Hepatitis C: The Curable Virus Silent Killer: Colorectal Cancer Protecting Patient Choices Reduces Healthcare Costs What is a quality Colonoscopy?
Terrence Howard 1
# 1 MOST PRESCRIBED, BRANDED BOWEL PREP KIT1
FIVE-STAR EFF1CACY WITH SUPREP ® Distinctive results in all colon segments >90% no residual stool in all colon segments compared to Standard 4-Liter Prep2*†‡ • These results were statistically signiﬁcant in the cecum (P=.010)2*§ • Signiﬁcantly more patients in the SUPREP group had no residual ﬂuid in 4 out of 5 colon segments2*‡ Help meet the Gastroenterology Quality Improvement Consortium (GIQuIC) benchmark for 85% quality cleansing3 with the split-dose efficacy of SUPREP Bowel Prep Kit.4 *This clinical trial was not included in the product labeling. †Standard 4-Liter Prep [sulfate-free polyethylene glycol (PEG) electrolyte lavage solution]. ‡Based on investigator grading. §Statistically significant difference. References: 1. IMS Health, NPA Weekly, July 2016. 2. Rex DK, Di Palma JA, Rodriguez R, McGowan J, Cleveland M. A randomized clinical study comparing reducedvolume oral sulfate solution with standard 4-liter sulfate-free electrolyte lavage solution as preparation for colonoscopy. Gastrointest Endosc. 2010;72(2):328-336. 3. Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81(1):31-53. 4. SUPREP Bowel Prep Kit [package insert]. Braintree, MA: Braintree Laboratories, Inc; 2012.
©2016 Braintree Laboratories, Inc. All rights reserved.
IMPORTANT SAFETY INFORMATION SUPREP® Bowel Prep Kit (sodium sulfate, potassium sulfate and magnesium sulfate) Oral Solution is an osmotic laxative indicated for cleansing of the colon as a preparation for colonoscopy in adults. Most common adverse reactions (>2%) are overall discomfort, abdominal distention, abdominal pain, nausea, vomiting and headache. Use is contraindicated in the following conditions: gastrointestinal (GI) obstruction, bowel perforation, toxic colitis and toxic megacolon, gastric retention, ileus, known allergies to components of the kit. Use caution when prescribing for patients with a history of seizures, arrhythmias, impaired gag reflex, regurgitation or aspiration, severe active ulcerative colitis, impaired renal function or patients taking medications that may affect renal function or electrolytes. Use can cause temporary elevations in uric acid. Uric acid fluctuations in patients with gout may precipitate an acute flare. Administration of osmotic laxative products may produce mucosal aphthous ulcerations, and there have been reports of more serious cases of ischemic colitis requiring hospitalization. Patients with impaired water handling who experience severe vomiting should be closely monitored including measurement of electrolytes. Advise all patients to hydrate adequately before, during, and after use. Each bottle must be diluted with water to a final volume of 16 ounces and ingestion of additional water as recommended is important to patient tolerance.
BRIEF SUMMARY: Before prescribing, please see full Prescribing Information and Medication Guide for SUPREP® Bowel Prep Kit (sodium sulfate, potassium sulfate and magnesium sulfate) Oral Solution. INDICATIONS AND USAGE: An osmotic laxative indicated for cleansing of the colon as a preparation for colonoscopy in adults. CONTRAINDICATIONS: Use is contraindicated in the following conditions: gastrointestinal (GI) obstruction, bowel perforation, toxic colitis and toxic megacolon, gastric retention, ileus, known allergies to components of the kit. WARNINGS AND PRECAUTIONS: SUPREP Bowel Prep Kit is an osmotic laxative indicated for cleansing of the colon as a preparation for colonoscopy in adults. Use is contraindicated in the following conditions: gastrointestinal (GI) obstruction, bowel perforation, toxic colitis and toxic megacolon, gastric retention, ileus, known allergies to components of the kit. Use caution when prescribing for patients with a history of seizures, arrhythmias, impaired gag reflex, regurgitation or aspiration, severe active ulcerative colitis, impaired renal function or patients taking medications that may affect renal function or electrolytes. Pre-dose and post-colonoscopy ECG’s should be considered in patients at increased risk of serious cardiac arrhythmias. Use can cause temporary elevations in uric acid. Uric acid fluctuations in patients with gout may precipitate an acute flare. Administration of osmotic laxative products may produce mucosal aphthous ulcerations, and there have been reports of more serious cases of ischemic colitis requiring hospitalization. Patients with impaired water handling who experience severe vomiting should be closely monitored including measurement of electrolytes. Advise all patients to hydrate adequately before, during, and after use. Each bottle must be diluted with water to a final volume of 16 ounces and ingestion of additional water as recommended is important to patient tolerance. Pregnancy: Pregnancy Category C. Animal reproduction studies have not been conducted. It is not known whether this product can cause fetal harm or can affect reproductive capacity. Pediatric Use: Safety and effectiveness in pediatric patients has not been established. Geriatric Use: Of the 375 patients who took SUPREP Bowel Prep Kit in clinical trials, 94 (25%) were 65 years of age or older, while 25 (7%) were 75 years of age or older. No overall differences in safety or effectiveness of SUPREP Bowel Prep Kit administered as a split-dose (2-day) regimen were observed between geriatric patients and younger patients. DRUG INTERACTIONS: Oral medication administered within one hour of the start of administration of SUPREP may not be absorbed completely. ADVERSE REACTIONS: Most common adverse reactions (>2%) are overall discomfort, abdominal distention, abdominal pain, nausea, vomiting and headache. Oral Administration: Split-Dose (Two-Day) Regimen: Early in the evening prior to the colonoscopy: Pour the contents of one bottle of SUPREP Bowel Prep Kit into the mixing container provided. Fill the container with water to the 16 ounce fill line, and drink the entire amount. Drink two additional containers filled to the 16 ounce line with water over the next hour. Consume only a light breakfast or have only clear liquids on the day before colonoscopy. Day of Colonoscopy (10 to 12 hours after the evening dose): Pour the contents of the second SUPREP Bowel Prep Kit into the mixing container provided. Fill the container with water to the 16 ounce fill line, and drink the entire amount. Drink two additional containers filled to the 16 ounce line with water over the next hour. Complete all SUPREP Bowel Prep Kit and required water at least two hours prior to colonoscopy. Consume only clear liquids until after the colonoscopy. STORAGE: Store at 20°-25°C (68°-77°F). Excursions permitted between 15°-30°C (59°-86°F). Rx only. Distributed by Braintree Laboratories, Inc. Braintree, MA 02185.
For additional information, please call 1-800-874-6756 or visit www.suprepkit.com
©2016 Braintree Laboratories, Inc. All rights reserved.
Illinois Gastroenterology Digest Welcomes You
Dr. Fred Rosenberg President, IGG
Welcome to the premier edition of Digest, the Illinois Gastro Magazine. In this and future issues, we will present information about gastrointestinal diseases and treatments. We believe that an informed patient is better able to communicate with their doctor and understand disease management which results in improved outcomes. This issue features actor, singer and songwriter Terrence Howard. The Oscar and People’s Choice nominee is currently the star of the hit TV series Empire. Mr. Howard became a spokesman for the Colon Cancer Alliance after his mother passed away from colon cancer in 2008 (www.ccalliance.org/story-of-hope/ terrence-howard/). Terrence is now a strong voice for colon cancer awareness, “March is National Colorectal Cancer Awareness Month. In honor of my mom and the thousands of other people who have lost their battle with this disease, it’s time to become proactive. I’ve talked to everyone in my family about the importance of screening. Make it a priority to talk to yours. Pledge to get screened. “ Also inside, the start of the new year means, for many, the start of another year of insurance deductibles and copays. Learn how to reduce healthcare costs by recognizing the choices you have in selecting where you receive your care. Other articles include discussions about new options in the treatment of obesity, the dramatic improvements in treating and curing Hepatitis C, and how to prepare for your colonoscopy.
