel that if I am doing something I am passionate about, it doesn’t seem like additional work.

Second, set a time on your calendar to work on these things, but also be judicious with yourself. It’s important to know that your career is a marathon and not a sprint, so it’s critical to pace yourself accordingly.”

DR. DUNLEAVY: IN CONCLUSION This past year has been a whirlwind of growth and learning, and as I step into this next chapter, I’m grateful for all the experiences that have shaped me.

After graduation, I’m looking forward to taking some time to celebrate and reflect—starting with a trip to Ireland with my fiancé and family to get married. It’s the perfect opportunity to recharge and appreciate the journey so far.

Throughout my fellowship, there were times when the weight of decision-making and complex patient care felt overwhelming. However, I’ve

come to realize that seeking advice from experienced colleagues is not a weakness, but an important strength.

As I move into my new role, I know I will continue to rely on the support of mentors and peers to help navigate the challenges of being an attending physician.

Working alongside nurses, technicians, and administrative staff has reinforced the importance of multidisciplinary collaboration in providing quality care. Moving forward, I plan to continue nurturing these relationships, understanding that the strength of my team will be integral to my success. I’ve also learned the value of celebrating small victories and focusing on the journey rather than just the end goal. Fellowship has been an intense learning experience, but taking time to reflect on my progress has kept me grounded and motivated.

Dr. Oxentenko’s guidance on mentorship has shaped how I approach my own professional development. I’ve been fortunate to have several key mentors who’ve helped me navigate difficult decisions and served as role models. I’m committed to maintaining these relationships and seeking out new mentors to continue growing in various aspects of my career. As I prepare for this transition, I plan to prioritize my time intentionally, with my core mission at the center of all I do. I am so appreciative to our experts for their guidance and advice, and I will put it to good use as I begin my role as IBD faculty at Massachusetts General Hospital and Harvard Medical School this summer.

CONTRIBUTORS: Amy S. Oxentenko, MD, FACG, Professor of Medicine; Vice Dean of Practice, Mayo Clinic, Mayo Clinic, Rochester, MN; President, American College of Gastroenterology Kathryn E. Hutchins, MD, FACG, Assistant Professor, University of Nebraska Medical Center; Program Director, Gastroenterology and Hepatology Fellowship; Vice Chair, ACG Women in GI Committee Loren G. Rabinowitz, MD, Instructor in Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School Tauseef Ali, MD, FACG, Medical Executive Director, Crohn’s & Colitis Center at SSM Health St. Anthony Digestive Care, Oklahoma City, OK; Member, Board of Directors, ACG Institute for Clinical Research & Education Andrew Moon, MD, MPH, Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, The University of North Carolina at Chapel Hill; Chair, ACG Digital Communications & Publications Committee Mohammad Bilal, MD, FACG, Associate Professor of Medicine, University of Colorado; Associate Program Director, Advanced Endoscopy Fellowship; Director of Third Space and Bariatric Endoscopy; Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Center; Chair, ACG Training Committee Cassandra Sanossian, MD, RD, Northwell Health Gastroenterology Associates at Uniondale; Assistant Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Joshua M. Steinberg, MD, Director of IBD, Gastroenterology of the Rockies; Clinical Instructor of Medicine, University of Colorado School of Medicine Carl Kay, MD, Assistant Professor of Medicine, Carl R. Darnall Army Medical Center, Uniformed Services University of the Health Sciences; Deputy Consultant to the Army Surgeon General for Gastroenterology Sumana Moole, MD, Physician Founder, Merus Gastroenterology & Gut Health, LLC

Cover Story | 25

// PERSPECTIVES

PEARLS FROM THE PANEL 1. Take Time to Recharge & Reconnect Dr. Sumana Moole “Disconnect, reflect, and organize your priorities.

Sign off the beeper, take off the ID badge, and go on a month-long (or longer) sabbatical to help guide you in the right direction. Remember, you’ve climbed the mountain; now take a moment to enjoy the view before scaling the next peak.”

2. Build Your Skills & Advance Your Knowledge – Read, Alert, Repeat Dr. Andrew Moon “An effective strategy I’ve used is keeping my senior colleagues on speed dial. Working in a place with highly knowledgeable and approachable colleagues has always been a huge perk and we continually learn from each other by discussing difficult clinical cases.”

3. Balance Relaxation with GI Boards Studying Dr. Carl Kay • “Relax in June and July. There’s no need to stress about boards right away. Begin structured studying in August with a clear plan.”

• “Use AI tools (e.g., ChatGPT) to organize and customize a study plan tailored to your resources and timeline.”

• Example: Test Date: 11/18/25 • Resources: • ACG Self-Assessment Exams (e.g., 2023, 2024, 2025 editions with 300 questions/exam) • Acing the GI Board Exam Crunch Time (200 questions for General GI; 150 questions for Pancreaticobiliary) • Two DDSEP Plus practice exams (60 questions each) • Study day: X min per day (before/after work) and X days/week • Board study courses: Consider Steinberg, Baylor College of Medicine Annual Board Review, or Mayo Clinic Board Review 4. Set Priorities & Boundaries – Be Intentional Dr. Joshua Steinberg “Creating a priority list of desired goals is extremely helpful, and having a ‘mission statement’ to stay true to will help guide your decision making in the short and long term…If you wouldn’t say ‘yes’ to doing something (such as a research project, article, etc.) if it were to happen tomorrow – don’t say ‘yes’ at all!”

5. Expect to Ask for Help – Confidence Takes Time Dr. Cassandra Sanossian “Knowing it’s OK to ask questions – from your coworkers, former mentors and co-fellows. You won’t know even close to everything and that’s OK. Sometimes seeking guidance from someone who has years of experience is more valuable.”

26 | GI.ORG/ACGMAGAZINE

6. Celebrate the Joy of Patient Care with Self-Reflection Dr. Kathryn Hutchins “To manage both clinical demands and the learning curve of new responsibilities, I focus on prioritizing tasks, delegating when possible, and setting aside dedicated time for learning. Breaking down new skills into manageable steps, seeking mentorship, and using available resources like training programs or clinical support tools can enhance efficiency. Regular feedback and self-reflection are key to preventing burnout. Focusing on small, achievable goals and celebrating progress helps keep motivation high while balancing clinical duties with continued professional development.”

7. Delegate and Rely on Your Team Dr. Tauseef Ali • “The Learning Curve is Real: Fellowship gives you a solid foundation, but real-world practice throws curveballs—stay humble and keep learning!

• Teamwork Makes the Dream Work: Your nurses, techs, and admin? They’re your MVPs—build those relationships!

• Talk the Talk: Patients remember how you make them feel.

Master the art of clear, compassionate communication—it’s as crucial as your technical skills.

• Give Yourself Grace. You won’t have it all figured out on day one. Mistakes are part of the journey—embrace the process!”

8. Embrace the Steep Learning Curve Dr. Loren Rabinowitz “The learning curve (clinically and procedurally) is very steep during the first year. This is especially true if you find yourself in a new practice setting.

Be kind to everyone you meet – techs, RNs, admins, fellows, colleagues, and patients. They will be vital in helping you navigate a new environment.”

9. Dedicate Time to Build Connections and Nurture Existing Mentorship Dr. Amy Oxentenko “You need to dedicate the time to establish a strong network of colleagues. Mentorship can start with an invite for someone to join you for coffee and see if your interests align. Friendships and mentorship are like plants – they need to be tended to with some regularity in order to grow and flourish…Mentorships are relationships that develop over time, and you can have a number of different mentors to help guide in different aspects of your career and life.”

10. Face Challenges with Courage and Support Dr. Mohammad Bilal “I think the biggest challenge was the need for validation. It’s important to remember we are not alone and being vulnerable, too, is a strength.”

Resources: Bilal M, Steinberg JM, Louissaint J, Phan J. First Year on the Job as a Gastroenterologist and Hepatologist: Lessons Learned. Gastroenterology.

2024 Apr;166(4):553-556. doi: 10.1053/j.gastro.2024.01.038. Epub 2024 Feb 1.

PMID: 38309632.

Culinary Connections Meets at ACG 2024 Editors Vani Paleti, MD; Alexander Perelman, DO & Christina Tennyson, MD

AFTER COLLABORATING ONLINE FOR YEARS, the #ACGfoodies team finally met in person at ACG 2024 in Philadelphia!

The group consists of GI physicians, fellows, registered dietitians, and GI psychologists who have shared their culinary journeys and plant-forward recipes online and in the pages of ACG MAGAZINE. The group is passionate about the intersection of food, gut health, and education to improve the health of not only our patients, but ourselves.

We gathered during the opening Welcome Reception in the ACG 2024 Exhibit Hall to celebrate and publicize three completed volumes of Culinary Connection e-books with recipes from members. (For the latest volume, please see bit.ly/acg-foodies-3).

We also were excited to support the ACG “Gut Master” apron sale with proceeds benefiting Share Food Program, a local Philadelphia non-profit whose mission is eradicating food insecurity among children, families, and seniors in the region (www.sharefoodprogram.org).

Following this event, we hosted an evening hands-on culinary workshop experience at Old City Kitchen, a commercial kitchen and venue in Philadelphia’s historic Old City neighborhood. Our practices have hosted culinary medicine workshops at our individual institutions, and we had an amazing time gathering to cook and eat together.

ACG Perspectives | 27

// PERSPECTIVES

ABOUT CULINARY MEDICINE

Culinary medicine is an evidencebased field blending nutrition science with culinary arts to help individuals access and cook delicious food to both maintain and improve health. Culinary medicine programs help bridge the gap from offering dietary recommendations to helping individuals implement changes. Programs teach meal planning, shopping, budgeting, and cooking. These programs help build confidence in the kitchen, focus on the enjoyment of food, and help educate on practical aspects of nutrition.

HEALTHY COOKING AND TIME WITH #ACGFOODIES FRIENDS

Our cooking class at ACG 2024 focused on Mediterranean-inspired recipes and our crew prepared a full meal under the direction of Chef Mike McKinley. Chef Mike has spent time in Ikaria, a Greek island known for having residents with significantly long life spans and popularly described by author Dan Buettner in his book Blue Zones. Chef Mike instructed us on meal prep and knife skills, and we explored new ingredients and cooking techniques.

We discussed the benefits of fiber, plant diversity, and savored our meal, as well as each other’s company – #ACGfoodies done the right way!

We share our Mediterranean-inspired salad from Chef Mike’s culinary medicine cooking class, as well as a recipe from another dish we prepared, polenta and soufiko, a vegetable stew.

We aspire to host additional classes at future ACG meetings. Please contact us if you are interested at acgmag@gi.org.

28 | GI.ORG/ACGMAGAZINE

IKARIAN HEALTH SALA

D

 Ingredients: • 1.5 lbs. sweet po tatoes, washed and scrubbed • Salt and pepper • 1 red onion, thinl y sliced • 8 oz. baby arug ula • ½ cup extra virgin olive oil • 3 Tbsp red wine vinegar • Optional: 1 cup crumbled feta or goat’s milk chee se

POL

UFIKO ENTA WITH SO

 Steps: 1. Place the clean ed sweet potatoes in a large pot of sa lted water.

2. Bring to a boil, then reduce to a simmer for 15 mi nutes. The potatoes should be fork-tender.

3. When cooled, peel and dice into ½-inch pieces.

4. Thinly slice the red onion.

5. Toss potatoes with olive oil, vinegar, salt, and pepper, to taste.

6. Mix in the onion s.

7. Toss arugula in olive oil and salt.

8. Layer the salad : arugula first, then onion/potato mix.

9. Garnish with ch eese, if using.

gredients:

 Soufiko In ed gplant, peel s: nt ie d 1 medium eg re • g In a nt le  Po n, peeled • 1 large onio nta • 1 cup pole cchini zu k table stoc • 1 medium • 2 cups vege llow squash ye m • 1 mediu oil a virgin olive • ~1 cup extr drizzle to r, s: ga ep ne St  balsamic vi ock to just g st Fi ata e • bl ta ge egano; Kalam 1. Warm ve . ional: fresh or pt an O ep • uc sa a se boiling in goat chee add salt and olives, feta or ir in polenta, 2. Slowly st ste. pepper to ta minutes.  Steps: ly for 14 to 16 nt -inch pieces ta 3. Stir cons ggies into ½ ve l ns al ai e gr ic n D 5. done whe parate.

