Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download 09 cover outlined.indd - Ohio Gastroenterology and Liver Institute
Document related concepts
Transcript
CONTACT US Patient Referrals Ohio GI Administration Please see our map on the back cover. Dan Walker - Chief Operating Officer Phone - 513-569-1310 Email: [email protected] RoseAnn Maher - Office Manager Phone - 513-569-1300 Email: [email protected] Research Division Billing Consultants for Clinical Research Phone - 513-872-4549 www.ccrstudy.com Phone - 513-872-4555 Table of Contents Our Work OHIO GI LEADERSHIP AND QUALITY REPORT Outpatient Inpatient Hospital Coverage Endoscopic/Therapeutic Services Clinical Research Education Leadership Our Patients Patient Encounters Specific Disease Encounters Our Endoscopy Centers Our Commitment to Quality www.ohiogi.com Endoscopy Center Complication Rate Colorectal Cancer Prevention Studies Patient Satisfaction Surveys Inflammatory Bowel Disease Irritable Bowel Syndrome Liver Disease Women’s Digestive Health Endoscopic Ultrasound Endoscopic Retrograde Cholangiopancreatography Esophageal Disorders Small Bowel Evaluation Pancreatic Disorders Endoscopic Mucosal Resection Our Research Division Consultants for Clinical Research Our Physicians 2925 Vernon Place • Suite 100 • Cincinnati, Ohio 45219 www.ohiogi.com Physicians Physician Assistants Contact Us OUR WORK PHYSICIAN ASSISTANTS Outpatient Convenient locations Individualized care Expedited visits Close communication with referring doctors With offices located throughout Cincinnati, Fairfield and surrounding suburbs and counties, we are able to offer convenience to our patients. We provide outpatient consultation and follow-up care and see patients on a timely basis. For urgent outpatient care, appointments with our physicians and physician assistants can usually be made within 24 hours. We emphasize close communication with referring physicians by direct discussion for more urgent or serious conditions and always with prompt written reports of patient encounters. Other modalities such as voice mail, fax referral forms, and email have also been developed to enhance communication. Inpatient Always available Rapid consultation and endoscopic response Ohio GI physicians work at most hospitals within the Greater Cincinnati area where we provide inpatient services and are available on a 24 hr/7 day per week/365 day per year basis. When we receive a consultation request we see patients quickly and provide thoughtful and expedited endoscopic services. We are the primary providers of GI services and our physicians are directors of the GI divisions or endoscopy committees at many of the hospitals. Jennifer Acosta, PA-C, MPAS • Special Interest: Outpatient digestive care, Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), Hepatitis Ms. Acosta graduated from South University with a Bachelor Degree in Physician Assistant Studies. She received her Master’s Degree in PA Studies from the University of Nebraska. Jennifer is Board Certified by the National Commission on Certification of Physician Assistants. Laurie Einwald, PA-C, MPAS • Special Interest: Inpatient and outpatient digestive care, Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), Hepatitis Ms. Einwald graduated from the University of Dayton with a Bachelor Degree in pre-medicine. She received her Master’s Degree in Physician Assistant Studies from Marquette University. Laurie is Board Certified by the National Commission on Certification of Physician Assistants. James Fry, PA-C, MS • Special Interest: Outpatient digestive care, Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), Hepatitis, Clinical research Mr. Fry received his Physician Assistant training while serving in the US Air Force and then obtained his Master’s Degree from Alderson-Broaddus College. Prior to being recruited to Ohio GI, he was a professor in the PA programs at the University of Kentucky and Marietta College. He has been chairman of the education council of the American Academy of Physician Assistants and VP of the Ohio Association of Physician Assistants. Jim is Board Certified by the National Commission on Certification of Physician Assistants. Jim is a Distinguished Fellow of the American Academy of Physician Assistants. Dr. Jeffrey D. Stotz Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Gastroesophageal reflux (GERD), Inflammatory bowel disease (IBD) Dr. Stotz graduated from The Ohio State University College of Medicine and completed his Internal Medicine Residency and his Gastroenterology Fellowship at University Hospitals of Cleveland/Case Western Reserve University. Dr. Stotz has recently lectured to a medical audience on Celiac Disease. He is Board Certified in Internal Medicine and Gastroenterology. Dr. George Waissbluth Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Irritable bowel syndrome (IBS) Dr. Waissbluth graduated from the Universidad de Chile in Santiago, Chile, and completed his Residency in Internal Medicine at Jewish Hospital, Cincinnati. His Gastroenterology Fellowship was completed at the University of Cincinnati. Dr. Waissbluth is Board Certified in Internal Medicine and Board Eligible in Gastroenterology. Hospital Coverage: Bethesda Hospital Children’s Hospital Medical Center* Christ Hospital Jewish Hospital Mercy Fairfield Hospital Mercy Western Hills Hospital Mercy Mt Airy Hospital* West Chester Medical Center Adams County Hospital* VA Hospital* * Limited to outpatient coverage Endoscopic/Therapeutic Services Proven high standards and superior results Experts with high volume of experience All of our physicians are experts in the performance of endoscopy and colonoscopy. Additional subspecialization within our group includes physicians who have had specific and extensive experience and training in more advanced endoscopic procedures such as: endoscopic ultrasound (EUS) with fine needle aspiration (FNA), Endoscopic Retrograde Cholangiopancreatography (ERCP), and endoscopic mucosal resection (EMR). We were the first in the area to perform small bowel wireless capsule endoscopy with the “Pillcam”. Liver biopsies are performed by one of our Hepatologists in our endoscopy centers. Experts in esophageal disorders perform a variety of specialized esophageal testing. Our pathologist, an expert in gastrointestinal pathology, evaluates biopsy material from our endoscopy centers. Some of the procedures we perform: • EGD with related therapies • Colonoscopy with related therapies • Endoscopic Ultrasound (EUS) for GI and non-GI (pulmonary) lesions • Fine needle aspiration during EUS • ERCP, sphincterotomy, pancreatic and biliary stent placement, manometry • Choledochoscopy • Esophageal, small bowel, pancreatobiliary, and colonic dilation • Esophageal and colonic stenting • Pancreatic pseudocyst drainage. • Endoscopic mucosal resection (EMR) • Celiac plexus block under endoscopic ultrasound guidance • Argon plasma coagulation of polyps and vascular lesions • Percutaneous endoscopic gastrostomy and jejunostomy • Hydrogen breath testing for small bacterial overgrowth and carbohydrate intolerance • Endoscopic banding for internal hemorrhoids • Small bowel wireless capsule endoscopy “pill cam” • Liver biopsy • Esophageal Manometry • Esophageal catheter and BRAVO pH testing • Esophageal impedance • Halo Ablation of Barrett’s esophagus Dr. Alan V. Safdi, FACG Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), Clinical research Dr. Alan Safdi graduated from the University of Cincinnati College of Medicine (with distinction being nominated to the honorary medical society of AOA) and completed his Residency in Internal Medicine at the University of California at San Diego. He did his undergraduate education at Northwestern University and was inducted into the honorary society, Phi Beta Kappa. His Gastroenterology Fellowship was completed at the University of Cincinnati. Dr. Safdi lectures nationally on IBD, colonoscopy preparation, esophageal reflux, and a variety of gastrointestinal disorders. He has authored many articles, reviews and updates related to Gastroenterology. He is actively involved in clinical research in internal medicine and digestive disease disorders. Dr. Safdi has been awarded Cincinnati Magazine’s “Top Doctor” recognition. He has been the director of the Gastroenterology section at Deaconess Hospital and was past Chairman of the Cincinnati Crohn’s and Colitis Medical Advisory Committee. Dr. Alan Safdi is a Fellow of the American College of Gastroenterology and is Board Certified in Internal Medicine and Gastroenterology. Dr. Michael A. Safdi, MACG, FACP Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Hemorrhoidal band ligation, Gastroesophageal Reflux (GERD), Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), Peptic Ulcer Disease, Clinical research Dr. Michael Safdi graduated from the University of Cincinnati College of Medicine and completed his Residency in Internal Medicine at the University of California at San Diego. His Gastroenterology Fellowship was also completed at the University of California at San Diego. He has served on numerous local, regional and national boards and committees with the American College of Gastroenterology and other organizations. He is actively involved in clinical research of new medications for digestive disorders and with training young CCFA investigators. Dr. Safdi has been awarded Cincinnati Magazine’s “Top Doctor” recognition. Dr. Safdi is a Master of the American College of Gastroenterology, a Fellow of the American College of Physicians, and is Board Certified in Internal Medicine and Gastroenterology. Dr. Kris Ramprasad Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Gastroesophageal Reflux Disease (GERD) Dr. Ramprasad graduated from Madras Medical School, Madras, India. He completed his Residency in Internal Medicine at the Veteran’s Administration Hospital and at Wright State University, both in Dayton, Ohio. His Gastroenterology Fellowship was completed at the University of Cincinnati. Dr. Ramprasad is the Gastroenterology