PROTECTING PATIENT CHOICES REDUCES HEALTHCARE COSTS
HEPATITIS C, THE CURABLE VIRUS
EOSINOPHILIC ESOPHAGITIS (EOE)
THE SILENT KILLER: COLORECTAL CANCER
WHAT IS A QUALITY COLONOSCOPY?
Illinois Gastroenterology Group was established in 2010 and has grown to over 200 employees including more than 50 physicians and nurse practitioners. At IGG, we are dedicated to improving the health of our patients by providing the highest quality, cost efficient personalized gastrointestinal care in an independent practice setting. Best wishes for a Happy and Healthy 2017 from Illinois Gastroenterology Group! Designed and Published by:
1415 S. Arlington Heights Road Arlington Heights, IL 60005
www.illinoisgastro.com Copyright © 2017 Illinois Gastroenterology Group, LLC., All rights reserved. This publication is published by Illinois Gastronenterology Group, LLC., which is solely responsible for its contents. This information presented is intended only for residents of the United States. The material presented is intended only as informational, or as an educational aid, and it is not intended to be taken as medical advice. The ultimate responsibility for patient care resides with a healthcare professional.
12000 Biscayne Boulevard Suite 703, Miami, FL 33181 T. 305.820.0690 firstname.lastname@example.org
All rights reserved. Cover Photo Credit: Getty Images
Our Mission â€œIGG is dedicated to improving the health of our patients by providing the highest quality gastrointestinal care utilizing evidence-based medicine in a safe, compassionate manner and following clinical standards as determined by available scientific knowledge, best practice and innovative treatment.â€?
SIDE EFFECTS INCLUDE Increased Sales Brand Awareness
WINTER 2017 ISSUE ILLINOIS GASTRO DIGEST
Are you 50 or older? Do you have a family history of colon cancer? Are you having digestive issues? If you answered YES to any of the above questions, it might be time for your colonoscopy. Give us a call to learn more and schedule today!
Convenient Locations: The Glen Endoscopy Center: (847) 686-3784 glenendo.com 6
North Shore Endoscopy Center: (847) 457-0028 northshoreendocenter.com
Oak Lawn Endoscopy Center: (708) 459-9553 oaklawnendoscopy.com
BY Fred Rosenberg, MD President, Illinois Gastroenterology Group
Protecting Patient Choice Reduces Healthcare Costs
merican families are feeling the strain on their wallets from many different directions. Paying a mortgage, raising a family, and paying for college are all major expenses – but the number one financial burden that families face, according to a recent Gallup poll, is paying for health care. This problem is only compounded when policies undermine patient choice in favor of large hospital systems, causing patients to receive their care in higher cost environments. As Americans, we take finding good deals seriously. For example, we search websites to make sure we’re getting the best price on the newest smart phone, HD television, or appliance that we rely on in our daily lives. We pride ourselves in being able to find the best value for our money. And in health care, that value is measured by patient outcomes, satisfaction, and cost. But in health care, we often don’t do our due diligence. Instead, we follow the doctor’s orders—and referrals. Just recently, a nurse working in my practice needed a routine follow-up colonoscopy and was referred by her primary care physician to a large hospital system. Her insurance ended up paying $6,800 for a routine examination with biopsies, even though the same procedure would only cost $1,200 at the ambulatory surgery center where she works. Her procedure cost nearly six times what it should have. Unfortunately, this is far from unusual. In a recent study published in the Journal of the American Medical Association (JAMA), researchers at the University of
California found that costs were nearly 20 percent higher in hospital networks compared to visits at independent physician offices. We must empower patients and encourage them to determine how much care costs. We must do more in educating patients to be better health care consumers. But this isn’t enough. Price transparency will not have much impact if choices are limited. According to the New England Journal of Medicine, over the past decade there has been a
dramatic increase in the number of doctors employed by hospitals. The result will be reduced patient choice, and care that is fragmented and more expensive. In fact, fourteen members of Congress, who are also physicians, agree. They sent a letter to the House Leadership encouraging policies that support the ability of independent physician practices to offer comprehensive care and lower costs.
WINTER 2017 ISSUE ILLINOIS GASTRO DIGEST
Douglas Adler, MD Gastroenterologist
Thomas Arndt, MD Gastroenterologist
Rick Chadha, MD Gastroenterologist
Kenneth Chi, MD Gastroenterologist
Reid Glaws, DO Gastroenterologist
Sonia Godambe, MD Gastroenterologist
Sunil Joseph, MD Gastroenterologist
Amit Kalra, MD Gastroenterologist
Lawrence Kosinski, MD, MBA, AGAF, FACG
Joseph Losurdo, MD Gastroenterologist
William Kosmala, MD Gastroenterologist
Wayne Lu, MD Gastroenterologist
Mitchell Bernsen, MD Gastroenterologist
Jennifer Dorfmeister, MD Gastroenterologist
Ronald Bloom, MD Gastroenterologist
Brian Blumenstein, MD Gastroenterologist
James Dragueski, MD Gastroenterologist
Greg Gambla, DO Gastroenterologist
Bruce Greenberg, MD Gastroenterologist
Harsh Gupta, MD Gastroenterologist
Jeffrey Jacobs, MD Gastroenterologist
Mitchell Kaplan, MD Gastroenterologist
David Kim, MD Gastroenterologist / Hepatologist
Everett Kirch, MD Gastroenterologist
Joel Lattin, DO Gastroenterologist
William Levis, MD Gastroenterologist
Kevin Liebovich, MD Gastroenterologist
Nina Merel, MD Gastroenterologist
Darran Moxon, MD Gastroenterologist
Vincent Muscarello, MD Gastroenterologist
WINTER 2017 ISSUE ILLINOIS GASTRO DIGEST 10
Daniel Oâ€™Reilly, MD Gastroenterologist
Veeral Oza MD Gastroenterologist
Yogesh Patel MD Gastroenterologist
Samir Patel MD Gastroenterologist
Rajesh Pillai, MD Gastroenterologist
Baseer Qazi, MD Gastroenterologist
Fred Rosenberg, MD Gastroenterologist
Jonathan Rosenberg, MD Gastroenterologist
Karen Sable, MD Gastroenterologist
David Sales, MD, PhD,
Alan Shapiro, MD Gastroenterologist
Hadi Siddiqui MD Gastroenterologist
James Stinneford, MD Gastroenterologist
Patricia Sun, MD Gastroenterologist
Wei Sun, MD, PhD, FACG Gastroenterologist
John Vainder, MD Gastroenterologist
Jeff Victor DO Gastroenterologist
Cynthia Wait, MD Gastroenterologist
Loren White, MD Gastroenterologist
Christine Bialko, PA-C
Heather Creed, FNP-C
Rhiannon Mazenis PA-C
Kelly Winkelman, ANP-BC
Algonquin Road Surgery Center 255 W. Algonquin Road Lake in the Hills, IL 60156
North Shore Surgical Center 3725 W. Touhy Ave Lincolnwood, IL 60712
Highland Park 806 Central Ave, Suite 202 Highland Park, IL 60035