4. Polenta is and keep se Add water if y. ff allow flu d an lant with salt; are soft gp eg e . th is t th us e D 6. achiev ur. necessary to least one ho to rest for at e with bl ta ge type of ve 7. Toss each . at co to olive oil extra virgin e in a bl ta ge type of ve ch ea ar Se 8. es. n for 5 minut non-stick pa rately pa se e veggies 9. Cook all th bine m co ill e; you w and set asid g. during platin

dients: assata Ingre

 Tomato P tomatoes • 1 cup plum ine • 1 cup red w o paste at • ¼ cup tom er, to taste pp • Salt and pe

 Step: s and all ingredient 10. Combine ickened. th ly slight simmer until  Plating: nta on your base of pole 11. Spread a plate. ssata. a layer of pa 12. Top with each of s amount 13. Add even vegetable. se, olives, or goat chee 14. Add feta sired. egano, if de and fresh or vinegar. ic am ls ith fig ba 15. Drizzle w

ACG Perspectives | 29

UNLOCK YOUR GI EXPERTISE with the

APP GI TRAINING SERIES MODULES!

Elevate your understanding and mastery of gastroenterology with our comprehensive GI Training Series for APPs. Whether you’re a healthcare professional looking to expand your knowledge or deepen your skills, our 13 expertly crafted modules cover the full spectrum of gastrointestinal care.

New Additions: • Advanced IBD • Advanced Hepatology Comprehensive Core Modules Include: • Functional GI Disorders • In-Patient GI Care • Hepatology • Mixed Subject Area • Small Bowel Disorders • Stomach Disorders

Get started today and take your GI knowledge to the next level with the GI TRAINING SERIES MODULES!

• Pancreaticobiliary Conditions • Esophageal Diseases • GI Bleeding • The Basics of IBD • Colon Disorders



Unrestricted Sponsorship Support from Ironwood Pharmaceuticals, Inc.

30 | GI.ORG/ACGMAGAZINE

Jill K.J. Gaidos, MD, FACG in Conversation with Rosemarie L. Fisher, MD, FACG

Conversations with Women in GI

Dr. Jill Gaidos talks with Dr. Rosemarie Fisher, the first woman on the ACG Board of Trustees (1988-1992), about her career in medical education and establishing a niche in GI Nutrition. Dr. Fisher is Professor Emerita of Medicine, Yale School of Medicine.

JG: When I think about your career, I think about two major areas of focus: your career in education and your career in GI nutrition. How did you get into nutrition and nutritional support as part of your career?

RF: I got into nutritional support, interestingly enough, because at Yale the only promotion track at that time was the tenure track, which was basically bench research. Bob Donaldson was my Medicine Department Chair at the VA, (former Editor of Gastroenterology and former President of the AGA) where I was GI section chief. Because I had done research on alpha-1-antitrypsin during the year I spent with Sheila Sherlock, Bob suggested that I look at the effect of alcohol on glycoprotein synthesis by the

liver. So, I was decapitating rats and infusing alcohol into portal veins, while being Chief of GI at the VA, teaching fellows, seeing consults, and doing procedures. He and I and Howard Spiro (who was then Section Chief at Yale) realized (not to my surprise) that bench research was not to my liking or where my strengths were.

Yale, by chance, had just instituted a Clinical Scholar Track for promotion and that’s where I would focus and develop a niche. Yale-New Haven had just formed a nutritional support team, a TPN/enteral support team, but without a gastroenterologist. I was following a lot of IBD patients who were on home TPN, so Bob and Howard said, “I think this is where you should go.” So, I became the GI physician member and head of the TPN team at the time. We had a surgeon, a part-time endocrinologist, a nurse practitioner, and a pharmacist on the team. Bob Donaldson also said, “we need to get your name out there in different groups.” He said, “I want you to get on the Training Committee

and I want you to give a ‘Meet the Professors’ luncheon on nutrition” and the education part came with that. He was also Editor-in-Chief of Current Opinions in Gastroenterology, so he appointed me to become the Section editor on nutrition for the journal. I was really getting interested in nutrition support, not in nutrition as dietary modification, but more looking at nutrition in disease processes. It was a quarterly journal, and I could pick topics and authors, and the journal would pay for secretarial support. We didn’t have that support from the GI section at that time or from the VA. About six months into it, he said, “How much are they paying you?” and I said, “$200” and he said, “That’s not enough. Tell them after this year you are not going to do this anymore and one year on your CV is enough.” So, that was it. Support, networking, and connections meant everything at that stage of my career.

At the same time, I had been active in the ACG. Larry Brandt, Arvey Rogers, and Jamie Barkin had started pushing me to do more things with the ACG. Being more clinical, I felt very welcome in the ACG. I had trained at Montefiore-Einstein for residency right when Larry Brandt came and I got to know him more. As I became more involved, Larry said, “We want to nominate you to become a Trustee.”

Every time someone asked if I would do something, it seemed to involve nutrition support: give a grand rounds lecture, comment on a paper, write an editorial, etc. That is how my niche in GI became nutrition. Marty Floch took over the Red Journal for the ACG and asked me to be an associate editor, so that helped as well.

JG: So, how did you get involved in medical education?

RF: The plan was for me to go from being the chief of GI at the VA and to go back to Yale to oversee the nutrition support team and GI clinical services (although I left ERCP to others). I had always been involved in the fellowship teaching and was always worried about the wellness of fellows and residents.

There were several incidents where the Chief Residents had to deal with ACG Perspectives | 31

// PERSPECTIVES

serious wellness issues and there was no program director at the time. The Chair of Medicine ran the program with the Chiefs. We were one of the few programs in the country that did not have a program director. At this point, I had just been appointed as Chair of the internship selection committee and a new chair of medicine was just appointed. I told the new chair that he needed to have a program director for internal medicine, and I wanted to do that job. So, that started the educational and administrative roles. I did get promoted.

But nutritional support didn’t have anyone overseeing it and there wasn’t really anyone who knew how to manage it, so I kept on doing that.

JG: I feel like nutritional support is such a small part of GI training and few of us do it regularly in practice.

How do we get more training and more interest in nutritional training?

RF: I believe we have to have more down-to-earth case presentations.

I have two fellows in clinic with me and we have about six patients on home TPN and they are starting to see some of the lab abnormalities and complications that can arise. These two are getting it because they see the patients, we review the formula prescriptions, we review the laboratory data and review the possible complications. I have also started to compile some articles for them. I think that if we made some of the modules from American Society for Parenteral and Enteral Nutrition (ASPEN) available to the fellows and faculty, it would be helpful. There is just so much to learn that it is difficult to add much more to the present curriculum.

JG: And find more time to complete the additional training! How has medical education changed over the years? I’m sure you have seen several reiterations of medical education but what has been successful and what has not worked as well?

RF: Nobody had any idea about developing a curriculum when I was in fellowship. Being the program director for medicine, we decided that the subspecialties needed to develop a curriculum of what a general internist needed to know from their subspecialty.

The problem is that if you didn’t have someone evaluating those topics or how people are learning those topics, people were getting nowhere. We got a little too much into the grass as opposed to looking at the trees. We got too minutiae driven. I was amazed when I went to my first Accreditation Council for Graduate Medical Education (ACGME) visit as program director, what the ACGME was looking at. They reviewed the program and all the subspecialty programs all together and the program director for medicine was responsible for all the other subspecialties. The first time we encountered them in a site visit, they had a little booklet that was like 10 pages of requirements and that was it, but the residents had to fill out a 250-question survey that the program was judged on, and the answers depended on how the residents felt that day. That started my involvement in looking at what both core internal medicine and subspecialty training programs were to be responsible for training their trainees. At that time, both the accrediting bodies for programs [ACGME and their residency review committees (RRCs)] and the certifying bodies for individuals (i.e., American Board of Internal Medicine) looked at the details, but didn’t look at overall competency.

Looking at competency now and how

“I believe you have to do what you feel you need to do to get your work done, and to show your patients that you are responsible for them, and make sure that there is humanism in medicine.”

32 | GI.ORG/ACGMAGAZINE

programs are training their residents/ fellows to be competent is where we stand. This has been the biggest change in education. We, as of yet, in my opinion, do not have the final way to really judge the competency of our trainees. We need to incorporate more faculty development into programs so faculty can be better judges of the competency of their trainees.

JG: How do you think work hour restrictions have impacted training?

RF: The Medicine RRC actually had work hour restrictions before the ACGME implemented them for all of the training programs. We always had 80-hour work limitations, one day off a week averaged over four weeks. I was actually on the first RRC committee that wrote those initial work hour restrictions affecting all of the programs. While I believe everyone meant well, I don’t believe there was enough back up support for people to have those work hour restrictions and get rid of the scut work they were doing. The problem I saw was that people were doing the same amount of work with less time and that the residents thought they were supposed to do less work overall so there was a conflict there. Trainees’ attention to what was happening to patients started to go way down. I may not know the latest LA Grade scale for esophagitis, but I have patients that I have been seeing for 40 years and I am teaching trainees how to talk to patients and build relationships that last and attain knowledge about the patients which shows that you are responsible for them. It still amazes me when a woman comes in with constipation and no one has asked if she has had any children and had any complications. I just think that sometimes it’s a matter of “how soon can I get out of here?” and not a dedication to the patient. I’m pleased to say that it hasn’t been as common as it could be. We haven’t done enough though to get rid of the secretarial duties. We (faculty) don’t get enough administrative support, much less the fellows getting administrative support. Looking at the institution of milestones and board

pass rates, only ABIM certification scores showed a difference in clinical outcomes. I think this was just published in JAMA a couple of weeks ago (Gray BM, Vandergrift JL, Stevens JP et al. Associations of Internal Medicine Residency Milestone Ratings and Certification Examination Scores with patient Outcomes. JAMA 2024;332(4):300-309). I believe in duty hours but put the onus on the trainee to get out of there. They need to do things like go to the dentist.

They have things to do. It’s the good old times that were bad, but we didn’t realize it. The one thing that we need to get out of this is to make the trainees feel more responsible for and to their patients.

JG: There is a little bit of a learning curve because once they are out of fellowship, they will no longer have these duty hour restrictions. Now is the time for the fellows to learn how to manage their clinical duties, notes, and in-basket messages during work hours so they learn how to avoid taking as much work home to work on after hours.

RF: I tell them, “I’m not the example to follow.”

JG (laughing): Right!

RF: It was interesting even when I became the program director. I had four women in each class of trainees and one of them came up to me and said, “You know you are not a good role model for women in medicine.”

I said, “Why?” “You work too hard.”

OK, you have to do what you are comfortable doing. To me, it doesn’t look like I’m working too hard because I haven’t stopped it. I believe you have to do what you feel you need to do to get your work done, and to show your patients that you are responsible for them, and make sure that there is humanism in medicine. I enjoy really spending that time talking to my patients about their lives, before the administrative/secretarial work. I just finished charts from a week and a half ago! Oops – I shouldn’t have said that!

JG: You were also the Director of Resident/ Fellow Wellbeing. How did that position come about?