section head at Mercy Hospital Western Hills. He is a clinical teacher of Gastroenterology Fellows at the University of Cincinnati and has been awarded Cincinnati Magazine’s “Top Doctor” recognition. Dr. Ramprasad is Board Certified in Internal Medicine and Gastroenterology. Dr. Ravi Ravinuthala, Member of the Royal College of Physicians (UK) Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Hepatology, Mind-Body interaction Clinical Research Three decades experience Involvement in the leading edge of GI therapies Availability of alternative treatments for patients We have been involved in clinical research for nearly thirty years. Our research division, Consultants for Clinical Research (www.ccrstudy.com), has conducted over 350 gastroenterology and hepatology clinical trials. We have participated in numerous pivotal clinical trials that now form the basis of advanced treatment in many GI disorders such as: Crohn’s disease, ulcerative colitis, irritable bowel syndrome, GERD, Hepatitis B, Hepatitis C, Peptic Ulcer Disease, eradication of Helicobacter pylori, and others. Our involvement in clinical research trials provides us with an increased level of experience and knowledge regarding new treatments and related pharmacology as well as the ability to offer treatment alternatives to patients that would otherwise not be available to them. Dr. Ravinuthala graduated from Rangaraya Medical College in India. He completed his Internal Medicine Residency, Gastroenterology Fellowship and Transplant Hepatology Fellowship at Henry Ford Hospital, Detroit, Michigan. He is Board Certified in Internal Medicine, Gastroenterology, and Transplant Hepatology and is UNOS approved for liver transplantation. Dr. Z. A. Saeed, FACG Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Pancreaticobiliary (ERCP) and therapeutic endoscopy, Endoscopic ultrasound-guided biopsies (EUS), Hemorrhoidal band ligation, Pancreatic and biliary disorders Dr. Saeed graduated from King Edward Medical College, Lahore, Pakistan. He completed his Residency in Internal Medicine at Texas Tech University, Amarillo. He received Fellowship training in Gastroenterology and Hepatology at Georgetown University, Washington, D.C., followed by clinical and basic research training at The National Institutes of Health, Bethesda, Maryland. He also completed a Fellowship in Advanced Therapeutic Endoscopy and Endoscopic Research at Baylor College of Medicine, Houston, Texas, and received formal training in endoscopic ultrasound procedures at Institut Paoli-Calmette, Marseilles, France. Dr. Saeed is a Fellow of the American College of Gastroenterology and has been awarded Cincinnati Magazine’s “Top Doctor” recognition. Dr. Saeed is Board Certified in Internal Medicine and Gastroenterology. Education Patients and the public Physicians Medical students and residents Nurses With the enormous amount of medical information available, Ohio GI recognizes the importance of educating physicians, students, medical residents, patients, and the public at large. Many of our physicians present lectures to medical audiences on state-of-the-art topics during medical conferences and hospital grand rounds in town and around the country. Ohio GI conducts an annual CME conference (usually held in February) for approximately one hundred primary care providers to hear talks on the latest breakthroughs in the field. We frequently provide lectures to community groups in a variety of settings on requested topics, such as: inflammatory bowel disease, irritable bowel syndrome, reflux, colon cancer prevention, liver disease, and others. Through our involvement with the American Cancer Society, programs have been brought to the area reaching tens of thousands of people with information and education about colon cancer prevention. We are involved in teaching GI fellows, medical residents, family practice residents, medical students, nursing students, physician assistant students, and as preceptors for undergraduate students who are considering a career in medicine. On an individual patient level, we have developed a wide array of materials and information that focus on specific diseases or symptoms for patient education. We believe a well informed patient is a healthier patient. Our website (www.ohiogi.com) contains many additional informative resources for patients and physicians. Leadership State of Ohio GI leadership National GI Society Leadership Ohio GI CME Conference Ohio GI staff hold or have held leadership positions in the GI division and endoscopy departments at many of our local hospitals. Leadership involvement in national, state, and local organizations has included: National Board of Trustees of the American College of Gastroenterology, Southern Ohio Governors for the American College of Gastroenterology, Practice Management Committee for the American Society for Gastrointestinal Endoscopy, founding officer of the Gastroenterology Assembly for the Medical Group Managers Association, National and State GI representative to the Medicare Carrier Advisory Committee, Chairman of Colorectal Cancer Task Force at the Cincinnati Chapter of the American Cancer Society, Chairman of the Medical Advisory Committee for the Cincinnati Crohn’s and Colitis Foundation chapter, National CCFA young investigator training course , Medical Director of the Christ Hospital Center for Swallowing Disorders, and many others. Dr. Mangels graduated from the Medical College of Ohio in Toledo and completed his Residency in Internal Medicine at the University of Cincinnati. His Gastroenterology Fellowship was also completed at the University of Cincinnati. He is the co-chairman of the Gastroenterology Section at Bethesda North Hospital and has been awarded Cincinnati Magazine’s “Top Doctor” recognition. He has presented lectures at medical conferences on a variety of topics such as Gastrointestinal Bleeding. Dr. Mangels is a Fellow of the American College of Gastroenterology and is Board Certified in Gastroenterology. Dr. Stephen P. Martin Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Pancreaticobiliary (ERCP) and therapeutic endoscopy, Capsule endoscopy “Pillcam”, Pancreatic and biliary disorders Hospital GI leadership Local Not-for-profit organization leadership Dr. David Mangels, FACG Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Gastroesophageal Reflux Disease (GERD) Dr. Martin graduated from the University of Cincinnati College of Medicine and completed his Residency in Internal Medicine at the University Hospitals of Cleveland/Case Western Reserve University. His Gastroenterology Fellowship, which was completed at the University of Pittsburgh, included a focused year of pancreaticobiliary endoscopy and pancreatic physiology training. He is the Chief of Endoscopy at Mercy Hospital Fairfield and has been awarded Cincinnati Magazine’s “Top Doctor” and Cincy Magazine’s “Best Doctor” recognitions. Dr. Martin is Board Certified in Gastroenterology. Dr. Terrance O’Toole Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Gastroesophageal Reflux Disease (GERD), Barrett’s therapy, Clinical outcomes Dr. O’Toole graduated from the Ohio University College of Osteopathic Medicine in Athens, Ohio. He completed his Internal Medicine residency training at the University of Cincinnati. He continued his training at the University of Cincinnati, where he completed his Gastroenterology Fellowship. Dr. O’Toole has lectured on numerous topics such as Barrett’s, Gastroparesis, and Refractory celiac disease. Dr. O’Toole is Board Certified in Internal Medicine and Gastroenterology. Dr. Michael D. Kreines, FACG, FAGA, FACP Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), Gastroesophageal Reflux Disease (GERD), Esophageal Disorders Dr. Kreines graduated from the University of Cincinnati College of Medicine and completed his Residency in Internal Medicine at the University of Minnesota. His Gastroenterology Fellowship was performed at the University of California in San Diego followed by an Inflammatory Bowel Disease Fellowship and faculty position at the University of Chicago. He was a founding member and is a current board member of the Cincinnati CCFA chapter and is an active participant in IBD clinical research trials. He was recently appointed to the National Medical Scientific Advisory Committee of the Colon Cancer Alliance (CCA). He is the chief of Gastroenterology and the Director of the Center for Swallowing Disorders at the Christ Hospital and Co-chairman of the local Colorectal Task Force at the American Cancer Society. He is actively involved in teaching medical students and internal medicine and family practice residents. Dr. Kreines has been awarded Cincinnati Magazine’s “Top Doctor” recognition. He has lectured extensively at medical and nursing and community conferences on a variety of topics such as: Inflammatory Bowel Disease, Irritable Bowel Syndrome, Colon Cancer Prevention, and Esophageal Disorders. Dr Kreines is a Fellow of the American College of Gastroenterology, the American Gastroenterology Association, and the American College of Physicians and is Board Certified in Internal Medicine and Gastroenterology. Dr. Lisa S. Lestina Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Gastroesophageal Reflux Disease (GERD), Women’s health Dr. Lestina graduated from Northwestern University Medical School in Chicago. She subsequently completed her Residency and Chief Residency in Internal Medicine at Dartmouth-Hitchcock Medical Center in New Hampshire. Dr. Lestina continued her training at Dartmouth, completing her Fellowship in Gastroenterology. Dr. Lestina has presented lectures to medical and nursing audiences on a variety of topics such as: Celiac Disease, Helicobacter Pylori and Clostridium Difficile. She is Board Certified in Internal Medicine and Gastroenterology. OUR PATIENTS Our mission is to provide outstanding and very personalized care to all patients within the broad range of digestive disorders. Ohio GI is a large subspecialized practice to which a high volume of patients