Elgin Gastroenterology Endoscopy Center 745 Fltecher Drive - Suite 201 Elgin, IL 60123
Algonquin 600 South Randal Road (Shermand Family Healthcare Facility) Algonquin, IL 60102
Libertyville 755 S. Milwaukee Ave - Suite 292 Libertyville, IL 60048
Glen Endoscopy Center 2551 Compass Road Suite 115 Glenview, IL 60025 Kendall Point Surgery Center 100 W. Fifth Street Oswego, IL 60543
Tri-Cities Surgery Center 345 Delnor Drive Geneva, IL 60134 Valley Ambulatory Center 2210 Dean Street St. Charles, IL 60175
Orland Park 16525 106th Court Orland Park, IL 60464
Elgin 745 Fletcher Drive - Suite 201 Elgin, IL 60123
Northwest Endoscopy Center 1415 South Arlington Heights Road Arlington Heights, IL 60005
The Center for Surgery 475 E. Diehl Road Naperville, IL 60563
Oak Lawn 9921 Southwest Highway Oak Lawn, IL 60453
Barrington 27750 W. Highway 22 - Suite 150 Barrington, IL 60010
North Shore Endoscopy Center 101 Waukegan Road Suite 980 Lake Bluff, IL 60044
Oak Lawn Endoscopy 9921 Southwest Highway Oak Lawn, IL 60453
Lindenhurst 1025 Red Oak Lane - Suite 280 Lindenhurst, IL 60046
Arlington Heights 1415 South Arlington Heights Road Arlington Heights, IL 60005
Elk Groove 800 Biesterfield Road, Wimmer Building-Suite 304 Elk Grove Village, IL 60007
Skokie 9669 Kenton Ave - Suite 550 Skokie, IL 60076
Evanston 800 Austin Street - West Tower - Suite 403 Evanston, IL 60202
South Elgin 2000 McDonald Road (Shermand Family Health Center) South Elgin, IL 60177
Glenview 2501 Compass Rd Suite 130 Glenview, IL 60026
St. Charles 2320 Dean St. Suite 201 St. Charles, IL 60175
Glenview 2551 Compass Road - Sute 115 Glenview, IL 60026
Billing Office 20 Tower Court - Suite C Gurnee, IL 60031
Gurnee 20 Tower Court - Suite C Gurnee, IL 60031
Palos Park 12150 South Harlem Ave Palos Heights, IL 60463
Advocate (ACE) Aetna Ascension Health – Smart Health Ambetter (exchange thru Illinicare) Blue Cross Blue Shield Beech Street/PPO Next Cigna Choicecare PPO – POS Corvel Coventry Evolutions Harkin Health (thru UHC) Harmony-Medicaid Health Market/Interplan/ Preferred Plan HealthLink/Unicare PPO Health Smart /Preferred plan/Interplan PPO HFN,PPO,EPO, Platinum EPO Humana Advocate EPO Select/Illinois Platinum HMO Humana – HMO- POS –EPO Humana ICP - MMAI Illinicare ICP –MMAI –FHP - Exchange Land of Lincoln (exchange) Medicare Meridian AAP, FHP/ACA, ICP /MMAI Meritan Health PHCS-Multiplan Only Preferred Network Access Public Aid Railroad Medicare Senior Care Partners Tricare Health Net Unicared Healthcare
United Healthcare –PPO UMR United Healthcare Mediacre Complete United Healthcare AARP United Healthcare – All Savers United Healthcare – Compass (exchange) United Healthcare – Navigate – Core Veterans Choice MultiPlan Neighborhood Health Plan Preferred Care Partners Prestige Health Choice Simply Healthcare Sunshine Health United Healthcare Wellcare / Staywell
MARCH IS COLON CANCER AWARNESS MONTH GUIDELINES FOR COLORECTAL CANCER SCREENING
AGE 50 No Risk Factors
Colonoscopy beginning at age 50 (for African-Americans beginning at the age of 45)
Family history of colon cancer or polyps
Colonoscopy beginning 10 years younger than the age the relative was diagnosed
Blood in stool or iron deficiency anemia, rectal bleeding, or a change in bowel habits
Ulcerative Colitis or Crohn’s Disease
Yearly colonoscopy, after 10 years of disease
Personal history of colon cancer or polyps
Regular screening colonoscopy as determined by your physician*
INDIVIDUALIZED APPROACH Other gastrointestinal symptoms which may include: abdominal pain, narrow stools, constipation, diarrhea, "gas" or bloating, family history of breast, gynecological, abdominal, colon or other gastrointestinal cancers.
*Call Illinois Gastro Digest and discuss with your physician.
1 IN 3
Colorectal cancer is the #2 leading cause of death in the US
1 in 3 adults aged 50-75 are NOT up-to-date with recommended colorectal cancer screenings
140,000 Approximately 140,000 new cases of colorectal cancer will be diagnosed this year
Overall 90% of new cases and 93% of deaths occur in people 50 and older
Early screening can prevent up to 60% of colon cancer deaths
WINTER 2017 ISSUE ILLINOIS GASTRO DIGEST
If other treatments haven’t worked well enough, ask your gastroenterologist about ENTYVIO.® Uses of ENTYVIO® (vedolizumab): ENTYVIO is a prescription medicine used in adults: • With moderate to severe ulcerative colitis (UC) when certain other UC medicines have not worked well enough or cannot be tolerated. ENTYVIO may help to: begin reducing some symptoms, induce and maintain remission, reduce or stop the use of corticosteroids, and improve the way the lining of your large intestine looks to your healthcare provider. • With moderate to severe Crohn’s disease (CD) when certain other CD medicines have not worked well enough or cannot be tolerated. ENTYVIO may help to: begin reducing some symptoms, achieve remission, and reduce or stop the use of corticosteroids.
Important Safety Information about ENTYVIO® • Do not receive ENTYVIO if you have had an allergic reaction to ENTYVIO or any of its ingredients. • ENTYVIO may cause serious side effects, including: • Infusion and serious allergic reactions can happen while you are receiving ENTYVIO or several hours after treatment. You may need treatment if you
have an allergic reaction. Tell your healthcare provider or get immediate medical help if you get any of these symptoms during or after an infusion of ENTYVIO: rash; itching; swelling of your lips, tongue, throat or face; shortness of breath or trouble breathing; wheezing; dizziness; feeling hot; or palpitations (feel like your heart is racing). • ENTYVIO may increase your risk of getting a serious infection. Before receiving and during treatment with ENTYVIO, tell your healthcare provider if you think you have an infection or symptoms of an infection, such as fever, chills, muscle aches, cough, shortness of breath, runny nose, sore throat, red or painful skin or sores on your body, tiredness, or pain during urination. • Although it has not been reported with ENTYVIO, it may be possible for a person to get progressive multifocal leukoencephalopathy (PML) (a rare, serious brain infection caused by a virus). People with weakened immune systems can get PML, which can result in death or severe disability. There is no known treatment, prevention, or cure for PML. Tell your healthcare provider right away if you have any of the following symptoms:
ENTYVIO is a trademark of Millennium Pharmaceuticals, Inc., registered with the U.S. Patent and Trademark Office, and is used under license by Takeda Pharmaceuticals America, Inc. © 2016 Takeda Pharmaceuticals U.S.A., Inc. All rights reserved.
Printed in U.S.A./January 2017 USD/VED/15/0279(1)a
MODERATE TO SEVERE ULCERATIVE COLITIS OR CROHN’S SYMPTOMS LEAVING YOU WITH THE SAME VIEW? It may be time for a different perspective.