RF: When I stepped down from being the Associate Dean of GME, I, with Steve Huot established the position of Director of Wellness and Resident/Fellow Wellbeing along with continuing my position as one of the Deputy Title IX coordinators for the Medical School. My GME involvement included being an advisor to the resident and fellows’ senate. I also started a peer support group called “Call a Friend” which included trainees who received training to be active listeners and had access to resources for mental health needs. We developed a whole network of therapists who will see trainees for mental health concerns. We got the hospital to agree that the needs of residents and fellows are different from the needs of hospital staff. They needed extra help at times.

Paul Desan, a consultation psychiatrist and Program Director of the consult liaison psychiatry fellowship, and I had gone to the hospital and got them to agree to set up a system either through the “Call a Friend” program or directly through me or Paul to get access to mental health practitioners which would be billed to the hospital, not through insurance, and no records would be included in Epic.

That has continued and I’m just now in the phase of turning it over to someone else. We also created a Resident/Fellow Appreciation Week.

Resilience recently, however, has gotten a bad reputation because people think it means you need to just toughen up and tolerate bad things. But it’s not that. Medicine is a 24/7 job, and it can be depressing at times but you have got to learn how to deal with those times.

Resilience is about learning how to change some of the things you can change in yourself to help deal with these difficult times.

JG: When you were on the Board of Trustees, what was a current focus of ACG and what were some of the issues you had to face?

RF: Some of it was improving fellowships to include more clinical research and less basic science research-oriented training.

I remember when I came to interview for

fellowship with Howard Spiro and Henry Binder was a junior attending.

Henry said to me, “What do you mean by clinical research?” “Patientoriented research.” We started to talk more about that on the Board.

We also started to talk more about involvement with the FDA, looking at new drug development and the problems with some of the drugs.

That lead to my position on the FDA GI Drugs Advisory Committee and then I become chair of the GI Drugs Advisory Committee. We (the ACG) also had a committee that wrote articles for the Red Journal that was an FDA-associated committee that put together articles on drug development for different types of therapies for different disease states. So, the ACG really looked at that in depth and built those relationships. Since we had so many people in practice, the Board started looking at what was happening to people in practice – their wellness and their practices. We were also working on getting more women involved in the ACG and getting more fellows involved in research posters and presentations. ACG did have a training and education committee.

They focused on things that were more clinically relevant. We saw ACG as being total gastroenterology and hepatology, not separate from each other. The big thing was getting people involved and keeping them involved once they were in practice.

JG: That is still one of our goals!

Dr. Gaidos is a Trustee of the College and Associate Professor at the Yale School of Medicine Section of Digestive Diseases and Director of Clinical Research for the Yale IBD Program. .

Dr. Fisher is Professor Emerita of Medicine at Yale School of Medicine.

She was the first woman on the ACG Board of Trustees, serving from 1988 to 1992.

ACG Perspectives | 33

JUNE 6-N8M,AR2RI0OT2T5AT METRO CENTER WASHINGTO WASHINGTON, DC

2ACG0'S 2END5OSCOPY

N R E T S A E & L SCHOO DUATE COURSE REGIONAL POSTGRA OPY ACG’S ENDOSC EARN UP TO

8

ME C CREDITS

EARN UP TO

SCHOOL

8

OC M POINTS

EARN UP TO

URSE

UATE CO AL POSTGRAD

ON EASTERN REGI

12 CME

CREDITS

EARN UP TO

12 MOC POINTS

Register for

EASTERN REGIONAL POSTGRADUATE COURSE & ENDOSCOPY SCHOOL 34 | GI.ORG/ACGMAGAZINE

SCAN THE QR CODE TO REGISTER!

ACG SUMMER SCHOLARS:

SHAPING THE FUTURE OF GASTROENTEROLOGY THROUGH DIVERSITY, EQUITY AND INCLUSION

Editor: Chioma Owo, MSc; Contributors: Chioma Owo, MSc; Alexandra Goad; Christopher Vélez, MD; Eric D. Shah, MD, MBA, FACG; Marquise Soto; Somaya Albhaisi, MBBCh, MPH; Lavanya Viswanathan, MD, MS, FACG

INTRODUCTION Despite remarkable advancements in patient care and research, the field of gastroenterology faces a persistent challenge: a lack of diversity in the workforce. In 2022, women made up just 20.5% of the field, while Black and Hispanic physicians accounted for only 3.9% and 5.9%, respectively. Meanwhile, Asian and White physicians dominated at 26.8% and 49.0%.[1] These disparities are more than statistics—they reflect systemic barriers that limit who can enter the field and whose voices shape its future. While corrective efforts are under increasing partisan scrutiny, data in other fields suggests improved outcomes when clinicians caring for patients match their communities. We need a workforce which reflects the demographics of our patient population.[2] Without greater diversity, the profession risks falling short of meeting the needs of an increasingly diverse patient population. Addressing these gaps is not just an ethical imperative; it’s essential for innovation, equity, and

empowering the next generation of leaders in gastroenterology.

Recognizing this need, the American College of Gastroenterology (ACG) has taken significant steps to cultivate a diverse pipeline of future leaders. A strong example of this commitment is the ACG Summer Scholars Program which provides medical students from groups underrepresented in medicine with immersive research experiences in gastroenterology and hepatology. Under the visionary leadership of Sophie M. Balzora, MD, FACG, and Somaya Albhaisi, MBBCh, MPH, this program has become a beacon of opportunity, empowering mentees and inspiring mentors alike.

Dr. Somaya Albhaisi eloquently captures the program’s impact: “The ACG Summer Scholars program is a game-changer for both its participants and the field of gastroenterology. It offers unparalleled opportunities for student scholars to engage in cutting-edge research, fostering a deeper understanding and passion for the field.

This experience not only enhances their academic and professional growth but also inspires a lifelong commitment to advancing the field. On a broader scale, the program is nurturing the next generation of leaders and innovators who will drive progress in healthcare and science. Additionally, it plays a crucial role in promoting diversity within the field, ensuring a wide range of perspectives and ideas that fuel innovation and improve patient care.

The ripple effect of this program is palpable throughout the medical community, as these scholars bring fresh perspectives, new ideas, and novel solutions to tackle the challenges faced in gastroenterology.”

She further emphasizes the collective effort behind the program’s success, stating, “The ACG Summer Scholars program owes its success to the dedication of the DEI Committee, mentors, and student scholars, whose collective efforts foster an inclusive and enriching environment.

Their hard work and collaboration are

ACG Perspectives | 35

// PERSPECTIVES

key to driving the program forward and advancing the field of gastroenterology.”

Through intensive mentorship, handson research opportunities, and a focus on diversity, the ACG Summer Scholars Program is shaping the next generation of gastroenterologists while bridging equity gaps in medicine.

Origins and Goals of the ACG Summer Scholars Program The Summer Scholars Program found its beginnings following a 2009 report showing that underrepresented racial and ethnic minorities (URM) combined made up less than 20% of the gastroenterology trainee population.[3] More recently, in 2021, a survey of GI workforce demographics led by Folasade P. May, MD, PhD, MPhil, examined racial and ethnic representation in gastroenterology and hepatology to identify workforce disparities. The investigators’ aims included informing interventions to address the representation of URM groups and establishing priorities toward improving health equity.[4] Sponsored jointly by the GI professional societies (AASLD, ACG, AGA, ASGE, and NASPGHAN), the survey found significant underrepresentation of Black and Hispanic physicians and identified systemic barriers, including limited mentorship, financial constraints, and fewer research opportunities for URM trainees.

To address these gaps, the most frequently recommended interventions suggested by survey participants included expanding mentorship for URM residents and medical students and increasing representation of URM gastroenterologists and hepatologists in leadership roles – emphasizing mentorship and visibility as critical to shaping career trajectories.

Recognizing similar barriers, Johns Hopkins University successfully implemented a summer scholars’ program aimed at increasing URM exposure to geriatrics, gerontology, and academic research.[5] The program introduced URM students to these fields, with the long-term goal of increasing minority representation in academic medicine. By the program’s

36 | GI.ORG/ACGMAGAZINE

conclusion, 66% of participants expressed an interest in geriatrics and academic medicine, highlighting the program’s impact.

Inspired by this model, ACG’s Diversity, Equity, and Inclusion Committee established the ACG Summer Scholars Program to provide structured mentorship and research opportunities for students from diverse backgrounds, with a focus on gastroenterology. The program offers medical students from traditionally underrepresented academic medicine communities the opportunity to conduct research over eight to ten weeks.

In a typical year, three participants are selected and paired with a gastroenterologist who is equally passionate about fostering diversity and innovative research in their field. Mentors guide, educate, and shape the potential of each student to allow them a chance to experience research at a worldrenowned institution. Through instruction on projects, shadowing in clinical settings, and providing opportunities to learn and network, mentor-mentee relationships often extend far beyond the summer. Participants are expected to produce an abstract or progress report by the program’s conclusion and present their work at a local, regional, or national conference. Ultimately, the program cultivates a lasting interest in gastroenterology and academic medicine among a diverse group of passionate young professionals.

MENTEE-MENTOR SPOTLIGHTS: PERSPECTIVES FROM ACG’S 2024 SUMMER SCHOLARS & MENTORS The 2024 ACG Summer Scholars and their mentors share experiences from their respective program sites and reflect on the impact of the program, the research and clinical opportunities pursued, and the relationships built along the way.

Alexandra Goad, MS2, University of Louisville School of Medicine Mentor: Christopher D. Vélez, MD Program Site: Massachusetts General Hospital My passion for gastroenterology stems from personal health battles. My goal has always been to help those who struggle in similar ways, so it was a dream come true being able to spend the summer learning from some of the world’s leading motility experts

at Massachusetts General Hospital.

Not only was I able to collaborate on various research projects, but I also was able to learn about the clinical side of neurogastroenterology.

The summer’s learning curve was very steep, but being immersed in a protected and nurturing environment where I was pushed to adapt and perform was invaluable. Opportunities such as developing, writing, refining, and even presenting an original research idea to the department’s physicians allowed me to push my limits and grow exponentially.

Healthcare needs passionate people who will champion a cause in order to move healthcare forward for all people. The ACG Summer Scholars program fosters young professionals’ interest in GI research while also expanding diversity in the field. The physicians who are chosen to mentor this program are passionate about GI healthcare, education, and inclusion.

The professional relationships that I have formed through this program will stay with me throughout the rest of my education and career.

Christopher Vélez, MD I have been enormously privileged to be a member of two separate career development programs of the American College of Gastroenterology, the Early Career Leadership Program and the Clinical Research Leadership Program.

During activities related to these programs, there has been mention of “the pipeline,” with our clinical and research workforce not looking as diverse as the rest of the country.

The Summer Scholars Program is the flagship attempt by the College to remedy this circumstance, and I had the privilege to work with Alexandra Goad in 2024 through this mechanism. Through generous ACG sponsorship, Alex was able to spend time pursuing research in sexual and gender minority-based health with me in Massachusetts. She also worked with me in my bilingual Spanish/ English general gastroenterology clinic (one that Mass General Brigham has supported to improve access for historically marginalized predominantly

Latino communities). After she returned to Kentucky, we have continued to collaborate in ways that I hope will prove formative to her career. As it seems that diversity-related initiatives will be facing unprecedented challenges at the federal level for the foreseeable future, it is important that organizations like ACG continue these efforts, for the future of our profession.

Chioma Owo, MS4, Long School of Medicine, UT Health San Antonio Mentor: Lavanya Viswanathan, MD, MS, FACG Program Site: MD Anderson Cancer Center As an ACG Summer Scholar at MD Anderson Cancer Center, I had the opportunity to delve into the scope of gastrointestinal motility disorders under the mentorship of Dr. Viswanathan. My research focus combined equity and innovation, consisting of a study on microaggressions in gastroenterology and an exploration of anorectal manometry’s diagnostic applications for motility disorders. These experiences enhanced my research skills and offered me a deeper appreciation for the complexity and potential of this subspecialty.

The clinical component of the program was equally transformative.