with common and uncommon disorders are referred, resulting in unparalleled expertise in diagnostic and therapeutic capabilities. Annually, Ohio GI provides over 70,000 digestive services which include inpatient encounters, outpatient encounters, and endoscopic procedures to patients mainly from Ohio, Kentucky, and Indiana. Numbers of patients seen in several diagnostic categories: DIAGNOSIS PATIENT VISITS Crohn’s Disease.......................4,084 Ulcerative Colitis.....................1,869 Liver Disease............................1,734 Irritable Bowel Syndrome..........843 Pancreatic Disorders..............1,682 Esophageal Disorders.............6,228 Abdominal Pain*......................6,839 GI Bleeding................................3,694 Diarrhea*................................4,488 Constipation.............................1,488 *Includes some patients with IBS OUR ENDOSCOPY CENTERS We operate four state-of-the-art endoscopy centers that provide specialized services at convenient locations in Clifton, Montgomery, Fairfield, and Norwood. These facilities provide a comfortable, friendly, and personal environment. We have meticulous standards of high quality care and consistently receive high ratings for patient satisfaction. We have developed an in-house electronic medical record system (eMerge), specific to endoscopic procedures, that is currently used at our primary endoscopy centers. This allows a detailed report to be generated at the time of the procedure and immediately faxed to the primary physician. The patient is also provided with a report for their personal records that helps to clearly convey the results, recommendations, and follow-up. Patients can also access their reports and results on-line via a secure patient portal. Additional educational materials are provided to enhance the understanding of the underlying disease process and healthy lifestyle recommendations. A computerized recall system is utilized to remind patients to schedule a follow-up visit. For example, a patient who has had adenomatous colonic polyps will usually need follow-up colonoscopy in the future. The recommended interval is entered into the computer and when the time arrives, a patient letter is generated and sent to inform them that it is time to schedule a surveillance procedure. These scheduling reminders are especially important in conditions where a premalignant state may occur, such as preventing colon cancer by appropriate follow-up colonoscopy. Dr. Kim R. Jurell Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Gastroesophageal Reflux Disease (GERD), Inflammatory Bowel Disease (IBD) Dr. Jurell graduated from the Indiana University College of Medicine and completed his Residency in Internal Medicine at St. Vincent Hospital in Indianapolis. His Gastroenterology Fellowship was completed at the Medical College of Wisconsin in Milwaukee. He has presented lectures at medical conferences on a variety of topics such as Clostridium Difficile. He has been awarded Cincy Magazine’s “Best Doctor” recognition. Dr. Jurell is Board Certified in Gastroenterology. Dr. Terry R. Kaylor Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Barrett’s therapy, Peptic Ulcer Disease Dr. Kaylor graduated from the University of Cincinnati College of Medicine and completed his Internal Medicine Residency and Gastroenterology Fellowship at The Ohio State University. Dr. Kaylor is interested in all areas of Gastroenterology and Hepatology. He has presented lectures at medical conferences on a variety of topics such as Gastrointestinal Inflammatory Disorders. He is Board Certified in Internal Medicine and Gastroenterology. Dr. John P. Czarnecki Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Gastroesophageal Reflux Disease (GERD) Dr. Czarnecki graduated from Northwestern University Medical School in Chicago and completed his Residency in Internal Medicine at Dartmouth-Hitchcock Medical Center. He continued his training at Dartmouth, where he completed his Gastroenterology Fellowship. He has presented lectures at medical conferences on a variety of topics such as Colorectal Cancer Screening, GERD, Celiac Disease, and Evaluation of Swallowing Disorders. Dr. Czarnecki is Board Certified in Internal Medicine and Gastroenterology. OUR COMMITMENT TO QUALITY We are able to report quality data where information is measurable and available. In many areas there are no established benchmark indicators of quality performance and we present highlights of numbers of patient volume or descriptions of clinical areas of expertise. We believe, and studies have documented, that seeing a high volume of patients with any given condition leads to expertise that correlates with better outcomes. Endoscopy Center Complication Rate Dr. Karen Haberthier Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Women’s health When performing procedures on our patients, we strive to maximize accuracy and minimize risk and complications. Complications can occur during any medical procedure and we track and compare our data with nationally published complication rates. Dr. Haberthier graduated from University of Medicine and Dentistry of New Jersey - New Jersey Medical School and completed her residency in Internal Medicine at Boston University Medical Center Her Gastroenterology fellowship was performed at University of Pittsburgh Medical Center, where she also served as Chief GI Fellow. Dr. Haberthier is Board Certified in Internal Medicine and Gastroenterology. In 2008, 15,303 patients underwent gastrointestinal endoscopy and/or colonoscopy in one of our outpatient endoscopy facilities. The major complications that can occur include perforation, bleeding from therapeutic maneuvers such as polypectomy, and death. An endoscopic complication occurred in only 8 patients for a rate of 0.0005%. Bleeding accounted for 7 of the 8 events, all from polypectomy sites. None of these patients required surgery and only one needed transfusion. One patient developed an esophageal tear after dilation for which he was briefly hospitalized and medically treated. There were no colonic perforations. Dr. Mark E. Jonas Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Hepatology, Gastrointestinal bleeding, Capsule endoscopy “Pillcam” Dr. Jonas graduated from the State of New York Health Sciences Center at the Brooklyn College of Medicine. He completed his Residency in Internal Medicine at the Montefiore Medical Center of the Albert Einstein College of Medicine. His Gastroenterology Fellowship was performed at the University of Medicine and Dentistry of New Jersey - New Jersey Medical School. Dr. Jonas completed an additional year of Fellowship in Hepatology and Liver Transplantation at the Mount Sinai Medical Center in New York City. Dr. Jonas is the Internal Medicine residency program Education Director at Jewish Hospital. Dr. Jonas has been awarded Cincinnati Magazine’s “Top Doctor” recognition. He is Board Certified in Internal Medicine, Gastroenterology, and Transplant Hepatology and is UNOS approved for liver transplantation. The following data summarizes the complications and compares with national averages. OHIO GI Total complications Perforation Hemorrhage* Death 0.0005% 0.00006% 0.00006% 0.0% NATIONAL RATES 0.5% 0.09% 0.48% 0.0006% *Requiring transfusion or hospitalization Colonoscopy and EGD performed by Ohio GI physicians is as safe or safer than national averages. Colonoscopy quality - Colorectal Cancer (CRC) Prevention Colonoscopy with polypectomy is currently the best method of colorectal cancer (CRC) prevention. CRC usually begins as an asymptomatic polyp. With time as the polyp grows, malignant degeneration can occur. To prevent CRC, polyps need to be found and removed with colonoscopy. Colonoscopy is highly effective but it has some limitations in that it does not identify all polyps and cancers. To address this concern, studies have demonstrated three main parameters that correlate with greater colonoscopic accuracy: high rate of complete colonoscopy with visualization into the base of the cecum, inspection time during colonoscopy withdrawal of six minutes or greater, and quality colonoscopy preparation to minimize “hidden lesions”. We routinely monitor these quality parameters and our data demonstrates performance superior to the current recommendations and national standards, as demonstrated in the following graphs: 1. Complete Colonoscopy Study: To detect all lesions, the entire colon needs to be carefully examined. Given certain technical factors such as adequacy of the bowel preparation, adhesions, and the tortuous nature of some colons, insertion of the colonoscopy all the way into the cecum can present a challenge. Our experienced and skilled colonoscopists do reach the cecum in almost all cases. Cecal Intubation Rates 98.71% Ohio GI 97 96 National* 95 95.0% 94 All of our physicians are expert in outpatient and inpatient consultative gastroenterology, hepatology, endoscopy, colonoscopy, and colorectal cancer prevention. We all see patients spanning the spectrum of digestive and liver disorders. Highlighted below is a brief synopsis of background information, mention of specific leadership roles, and designation of additional area of focused expertise for each of our physicians and physician assistants. Dr. Pradeep K. Bekal Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Pancreaticobiliary (ERCP) and therapeutic endoscopy, Endoscopic ultrasound-guided biopsies (EUS), Pancreatic and biliary disorders Dr. Bekal graduated from Madras Medical School, Madras, India, and completed his Residency in Internal Medicine at New York Methodist Hospital in Brooklyn, New York. His Gastroenterology Fellowship was completed at the Brooklyn Hospital Medical Center. Dr. Bekal completed an Advanced Therapeutic Endoscopy Fellowship at Allegheny General Hospital in Pittsburgh. Dr. Bekal is the Gastroenterology Director at West Chester Medical Center and has been awarded Cincinnati Magazine’s “Top Doctor” recognition. He is Board Certified in Gastroenterology. Dr. Manish