• DEVELOPED ONLY FOR UC AND CROHN’S • GI-FOCUSED • PROVEN TO PROVIDE RELIEF AND REMISSION Individual results may vary.
confusion or problems thinking, loss of balance, change in the way you walk or talk, decreased strength or weakness on one side of the body, blurred vision, or loss of vision. • Liver problems can happen in people who receive ENTYVIO. Tell your healthcare provider right away if you have any of the following symptoms: tiredness, loss of appetite, pain on the right side of your abdomen, dark urine, or yellowing of the skin and eyes (jaundice). • The most common side effects of ENTYVIO include common cold, headache, joint pain, nausea, fever, infections of the nose and throat, tiredness, cough, bronchitis, ﬂu, back pain, rash, itching, sinus infection, throat pain, and pain in extremities. These are not all the possible side effects of ENTYVIO. Call your healthcare provider for medical advice about side effects.
with TB; have recently received or are scheduled to receive a vaccine; or if you are pregnant, breastfeeding, plan to become pregnant, or plan to breastfeed. Please see the Medication Guide for ENTYVIO on the adjacent page and talk with your healthcare provider. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
• Before receiving ENTYVIO, tell your healthcare provider about all of your medical conditions, including if you: have or think you may have an infection or have infections that keep coming back; have liver problems; have tuberculosis (TB) or have been in close contact with someone
Learn more at ENTYVIO.com
Relief and Remission within reach.
WINTER 2017 ISSUE ILLINOIS GASTRO DIGEST 14
Medication Guide ENTYVIO (en ti' vee oh) (vedolizumab) What is the most important information I should know about ENTYVIO? ENTYVIO may cause serious side effects, including: • Infusion and serious allergic reactions. These reactions can happen while you are receiving ENTYVIO or several hours after treatment. You may need treatment if you have an allergic reaction. Tell your healthcare provider or get medical help right away if you get any of these symptoms during or after an infusion of ENTYVIO: rash, itching, swelling of your lips, tongue throat or face, shortness of breath or trouble breathing, wheezing, dizziness, feeling hot, or palpitations (feel like your heart is racing). • Infections. ENTYVIO may increase your risk of getting a serious infection. Before receiving ENTYVIO and during treatment with ENTYVIO, tell your healthcare provider if you think you have an infection or have symptoms of an infection such as fever, chills, muscle aches, cough, shortness of breath, runny nose, sore throat, red or painful skin or sores on your body, tiredness, or pain during urination. • Progressive Multifocal Leukoencephalopathy (PML). Although it has not been reported with ENTYVIO, it may be possible for a person to get progressive multifocal leukoencephalopathy (PML) (a rare, serious brain infection caused by a virus). People with weakened immune systems can get PML. PML can result in death or severe disability. There is no known treatment, prevention, or cure for PML. Tell your healthcare provider right away if you have any of the following symptoms: confusion or problems thinking, loss of balance, change in the way you walk or talk, decreased strength or weakness on one side of the body, blurred vision, or loss of vision. • Liver Problems. Liver problems can happen in people who receive ENTYVIO. Tell your healthcare provider right away if you have any of the following symptoms: tiredness, loss of appetite, pain on the right side of your stomach (abdomen), dark urine, or yellowing of the skin and eyes (jaundice). See “What are the possible side effects of ENTYVIO?” for more information about side effects. What is ENTYVIO? ENTYVIO is a prescription medicine used in adults: • with moderate to severe active ulcerative colitis (UC) when certain other UC medicines have not worked well enough or cannot be tolerated: ° to begin helping some of your symptoms ° in people who respond to ENTYVIO, to help get UC under control (induce remission) and keep UC under control (maintain remission) ° for people who respond to ENTYVIO, you may be able to reduce or stop the use of corticosteroid medicines ° to improve the way the lining of your large intestine looks to your healthcare provider during colonoscopy • with moderate to severe active Crohn’s disease when certain other Crohn’s disease medicines have not worked well enough or cannot be tolerated: ° to begin helping some of your symptoms ° in people who respond to ENTYVIO, to help get Crohn’s disease under control (achieve remission) ° for people who respond to ENTYVIO, you may be able to reduce or stop the use of corticosteroid medicines It is not known if ENTYVIO is safe and effective in children under 18 years of age. Who should not receive ENTYVIO? Do not receive ENTYVIO if you have had an allergic reaction to ENTYVIO or any of the ingredients in ENTYVIO. See the end of this Medication Guide for a complete list of ingredients in ENTYVIO.
Before receiving ENTYVIO, tell your healthcare provider about all of your medical conditions, including if you: • have an infection, think you may have an infection or have infections that keep coming back (see “What is the most important information I should know about ENTYVIO?”). • have liver problems • have tuberculosis (TB) or have been in close contact with someone with TB. • have recently received or are scheduled to receive a vaccine. Talk to your healthcare provider about bringing your vaccines up-to-date before starting treatment with ENTYVIO. • are pregnant or plan to become pregnant. It is not known if ENTYVIO will harm your unborn baby. Tell your healthcare provider right away if you become pregnant while receiving ENTYVIO. • are breastfeeding or plan to breastfeed. It is not known if ENTYVIO passes into your breast milk. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. Especially tell your healthcare provider if you take or have recently taken Tysabri (natalizumab), a Tumor Necrosis Factor (TNF) blocker medicine, a medicine that weakens your immune system (immunosuppressant), or corticosteroid medicine. How will I receive ENTYVIO? • ENTYVIO is given through a needle placed in a vein (intravenous infusion) in your arm. • ENTYVIO is given to you over a period of about 30 minutes. • Your healthcare provider will monitor you during and after the ENTYVIO infusion for side effects to see if you have a reaction to the treatment. What are the possible side effects of ENTYVIO? ENTYVIO may cause serious side effects, See “What is the most important information I should know about ENTYVIO?” The most common side effects of ENTYVIO include: common cold, headache, joint pain, nausea, fever, infections of the nose and throat, tiredness, cough, bronchitis, flu, back pain, rash, itching, sinus infection, throat pain, and pain in extremities. These are not all of the possible side effects of ENTYVIO. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. General information about ENTYVIO Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. You can ask your pharmacist or healthcare provider for information about ENTYVIO that is written for health professionals. Do not use ENTYVIO for a condition for which it was not prescribed. What are the ingredients in ENTYVIO? Active ingredient: vedolizumab Inactive ingredients: L-histidine, L-histidine monohydrochloride, L-arginine hydrochloride, sucrose and polysorbate 80 Distributed by: Takeda Pharmaceuticals America, Inc. Deerfield, IL 60015 U.S. License No. 1898 For more information, go to www.ENTYVIO.com or call 1-877-825-3327 This Medication Guide has been approved by the U.S. Food and Drug Administration. Issued: May 2014 ENTYVIO is a trademark of Millennium Pharmaceuticals Inc. and is used under license by Takeda Pharmaceuticals America, Inc. All other trademark names are the property of their respective owners. ©2014 Takeda Pharmaceuticals America, Inc. VMB245 R1_CFBS L-BZV-0514-4
BY David Kim, MD Gastroenterologist / Hepatologist
Hepatitis C, The Curable Virus
epatitis C (HCV) was discovered in 1989 by scientists working at the CDC and NIH. Prior to this discovery,
patients were informed that they had “non-A, non-B” virus. Shortly afterwards, in 1992, blood products were screened for HCV. However, patients who received blood products prior to this date were at risk for having been exposed to hepatitis C. Additional risk factors include intravenous drug use, having tattoos with shared needles and being born between 1945 and 1965. Commonly, patients feel fine and as a result, do not know they have the disease. Hepatitis C testing is not routinely done during annual exams and is therefore not always detected. It is usually diagnosed when people donate blood or have their blood checked for insurance exams. It can also be diagnosed if a person is found to have abnormal liver enzymes which are usually checked as part of a healthy physical exam. However, even normal liver enzymes do not exclude the possibility of the presence of hepatitis C.
cured. In 2013, major medical breakthroughs
mortality rate than those without the virus.