Observing advanced endoscopic procedures such as colonoscopies and upper endoscopies allowed me to connect theoretical knowledge to practical application. Shadowing in motility clinics and inpatient consults exposed me to the nuances of managing complex gastrointestinal conditions in both outpatient and hospital settings.

Further, I had the opportunity to attend the AGA Women in GI Southwest Regional Workshop, TSGE 2024, and the ACG Annual Scientific Meeting, which allowed me to network with experts, explore advancements in GI care, and engage with emerging research. These experiences enriched my understanding of gastroenterology and reinforced my fascination with its diagnostic and therapeutic capabilities, especially within academic medicine.

Through this program, I have grown both personally and professionally, gaining a clearer vision of my future in academic gastroenterology. I am committed to addressing healthcare disparities, advancing research, and mentoring underrepresented students in medicine. The ACG Summer Scholars Program has been a pivotal step in my journey, equipping me with the tools and inspiration to contribute meaningfully to the field.

Lavanya Viswanathan, MD, MS, FACG This experience came at a unique time in my career, as I was transitioning from the end of my military medical career to my current position at MD Anderson. As I was learning the ropes of a new institution, it was interesting to see it through the eyes of a medical student.

Chioma was genuinely interested in my work on microaggressions in medicine and took the initiative to build on that by surveying various groups to see whether interventions such as career workshops are helpful in raising awareness and equipping professionals with the tools to better cope with microaggressive behaviors when they arise.

Microaggressions disproportionately affect women and underrepresented minorities, which dovetailed brilliantly with Chioma’s interest in healthcare disparities. This is an evergreen issue which is relevant to medical students, trainees, and attendings alike.

Fortunately, our younger trainees are more aware of these issues than most and feel it is a part of career development and overall well-being. I sincerely hope that our work will be the basis of future curriculum in medical and professional training so that we can empower physicians to feel more supported in our field.

On a personal level, it was a joy to introduce Chioma to the world of gastroenterology and motility and I’m even more convinced of my charge to inspire the next generation of gastroenterologists. The act of mentorship is self-renewing, as I feel I always receive more than I give. I encourage others to take advantage of this opportunity to see their profession through fresh eyes and renew their own passion in the field by taking part in the ACG Summer Scholars Program.

Marquise Soto, MS4, Renaissance School of Medicine at Stony Brook University Mentor: Eric D. Shah, MD, MBA, FACG Program Site: University of Michigan This experience was transformative for me. Prior to the ACG Summer Scholars Program, I had limited research experience and did not feel comfortable with the research process. Dr. Shah invited me to participate in a course at the University of Michigan entitled fastPACE: Fast Forwarding Medical Innovation, where I learned about the commercialization of research projects in gastroenterology. Dr. Shah and I submitted an overview of this course as an abstract to the ACG Annual Scientific Meeting last year and received a Presidential Poster Award. This was a huge milestone for me as it was the first abstract I’ve ever submitted/presented at a conference! We then collaborated on two systematic review projects that we submitted to another GI conference.

The undertaking of this work was yet another milestone event for me because I’d never done a systematic review. I learned critical skills such as how to refine a literature search to increase the pool of papers, how to distill this large pool into a subset of relevant literature, then how to synthesize the information from these sources and draw conclusions, and how to present that information in a digestible way. These are skills I wouldn’t have developed until well into residency had it not been for the ACG Summer Scholars program and Dr. Shah’s mentorship.

The “competitiveness” of GI is one of the barriers to increasing diversity in the field and participation in research is a key component for residents who successfully match into GI. Identifying a research mentor and getting engaged in research can be a challenging experience and is often even more challenging for students that are underrepresented in medicine, who lack the needed connections. The ACG Summer Scholars Program leveled the playing field for me by connecting me to an amazing mentor and teaching me the research process. As the first person to pursue medicine in my family, access to mentors has been the foundation to the

ACG Perspectives | 37

success I’ve had throughout my journey.

I’m grateful for the mentorship this program afforded me.

Eric D. Shah, MD, MBA, FACG Across medicine, much of career success and advancement relies on access to creating one’s professional network to find a fulfilling career path for long-lasting professional satisfaction.

The College addresses this need with the ACG Summer Scholars Program, which provides critical resources and access to mentorship opportunities that might not otherwise be available.

Marquise dived into the world of medical technology development that is so key to gastroenterology. He took total ownership of his projects, expanded his network, and is on track to publish at least two manuscripts arising from his work. Through the ACG Summer Scholars Program, I have been fortunate to meet Marquise who has truly leveraged the opportunities that I connected him with as he creates his own vision for his independent future medical career.

ALUMNI IMPACT The ACG Summer Scholars Program boasts a growing list of alumni making significant contributions to gastroenterology. Past participants have pursued fellowships, published impactful research, and taken leadership roles in academic medicine. Their stories highlight the program’s transformative role in advancing diversity and innovation in the field.

Daniel Huynh, MS4, at the Renaissance School of Medicine at Stony Brook University, reflected on his journey: Throughout my medical training, advisors have often told me that mentorship is available at every institution. However, no one warned me that finding a mentor willing to invest in my professional development in gastroenterology and hepatology would be extremely difficult.

My family, life, and previous research experiences have instilled the momentum

38 | GI.ORG/ACGMAGAZINE

to be part of the ACG Summer Scholars Program, I was amazed and grateful at how much of an impact this program had on me. I was paired with Dr. Vélez at MGH where I helped conduct a qualitative study investigating barriers to transition of care in pediatric patients.

Down the line, I was able to attend national conferences such as DDW, ACG, and AASLD, where I continued to make new friendships and find additional meaningful mentorship.

The ACG Summer Scholars Program isn’t just a research program. It is a network where I’ve found friends and mentorships who not only guided me to the path of gastroenterology and hepatology but also supported and uplifted me in how I identified and expressed myself. This program has truly had a positive influence on my professional development.

in me to pursue this field. However, I lacked the mentorship to know where to begin.

As someone who identifies as LGBTQ+, I often wondered how that would impact my opportunities. When I had the opportunity

Sponsorship and Support The ACG Summer Scholars Program thrives thanks to the generous support of its sponsors. Generous sponsorship for initiatives such as the annual #DiversityInGI Virtual 5K and Fun Runs at the ACG Annual Scientific Meeting directly fund scholarships

ACG Summer Scholars Participants Year in ACG Program

Name (First Last)

Medical School

Aiya Aboubakr, MD

Icahn School of Medicine at Mount Sinai

2018

Cladimar Vasquez, MD

CUNY School of Medicine

2018

Carey L. Ford Jr., MS, MD

LSU Health Shreveport

2019

Nicolette Veracruz, MD

Central Michigan University College of Medicine

2021

Darius Whitmore-Carter, MD

Morehouse School of Medicine

2021

Joseph Nwokedi Chibueze

Lewis Katz School of Medicine at Temple University

2022

Marie-Lise Chrysostome, MS

Drexel University College of Medicine

2022

Daniel Huynh

Renaissance School of Medicine at Stony Brook University

2022

Bethlehem Simon Michael

UCLA David Geffen School of Medicine

2023

Cynthia Okafor

UTMB John Sealy School of Medicine

2023

Elias Arellano Villanueva

UTRGV School of Medicine

2023

Alexandra Goad

University of Louisville School of Medicine

2024

Chioma Owo

UTHSCSA Long School of Medicine

2024

Marquise Soto

Renaissance School of Medicine at Stony Brook University

2024

How to Get Involved in the ACG Summer Scholars Program The ACG Summer Scholars Program is open to first- through fourth-year medical students with a passion for gastroenterology and a commitment to advancing diversity in medicine.

Eligible applicants must be enrolled in an accredited allopathic or osteopathic medical school, in good academic standing, and from a racial or ethnic group historically underrepresented in medicine: Black or African American, Mexican-American, Native American (American Indian, Alaska Native, and Native Hawaiian), or mainland Puerto Rican.

Tips for a Strong Application 1. Craft a Compelling Personal Narrative: Write two short essays that reflect your career goals and reasons for participating in the program. Share your passion for gastroenterology, your dedication to health equity, and how the program aligns with your aspirations. Highlight experiences that showcase resilience, leadership, and innovation.

2. Secure Strong Recommendations: Request letters from mentors or professors who can attest to your potential, work ethic, and commitment to advancing diversity in medicine.

3. Showcase Your Unique Perspective: The selection process values applicants who demonstrate leadership, alignment with the program’s mission, and a clear vision for contributing to the field.

For Mentors: Faculty members interested in mentoring participants must be ACG members and submit their CV, a brief description of potential projects, and their interest in the program. Mentors need not belong to an underrepresented minority group, but those who do are strongly encouraged to apply.

Timing: The application process typically opens in late fall, with selections announced in February.

and mentorship opportunities, fostering a shared vision of a more inclusive future in gastroenterology.

Organizations and individuals can contribute by sponsoring scholars, donating to the ACG Institute G.U.T. Fund, or partnering on outreach initiatives. Every contribution helps shape the next generation of GI leaders and supports the program’s mission to advance equity in medicine.

CONCLUSION The ACG Summer Scholars Program is more than an internship — it is a driving force for change in gastroenterology. By promoting diversity and inclusion, the program inspires trainees with an interest in issues affecting URMs to pursue a career in gastroenterology.

This not only broadens the demographics of our specialty but also ensures that patients receive care from physicians who reflect and understand their communities.

As the program expands, its influence grows, transforming the lives of mentees, mentors, and the GI community. Whether you’re a prospective scholar, a mentor, or an advocate for diversity in medicine, you are invited to join this vital mission. Together, we can shape a future for gastroenterology that is innovative, inclusive, and representative of the diverse patients it serves.

REFERENCES 1. American Association of Medical Colleges, U.S. Physician Workforce Data Dashboard, aamc.org/data-reports/ report/us-physician-workforce-data-dashboard accessed January 30, 2025.

2. Peek ME. Increasing Representation of Black Primary Care Physicians-A Critical Strategy to Advance Racial Health Equity. JAMA Netw Open. 2023 Apr 3;6(4):e236678. DOI: 10.1001/ jamanetworkopen.2023.6678. Erratum in: JAMA Netw Open. 2023 May 1;6(5):e2317327. DOI: 10.1001/ jamanetworkopen.2023.17327.

3. Merchant, JL, et al. Underrepresentation of Underrepresented Minorities in Academic Medicine: The Need to Enhance the Pipeline and the Pipe.

Gastroenterology, Volume 138, Issue 1, 19 - 26.e3. DOI: 10.1053/j.gastro.2009.11.017 4. Rahal HK; Tabibian JH; Issaka R; Quezada S; Gray DM; Balzora, SM; Yang L; Badiee J; May FP. Diversity, Equity, and Inclusion in Gastroenterology and Hepatology: A Survey of Where We Stand. Am J Gastroenterol 117(12):p 1954-1962, December 2022. DOI: 10.14309/ ajg.0000000000001984.

5. iiSimpson C, Durso SC, Fried LP, Bailey T, Boyd CM, and Burton J. (2005). The Johns Hopkins Geriatric Summer Scholars Program: A Model to Increase Diversity in Geriatric Medicine. J Am Geriatr Soc, 53(9), 1607-1612.

DOI: 10.1111/j.1532-5415.2005.53527.

ABOUT Somaya Albhaisi, MBBCh, MPH – Dr. Albhaisi is a GI fellow-intraining at the Keck School of Medicine, University of Southern California. She is a member of the ACG DEI Committee and the Women in GI Committee.

Alexandra Goad – Alexandra Goad is a member of the 2027 class at the University of Louisville School of Medicine and a 2022 graduate of the Ohio State University with a BM in Flute Performance.

Chioma Owo, MSc – Chioma Owo is a medical student at UT Health San Antonio Long School of Medicine and received her Master of Science degree in Global Health from McMaster University in 2021.