M. Chokshi Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Hemorrhoidal band ligation, Capsule endoscopy “Pillcam”, Hydrogen breath testing, Esophageal studies 99 98 OUR PHYSICIANS *American College of Gastroenterology 2009 93 1 Colonoscopy by Ohio GI Gastroenterologists reliably examines the entire colon, meeting or exceeding national standards. Dr. Chokshi graduated from Case Western Reserve University School of Medicine and completed his Internal Medicine Residency at Metro Health Medical Center, both in Cleveland. Dr. Chokshi then completed his Fellowship in Gastroenterology at the University of Michigan Medical Center in Ann Arbor. He has presented lectures at medical conferences on a variety of topics such as: Evaluation of Anemia from the GI Prospective and Clinically Useful Pharmacology of GI Drugs. He is Board Certified in Internal Medicine and Gastroenterology. CONSULTANTS FOR CLINICAL RESEARCH Consultants for Clinical Research (CCR) is a multi-specialty clinical research center. For over 25 years, CCR has conducted clinical pharmaceutical trials and Investigator initiated clinical trials. CCR has demonstrated a commitment to excellence in the clinical trials process by providing high quality data collection while meeting strict ethical and professional standards for our patients and the industry. CCR employs a dedicated experienced staff of Physician Assistants, Registered Nurses, Certified Medical Assistants, administrators, and clerical staff in a 4,000 square foot facility plus satellite offices. Infusion suites are utilized to administer investigational as well as commercially available therapies. A national leading research center, Consultants for Clinical Research has participated in over 500 clinical trials for medical conditions such as the following: Ankle Sprain Back Pain (Chronic) Bronchitis C. Difficile Toxin Crohn’s Disease Diabetes Dyspepsia Gastroparesis Gastropathy (NSAID induced) GERD (Erosive & non-erosive) Hemorrhoids Hepatitis B Hepatitis C Hyperlipidemia Hypertension Irritable Bowel Syndrome Non Alcholic Steatohepatitis (NASH) Osteoarthritis Otitis Externa Pain Management Pancreatitis Peptic Ulcer Disease Pneumonia Rheumatoid Arthritis Strep Pharyngitis Ulcerative Colitis Contact Call Linda Magaw (513-872-4549) for information about CCR, for patient referrals, or to receive information on participating in clinical research trials (physicians). 2. Colonoscopy Withdrawal Time Study: After reaching the cecum, the colonoscope should be slowly withdrawn during careful inspection for polyps, cancer and other abnormalities. Studies have demonstrated and the American College of Gastroenterology recommends that a withdrawal time of 6 minutes or greater correlates with a higher likelihood of finding lesions. Colonoscopy Withdrawal Time 12 10 11.2 Ohio GI 8 6 6.0 4 National* *American College of Gastroenterology 2009 2 0 Minutes Colonoscopy by Ohio GI Gastroenterologists involves careful and deliberate inspection of the colon that exceeds national standards. 3. Colonoscopy Bowel Preparation Study: Thorough bowel cleansing is critically important to visualize abnormalities in the colon. There are many different techniques available to purge the colon of debris. Patients repeatedly tell us that the colon cleansing process is the “most difficult part” of colonoscopy. We review and reevaluate various bowel cleansing methods for palatability and effectiveness. Recent data has indicated rare kidney toxicity from a commonly used prep (phosphosoda), thus we are using other preps and tracking their effectiveness. A study of these new bowel cleansing programs is currently in progress. www.ccrstudy.com 4. Polyp Detection Rate Study: As a more direct marker of quality, the rate at which adenomas are detected during screening colonoscopies can also be measured and compared with nationally published rates and medical society recommendations. Adenoma Detection Rate - Males 35 30 31.7% 25 Ohio GI 25.0% 20 15 National* 10 *American College of Gastroenterology 2009 5 0 Adenoma Detection Rate - Females 35 30 25 Ohio GI 29.3% 20 National* 15 10 15.0% *American College of Gastroenterology 2009 5 0 These graphs demonstrate superior performance by Ohio GI Gastroenterologists. Pancreatic Disorders Ohio GI “pancreatologists” treat a variety of pancreatic diseases such as: acute, recurrent acute, and chronic pancreatitis, pancreatic cancer, and pancreatic insufficiency with medical, dietary, and endoscopic therapies. We remain actively involved with patients that require surgery as well. Subspecialized techniques that our experts provide include endoscopic drainage of pancreatic cysts, thereby avoiding major surgery. Sphincter of Oddi manometry and sphincterotomy and stent placement are ERCP techniques with which we have extensive experience. Choledochoscopy allows the placement of a thin bore endoscope directly up into the bile duct for visualization of pathology and application of a variety of therapies to detect and treat stones or tumors. Endoscopic Mucosal Resection (EMR) EMR is a more aggressive technique of lesion removal involving submucosal injection of saline to raise a lesion up from deeper tissue layers. The lesion is then removed with snare cautery or bands. In appropriately selected patients, larger lesions can sometimes be removed with this specialized approach by our experienced endoscopists, eliminating the need for surgical resection. Patient Satisfaction Survey - Endoscopy Centers Capsule Endoscopy Indications After undergoing a procedure at one of our centers, patients are asked to fill out an evaluation form, rating their experience from various perspectives. Questions address the spectrum of the encounter from evaluation of registration and release to judging the level of respect, efficiency, and professional skills of our staff and physicians. In all parameters, 95% or more of patients rated us as having either met or exceeded their expectations. Number of Patients 100 80 60 40 40 19 20 8 4 12 9 3 3 99% 100% 0 99% 99% 99% 99% 90% 80% 70% 60% 50% 40% 30% Capsule Endoscopy Findings 20% 10% Number of Patients 100 1% 1% 1% 1% 1% 0% 1 80 2 3 4 5 Survey Question (see below) 60 60 1. Our staff’s personal manner was clear, courteous, and respectful. 40 3 0 2. Our nurses’ professional skills were competent and efficient. 17 20 6 3 1 2 1 1 1 4 1 1 3. Our physicians’ professional skills were competent and efficient. 4. Our physicians’ effectiveness in answering questions, addressing treatments, needs and concerns was clear. 5. Our physicians’ personal manner was clear, courteous, and respectful. Patient Satisfaction Survey - Office Small Bowel Evaluation A prospective survey study was performed by an independent research group on randomly selected patients coming to our offices. Patients were given a questionnaire that asked them to evaluate the practice environment, staff communication, education of patients, physician communication, office management, and physician/staff teamwork. Results were then compared to national and regional responses to the identical questionnaire. The following table shows the results of the Ohio GI survey indicating superiority for all parameters when compared to both national and regional results. Routine endoscopy with EGD and colonoscopy (with retrograde cannulation of the terminal ileum) still leaves approximately 15-20 feet of small intestine that has been challenging to visualize endoscopically. We perform small bowel enteroscopy utilizing a fiberoptic push enteroscope that can reach into the jejunum and balloon enteroscopy that can penetrate even further. Ohio GI was the first practice in our area to utilize the “Pillcam”. This noninvasive device incorporates a camera in a mechanical pill format that, after being swallowed, takes a video of the entire small intestine. In 2008, we performed 268 small bowel Pillcam examinations. Indications for this test were often to diagnose unexplained anemia or gastrointestinal bleeding or to evaluate for IBD/diarrhea. These patients had already undergone other standard tests to evaluate their condition, without an answer. Pillcam results did elucidate the condition in 40% of patients. Patient Satisfaction for Ohio GI Practice 5.00 Ohio GI 4.00 National Regional (Ohio) 3.00 Environment Staff Communication Education Patients MD Communications Office Management MD/Staff Teamwork Pillcam Small Intestine Small Intestine Large Polyp Survey Categories This technique is highly specialized requiring in-depth and extensive training. Our expert physicians who have undergone this level of training were the first in our area to perform endoscopic ultrasound. Our experience with fine needle aspiration, which greatly enhances the diagnostic accuracy of this procedure, is unparalleled locally. Endoscopic Retrograde Cholangiopancreatography (ERCP) ERCP is a highly specialized endoscopic procedure combining endoscopic and radiographic images to evaluate the biliary tree and pancreas. ERCP is a tool for the diagnosis of liver, bile duct, and pancreatic disorders. ERCP can also offer treatment such as sphincterotomy, stone removal, and stent placement in the bile and pancreatic ducts. Studies have shown that physicians who perform a high volume of ERCP’s experience lower rates of complications, such as pancreatitis. Among the physicians of Ohio GI, three are super-specialized in ERCP techniques and thus maintain a high volume practice. Esophageal Disorders Ohio GI offers comprehensive testing, evaluation and recommendations regarding esophageal disorders. Esophageal reflux testing modalities include the measurement of gastric acid reflux into the esophagus with nasal catheter ambulatory 24 hour pH probes and attached Bravo 48 hour esophageal acid monitoring. Through our leadership as the Director of the Swallowing Center, we introduced the newer technology of esophageal impedance. This allows more sophisticated testing of esophageal symptoms that may be related to reflux of nonacidic gastric contents. Patients with gastroesophageal