Checking for HCV is easily performed by a
resulted in new treatments for hepatitis C.
Now that treatment is so safe and effective,
simple blood test. If positive, it indicates that
Currently, HCV can be cured in as short as 12
there are few reasons why a person should not
exposure has occurred. Not all people who
weeks with a single pill in up to 95% of people
have been exposed to HCV develop chronic
affected by HCV. Unlike IFN based therapies,
hepatitis C, but the majority do.
current regimens have minimal side effects
If you have a history of any of the risk factors
and are extremely well tolerated. In studies,
mentioned above, it would be advisable to ask
The biggest misconception regarding HCV
less than 1% of people discontinued treatment
your doctor for a screening test. If the test is
is that most people do not know that it is a
due to side effects.
positive, don’t panic! Further lab tests will be
curable disease. Unlike other viral illnesses,
done to confirm that you have the virus by
such as HIV, hepatitis C is completely curable
So who should be treated? Currently, the
checking the viral count and the subtype of
with treatment. Treatment for HCV has
American Association for the Study of Liver
virus (there are 6 subtypes, called genotypes).
evolved tremendously in the last 3 years. In
Diseases (AASLD) guidelines recommends
If these tests confirm the presence of HCV,
the past, treatment was based on an injection
that anyone infected with HCV should be
there has never been an easier time in history to
called interferon (IFN). Patients would be
considered for treatment. Like many chronic
be cured. There are currently 3 FDA approved
required to self-inject every week, in addition
diseases, the absence of symptoms is not a
regimens all of which have an approximately
to taking pills called ribavirin. Side effects were
reliable indicator of health. Even normal liver
95% cure rate depending on individual patient
significant, with many patients experiencing
enzymes do not ensure that liver disease is
characteristics. Your doctor can then refer you
profound fatigue, headaches, nausea and
not present. Studies have shown that patients
to a liver specialist who can talk to you about
muscle aches. This treatment would last a year
living with HCV are at higher risk of developing
the available types of treatment.
and would result in about 50% of people being
cirrhosis, liver cancer, and have a greater 15
BY Larry Kosinski, MD MBA, AGAF and FACG Gastroenterologist
WINTER 2017 ISSUE ILLINOIS GASTRO DIGEST
besity is a disease defined as abnormal or excessive fat accumulation which may impair health and increase the risk of other diseases. Obesity is much more than just being overweight. It is directly linked to the top ten causes of diseases including cardiovascular disease, diabetes mellitus, sleep apnea, cancer, reproductive disorders, endocrine disorders, psychological disorders, bone, joint and connective tissue disorders and gastrointestinal disorders. Many of these conditions can lead to death. Your risk of dying is directly related to your degree of obesity! How do you determine if you are obese? Normal weight, overweight and obesity are measured by the Body Mass Index (BMI) which is your weight divided by the square of your height. The BMI for a healthy adult is from 18.5 to 24.9 kg/ m2, overweight is from 25
to 29.9 kg/m2 and obese is 30 kg/m2 or above. Obesity is considered severe when BMI is higher than 40 kg/m2. Obesity can also be measured by a waist circumference defined as larger than 40 inches or waist-to-hip ratios >0.9 in men, and 35 inches or waist-to-hip ratios >0.85 respectively in women. Elevated BMI and waist circumference are associated with increased health risks and obesity related co-morbidities. Obesity has reached epidemic proportions and its prevalence is increasing. In the USA, the prevalence of overweight adults is 69%, and the obesity prevalence is 36.5%. In children and adolescents, the obesity prevalence has increased to 16.9%. This alarming obesity epidemic poses a heavy burden to the U.S. economy, costing more than $150 billion every year, or 10 percent of the total health budget (CDC 2012).
Because of these staggering statistics and the failure of the many diet programs out there, the Illinois Gastroenterology Group (IGG) has developed an obesity program. We understand the importance of embracing obesity as a chronic disease and support a team-based approach to the management of obesity. The gastroenterologist is in a unique position to play an important role in the multidisciplinary treatment of obesity. Treating obesity is best accomplished when physicians partner with other professionals with specific expertise in the dietary, behavioral, and physical activity aspects of treatment. This partnership is referred to as a multidisciplinary team and works best when there is regularly scheduled communication between members. An ideal comprehensive team may include a physician with training in obesity medicine or a gastroenterologist with an expertise in nutrition. Other team members may include a physician assistant, nurse practitioner or nurse, registered dietitian, social worker, psychiatrist or psychologist, medical assistants, endoscopists and bariatric surgeons. The gastroenterologist is an ideal leader of the multidisciplinary team. There are three phases to the IGG obesity treatment program: 1- Clinical Evaluation Period 2- Intensive Weight Loss Period 3- Weight Maintenance Period Clinical Evaluation Period Anyone interested in losing weight wants to start losing immediately. We want you to as well but realize that
the serious health consequences of obesity must be evaluated first before initiating an aggressive weight reduction program. This evaluation includes the following components: 1-Medical Evaluation focused on the detection of Hypertension, Diabetes, Sleep Apnea, GERD, Fatty Liver Disease and other weight-related disorders. 2-Dietary Evaluation designed to assess your current eating habits and how we can adjust them to foster weight loss. 3-Physical Activity and Exercise Evaluation. How active are you? Do you exercise on a regular basis? Can you exercise or do you have physical impairments that limit your ability to do this? 4-Psychosocial Evaluation. We recognize that obesity can be a very isolating condition associated with very significant psychosocial issues. These need to be discussed and brought to the forefront if we are going to be successful. Intensive Weight Loss Period Depending upon your degree of obesity, you will be placed in one of several intensive weight loss programs. This plan has to be individualized to your specific needs. The “one size fits all” type of program is not an ideal way to treat all patients. The types of individualized programs will first depend upon your BMI. If you have a BMI between 25 and 30 and have no other medical conditions like Hypertension or Diabetes, then diet therapy combined with an exercise program are the mainstay of your
treatment. Our professionals can assist you in developing an appropriate diet plan for your specific needs. If your BMI is between 30 and 35 or if you have other conditions like hypertension, diabetes, sleep apnea, etc. then you will need more than diet and exercise. We have multiple options for you, including medications and endoscopic balloon therapy (EBT). There are multiple categories of medications in use today which can be tailored to your needs. In addition, the gastroenterologists of the Illinois Gastroenterology Group can perform Endoscopic Balloon Therapy in which a removable balloon is placed in your stomach using an endoscope. This is a noninvasive, outpatient procedure. There are two FDA approved balloons available today, the Orbera, which is a single balloon filled with saline and the Reshape Duo, which is a dual balloon system. Both are available for a six month implantation to treat obesity in appropriate patients in conjunction with comprehensive lifestyle modification and supportive follow up. Weight Maintenance Period Obesity is a “chronic disease” which means even after you lose weight, you still have a tendency to regain what you have lost. Therefore, weight maintenance is critical to your success. You will never actually “go off” your diet plan. It’s a lifetime program for weight and health. We can help you succeed with this. If you are considering a weight reduction program, always discuss it with your physician first. The Illinois Gastroenterology Group is ready to assist you in your efforts.
WINTER 2017 ISSUE ILLINOIS GASTRO DIGEST
Actor / Producer / Singer / Song Writer By Owen Johnston
orn on March 11, 1969 in Chicago, Terrence Howard wanted to be an actor from an early age. At sixteen, he moved to New York City to attend college and to pursue his dream of landing on the silver screen.