Eric D. Shah, MD, MBA, FACG – Dr. Shah is Associate Professor of Medicine in the Division of Gastroenterology and Hepatology at University of Michigan School of Medicine. He is director of the Michigan Medicine GI Physiology Laboratories and a member of ACG’s Legislative & Public Policy Council and Research Committee.

Marquise Soto – Marquise Soto is a medical student at the Renaissance School of Medicine at Stony Brook University and a 2021 graduate of Hofstra University with a BA in Chemistry.

Christopher Vélez, MD – Dr. Vélez is Associate Program Director, Advanced Fellowship in Functional and Gastrointestinal Motility Disorders at the Mass General Brigham GI Division.

He is a member of the ACG’s DEI Committee and Research Committee.

Lavanya Viswanathan, MD, MS, FACG – Dr. Viswanathan is Associate Professor of Medicine, Department of Gastroenterology Hepatology and Nutrition, University of Texas MD Anderson Cancer Center. Dr. Viswanathan is a member of the College’s Legislative & Public Policy Council.

ACG Perspectives | 39

SHOWING UP

By Sidney J. Winawer, MD, DSc (Hon), MACG

“80% of success in life is showing up.”

— Woody Allen As a young boy, my parents took me to Winawer Family Circle festive gatherings. Aunts, uncles, cousins, etc., all “showed up.” As immigrants, social life was with family. When I married and had my own children, we all showed up at every wedding, birthday, funeral, etc.

As a result, the next generation became very close with each other – a blessing for parents. The concept of showing up became part of my DNA - professionally as well as personally.

My GI fellowship was Harvardaffiliated but located in the Boston University Mallory Institute of Pathology. The BU pathologists held a conference every morning. I showed up. It was there that I first learned about the work published in 1927 from St. Mark’s Hospital in London on the adenoma-colorectal cancer (CRC) link.

The concept took root in the back of

my mind. Our cytologist had a program of early cancer detection in Pernicious Anemia (PA) patients through gastric washings.

I showed up at her morning lavages and was introduced to the approach of early curable cancer detection before its clinical appearance. The Nobel Prize Foundation honored William B. Castle in 1938 for the B12 cure of PA. He had a PA Clinic where patients were encouraged to bring in stool specimens for occult blood detection of early gastric cancer. I showed up and, having been converted by our cytologist’s concept, joined in the effort. The occult blood method intrigued me.

Boston City Hospital and the BU University Hospital across the street were treasure troves of talent in GI. I had applied and was rejected by Franz Ingelfinger at BU who had one of the country’s GI “Meccas.”

Nevertheless, I showed up at his rounds, presented cases, and secured an invitation to his journal club and casual dinners with his fellows. I even showed up at a BU medical grand rounds that he conducted.

“Looking back, there is one lesson that I learned that is as meaningful now as it was then: the value of showing up, both professionally and personally.”

40 | GI.ORG/ACGMAGAZINE

He was stunned. No Harvard fellow had ever done that. We developed a close relationship, and I learned a lot from him. He offered me a faculty position.

This time it was my turn to reject. I accepted an offer at Cornell.

I arrived back in my hometown of New York City with appointments at three Cornell hospitals. My lab was at Bellevue, but I began to take an interest in Memorial Sloan Kettering Cancer Center (MSKCC) because of its focus on cancer. I showed up at rounds and conferences organized by Paul Sherlock, the only gastroenterologist there. We became friends and colleagues. When MSKCC transformed into a full-time academic center, GI was the first designated service, and Paul invited me to join him as Director of the Endoscopy Unit. Showing up gave me the entry.

As I began to consider a research program, experience with countless advanced CRC patients coupled with my various Boston episodes of showing up crystallized into a focus on cancer prevention. Screening, surveillance, and interruption of the adenoma-CRC progression became my crusade. Showing up in the NCI cafeteria as an AGA representative to the National Cancer Advisory Board led to a wonderful friendship with board member and chair of Howard University Department of Surgery, LaSalle Leffall. He became helpful with the National Polyp Study review by the board. There were many other situations when showing up led to interesting outcomes – e.g., an invitation to Yale Club dinners by my friend and colleague Dick McCray resulted in our organizing the New York Society for GI Endoscopy.

Many things have changed in the practice of medicine since I went to medical school, and surely, they will continue to change in the decades ahead. But looking back, there is one lesson that I learned that is as meaningful now as it was then: the value of showing up, both professionally and personally.

Dr. Winawer is Emeritus Chief, Gastroenterology and Nutrition Service, Chair, Cancer Prevention Program; Memorial Sloan Kettering.

He has been a member of the College since 1971 and served as ACG President, 1979-1980.

INCREASING ACCESS TO COLONOSCOPIES

FOR UNDER-RESOURCED PATIENTS – SUCCESS OF A FREE COMMUNITY CLINIC AND ACADEMIC MEDICAL CENTER PARTNERSHIP Timothy McAuliffe, BA1, Adriana Radosavljevic, BS1, Michelle D. Dong, BMSc, MMSc1, Rachael S. Chacko, BA1, Lauren A. Barry, BA2, Elizabeth R. Austin, MHA3, Corey A. Siegel, MD, MS1,2, Timothy B. Gardner, MD, MS1,2 1. Geisel School of Medicine at Dartmouth, Hanover, NH 2. Center for Digestive Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH 3. Good Neighbor Health Clinics and Red Logan Dental Clinic, White River Junction, VT

Introduction While volunteering at a free community clinic in Vermont and New Hampshire, our team from the Geisel School of Medicine at Dartmouth and DartmouthHitchcock Medical Center cared for multiple patients without insurance who had positive fecal immunochemical tests (FIT) or concerning gastrointestinal symptoms. As a result, we recommended these patients receive colonoscopies to further evaluate their symptoms. However, many patients communicated the immense financial barrier to completing a colonoscopy without insurance.

Unfortunately, this challenge has been documented extensively among underresourced patients – with uninsured patients receiving colorectal cancer (CRC) screening at less than a third of the rate of the general US adult population.1-3 These patient encounters highlighted directly to our team the major gaps in access to GI care patients still experience at a free community clinic. Our goal in developing a partnership between this clinic and the local tertiary academic medical center was to provide accessible colonoscopies to patients and strengthen community collaboration.

Medical student team presenting project poster at the 2024 ACG Annual Scientific Meeting. Left to right: Timothy McAuliffe, BA; Michelle D. Dong, BMSc, MMSc; Rachael Chacko, BA; and Adriana Radosavljevic, BS.

Background Diagnostic colonoscopies are a crucial procedure for evaluation and management of numerous GI conditions. For patients presenting with hematochezia, concern for GI blood loss, inflammatory bowel disease, or positive FIT, visualization of the colon with colonoscopy remains a key component of diagnosis and evaluation.4-10 Numerous studies have emphasized that delaying or forgoing a follow-up diagnostic colonoscopy increases incidence of and risk of mortality from colorectal cancer.11-13 In spite of the benefits of colonoscopies for diagnostic purposes, under-resourced patients often encounter significant barriers to receiving this procedure. High out-ofpocket costs or insurance challenges are consistently cited barriers to accessing screening colonoscopies.1,14-16 Specific to diagnostic colonoscopies following positive FIT, uninsured patients cited health insurance-related challenges and social barriers, such as transportation difficulties and lack of social support, as two of the most common reasons for not receiving a colonoscopy.17

To mitigate the barriers to care, free community clinics can provide a critical source of accessible, affordable healthcare for under-resourced patients. Regular care at free community clinics has been shown to improve health outcomes and reduce costs associated with future care through early intervention.18,19 Historical examples have shown that free community clinics have successfully improved CRC screening colonoscopy rates among underresourced populations.1,20 For diagnostic colonoscopies following a positive FIT, a retrospective study found that re-issuance of payment

Good Neighbor Health Clinic, White River Junction, VT

ACG Perspectives | 41

// PERSPECTIVES

vouchers to uninsured patients was an intervention that increased colonoscopy use.21 Good Neighbor Health Clinic in White River Junction, VT Good Neighbor Health Clinic (GNHC) is a nonprofit free healthcare facility located in White River Junction, Vermont, that serves more than 1,000 under-resourced patients annually in the Dartmouth/Upper Valley region of New Hampshire and Vermont.22 In 2024, GNHC’s patient demographic was reported to be 71% uninsured, and GNHC conducted 1,427 medical visits. This community clinic is staffed by a central team of employees and supported by over 80 volunteer physicians, nurses, medical students, and community members.

GNHC offers a variety of medical services in the fields of primary care, women’s health, dermatology, endocrinology, and gastroenterology – providing in-person appointments, preventive care, and minor in-office procedures. Relevant to GI care, FIT testing for CRC screening is available

for free to all GNHC patients through grant funding. While GNHC covers most basic services in each of these specialties, it does not provide some higher-cost procedures performed at a hospital or specialized outpatient clinic, making colonoscopies and other costly procedures inaccessible to most of their patients.

Numerous patients at GNHC have communicated to their provider team that they are unable to complete care, particularly forgoing colonoscopies or upper endoscopies due to the high cost barrier. The associated procedural cost barriers have prevented patients from completing care plans developed with their GNHC providers and limited their ability to follow up on concerning symptoms or test results.

The GNHC and Dartmouth-Hitchcock Medical Center Partnership: How We Did It Our aim was to identify opportunities to increase access to diagnostic colonoscopies so that patients could receive high-quality and equitable care, irrespective of personal financial access.

We sought to develop a program with funding to support patients’ abilities to

Figure 1. GNHC patients referred for diagnostic colonoscopies from 2012 to 2021 prior to establishment of charity care model. Data was collected from GNHC, Vermont Coalition of Clinics for the Uninsured, and Vermont's Free & Referral Clinics Patient Management Registry.

“Our aim was to identify opportunities to increase access to diagnostic colonoscopies so that patients could receive high-quality and equitable care irrespective of personal financial access.”

42 | GI.ORG/ACGMAGAZINE

receive diagnostic colonoscopies at a reduced cost. In collaboration with GNHC, we determined the unmet need for colonoscopies by analyzing GNHC data in the Vermont Coalition of Clinics for the Uninsured and Vermont's Free & Referral Clinics Patient Management Registry (Figure 1). We identified that there was a critical and consistent need for diagnostic colonoscopies among GNHC patients. Specifically, within the period of available data (20122021), there was an ongoing need for diagnostic colonoscopies with as many as 14 referrals submitted by GNHC providers in one year, with an annual mean of eight colonoscopy referrals.

With this context, our team concluded that a private partnership could provide financial support for colonoscopies for a defined number of GNHC patients for clear indications to fill this gap in care. With the involvement of medical students from Geisel School of Medicine at Dartmouth and physicians from Dartmouth-Hitchcock Medical Center (DH; Lebanon, NH), we determined an academic hospital partnership could provide unique resources, expertise, and aligned values for this program. We connected with clinical and operational leadership within the DH Center for Digestive Health to inaugurate this program.

The team developed a proposal to present to DH and Finance leadership about the need, community impact, and future steps to establish this program. The proposal requested financial support for ten diagnostic colonoscopies annually at no cost to under-resourced patients. We delineated the clinical guidelines for patients receiving a diagnostic colonoscopy to participate in this program, such as individuals with a positive FIT test or highly suspicious GI symptoms. While engaging with DH leadership, we also discussed the support of providing public recognition and marketing for their generosity to GNHC and the Upper Valley community as a mutually beneficial objective for this partnership.

Our team additionally established clear operational plans to ensure this program would run effectively. We organized a standardized referral process to communicate between GNHC and DH teams and defined a scheduling process that would efficiently connect the identified patients with a timely colonoscopy appointment. Working with the DH Finance leadership, we further outlined a system and designated billing code that would provide a diagnostic colonoscopy to patients without the patient or GNHC receiving an invoice.