reflux disease (GERD) are treated with a comprehensive review of diet, medications, lifestyle, and other relevant factors. Esophageal function is usually assessed with motility testing. In 2008 we performed 149 esophageal pH and motility tests. Patients with esophageal motility disorders such as achalasia may undergo pneumatic dilation, BoTox injection or be referred to a GI surgeon, as appropriate, for each individual circumstance based on detailed consultation. Barrett’s esophagus, a potentially precancerous complication of gastroesophageal reflux disease (GERD) is sought out during every endoscopic exam of the UGI tract using standard white light video endoscopy. In some cases Narrow Band Imaging (NBI) using blue light technology that highlights the appearance of Barrett’s is utilized. Halo ablation of Barrett’s has recently been introduced by us to endoscopically ablate Barrett’s esophagus with dysplasia. Inflammatory Bowel Disease Ohio GI is an acknowledged leader in the treatment of patients with inflammatory bowel disease. In 2008 we saw 5,953 patient visits with ulcerative colitis or Crohn’s disease. Many patients are seen in consultation by us for a second opinion. We have been actively involved in IBD clinical research, leading to publication of numerous journal articles and participation in many national conferences. Our patients with IBD may choose to participate in clinical trials, availing themselves of treatments not otherwise accessible. In Cincinnati, we helped form the local chapter of the Crohn’s & Colitis Foundation of America (CCFA) and have remained active in its organization, research, fund raising, educational activities, and chairing the medical advisory committee. We strive to provide IBD patients with the most safe and effective therapies available including prescription medications, over-the-counter products, dietary advice, life style support, and clinical research trials. We have had great success in reducing the use of steroids which have many short and long-term side effects. Our dedicated IBD nursing staff is responsible for administering and assisting in monitoring biologic medications such as Remicade (Infliximab) and others. We utilize additional tools such as disease activity indices to follow many patients to track their progress and provide objective information on each patient’s status. Crohn’s disease is a lifelong and potentially serious condition that has significant medical, economic, and social impact. The use of expensive biologic therapies thus needs to be carefully evaluated in terms of providing substantial benefits for our patients. We performed a study to examine and document the response of patients with Crohn’s disease to biologic therapy with Remicade (Infliximab). A standardized inflammatory bowel disease questionnaire (IBDQ) was used as the tool to measure the patient’s clinical status. Patients entering this study were patients with moderate to severe Crohn’s disease, most of whom had active disease in spite of treatment with other available modalities (typically steroids and immune modulator therapies such as azathioprine or 6-mercaptopurine). After treatment with Remicade, the IBDQ score improved in 72% of our patients, was unchanged in 8% and worsened in 20%. This study did document improvement in a very significant percentage of our patients undergoing biologic treatment. Irritable Bowel Syndrome Irritable bowel syndrome is a chronic gastrointestinal disorder of unclear etiology. Recent studies have suggested that in some patients, small bowel bacterial overgrowth (SBBO) may cause symptoms or be a contributing factor. Thus, identification and treatment of SBBO may be potentially beneficial to patients who have IBS. Ohio GI was the first adult GI practice in Greater Cincinnati to acquire equipment to test for SBBO. The fairly simple test is performed by measuring the amount of hydrogen in a patient’s breath, having the patient ingest a nonabsorbable sugar (lactulose) and retesting breath hydrogen over a period of time looking for an “early peak” that may signify bacterial metabolism of the lactulose in the small intestine due to an abnormal accumulation of bacteria. We performed a study of our patients undergoing hydrogen breath testing to assess the performance of this test and the response to therapy. Initially, out of 244 lactulose breath tests, 217 were positive (89%). We then prospectively studied 64 patients who tested positive and were followed up 1 month and 3 months after starting treatment with either rifaxamin 400mg TID or metronidazole 250mg TID for one week. Patients had an average age of 48 years and 89% were female. Results showed that approximately 90% experienced at least some relief of symptoms while on treatment. Patients were asked to rate their overall relief of symptoms as poor, fair, good or excellent. At 1 month 39% rated their relief as “good or excellent”. At 3 months 61% of patients rated their relief as “good or excellent”. Patients presenting with symptoms of bloating and diarrhea reported the most improvement. Liver Disease Ohio Gastroenterology and Liver Institute is the largest hepatology practice in the greater Cincinnati area. All Ohio GI physicians are trained in hepatology and several have a special interest in liver disease. In fact, Ohio GI is the only private practice in the tristate area with physicians who are board certified specifically in hepatology and liver transplantation. Our doctors evaluate and treat adult patients with any type of liver disease at the specialist and subspecialist level. Patients are seen at all stages of disease including those very ill who require liver transplantation and those who are too ill to be considered for transplantation. Fortunately, progress in hepatology over the years has allowed most liver patients to be treated successfully without need for transplantation. Liver diseases we’ve treated include: viral hepatitis (A, B, and C), auto-immune hepatitis, fatty liver/NASH, hemochromatosis, bile duct disorders, liver tumors, and diagnosing abnormal liver blood tests. Ohio GI has the most fellowship trained interventional gastroenterologists in the tristate area who perform the advanced procedures of endoscopic ultrasonography and ERCP to help maximize healthcare delivery to our patients. Liver biopsies are performed in our endoscopy centers and interpreted by our pathologists and hepatologists. Our active research unit participates in many cutting edge trials involving different liver diseases. We are frequently the only practice in this area participating in these research protocols. This type of research in the past has led to new discoveries and advanced the treatment of many liver diseases. Women’s Digestive Health Ohio Gastroenterology and Liver Institute is proud to include board certified female gastroenterologists with special interests in women’s health, including but not limited to: Gastroesophageal Reflux Disease (GERD), Irritable Bowel Syndrome (IBS), Inflammatory Bowel Disease (IBD), Gallbladder Disease, Colon Cancer, Liver Disease, GI Disease during Pregnancy, Fecal Incontinence, and Hemorrhoids. Patients need to feel comfortable seeking care for their gastrointestinal health. They seek doctors who will listen to their concerns, spend time with them, and make them feel at ease, even when discussing matters that may be embarrassing or unsettling. Additionally, there may be gender differences and barriers to cancer prevention strategies for women. We ensure that women who prefer to see a female physician for their screening colonoscopy and consultation can do so. Endoscopic Ultrasound (EUS) EUS has emerged as a highly sensitive and specific minimally invasive diagnostic tool. The procedure involves insertion of an endoscope which has an ultrasound probe at its tip. The ultrasound beam can be placed in close proximity to an area of interest, such as a tumor or cyst, to image its size and appearance and to assess potential invasion into surrounding structures. Through the channel of the scope, a fine needle aspiration (FNA) can be performed to obtain material for cytologic analysis. EUS can also be used in the evaluation of upper GI and lower GI lesions, solid organs, IBD, vascular structures, and chest/ pulmonary lesions. Irritable Bowel Syndrome Irritable bowel syndrome is a chronic gastrointestinal disorder of unclear etiology. Recent studies have suggested that in some patients, small bowel bacterial overgrowth (SBBO) may cause symptoms or be a contributing factor. Thus, identification and treatment of SBBO may be potentially beneficial to patients who have IBS. Ohio GI was the first adult GI practice in Greater Cincinnati to acquire equipment to test for SBBO. The fairly simple test is performed by measuring the amount of hydrogen in a patient’s breath, having the patient ingest a nonabsorbable sugar (lactulose) and retesting breath hydrogen over a period of time looking for an “early peak” that may signify bacterial metabolism of the lactulose in the small intestine due to an abnormal accumulation of bacteria. We performed a study of our patients undergoing hydrogen breath testing to assess the performance of this test and the response to therapy. Initially, out of 244 lactulose breath tests, 217 were positive (89%). We then prospectively studied 64 patients who tested positive and were followed up 1 month and 3 months after starting treatment with either rifaxamin 400mg TID or metronidazole 250mg TID for one week. Patients had an average age of 48 years and 89% were female. Results showed that approximately 90% experienced at least some relief of symptoms while on treatment. Patients were asked to rate their overall relief of symptoms as poor, fair, good or excellent. At 1 month 39% rated their relief as “good or excellent”. At 3 months 61% of patients rated their relief as “good or excellent”. Patients presenting with symptoms of bloating and diarrhea reported the most improvement. Liver Disease Ohio Gastroenterology and Liver Institute is the