Terrence attended Pratt University and started acting in a series of small TV roles. In 1995, he began landing major roles in Dead Presidents and Mr. Holland’s Opus. Terrence’s star continued to rise, and in 2005 he received nominations from The Screen Actors Guild and The Golden Globes for his role in Hustle and Flow. Today, he is a household name known especially for his role as “Lucious Lyon” on HBO’s hit show Empire. Nowadays, Terrence is also known for his fight against colon cancer. His mother died tragically of the disease at the young age of 56, in 2008. Terrence attributes his success in acting to the determination she taught him, and he reports that her death has left a void in his life. “I miss her voice and her gentle kindness.”
“I miss her voice and her gentle kindness”
Terrence admits that had her cancer been detected earlier, she might be alive today. By the time she was diagnosed at age 50, the cancer was already at stage 3. She then battled the disease for six years until her untimely death at age 56. Terrence stresses that with proper screening, her death could have been prevented. That’s why he works so hard to advocate for regular colon cancer screening, especially for high risk groups such as African-Americans or those with a family history of the disease. Today, Terrence honors his mother’s death by helping to fight this disease in her name. He knows she would be proud of his efforts to save the lives of others. By volunteering with The Colon Cancer Alliance, he is spreading the critical message that screening and early detection can defeat colon cancer. Colon cancer claims the lives of over 50,000 American men and women each year. It is most often found in those over 50, but many groups are at an even higher risk. However, routine screening can prevent this terrible disease. Call your doctor today to ask if you should be screened for colon cancer. It could be the most important phone call of your life.
BY Darran R. Moxon, MD MS Gastroenterologist
Eosinophilic Esophagitis (EoE)
WINTER 2017 ISSUE ILLINOIS GASTRO DIGEST
o you ever get the feeling food is getting stuck when you swallow? Or maybe you have witnessed somebody getting food stuck when they eat. This phenomenon is called dysphagia, and the problem should be addressed by a gastroenterologist. When we swallow, a complex set of muscle movements transfer food from the mouth into the esophagus (the tube from the mouth to the stomach). Eosinophilic esophagitis (EoE) is a chronic inflammation of the esophagus that is thought to be caused by certain allergies. This inflammation causes scar tissue to develop underneath the esophageal wall which, in turn, causes strictures (narrowing) that prevents certain foods from passing into the stomach. The understanding of this and other related disorders is evolving.
Typically, food such as meat, bread and rice get stuck. Diagnosis is made by your Gastroenterologist who looks into the esophagus with a small camera. There is often a classic appearance of multiple small ridges along the esophagus. Biopsies are taken to confirm the diagnosis. The treatments for EoE range from food avoidance, specific antacid medications, swallowed topical steroids or even remodeling the esophagus by stretching the strictures. The latter is called esophageal dilation. So what should you do if you have food getting stuck in your throat after you swallow? Make an appointment with your gastroenterologist and address this problem before it gets worse.
TOGETHER WE CAN BEAT CROHN’S The right support makes a difference. That’s why for over a decade, at UCB, Inc. we have been supporting the Crohn’s community online at CrohnsandMe.com. You can find tips, recipes, stories from others in the community, and educational info about the disease. Visit CrohnsandMe.com or our Crohn’s and Me Facebook page to learn more!
BY Mitchell B. Bernsen, MD Gastroenterologist
The Silent Killer: Colorectal Cancer
WINTER 2017 ISSUE ILLINOIS GASTRO DIGEST
t canâ€™t happen to me! Do you
Both men and women are at almost
Most colon cancers develop without any
want to gamble with your life?
equal risk of developing colon cancer.
symptoms until they are far advanced
Approximately 150,000 new cases
It occurs more commonly in people
and less curable. When symptoms do
of colorectal cancer will be diagnosed
over age 50 and the risk increases
occur they can include blood in the
each year, and 60,000 people will die
with age. Some groups of people are
stool or on toilet paper, rectal bleeding,
annually from the disease. This makes
at higher risk and may need to be
change in bowel habits (constipation
colon cancer the second leading cause
screened earlier than age 50. Some
or diarrhea), change in stool shape or
of cancer related deaths in the United
States. The good news is that colon
American, which carries a 20% higher
bloating, unintentional weight loss, and
cancer screening can save as many as
incidence rate, having a family history
persistent fatigue. Colon cancers start
30,000 lives per year and will allow
of polyps or colon cancer in a first-
out as tiny growths, known as polyps,
detection of early stage cancers, which
degree relative (parent, sibling, or
that develop in the lining of the colon.
may be up to 95% curable. There has
offspring) which increases the rate
If these polyps are left to grow over the
been significant progress in colon
by 2 to 3 times; having inflammatory
next 5-10 years, they have the potential
cancer screening programs that have
bowel disease which has a 10% higher
to eventually become cancerous and
reduced the incidence and death rates
incidence rate after 10 years of disease;
spread outside of the colon to other
in the United States, but increasing
organs. These precancerous polyps,
access and reducing costs to screening
Other possible risk factors associated
that can develop into cancer, are also
tests can do even more. Only about half
with colon cancer that can be modified
known as adenomas and about 10% of
of the US population that is over the
are: a sedentary lifestyle, obesity, diet
adenomas will transform into cancer.
age of 50 has undergone appropriate
high in fat, red meat and not enough
Adenomas are very common in that
testing for colon cancer.
fruit, vegetables, and grains.
about 25-30% of the population over
age 50 will develop them. The problem is that no one can tell which adenomas will turn cancerous so they all must be removed at an early stage. Patients that have localized cancer of the colon have a 90% five-year survival rate, compared to a 70% survival rate if regional spread occurs. If there is distant spread to other organs, then the survival rate over five years drops significantly to 12%. Early detection is the key. Screening saves lives. The main goal of any screening program is to prevent the development of colon cancer by removing the precancerous lesions and finding cancers at the earliest, most treatable stage. Based on the patientâ€™s risk factors and symptoms, the type
of screening procedure and frequency will vary. By obtaining a complete physical exam and reviewing the patientâ€™s health history, their physician can decide which procedure and frequency of testing will be the most appropriate. Average risk patients are all individuals over age 50, without any other risk factors. Screening options consist of the following: Flexible Sigmoidoscopy is the direct visualization of only the lower one-third of the colon using a long flexible light instrument called a sigmoidoscope. A simple bowel cleansing preparation is taken the day before the test with an overnight fast. The procedure can be done without sedation in the physicianâ€™s office or outpatient facility. This test is limited since it doesnâ€™t examine the entire colon and detects only about 65-75% of polyps and 40-65% of cancers. A flexible sigmoidoscopy needs to be performed every 5 years with the addition of a yearly FOBT (fecal occult blood test). experience some abdominal discomfort when a rectal Colonoscopy is the procedure of choice among all
tube is inserted to insufflate the colon with air. The test
patient risk groups. This test uses a long flexible light
has similar rates of polyp detection to colonoscopy if the
instrument called a colonoscope that visualizes the
polyps are greater than 1 cm in size; however, smaller
entire colon. A specialist in Gastroenterology performs
polyps are often missed. If a polyp/lesion is found, then
the procedure, and it can be done in an outpatient
the patient will need to be referred for a colonoscopy for
accredited, office-based center, an ambulatory surgical
biopsy or removal.
center or the hospital. It does require a complete bowel cleansing beforehand, and the patient is usually sedated.