Finally, we developed a system to assist patients in navigating this process while monitoring distribution of funds. Overall, these systems were developed in partnership with both GNHC and DH leadership to ensure ease of use, access to funding, and efficient clinical services to reduce financial and administrative barriers for GNHC patients.

Program Origins and Accomplishments Following these approaches and engagement, the DH Center for Digestive Health and Finance leadership granted charitable funding support for ten diagnostic colonoscopies to GNHC patients annually. This applies to GNHC patients who have a positive FIT test, symptoms for further evaluation (anemia, abdominal pain, diarrhea, constipation, blood in the stool, or weight loss), and/ or a history of polyps, cancer, ulcerative colitis, or Crohn’s disease requiring follow-up monitoring or evaluation of new symptoms).

Based on historical data on the GNHC patient needs, ten diagnostic colonoscopies per year are projected to adequately cover annual needs.

These designated funds have been assigned a billing code that covers the procedure, including the anesthesia and bowel preparation, so that patients are not directly billed. Three GNHC volunteer gastroenterologists employed at DH conduct these diagnostic colonoscopies and provide appropriate follow-up for patients.

“We hope these learnings and examples can serve as a foundation for other free community or student-run clinics to establish connections with academic medical centers to better support under-resourced patients’ needs.”

This GNHC-DH partnership colonoscopy program was formally launched in October 2023. The first patient was enrolled in the program in December 2023 due to rectal bleeding and successfully received a colonoscopy at DH within two weeks at no cost to the patient. Since the initiation of the program, a total of three GNHC patients have received colonoscopies at no cost through DH. Learnings from Establishing a Charity Care Model To establish this GNHC-DH partnership, this project involved determining patient need, identifying objectives for GNHC and DH in collaborating on this funding, and developing an organized system to provide these procedures. This initiative has already generated successful results as multiple GNHC patients have received colonoscopies at no cost through this program. These outcomes complement the success other clinics have shown for CRC screening and highlight a new area of patient need for diagnostic colonoscopies that has successfully been supported through this charitable care academic medical center partnership.

More broadly, this program has highlighted the range of stakeholders involved and thoughtful considerations required in developing a successful funding program for diagnostic colonoscopies. On this note, there have been crucial learnings about the necessary components and successful approaches to establishing a charitable partnership with an academic medical center. We hope these learnings and examples can serve as a foundation for other free community or student-run clinics to establish connections with academic medical centers to better support underresourced patients’ needs.

The major themes include: • Establishing goals to prioritize patient and clinic needs: A core learning was understanding the needs of GNHC patients and staff to develop a program that would best support those needs. For patients, this involved listening closely to their personal experiences of accessing endoscopies and understanding the settings of most urgent colonoscopy need. For staff, we met with a range of clinic team members throughout the project (including providers and clinic executive leadership) to develop a shared vision for this program, understand other funding channels, and refine the nuances of the program to ensure it could successfully be implemented for patients.

• Identifying multiple channels of support: GNHC had funding for FIT screening for all patients and active funding from DH for other clinic services. By understanding the existing funding inputs and searching for other state and national resources, we confirmed the need for local medical center financial support and were able to communicate that need.

• Defining a focused need for this partnership: Through collaboration with GNHC, we engaged with DH on a directed area of support – diagnostic colonoscopies with a defined number of colonoscopies per year in line with previous needs.

By proposing this focused, specific area of investment, we were able to discuss financial support that was feasible and clearly communicate concrete evidence for this need to our funding partner.

ACG Perspectives | 43

• Simplifying the program for both partners: Through the medical student team, we sought to support the development of a program between two organizations with many priorities. As a result, we prioritized simplifying the experience and supporting both partners as much as possible. For DH, we constructed a proposal and outlined program goals at the start of our discussions. For GNHC, we were the main contact with DH and worked to simplify the billing process for both GNHC staff and patients.

References

Ultimately, we successfully collaborated with GNHC, a free community clinic, and DH, a tertiary academic medical center, to organize a program that provides diagnostic colonoscopies for GNHC patients with funding support from DH. A thoughtful process to identify the need and seek funding led to a strong partnership. Further, we defined the process to manage patient logistics, operations, and funding for this program. In the future, we plan to maintain this GNHC-DH partnership and further evaluate the outcomes of this funding on under-resourced patients seeking care at GNHC. We hope this process can be a model for other community clinics, particularly those in rural locations where access to care is challenging, to establish comparable community clinicacademic medical center partnerships and improve access to affordable care.

5. Tang MH, Foo FJ, Ng CY. Endoscopic Findings in Patients Under the Age of 40 Years with Hematochezia in Singapore. Clin Endosc.

2020/07/30/ 2020;53(4):466-470. doi:10.5946/ ce.2019.029

Acknowledgments We would like to thank the Center for Digestive Health and DartmouthHitchcock Medical Center in Lebanon, NH, for their generosity in donating funds to support diagnostic colonoscopies for GNHC patients.

Further, we would like to thank Elaina Vitale, Pamela Bagley, and Dr. Sonia Chimienti from the Geisel School of Medicine at Dartmouth; Tricia Mashal and Heather Grohbrugge from the Good Neighbor Health Clinic; and Nathalie Hebert and Dana Michalovic.

Timothy McAuliffe, BA is a medical student at the Geisel School of Medicine at Dartmouth in Hanover, NH.

44 | GI.ORG/ACGMAGAZINE

1. Kattih Z, Uhlar C, Perera Y, et al. A Model for Colon Cancer Screening at a Free Community Clinic. J Stud Run Clin. 2018/07/22/ 2018;4(1)doi:10.59586/jsrc. v4i1.76 2. Shapiro JA, Klabunde CN, Thompson TD, Nadel MR, Seeff LC, White A. Patterns of Colorectal Cancer Test Use, Including CT Colonography, in the 2010 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev. 2012/06/01/ 2012;21(6):895-904. doi:10.1158/1055-9965.EPI-12-0192 3. Song EY, Swanson J, Patel A, et al. Colorectal Cancer Risk Factors and Screening Among the Uninsured of Tampa Bay: A Free Clinic Study. Prev Chronic Dis. 2021/02/25/ 2021;18:200496. doi:10.5888/ pcd18.200496 4. Abu Baker F, Samhat A, Taher Natour R, Zeina A-R, Kopelman Y. Colonoscopy in the young: An indication-based analysis of outcome. J Invest Med. 2023/12// 2023;71(8):797-803. doi:10.1177/10815589231193953

6. Acosta JA, Fournier TK, Knutson CO, Ragland JJ. Colonoscopic evaluation of rectal bleeding in young adults. Am Surg. 1994/11// 1994;60(11):903-906.

7. Spiceland CM, Lodhia N. Endoscopy in inflammatory bowel disease: Role in diagnosis, management, and treatment. World J Gastroentero. 2018/09/21/ 2018;24(35):4014-4020. doi:10.3748/wjg.v24. i35.4014 8. Kim YG, Jang BI. The Role of Colonoscopy in Inflammatory Bowel Disease. Clin Endosc. 2013 2013;46(4):317. doi:10.5946/ce.2013.46.4.317 9. Rex DK, Boland CR, Dominitz JA, et al. Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2017/07// 2017;153(1):307-323. doi:10.1053/j.gastro.2017.05.013 10. Lin JS, Perdue LA, Henrikson NB, Bean SI, Blasi PR. Screening for Colorectal Cancer: An Evidence Update for the U.S. Preventive Services Task Force. US Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews.

Agency for Healthcare Research and Quality (US); 2021.

11. Zorzi M, Battagello J, Selby K, et al. Noncompliance with colonoscopy after a positive faecal immunochemical test doubles the risk of dying from colorectal cancer. Gut. 2022/03// 2022;71(3):561-567. doi:10.1136/gutjnl-2020-322192 12. Mutneja HR, Bhurwal A, Arora S, Vohra I, Attar BM. A delay in colonoscopy after positive fecal tests leads to higher incidence of colorectal cancer: A systematic review and meta-analysis. J Gastroen Hepatol. 2021/06// 2021;36(6):1479-1486. doi:10.1111/ jgh.15381 13. Forbes N, Hilsden RJ, Martel M, et al. Association Between Time to Colonoscopy After Positive Fecal Testing and Colorectal Cancer Outcomes: A Systematic Review. Clin Gastroenterol H. 2021/07// 2021;19(7):1344-1354.e8. doi:10.1016/j. cgh.2020.09.048 14. Issa IA, Noureddine M. Colorectal cancer screening: An updated review of the available options. World J Gastroentero. 2017 2017;23(28):5086. doi:10.3748/ wjg.v23.i28.5086 15. Jones RM, Devers KJ, Kuzel AJ, Woolf SH. PatientReported Barriers to Colorectal Cancer Screening.

Am J Prev Med. 2010/05// 2010;38(5):508-516. doi:10.1016/j.amepre.2010.01.021 16. Perisetti A, Khan H, George NE, et al. Colorectal cancer screening use among insured adults: Is out-of-pocket cost a barrier to routine screening?

WJGPT. 2018/09/05/ 2018;9(4):31-38. doi:10.4292/ wjgpt.v9.i4.31

17. Jetelina KK, Yudkin JS, Miller S, et al. PatientReported Barriers to Completing a Diagnostic Colonoscopy Following Abnormal Fecal Immunochemical Test Among Uninsured Patients. J Gen Intern Med. 2019/09// 2019;34(9):1730-1736. doi:10.1007/s11606-01905117-0 18. Trumbo SP, Schuering KM, Kallos JA, et al.

The Effect of a Student-Run Free Clinic on Hospital Utilization. J Health Care Poor U. 2018 2018;29(2):701-710. doi:10.1353/hpu.2018.0053 19. Wallace S, Johnson TJ, Hendel E, Chakravarthy V, Leanos L, Ansell DA. The Financial Impact of a Partnership Between an Academic Medical Center and a Free Clinic. Am J Med. 2021/11// 2021;134(11):1389-1395.e4. doi:10.1016/j. amjmed.2021.06.011 20. Lairson DR, Kim J, Byrd T, Salaiz R, Shokar NK. Cost-Effectiveness of Community Interventions for Colorectal Cancer Screening: Low-Income Hispanic Population. Health Promot Pract. 2018/11// 2018;19(6):863-872. doi:10.1177/1524839917750815 21. Kennel B, Kubiak K, Suresh S, et al.

Colonoscopy completion following positive FIT results in uninsured patients. JAAPA. 2022/12// 2022;35(12):1-1. doi:10.1097/01.

JAA.0000892828.38238.3d 22. Austin E, Westling C. 2023 Annual Impact Report. Accessed 2025/01/06. https:// goodneighborhealthclinic.org/wp-content/ uploads/2024/09/Annual-Impact-Report-2024. pdf

Inside the

JOURNALS

G

AC RTS EPO E CAS RO J URN L G OM I.OR TS.C TS.G POR POR ERE ERE CAS CAS ACG ACG

VOLUME 6

orts edited by Case Rep rnal of orts edited by ine Jou Case Rep An Onl logy Fellows rnal of ine Jou gy & Hepato An Onl logy Fellows nterolo Gastroe gy & Hepato rolo nte troe Gas

UPDATED CLINICAL GUIDELINES on the diagnosis and management of eosinophilic esophagitis by Dellon, et al., were part of a special issue of The American Journal of Gastroenterology on inflammation in GI disease. A podcast and one-page summary further illuminate the evidence-based recommendations and key concepts.

Clinical and Translational Gastroenterology published the largest series to date of pregnant women with IBD on biosimilar infliximab in the PIANO cohort from 2017–2024, examining pregnancy complications, neonatal outcomes, and developmental milestones for children at one year.

A case series of patients with ulcerative colitis who underwent endoscopic fullthickness resection for challenging colonic polyps is featured in ACG Case Reports Journal and is the subject of the most recent “Behind the Case” podcast.