largest hepatology practice in the greater Cincinnati area. All Ohio GI physicians are trained in hepatology and several have a special interest in liver disease. In fact, Ohio GI is the only private practice in the tristate area with physicians who are board certified specifically in hepatology and liver transplantation. Our doctors evaluate and treat adult patients with any type of liver disease at the specialist and subspecialist level. Patients are seen at all stages of disease including those very ill who require liver transplantation and those who are too ill to be considered for transplantation. Fortunately, progress in hepatology over the years has allowed most liver patients to be treated successfully without need for transplantation. Liver diseases we’ve treated include: viral hepatitis (A, B, and C), auto-immune hepatitis, fatty liver/NASH, hemochromatosis, bile duct disorders, liver tumors, and diagnosing abnormal liver blood tests. Ohio GI has the most fellowship trained interventional gastroenterologists in the tristate area who perform the advanced procedures of endoscopic ultrasonography and ERCP to help maximize healthcare delivery to our patients. Liver biopsies are performed in our endoscopy centers and interpreted by our pathologists and hepatologists. Our active research unit participates in many cutting edge trials involving different liver diseases. We are frequently the only practice in this area participating in these research protocols. This type of research in the past has led to new discoveries and advanced the treatment of many liver diseases. Women’s Digestive Health Ohio Gastroenterology and Liver Institute is proud to include board certified female gastroenterologists with special interests in women’s health, including but not limited to: Gastroesophageal Reflux Disease (GERD), Irritable Bowel Syndrome (IBS), Inflammatory Bowel Disease (IBD), Gallbladder Disease, Colon Cancer, Liver Disease, GI Disease during Pregnancy, Fecal Incontinence, and Hemorrhoids. Patients need to feel comfortable seeking care for their gastrointestinal health. They seek doctors who will listen to their concerns, spend time with them, and make them feel at ease, even when discussing matters that may be embarrassing or unsettling. Additionally, there may be gender differences and barriers to cancer prevention strategies for women. We ensure that women who prefer to see a female physician for their screening colonoscopy and consultation can do so. Endoscopic Ultrasound (EUS) EUS has emerged as a highly sensitive and specific minimally invasive diagnostic tool. The procedure involves insertion of an endoscope which has an ultrasound probe at its tip. The ultrasound beam can be placed in close proximity to an area of interest, such as a tumor or cyst, to image its size and appearance and to assess potential invasion into surrounding structures. Through the channel of the scope, a fine needle aspiration (FNA) can be performed to obtain material for cytologic analysis. EUS can also be used in the evaluation of upper GI and lower GI lesions, solid organs, IBD, vascular structures, and chest/ pulmonary lesions. This technique is highly specialized requiring in-depth and extensive training. Our expert physicians who have undergone this level of training were the first in our area to perform endoscopic ultrasound. Our experience with fine needle aspiration, which greatly enhances the diagnostic accuracy of this procedure, is unparalleled locally. Endoscopic Retrograde Cholangiopancreatography (ERCP) ERCP is a highly specialized endoscopic procedure combining endoscopic and radiographic images to evaluate the biliary tree and pancreas. ERCP is a tool for the diagnosis of liver, bile duct, and pancreatic disorders. ERCP can also offer treatment such as sphincterotomy, stone removal, and stent placement in the bile and pancreatic ducts. Studies have shown that physicians who perform a high volume of ERCP’s experience lower rates of complications, such as pancreatitis. Among the physicians of Ohio GI, three are super-specialized in ERCP techniques and thus maintain a high volume practice. Esophageal Disorders Ohio GI offers comprehensive testing, evaluation and recommendations regarding esophageal disorders. Esophageal reflux testing modalities include the measurement of gastric acid reflux into the esophagus with nasal catheter ambulatory 24 hour pH probes and attached Bravo 48 hour esophageal acid monitoring. Through our leadership as the Director of the Swallowing Center, we introduced the newer technology of esophageal impedance. This allows more sophisticated testing of esophageal symptoms that may be related to reflux of nonacidic gastric contents. Patients with gastroesophageal reflux disease (GERD) are treated with a comprehensive review of diet, medications, lifestyle, and other relevant factors. Esophageal function is usually assessed with motility testing. In 2008 we performed 149 esophageal pH and motility tests. Patients with esophageal motility disorders such as achalasia may undergo pneumatic dilation, BoTox injection or be referred to a GI surgeon, as appropriate, for each individual circumstance based on detailed consultation. Barrett’s esophagus, a potentially precancerous complication of gastroesophageal reflux disease (GERD) is sought out during every endoscopic exam of the UGI tract using standard white light video endoscopy. In some cases Narrow Band Imaging (NBI) using blue light technology that highlights the appearance of Barrett’s is utilized. Halo ablation of Barrett’s has recently been introduced by us to endoscopically ablate Barrett’s esophagus with dysplasia. Inflammatory Bowel Disease Ohio GI is an acknowledged leader in the treatment of patients with inflammatory bowel disease. In 2008 we saw 5,953 patient visits with ulcerative colitis or Crohn’s disease. Many patients are seen in consultation by us for a second opinion. We have been actively involved in IBD clinical research, leading to publication of numerous journal articles and participation in many national conferences. Our patients with IBD may choose to participate in clinical trials, availing themselves of treatments not otherwise accessible. In Cincinnati, we helped form the local chapter of the Crohn’s & Colitis Foundation of America (CCFA) and have remained active in its organization, research, fund raising, educational activities, and chairing the medical advisory committee. We strive to provide IBD patients with the most safe and effective therapies available including prescription medications, over-the-counter products, dietary advice, life style support, and clinical research trials. We have had great success in reducing the use of steroids which have many short and long-term side effects. Our dedicated IBD nursing staff is responsible for administering and assisting in monitoring biologic medications such as Remicade (Infliximab) and others. We utilize additional tools such as disease activity indices to follow many patients to track their progress and provide objective information on each patient’s status. Crohn’s disease is a lifelong and potentially serious condition that has significant medical, economic, and social impact. The use of expensive biologic therapies thus needs to be carefully evaluated in terms of providing substantial benefits for our patients. We performed a study to examine and document the response of patients with Crohn’s disease to biologic therapy with Remicade (Infliximab). A standardized inflammatory bowel disease questionnaire (IBDQ) was used as the tool to measure the patient’s clinical status. Patients entering this study were patients with moderate to severe Crohn’s disease, most of whom had active disease in spite of treatment with other available modalities (typically steroids and immune modulator therapies such as azathioprine or 6-mercaptopurine). After treatment with Remicade, the IBDQ score improved in 72% of our patients, was unchanged in 8% and worsened in 20%. This study did document improvement in a very significant percentage of our patients undergoing biologic treatment. Patient Satisfaction Survey - Office Small Bowel Evaluation A prospective survey study was performed by an independent research group on randomly selected patients coming to our offices. Patients were given a questionnaire that asked them to evaluate the practice environment, staff communication, education of patients, physician communication, office management, and physician/staff teamwork. Results were then compared to national and regional responses to the identical questionnaire. The following table shows the results of the Ohio GI survey indicating superiority for all parameters when compared to both national and regional results. Routine endoscopy with EGD and colonoscopy (with retrograde cannulation of the terminal ileum) still leaves approximately 15-20 feet of small intestine that has been challenging to visualize endoscopically. We perform small bowel enteroscopy utilizing a fiberoptic push enteroscope that can reach into the jejunum and balloon enteroscopy that can penetrate even further. Ohio GI was the first practice in our area to utilize the “Pillcam”. This noninvasive device incorporates a camera in a mechanical pill format that, after being swallowed, takes a video of the entire small intestine. In 2008, we performed 268 small bowel Pillcam examinations. Indications for this test were often to diagnose unexplained anemia or gastrointestinal bleeding or to evaluate for IBD/diarrhea. These patients had already undergone other standard tests to evaluate their condition, without an answer. Pillcam results did elucidate the condition in 40% of patients. Patient Satisfaction for Ohio GI Practice 5.00 Ohio GI 4.00 National Regional (Ohio) 3.00 Environment Staff Communication Education Patients MD Communications Office Management MD/Staff Teamwork Pillcam Small Intestine Small Intestine Large Polyp Survey Categories Patient Satisfaction Survey - Endoscopy Centers Capsule Endoscopy Indications After undergoing a procedure at one of our centers, patients are asked to fill out an evaluation form, rating their experience from various perspectives. Questions address the spectrum of the encounter from evaluation of registration and release to judging the level of respect, efficiency, and professional skills of our staff and physicians. In all parameters, 95% or more of patients rated us as having either met or exceeded their expectations. Number of Patients 100 80 60 40 40 19 20 8 4 12 9 3 3 99% 100% 0 99% 99% 99% 99% 90% 80% 70% 60% 50% 40% 30% Capsule Endoscopy Findings 20% 10% Number of Patients 100 1% 1% 1% 1% 1% 0% 1 80 2 3 4 5 Survey Question (see below) 60 60 1. Our staff’s personal manner was clear, courteous, and respectful. 