Other tests that are utilized in detecting colon cancer
During the procedure, if a polyp or lesion is found it can
are the Fecal Occult Blood Test (FOBT) and the Stool
be sampled (biopsied) or removed entirely for analysis
DNA Test. These tests are limited in usage and are
by a pathologist for cancer risks. This test can detect
primarily used to detect the presence of neoplasms,
up to 80-90% of polyps or cancers. Most studies have
not as a primary screening tool. They detect less than
shown that colonoscopy has the highest detection rate
30% of neoplastic lesions. The FOBT is an inexpensive,
of polyps and cancers compared to the other screening
noninvasive and easy at-home test. The FOBT tests stool
tests now available. This is the only test that, if normal,
samples for the presence of blood but are not sensitive
has a rescreening interval of 10 years in the average risk
to the source. The Stool DNA test can detect gene
mutations in the cells that are shed into the stool from the neoplastic growths. This test is also non-invasive, easy
There are two screening tests that are done by
and can be done at home, but it is rather expensive. The
radiologists which are the Lower GI Barium Enema
patient will require further testing with a colonoscopy if
(ACBE) and the Computed Tomographic Colonography
either one of these tests are found to be positive.
(CTC), also known as Virtual Colonoscopy. Each of these tests is done in the hospital and requires a full bowel
In order for any screening program to be effective, patients
cleansing prior to the procedure and the patients are not
must have open access to the screening tools. The tests
sedated. The ACBE is a radiologic test in which barium
must be cost effective and safe. Healthcare providers
is injected by rectal enema to fill the entire colon. Air is
must educate their patients and follow the screening
then introduced into the colon to increase the sensitivity
guidelines that have been set up by the professional
of the exam to find polyps. The test is less sensitive in
health societies. There have been some beneficial changes
finding polyps and, if one is found, the patient will then
to the healthcare system in that private health plans and
require another full bowel preparation to undergo a
the Centers for Medicare and Medicaid Services (CMS)
colonoscopy for polyp removal. This test can miss up to
are now required to cover colon cancer screening tests
50% of polyps and requires a 5-year screening interval.
without any out-of-pocket costs. Although colon cancer
Virtual Colonoscopy utilizes a CT machine to examine
is a difficult topic to discuss, it is extremely important for
the entire colon. A full bowel cleansing is required prior
patients to seek medical attention and advice early to
to the test. No sedation is required but patients can
decrease the high mortality of this disease. 23
BY Larry Kosinski, MD MBA, AGAF and FACG Gastroenterologist
What is a Quality Colonoscopy?
WINTER 2017 ISSUE ILLINOIS GASTRO DIGEST
olorectal cancer (CRC) remains the second leading cause of cancer death in North America. Therefore, the American Cancer Society recommends that all people over the age of 50 undergo some form of screening procedure. Today, the most commonly used procedure for CRC screening is colonoscopy. Unfortunately, we are not screening enough people (65%) and some of those who are being screened are not being “adequately screened”. As a patient, you have to ask yourself the following questions: 1- How do I choose the right physician to perform my colonoscopy? What kind of doctor should it be? How do I know whether the doctor has been appropriately trained to perform the procedure? What qualifications should I look for? 2- Where should I have the procedure done? Is it necessary to have it done at a hospital? Can I have it done at an ambulatory surgery center? Is it safe to be done in a doctor’s office? How do I know if a facility is safe? 3- What kind of sedation should I be given? Do I need an anesthesiologist? 4- How do I know if I had a quality colonoscopy? 5- What kind of follow-up should I look for after the procedure? What should the physician tell me? How do I know when to have my next exam? How do I choose the right physician for my colonoscopy? In most circumstances it is your Primary Care Physician (PCP) who decides this, but you have every right
to ask how your PCP makes the decision. Some PCPs do their own colonoscopies. Surgeons do as well. The great majority of Colonoscopies are performed by Gastroenterologists, who have the most intensive and formalized training. Gastroenterologists must complete a three-year fellowship and a board exam specifically focused on diseases of the gastrointestinal track. Furthermore, their endoscopic training results in multiple years of observed performance. PCPs do not undergo this type of training. Stick with a board certified Gastroenterologist for your colonoscopy. Don’t hesitate to ask your Gastroenterologist about his/her complication rate. The doctor should willingly and happily provide you this information. Also, make sure your physician is on staff at a hospital. Physicians who maintain hospital privileges in good standing must undergo peer review. One of the major quality metrics that we follow in our assessment of our performance is the Adenoma Detection Rate (ADR). This is a measure
of the percentage of patients in which a polyp is found. The standard is around 25% for males and 20% for females. Whomever performs your colonoscopy should be able to tell you their specific ADR. This is how you can gain a comfort level that your colonoscopist is well trained and has a good record of performance. Where should I have my procedure done? You should only have your procedure done in a licensed, accredited facility. This automatically means that the facility has to be reviewed by the state department of public health, the Center for Medicare and Medicaid Services (CMS) and an accreditation agency. The many policies and procedures that are required in order for a facility to maintain licensure and accreditation lead to a more uniform level of quality. This means that you should have your colonoscopy at either an ambulatory surgery center or a hospital. There are some office facilities that are also accredited, but not licensed. Many of these are acceptable as well, but be careful.
What kind of sedation should I be given? Everyone who undergoes a colonoscopy should be provided adequate sedation so that they do not experience any unacceptable discomfort. Up until recently, sedation was provided by the Gastroenterologist using a narcotic and a sedative. The success rate of this form of sedation was very high. Despite the safety, many patients did not receive adequate control of their pain and anxiety. As a result, most endoscopic procedures are now performed under Monitored Anesthesia Care (MAC). The sedative used is Propofol which must be provided by an anesthesiologist. Both forms of sedation are acceptable. Safety should be the same in either case, but your level of sedation is more predictable using MAC anesthesia. How do I know I had a quality colonoscopy? Quality today is best measured by assessing outcome. In order to have a predictable outcome, processes must be well-defined and followed. A quality colonoscopy requires at least the following: an adequate prep, a comprehensive pre-procedure evaluation, appropriate sedation, documentation that the colon was completely evaluated and appropriate post-procedure documentation and education. This means that someone from the office should contact you before the procedure and take or update your clinical history. You should be questioned about your current medical problems, previous surgeries, family history, medications, weight and allergies. We need to know if you have had anesthesia issues in the past. This can all be obtained over the phone. You also will need to be educated on how to take your prep. If you are just scheduled for a procedure and do not receive this type of focus on quality, you probably should try another practice for your colonoscopy.
During the procedure, your colonoscopist is focused on getting safely to the other end of the colon called the cecum. A photo should be taken confirming that the cecum was reached. The prep should be assessed for adequacy. Then the colonoscopist must slowly withdraw the colonoscope and evaluate all surfaces for polyps. All polyps should be removed completely. This is a quality colonoscopy. What kind of follow-up should I look for after the procedure? Your physician should go over the entire procedure with you after the procedure. All findings should be discussed with you. If biopsies were obtained, you should be given clear instructions as to what will be determined on the basis of these biopsies and when you will be contacted. If polyps were removed then you should be given a follow-up plan for when you need your next colonoscopy. There are clear published guidelines that determine the interval for the next colonoscopy depending upon the pathology of the polyps removed. These should be followed. Conclusion Every patient who undergoes a colonoscopy deserves to have a quality colonoscopy. You are placing your life and future in the hands of the physicians and staff that are performing the procedure. There are well-defined policies and procedures for a colonoscopy. These must be followed for us to be able to guarantee that a quality procedure is performed.
PREPOPIKÂŽ is a registered trademark of Ferring B.V. ÂŠ 2016 Ferring B.V. All rights reserved. PK/3037/2016/US
DON’T LET DIARRHEA AND ABDOMINAL PAIN BOSS YOU AROUND. Your frustrating symptoms could be Irritable Bowel Syndrome with Diarrhea (IBS-D).