Inside the Journals | 45

// INSIDE THE JOURNALS [THE AMERICAN JOURNAL OF GASTROENTEROLOGY]

[CLINICAL & TRANSLATIONAL GASTROENTEROLOGY]

ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis

Use of Biosimilars to Infliximab During Pregnancy in Women with Inflammatory Bowel Disease: Results from the Pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes Study

Evan S. Dellon, MD, MPH, FACG; Amanda B. Muir, MD; David A. Katzka, MD, FACG; Shailja C. Shah, MD, MPH; Bryan G. Sauer, MD, MSc, FACG; Seema S. Aceves, MD, PhD; Glenn T. Furuta, MD; Nirmala Gonsalves, MD, FACG; Ikuo Hirano, MD, FACG. The American Journal of Gastroenterology 120(1):p 31-59, January 2025. | DOI: 10.14309/ajg.0000000000003194

 Since the publication in 2013 of ACG’s EoE guidelines, there have been paradigm-shifting changes in disease diagnosis and management, increases in knowledge about EoE risk factors, natural history, and pathogenesis, development of validated outcome metrics, a disease severity classification system, and updated nomenclature.

EoE has been established as an adaptive immune T-cell–mediated type-2 inflammatory disease.

In the College’s 2025 updated guidelines, Evan S. Dellon, MD, MPH, FACG, and colleagues offer practical and evidence-based recommendations that encompass major changes in the field, but that are also actionable and applicable across the range of patients with EoE and practice settings. The authors also present a set of key concepts to accompany the recommendations, which provide additional practical suggestions and expert opinion.

There have been major advances in therapeutic options with an explosion of clinical trials, culminating in two topical steroids and one biologic being approved for EoE and with a robust pipeline of novel candidate therapies, as well as a larger body of data on dietary interventions. The guideline presents an algorithm for EoE treatment.  READ: bit.ly/acg-eoe-2025

Millie D. Long, MD, MPH, FACG; Sunanda Kane, MD, FACG; Dawn Beaulieu, MD, FACG; Bincy Abraham, MD, FACG; Xian Zhang, PhD; Uma Mahadevan, MD, FACG. Clinical and Translational Gastroenterology 15(12):p e00795, December 2024. | DOI: 10.14309/ ctg.0000000000000795

 The authors compare pregnancy complications, neonatal outcomes, and developmental milestones for children at one year in a population of women with IBD exposed to originator infliximab (IFX) as compared with biosimilar IFX from 2017 to 2024. In the largest series to date of pregnant women with IBD on biosimilar infliximab, authors found that, overall, there were no differences in any pregnancy complication by IFX exposure status. Adverse outcomes were generally rare (all ≤ 10% except for C-section). Infant developmental milestones were comparable with the general population, and no difference in any milestone was seen by originator vs. biosimilar status.  READ: bit.ly/ctg-biosimilar-ifx-during-pregnancy-ibd

 LISTEN: bit.ly/ajg-podcast-dellon-eoe  HIGHLIGHTS: bit.ly/acg-eoe-guideline-highlights

[ACG CASE REPORTS JOURNAL]

Initial Experience with Safety and Efficacy of Endoscopic Full-Thickness Resection in Patients with Inflammatory Bowel Disease: A Case Series Himsikhar Khataniar, MD; Aakash Desai, MD; Gursimran S. Kochhar, MD. ACG Case Reports Journal 11(12):p e01571, December 2024. | DOI: 10.14309/ crj.0000000000001571

This case series includes five adult patients seen at Allegheny General Hospital with ulcerative colitis who underwent endoscopic full-thickness resection (EFTR) for challenging colonic polyps, presenting with fibrotic and nonlifting polyps considered unsuitable for conventional endoscopic resection techniques.

The authors note that, “The novelty of our study lies in demonstrating EFTR as a new treatment modality for patients with IBD, with high technical success rates and no postoperative complications.”  READ: bit.ly/acgcrj-eftr-ibd  BEHIND THE CASE: Associate Editor Dr. Dushyant Dahiya is joined by Dr. Amit Rastogi to discuss the novel use of EFTR techniques for the removal of colorectal polyps and a related case series published in the December 2024 issue.  LISTEN: bit.ly/acgcrj-eftr-ibd-podcast

46 | GI.ORG/ACGMAGAZINE

Advance to Fellowship

of the AMERICAN COLLEGE OF

GASTROENTEROLOGY (FACG)

Criteria for an ACG Physician

Member to Advance to Fellowship: Demonstration of scholarly activities, which include continuing education experience, professional leadership, and excellence in the fields of clinical practice and/or academic medicine.

Current uninterrupted membership or international membership in the College for a period of no less than five years (Post Resident/Trainee Membership).

Minimum of 3 distinct* ACG managed and sponsored CME courses within the last six years: • Three in-person meetings are required.

• *Attendance at multiple courses in the same meeting, e.g., PG Course and Annual Meeting, or Regional Meeting plus Hepatology School counts as one program Evidence of ongoing involvement in ACG activities: Committees, Courses, Annual Meeting attendance, etc.

Letters of recommendation from two Fellows of the College.

Documentation of initial certification by one or more of the following specialty boards recognized by the Council on Graduate Medical Education of the American Medical Association: American Board of Internal Medicine, (subspecialty Boards in Gastroenterology), or its equivalent, e.g., American Board of Pediatrics (subspecialty Board in Gastroenterology), American Board of Surgery, American Board of Radiology, American Board of Pathology, the American Osteopathic Board of Internal Medicine or the Canadian equivalent qualifications, Fellow of the Royal College of Physicians and Surgeons.

Benefits of ACG Fellowship: You can run for elected office on the Board of Governors You can serve as the Chair of an ACG Committee You can be nominated for the Board of Trustees You can be nominated for a Master Award or the Samuel S. Weiss Award Add FACG to your credentials, on business cards, and on your CV Recognition at the ACG Annual Meeting and on the ACG website Certificate of Advancement to Fellowship signed by the ACG President and Secretary

 Complete the application online: members.gi.org/acgmembership  Application fee is $50

Inside the Journals | 47

ACG GUIDELINE Highlights ACG GUIDELINE Highlighttss ACG GUIDELINE Highligh

Treatment of Helicobacter pylori Infection of Diagnosis and Management Diagnosis and Management of Eosinophilic Esophagitis Eosinophilic Esophagitis

William D. Chey, MD, FACG; Colin W. Howden, MD, FACG; Steven F. Moss, MD, FACG; Douglas R. Morgan, MD, MPH, FACG; Katarina B. Greer, MD, MSEpi; Shilpa Grover, MD, MPH; Shailja C. Shah, MD, MPH Concept and Content: Erica Duh, MD | Reviewers: William D. Chey, MD, FACG and Shailja C. Shah, MD, MPH

Evan S. Dellon, MD MPH B. Muir, MD;America David A.isKatzka, MD FACG; Shailja C. Shah, MD MPH; Bryan G. Sauer, MD MSc FACG; • H.FACG; pylori Amanda prevalence in North 30%-40% Epidemiology Seema S. Aceves, MD•PhD; Glennacquired T. Furuta, Nirmala Gonsalves, MD FACG; Ikuo Hirano, MD FACG Typically in MD; childhood Evan S. Dellon, MD MPH FACG; Amandaamong B. Muir, MD; Davidraces A. Katzka, MD FACG; Shailja C. Shah, MD MPH; Bryansanitary G. Sauer, MD MSc FACG; • More prevalent non-White or ethnicities, those living in crowded or poor conditions, Concept and Content: Erica Duh, MD | Reviewer: Evan S. Dellon, MD, MPH FACG Seema S. Aceves, MD PhD; T. Furuta, MD; Nirmala Gonsalves, MD regions.

FACG; Ikuo Hirano, MD FACG and Glenn early generation immigrants from endemic

Concept and Content: Erica MD | Reviewer: Evan S.the Dellon, MD, MPH EoEDuh, is diagnosed based onBenign presence of:FACG Diagnosis Conditions Premalignant and Malignant Conditions When to Test 1. Symptoms of esophageal dysfunction 2. 15 eosinophils per high-power field 3. Evaluation for non-EoE disorders that for H. pylori • Adult household members of • High risk gastric • MALT lymphoma • Dyspepsia if <60 years without EoE is diagnosed based on the presence of: on biopsy canpremalignant contribute to esophageal eosinophilia Diagnosis

features (GI bleeding, H. positive individuals condition 3. Evaluation for non-EoE • Gastric epithelial 1. alarm Symptoms of esophageal dysfunction 2. pylori 15 eosinophils per high-power field disorders that polyps Use theunexplained EoE Endoscopic Reference endoscopic of EoE during each endoscopy vomiting, weight loss, •Score ITPon (EREFS) - Atrophy, intestinal biopsy to systematically assess canfindings contribute to esophageal eosinophilia WHO recognizes iron deficiency) • Unexplained IDA metaplasia, dysplasia Use the EoE Endoscopic (EREFS) tohistory systematically endoscopicgastritis findings of EoE during endoscopy 1: <50 Present (decreased H. pylorieach as a group I •Edema Dyspepsia if years with Reference high vascularity) •Score Current or prior of PUD assess - Autoimmune (definite) carcinogen risk for gastric cancer • Chronically taking NSAID or Family history of gastric 3: Severe (standard Rings 1: Mild (ridges) 2: Moderate (does not Present (decreased vascularity) •Edema Endoscopy1:with biopsies if dyspepsia starting aspirin scope does not pass) cancer impede scopedaily passage) and alarm features, NSAID use, family therapies - Foreign born with immigration 3: Severe (standard Rings 1: Mild (ridges) 2: Moderate (does not Exudates 1: 10%cancer, of surface area 2: >10% of surface area scope does not pass) history of gastric immigration from high incidence region impede scope passage) from high incidence - High risk race or ethnicity Furrows 1: Mild region 2: Severe (with appreciable depth) Exudates 1: 10% of surface area 2: >10% of surface area Rx Stricture 1: Present; also estimate diameter inpylori mm Treatment Treatment Regimens for H. Rx Experienced (Salvage) Furrows 1: Mild 2: Severe (with appreciable depth) Naïve for H. pylori Obtain at 1: least 6 targeted biopsies from 2 esophageal •also PPI estimate b.i.d.

Stricture Present; diameter in mm levels!

Proven Rx Empiric Empiric Bismuth subcitrate mg) or subsalicylate (300 -524 mg) q.i.d.

• Quantify number of•eosinophils on biopsies(120-300 from every endoscopy!

Sensitivity Optimized bismuth Obtain at least 6 targeted biopsies from esophageal levels!

• Tetracycline 500 2mg q.i.d.

Shared Decision shared decision making to select first line dietary (empiric elimination) or pharmacologic (PPI or topical steroids) Treatment for quadruple • Quantify number Use of •eosinophils on biopsies from every endoscopy!

Metronidazole 500 mg t.i.d. or q.i.d.

Making therapy.

Doxycycline is not a recommended substitute for tetracycline Eosinophilic Decision Use shared decision making to select first line dietary (empiric elimination) or pharmacologic (PPI or topical steroids) Treatment for Shared Rifabutin 50 mg t.i.d.

Dietary An• empiric food elimination diet is suggested for treatment of EoE. Esophagitis Making therapy.

Eosinophilic (if dosestarting unavailable, substitute rifabutin mg b.i.d.)

• Consider with a less restrictive empiric 150 elimination (1FED or 2FED) initially Trials show that 1FED has similar response Elimination Rifabutin Triple rates to more restrictive diets Amoxicillin mg t.i.d.diet is suggested for treatment of EoE. Dietary An•empiric food1000 elimination Esophagitis Allergy testing to40 direct food elimination diets is not currently suggested • Consider starting with a less restrictive empiric elimination (1FED or 2FED) initially Trials show that 1FED has similar response • Omeprazole mg t.i.d.

Elimination rates to more restrictive diets • Vonoprazan mg b.i.d.