40 3 0 2. Our nurses’ professional skills were competent and efficient. 17 20 6 3 1 2 1 1 1 4 1 1 3. Our physicians’ professional skills were competent and efficient. 4. Our physicians’ effectiveness in answering questions, addressing treatments, needs and concerns was clear. 5. Our physicians’ personal manner was clear, courteous, and respectful. 4. Polyp Detection Rate Study: As a more direct marker of quality, the rate at which adenomas are detected during screening colonoscopies can also be measured and compared with nationally published rates and medical society recommendations. Adenoma Detection Rate - Males 35 30 31.7% 25 Ohio GI 25.0% 20 15 National* 10 *American College of Gastroenterology 2009 5 0 Adenoma Detection Rate - Females 35 30 25 Ohio GI 29.3% 20 National* 15 10 15.0% *American College of Gastroenterology 2009 5 0 These graphs demonstrate superior performance by Ohio GI Gastroenterologists. Pancreatic Disorders Ohio GI “pancreatologists” treat a variety of pancreatic diseases such as: acute, recurrent acute, and chronic pancreatitis, pancreatic cancer, and pancreatic insufficiency with medical, dietary, and endoscopic therapies. We remain actively involved with patients that require surgery as well. Subspecialized techniques that our experts provide include endoscopic drainage of pancreatic cysts, thereby avoiding major surgery. Sphincter of Oddi manometry and sphincterotomy and stent placement are ERCP techniques with which we have extensive experience. Choledochoscopy allows the placement of a thin bore endoscope directly up into the bile duct for visualization of pathology and application of a variety of therapies to detect and treat stones or tumors. Endoscopic Mucosal Resection (EMR) EMR is a more aggressive technique of lesion removal involving submucosal injection of saline to raise a lesion up from deeper tissue layers. The lesion is then removed with snare cautery or bands. In appropriately selected patients, larger lesions can sometimes be removed with this specialized approach by our experienced endoscopists, eliminating the need for surgical resection. CONSULTANTS FOR CLINICAL RESEARCH Consultants for Clinical Research (CCR) is a multi-specialty clinical research center. For over 25 years, CCR has conducted clinical pharmaceutical trials and Investigator initiated clinical trials. CCR has demonstrated a commitment to excellence in the clinical trials process by providing high quality data collection while meeting strict ethical and professional standards for our patients and the industry. CCR employs a dedicated experienced staff of Physician Assistants, Registered Nurses, Certified Medical Assistants, administrators, and clerical staff in a 4,000 square foot facility plus satellite offices. Infusion suites are utilized to administer investigational as well as commercially available therapies. A national leading research center, Consultants for Clinical Research has participated in over 500 clinical trials for medical conditions such as the following: Ankle Sprain Back Pain (Chronic) Bronchitis C. Difficile Toxin Crohn’s Disease Diabetes Dyspepsia Gastroparesis Gastropathy (NSAID induced) GERD (Erosive & non-erosive) Hemorrhoids Hepatitis B Hepatitis C Hyperlipidemia Hypertension Irritable Bowel Syndrome Non Alcholic Steatohepatitis (NASH) Osteoarthritis Otitis Externa Pain Management Pancreatitis Peptic Ulcer Disease Pneumonia Rheumatoid Arthritis Strep Pharyngitis Ulcerative Colitis Contact Call Linda Magaw (513-872-4549) for information about CCR, for patient referrals, or to receive information on participating in clinical research trials (physicians). 2. Colonoscopy Withdrawal Time Study: After reaching the cecum, the colonoscope should be slowly withdrawn during careful inspection for polyps, cancer and other abnormalities. Studies have demonstrated and the American College of Gastroenterology recommends that a withdrawal time of 6 minutes or greater correlates with a higher likelihood of finding lesions. Colonoscopy Withdrawal Time 12 10 11.2 Ohio GI 8 6 6.0 4 National* *American College of Gastroenterology 2009 2 0 Minutes Colonoscopy by Ohio GI Gastroenterologists involves careful and deliberate inspection of the colon that exceeds national standards. 3. Colonoscopy Bowel Preparation Study: Thorough bowel cleansing is critically important to visualize abnormalities in the colon. There are many different techniques available to purge the colon of debris. Patients repeatedly tell us that the colon cleansing process is the “most difficult part” of colonoscopy. We review and reevaluate various bowel cleansing methods for palatability and effectiveness. Recent data has indicated rare kidney toxicity from a commonly used prep (phosphosoda), thus we are using other preps and tracking their effectiveness. A study of these new bowel cleansing programs is currently in progress. www.ccrstudy.com Colonoscopy quality - Colorectal Cancer (CRC) Prevention Colonoscopy with polypectomy is currently the best method of colorectal cancer (CRC) prevention. CRC usually begins as an asymptomatic polyp. With time as the polyp grows, malignant degeneration can occur. To prevent CRC, polyps need to be found and removed with colonoscopy. Colonoscopy is highly effective but it has some limitations in that it does not identify all polyps and cancers. To address this concern, studies have demonstrated three main parameters that correlate with greater colonoscopic accuracy: high rate of complete colonoscopy with visualization into the base of the cecum, inspection time during colonoscopy withdrawal of six minutes or greater, and quality colonoscopy preparation to minimize “hidden lesions”. We routinely monitor these quality parameters and our data demonstrates performance superior to the current recommendations and national standards, as demonstrated in the following graphs: 1. Complete Colonoscopy Study: To detect all lesions, the entire colon needs to be carefully examined. Given certain technical factors such as adequacy of the bowel preparation, adhesions, and the tortuous nature of some colons, insertion of the colonoscopy all the way into the cecum can present a challenge. Our experienced and skilled colonoscopists do reach the cecum in almost all cases. Cecal Intubation Rates 98.71% Ohio GI 97 96 National* 95 95.0% 94 All of our physicians are expert in outpatient and inpatient consultative gastroenterology, hepatology, endoscopy, colonoscopy, and colorectal cancer prevention. We all see patients spanning the spectrum of digestive and liver disorders. Highlighted below is a brief synopsis of background information, mention of specific leadership roles, and designation of additional area of focused expertise for each of our physicians and physician assistants. Dr. Pradeep K. Bekal Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Pancreaticobiliary (ERCP) and therapeutic endoscopy, Endoscopic ultrasound-guided biopsies (EUS), Pancreatic and biliary disorders Dr. Bekal graduated from Madras Medical School, Madras, India, and completed his Residency in Internal Medicine at New York Methodist Hospital in Brooklyn, New York. His Gastroenterology Fellowship was completed at the Brooklyn Hospital Medical Center. Dr. Bekal completed an Advanced Therapeutic Endoscopy Fellowship at Allegheny General Hospital in Pittsburgh. Dr. Bekal is the Gastroenterology Director at West Chester Medical Center and has been awarded Cincinnati Magazine’s “Top Doctor” recognition. He is Board Certified in Gastroenterology. Dr. Manish M. Chokshi Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Hemorrhoidal band ligation, Capsule endoscopy “Pillcam”, Hydrogen breath testing, Esophageal studies 99 98 OUR PHYSICIANS *American College of Gastroenterology 2009 93 1 Colonoscopy by Ohio GI Gastroenterologists reliably examines the entire colon, meeting or exceeding national standards. Dr. Chokshi graduated from Case Western Reserve University School of Medicine and completed his Internal Medicine Residency at Metro Health Medical Center, both in Cleveland. Dr. Chokshi then completed his Fellowship in Gastroenterology at the University of Michigan Medical Center in Ann Arbor. He has presented lectures at medical conferences on a variety of topics such as: Evaluation of Anemia from the GI Prospective and Clinically Useful Pharmacology of GI Drugs. He is Board Certified in Internal Medicine and Gastroenterology. Dr. John P. Czarnecki Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Gastroesophageal Reflux Disease (GERD) Dr. Czarnecki graduated from Northwestern University Medical School in Chicago and completed his Residency in Internal Medicine at Dartmouth-Hitchcock Medical Center. He continued his training at Dartmouth, where he completed his Gastroenterology Fellowship. He has presented lectures at medical conferences on a variety of topics such as Colorectal Cancer Screening, GERD, Celiac Disease, and Evaluation of Swallowing Disorders. Dr. Czarnecki is Board Certified in Internal Medicine and Gastroenterology. OUR COMMITMENT TO QUALITY We are able to report quality data where information is measurable and available. In many areas there are no established benchmark indicators of quality performance and we present highlights of numbers of patient volume or descriptions