VIBERZI MAY HELP.
WINTER 2017 ISSUE ILLINOIS GASTRO DIGEST
VIBERZI is a daily treatment for adults that helps proactively manage the core symptoms of IBS-D—diarrhea and abdominal pain—at the same time.
Stay ahead of your IBS-D. Talk to your doctor or visit VIBERZI.com. IMPORTANT RISK INFORMATION • A spasm in a muscle of the digestive system (called the sphincter of Oddi), which may cause new or worsening abdominal pain. Your risk of having a spasm is increased if you do not have a gallbladder. This spasm usually happens within the ﬁrst week of treatment and usually goes away when treatment is stopped. • Inﬂammation of the pancreas (called pancreatitis). Symptoms of pancreatitis usually go away when treatment with VIBERZI is stopped. Your risk of getting pancreatitis is increased if you drink more than 3 alcoholic drinks a day. Stop taking VIBERZI and call your doctor if you have new or worsening stomach-area (abdomen) pain or pain in the upper right side of your stomach-area that may move to your back or shoulder, with or without nausea and vomiting. Do not take VIBERZI if you: • Have or may have had a blockage in your gallbladder or a sphincter of Oddi problem • Have or had problems with alcohol abuse, alcohol addiction, or drink more than 3 alcoholic drinks a day • Have had pancreatitis or other pancreas problems, including if you have had or may have had a blockage in your pancreas
Allergan® and its design are trademarks of Allergan, Inc. VIBERZI™ and its design are trademarks of ©2016 Allergan. All rights reserved. VBZ50065 03/16
• Have severe liver problems • Have had long-lasting (chronic) or severe constipation, or problems caused by constipation • Have or may have had a bowel blockage (intestinal obstruction) Before taking VIBERZI, tell your doctor about all of your medical conditions, including if you do not have a gallbladder, have liver problems, or are nursing, pregnant, or plan to become pregnant. Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. If you are taking VIBERZI you should not take medicines that cause constipation, including: Lotronex® (alosetron), anticholinergic medicines, and opioid pain medicines.
constipation, nausea, and abdominal pain. Stop taking VIBERZI and call your doctor if you have constipation that lasts more than 4 days. These are not all the
You are encouraged to report negative Visit www.FDA.gov/medwatch or call 1-800-FDA-1088. Please see brief summary of Medication Guide on the next page.
Brief Summary of the Medication Guide VIBERZI (vye BER zee), CIV (eluxadoline) tablets This information does not take the place of talking with your doctor about your medical condition or your treatment. What is VIBERZI? VIBERZI is a prescription medicine used to treat adults who have irritable bowel syndrome with diarrhea (IBS-D). • VIBERZI is a controlled substance (CIV) because it contains eluxadoline that can be a target for people who abuse prescription medicines or street drugs. Keep your VIBERZI in a safe place to protect it from theft. Never give your VIBERZI to anyone else, because it may harm them. Selling or giving away this medicine is against the law. It is not known if VIBERZI is safe and effective in children. People 65 years old and older have had an increased number of side effects, including serious side effects and stomach problems, while taking VIBERZI than people younger than 65 years old have had. What is the most important information I should know about VIBERZI? VIBERZI can cause serious side effects, including: • Sphincter of Oddi spasm. A spasm in a muscular valve of the digestive system (called the sphincter of Oddi), which may cause new or worsening stomach area (abdomen) pain. Your risk of having a spasm is increased if you do not have a gallbladder. This spasm usually happens within the first week of treatment with VIBERZI and usually goes away when treatment with VIBERZI is stopped. • Inflammation of the pancreas (pancreatitis). Symptoms of pancreatitis usually go away when treatment with VIBERZI is stopped. Your risk of getting pancreatitis is increased if you drink more than 3 alcoholic drinks a day. Limit your use of alcoholic drinks while you are taking VIBERZI. Stop taking VIBERZI and call your doctor if you have new or worsening stomach-area (abdomen) pain or pain in the upper right side of your stomach-area (abdomen) that may move to your back or shoulder, with or without nausea and vomiting. Who should not take VIBERZI? Do not take VIBERZI if you: • have or may have had a blockage in your gallbladder or a sphincter of Oddi problem • have or had problems with alcohol abuse, alcohol addiction, or drink more than 3 alcoholic drinks a day • have had inflammation of your pancreas (pancreatitis) or other pancreas problems, including if you have had or may have had a blockage in your pancreas • have severe liver problems • have had long-lasting (chronic) or severe constipation, or problems caused by constipation • have or may have had a bowel blockage (intestinal obstruction) Talk to your doctor if you are not sure if you have any of these conditions.
What should I tell my doctor before taking VIBERZI? Before taking VIBERZI, tell your doctor about all of your medical conditions, including if you: • do not have a gallbladder • have liver problems • are pregnant or plan to become pregnant. It is not known if VIBERZI will harm your unborn baby. • are breastfeeding or plan to breastfeed. It is not known if VIBERZI passes into your breast milk or could harm your baby. Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Keep a list of your medicines to show your doctor and pharmacist when you get a new medicine. VIBERZI and other medicines may affect each other causing side effects. If you are taking VIBERZI you should not take: • medicines that cause constipation including: o Lotronex® (alosetron) o anticholinergic medicines o opioid pain medicines Ask your doctor or pharmacist for a list of these medicines, if you are not sure. • Avoid taking loperamide, a medicine used to treat diarrhea, for a long time (chronic use). You may take loperamide occasionally to treat severe diarrhea. Stop taking loperamide right away if you become constipated. How should I take VIBERZI? • Take VIBERZI exactly as your doctor tells you to take it. • Take 1 tablet of VIBERZI 2 times each day with food. • If you miss a dose, take your next dose at your regular time. Do not take 2 doses at the same time to make up for a missed dose. • Do not change your dose or stop taking VIBERZI unless your doctor tells you to. • If you take too much VIBERZI, call your doctor or go to the nearest hospital emergency room right away. What should I avoid while taking VIBERZI? • Limit your use of alcoholic drinks while you are taking VIBERZI. • If you have liver problems, do not drive, operate machinery, or do other dangerous activities until you know how VIBERZI affects you. What are the possible side effects of VIBERZI? The most common side effects of VIBERZI include: constipation, nausea, and abdominal pain. Stop taking VIBERZI and call your doctor if you have constipation that lasts more than 4 days. These are not all the possible side effects of VIBERZI. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Keep VIBERZI and all medicines out of the reach of children. Need more information? • This section summarizes the most important information about VIBERZI. If you would like more information, talk with your doctor. • Go to www.VIBERZI.com or call 1-800-272-5525 VIBERZITM and its design are trademarks of Furiex Pharmaceuticals, LLC, an Allergan affiliate. Distributed by: Actavis Pharma, Inc. Parsippany, NJ 07054 USA © Actavis 2015. All rights reserved. ELX38198 10/15
FOCUS ON WINTER 2017 ISSUE ILLINOIS GASTRO DIGEST
At Illinois Gastroenterology Group, we are committed to providing personalized, high quality care in a convenient, lower cost and friendly environment. Thatâ€™s why we offer the professional screening procedures you can receive at a hospital in the convenience of our local outpatient surgery centers. If you are over 50, and haven't yet had a screening colonoscopy, begin the new year by scheduling yours with an IGG physician. Â Visit our website below to find one of our many practice locations, conveniently located throughout the Chicagoland area. Or, if you prefer, contact us to schedule an appointment at 855.455.4278 (855) ILL-GASTRO