Endoscopic Esophageal dilation should used in parallel with therapy in patients with esophageal Allergy testing to20 direct foodbeelimination diets is notanti-inflammatory currently suggested PCAB Dual • Amoxicillin 1000 mg t.i.d.

Dilation strictures and dysphagia, and not used as monotherapy.

Endoscopic Esophageal dilation should • Vonoprazan 20 mg b.i.d.be used in parallel with anti-inflammatory therapy in patients with esophageal Dilation strictures and dysphagia, and notPHARMACOLOGIC used as monotherapy.

THERAPY PCAB Triple • Clarithromycin 500 mg b.i.d.

• Amoxicillin 1000 mg b.i.d.

Proton Pump Inhibitors PHARMACOLOGIC THERAPY • PPI b.i.d.

• Adults: Omeprazole 20 mg BID or 40 mg daily or equivalent • Children: 2mg/kg/day (or 1mg/kg twice daily) Levofloxacin Triple • Amoxicillin 1000 mg b.i.d.

Proton Pump Inhibitors • Levofloxacin 500 mg b.i.d. Swallowed Topical Steroids • Adults: Omeprazole 20 mg BID or 40 mg daily or equivalent • Children: 2mg/kg/day (or 1mg/kg twice daily) Recommended Suggested May be considered when no other options Budesonide Fluticasone Swallowed Topical Steroids A trial comparing budesonide to fluticasone showed similar efficacy; choice of topical steroid depends on local • Adults: 1760 mcg/day Treatment in a dividedPearls dose • Adults: 2-4 mg/day and patient/provider preference showed Budesonide Fluticasone • Children: 1-2 mg/day • Children 110-880mcg/day in a divided dose Aavailability trial comparing budesonide to fluticasone • All patients found to be infected with H. pylori should be treated • To avoid false negatives in test of curesteroid – hold PPI x 2onweeks; similar efficacy; choice of topical depends local • Adults: 2-4 mg/day • Adults: 1760 mcg/day in a divided dose Dupilumab: Consider for patients who are non-responsive to PPI treatment and for step-up therapy in most cases.

• Complete of cure at least four• weeks after therapy with either: bismuthavailability and antibiotics x 4 weeks preference and patient/provider • Children:test 1-2 mg/day Children 110-880mcg/day in a divided dose breath testsubq every week • 30 to <40 kg: 300 mg subq every •other Avoidweek clarithromycin andkg: levofloxacin-containing Rx week •• Urea 40 kg: 300 mg • 15 to <30 200 mg subq every other Dupilumab: treatment and for step-up therapy in most cases.

• Fecal antigen test Consider for patients who are non-responsive to PPI unless demonstrated susceptibility PCNweek allergy – •consider formg formal •• Biopsy-based 40 kg: 300 mgtest subq every week • 30 toTherapy <40 kg: 300 mg subq every •other 15 Considerations to <30referral kg: 200 subqPCN every other week Monitoring Response Maintenance Pediatric and/orindesensitization Assess symptoms, esophageal Continue effective dietary or pharmacologicallergy testing • Dysphagia a child with EoE?

Monitoring Therapy Pediatric Considerations biopsies forResponse histologic findings, and therapy to prevent recurrence of symptoms, Consider an esophagram Abx = antibiotic ITP = immuneMaintenance thrombocytopenic purpura PCN = penicillin q.i.d. = four times a day b.i.d. = twicesymptoms, a dayfeatures IDA = iron deficiency anemia PCAB = potassium competitive acid blocker Rx = treatment Assess esophageal Continue effective dietaryand or pharmacologic ••Dysphagia in a child with EoE? therapist endoscopic (EREFS). Symptoms histologic inflammation, endoscopic Consider evaluation by a feeding GIM = gastric intestinal metaplasia mg = milligrams PPI = proton pump inhibitor t.i.d. = three times a day biopsies forbe histologic and therapy to prevent recurrence ofPUD symptoms, an esophagram should not monitored in isolation. abnormalities and/or dietician as an adjunct therapeutic H. pylori = Helicobacter pylori findings, NSAIDS = non-steroidal anti-inflammatory drugs = peptic ulcer disease Consider endoscopic features (EREFS). Symptoms

histologic inflammation, and endoscopic

• Consider evaluation a feeding intervention in thoseby with feedingtherapist dysfunction

should notMD, beFACG; monitored isolation. abnormalities and/or William D. Chey, Colin W.in Howden, MD, FACG; Steven F. Moss, MD, FACG; Douglas R. Morgan, MD, MPH, FACG; Katarina B. Greer, MD, MSEpi; dietician as an adjunct therapeutic BID Grover, = twiceMD, a day Eos = eosinophils FED =September food elimination = subcutaneous Shilpa MPH; Shailja C. Shah, MD, MPH The American Journal of Gastroenterology 119(9):p 1730-1753, 2024. |diet DOI: 10.14309/ intervention inSubq those with feeding dysfunction EoE = eosinophilic esophagitis EREFS = EOE Endoscopic Reference Score Hpf = high power field ajg.0000000000002968 BID = twice a day Eos = eosinophils  READ THE GUIDELINE: bit.ly/acg-h-pylori-guideline FED = food elimination diet Subq = subcutaneous EoE eosinophilic = EOE ScoreC. Shah, MD Hpf MPH; = highBryan powerG. field Evan=S. Dellon, MDesophagitis MPH FACG; Amanda B. Muir, EREFS MD; David A. Endoscopic Katzka, MDReference FACG; Shailja Sauer, MD MSc FACG; Seema S. Aceves, MD PhD; Glenn T. Furuta, MD; Nirmala Gonsalves, MD FACG; Ikuo Hirano, MD FACG The American Journal of Gastroenterology 120(1): 31-59, January 2025. doi.org/10.14309/ajg.0000000000003194 Evan S. Dellon, MD MPH FACG; Amanda B. Muir, MD; David A. Katzka, MD FACG; Shailja C. Shah, MD MPH; Bryan G. Sauer, MD MSc FACG; Seema S. Aceves, MD PhD; Glenn T. Furuta, MD; Nirmala Gonsalves, MD FACG; IkuoHirano, The American Journal of Gastroenterology 120(1): 31-59, READ MD THEFACG GUIDELINE: bit.ly/acg-eoe-2025 January 2025. doi.org/10.14309/ajg.0000000000003194  READ THE GUIDELINE: bit.ly/acg-eoe-2025

48 | GI.ORG/ACGMAGAZINE

Attend an upcoming Attend an upcoming ACG POSTGRADUATE COURSE

ACG POSTGRADUATE COURSE 2025

2025 ACG’s IBD School & 2024 ACG/FGS Annual Spring Symposium

2025

Functional GI and Motility 2024 MarchACG’s 7–9, 2025 Disorders School & Southern Regional  Naples Grande Beach Resort, Naples, FL Postgraduate Course

 December 6–8, Regional 2024 2025 ACG/LGS Postgraduate Course  Renaissance Nashville Hotel, Nashville, TN & Women Leading with Guts Course

2025

 March 14–16, 2025  DoubleTree by Hilton, New Orleans, LA 2025 ACG’s NEW Esophagus School & 2025 ACG’s Endoscopy School & Western Regional Postgraduate Course

ACG Weekly Virtual Grand Rounds ACGREGISTER Weekly Virtual NOW: gi.org/ACGVGR Grand Rounds Plus our monthly

webinar NOW: seriesgi.org/ACGVGR focused on REGISTER career-based topics!

Plus our monthly webinar series focused on career-based topics!

 January 24–26, 2025 Eastern Regional Postgraduate Course

Mandalay Bay, Las Vegas, NV June 6–8, 2025  2025 Washington Marriott Metro ACG’s IBD School & Center, Washington, DC

ACG/FGS Annual Spring Symposium

2025 ACG’s Functional GI and Motility Disorders  March 7–9, 2025 School Midwest Regional Postgraduate Course  Naples&Grande Beach Resort, Naples, FL  August 22–24, 2025 ACG/LGS Regional &  2025 Marriott Indianapolis Place,Postgraduate Indianapolis, Course IN Women Leading with Guts Course

 March 14–16,NEW 2025 Esophagus School & 2025 ACG’s  DoubleTree by Hilton, New Orleans,Postgraduate LA ACG/VGS/MASGNA Regional Course

 September 5–7, 2025 2025 ACG’s Endoscopy School &  Eastern Williamsburg Lodge, Williamsburg, VA Regional Postgraduate Course  June 6–8, 2025

2025 ACG Hepatology  Washington Marriott MetroSchool Center, Washington, DC & Southern Regional Course

ACG’s6-7, Functional 2025 December 2025 GI and Motility Disorders School & Regional  Midwest Renaissance Hotel, Postgraduate Nashville, TN Course  August 22–24, 2025  Marriott Place, Indianapolis, IN ACG 2025Indianapolis Annual Meeting & Postgraduate Course

 October 24-29, 2025 2025 ACG’s NEW Esophagus School &  ACG/VGS/MASGNA Phoenix Convention Center, Phoenix, AZ Regional Postgraduate Course  September 5–7, 2025  Williamsburg Lodge, Williamsburg, VA

FOR MORE INFORMATION VISIT: FOR MORE INFORMATION VISIT: gi.org/regional-meetings gi.org/regional-meetings Inside the Journals | 49

About Helicobacter pylori Infection Information for Patients from ACG’s 2024 Clinical Guideline: Treatment of Helicobacter pylori Infection

Overview Helicobacter pylori (H. pylori) is a germ that can infect some peoples’ stomachs. Although it usually causes no symptoms, infection may cause symptoms like upper belly pain, burning, or discomfort.

1 IN 3

Most people with H. pylori infection caught it when they were children.

Roughly one in three American adults has H. pylori infection but it might not cause symptoms.

H. pylori infection can lead to serious problems like peptic ulcers and stomach cancer.

Testing If you have a family member with stomach cancer, or one who has been diagnosed with H. pylori infection, you should get tested!

There are several tests for H. pylori infection.

• Simple breath or stool tests are very accurate and are the best ways to test for H. pylori infection.

• Blood tests are widely available but can provide misleading results.

Treatment At least 4 weeks after finishing treatment, you should undergo a breath or stool test to make sure the infection has been cured.

• Fortunately, once the infection is cured, it only rarely comes back.

• If the infection is still present after treatment, your doctor will work with you to find a combination of medicines (that are different from those previously used) to treat the infection.

Anyone who has H. pylori infection should be treated for it.

Treatment is a 2-week course of 2 to 4 medicines prescribed by your doctor.

• To help choose the best treatment, your doctor should ask about which antibiotics you have taken in the past. It is very important to take the complete course of medicines, even if you start to “feel better.”

What questions should I ask health care providers about my care?

• Should I be tested for H. pylori infection?

• If so, how can I be tested?

• If infected, how should I be treated? (It is important that your health care provider knows about any medication allergies and about the antibiotics you may have taken in the past.)

• What side effects might I get from the treatment?

• Should my family members be tested for H. pylori infection?

• After treatment, how should I be tested to make sure the infection has been cured?

What warning signs or alarm symptoms should never be ignored?

H. pylori infection usually does not cause symptoms. However, the following should not be ignored: • Frequent or severe pain or discomfort in the upper part of the belly • Weight loss that is unexplained or unintentional • Persistent vomiting • Vomiting of red blood or black material that looks like coffee grounds • Passing black stools • Family history of stomach cancer







Learn More: Info on Peptic Ulcer Disease gi.org/topics/peptic-ulcer-disease

Find a gastroenterologist near you: gi.org/findagi

Read 2024 ACG H. pylori Guidelines: bit.ly/acg-h-pylori-guideline

Authors: Colin W. Howden, MD, FACG & William D. Chey, MD, FACG | American College of Gastroenterology | gi.org

50 | GI.ORG/ACGMAGAZINE