of clinical areas of expertise. We believe, and studies have documented, that seeing a high volume of patients with any given condition leads to expertise that correlates with better outcomes. Endoscopy Center Complication Rate Dr. Karen Haberthier Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Women’s health When performing procedures on our patients, we strive to maximize accuracy and minimize risk and complications. Complications can occur during any medical procedure and we track and compare our data with nationally published complication rates. Dr. Haberthier graduated from University of Medicine and Dentistry of New Jersey - New Jersey Medical School and completed her residency in Internal Medicine at Boston University Medical Center Her Gastroenterology fellowship was performed at University of Pittsburgh Medical Center, where she also served as Chief GI Fellow. Dr. Haberthier is Board Certified in Internal Medicine and Gastroenterology. In 2008, 15,303 patients underwent gastrointestinal endoscopy and/or colonoscopy in one of our outpatient endoscopy facilities. The major complications that can occur include perforation, bleeding from therapeutic maneuvers such as polypectomy, and death. An endoscopic complication occurred in only 8 patients for a rate of 0.0005%. Bleeding accounted for 7 of the 8 events, all from polypectomy sites. None of these patients required surgery and only one needed transfusion. One patient developed an esophageal tear after dilation for which he was briefly hospitalized and medically treated. There were no colonic perforations. Dr. Mark E. Jonas Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Hepatology, Gastrointestinal bleeding, Capsule endoscopy “Pillcam” Dr. Jonas graduated from the State of New York Health Sciences Center at the Brooklyn College of Medicine. He completed his Residency in Internal Medicine at the Montefiore Medical Center of the Albert Einstein College of Medicine. His Gastroenterology Fellowship was performed at the University of Medicine and Dentistry of New Jersey - New Jersey Medical School. Dr. Jonas completed an additional year of Fellowship in Hepatology and Liver Transplantation at the Mount Sinai Medical Center in New York City. Dr. Jonas is the Internal Medicine residency program Education Director at Jewish Hospital. Dr. Jonas has been awarded Cincinnati Magazine’s “Top Doctor” recognition. He is Board Certified in Internal Medicine, Gastroenterology, and Transplant Hepatology and is UNOS approved for liver transplantation. The following data summarizes the complications and compares with national averages. OHIO GI Total complications Perforation Hemorrhage* Death 0.0005% 0.00006% 0.00006% 0.0% NATIONAL RATES 0.5% 0.09% 0.48% 0.0006% *Requiring transfusion or hospitalization Colonoscopy and EGD performed by Ohio GI physicians is as safe or safer than national averages. OUR ENDOSCOPY CENTERS We operate four state-of-the-art endoscopy centers that provide specialized services at convenient locations in Clifton, Montgomery, Fairfield, and Norwood. These facilities provide a comfortable, friendly, and personal environment. We have meticulous standards of high quality care and consistently receive high ratings for patient satisfaction. We have developed an in-house electronic medical record system (eMerge), specific to endoscopic procedures, that is currently used at our primary endoscopy centers. This allows a detailed report to be generated at the time of the procedure and immediately faxed to the primary physician. The patient is also provided with a report for their personal records that helps to clearly convey the results, recommendations, and follow-up. Patients can also access their reports and results on-line via a secure patient portal. Additional educational materials are provided to enhance the understanding of the underlying disease process and healthy lifestyle recommendations. A computerized recall system is utilized to remind patients to schedule a follow-up visit. For example, a patient who has had adenomatous colonic polyps will usually need follow-up colonoscopy in the future. The recommended interval is entered into the computer and when the time arrives, a patient letter is generated and sent to inform them that it is time to schedule a surveillance procedure. These scheduling reminders are especially important in conditions where a premalignant state may occur, such as preventing colon cancer by appropriate follow-up colonoscopy. Dr. Kim R. Jurell Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Gastroesophageal Reflux Disease (GERD), Inflammatory Bowel Disease (IBD) Dr. Jurell graduated from the Indiana University College of Medicine and completed his Residency in Internal Medicine at St. Vincent Hospital in Indianapolis. His Gastroenterology Fellowship was completed at the Medical College of Wisconsin in Milwaukee. He has presented lectures at medical conferences on a variety of topics such as Clostridium Difficile. He has been awarded Cincy Magazine’s “Best Doctor” recognition. Dr. Jurell is Board Certified in Gastroenterology. Dr. Terry R. Kaylor Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Barrett’s therapy, Peptic Ulcer Disease Dr. Kaylor graduated from the University of Cincinnati College of Medicine and completed his Internal Medicine Residency and Gastroenterology Fellowship at The Ohio State University. Dr. Kaylor is interested in all areas of Gastroenterology and Hepatology. He has presented lectures at medical conferences on a variety of topics such as Gastrointestinal Inflammatory Disorders. He is Board Certified in Internal Medicine and Gastroenterology. Dr. Michael D. Kreines, FACG, FAGA, FACP Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), Gastroesophageal Reflux Disease (GERD), Esophageal Disorders Dr. Kreines graduated from the University of Cincinnati College of Medicine and completed his Residency in Internal Medicine at the University of Minnesota. His Gastroenterology Fellowship was performed at the University of California in San Diego followed by an Inflammatory Bowel Disease Fellowship and faculty position at the University of Chicago. He was a founding member and is a current board member of the Cincinnati CCFA chapter and is an active participant in IBD clinical research trials. He was recently appointed to the National Medical Scientific Advisory Committee of the Colon Cancer Alliance (CCA). He is the chief of Gastroenterology and the Director of the Center for Swallowing Disorders at the Christ Hospital and Co-chairman of the local Colorectal Task Force at the American Cancer Society. He is actively involved in teaching medical students and internal medicine and family practice residents. Dr. Kreines has been awarded Cincinnati Magazine’s “Top Doctor” recognition. He has lectured extensively at medical and nursing and community conferences on a variety of topics such as: Inflammatory Bowel Disease, Irritable Bowel Syndrome, Colon Cancer Prevention, and Esophageal Disorders. Dr Kreines is a Fellow of the American College of Gastroenterology, the American Gastroenterology Association, and the American College of Physicians and is Board Certified in Internal Medicine and Gastroenterology. Dr. Lisa S. Lestina Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Gastroesophageal Reflux Disease (GERD), Women’s health Dr. Lestina graduated from Northwestern University Medical School in Chicago. She subsequently completed her Residency and Chief Residency in Internal Medicine at Dartmouth-Hitchcock Medical Center in New Hampshire. Dr. Lestina continued her training at Dartmouth, completing her Fellowship in Gastroenterology. Dr. Lestina has presented lectures to medical and nursing audiences on a variety of topics such as: Celiac Disease, Helicobacter Pylori and Clostridium Difficile. She is Board Certified in Internal Medicine and Gastroenterology. OUR PATIENTS Our mission is to provide outstanding and very personalized care to all patients within the broad range of digestive disorders. Ohio GI is a large subspecialized practice to which a high volume of patients with common and uncommon disorders are referred, resulting in unparalleled expertise in diagnostic and therapeutic capabilities. Annually, Ohio GI provides over 70,000 digestive services which include inpatient encounters, outpatient encounters, and endoscopic procedures to patients mainly from Ohio, Kentucky, and Indiana. Numbers of patients seen in several diagnostic categories: DIAGNOSIS PATIENT VISITS Crohn’s Disease.......................4,084 Ulcerative Colitis.....................1,869 Liver Disease............................1,734 Irritable Bowel Syndrome..........843 Pancreatic Disorders..............1,682 Esophageal Disorders.............6,228 Abdominal Pain*......................6,839 GI Bleeding................................3,694 Diarrhea*................................4,488 Constipation.............................1,488 *Includes some patients with IBS family practice residents, medical students, nursing students, physician assistant students, and as preceptors for undergraduate students who are considering a career in medicine. On an individual patient level, we have developed a wide array of materials and information that focus on specific diseases or symptoms for patient education. We believe a well informed patient is a healthier patient. Our website (www.ohiogi.com) contains many additional informative resources for patients and physicians. Leadership State of Ohio GI leadership National GI Society Leadership Ohio GI CME Conference Ohio GI staff hold or have held leadership positions in the GI division and endoscopy departments at many of our local hospitals. Leadership involvement in national, state, and local organizations has included: National Board of Trustees of the American College of Gastroenterology, Southern Ohio Governors for the American College of Gastroenterology, Practice Management Committee for the American Society for Gastrointestinal Endoscopy, founding officer of the Gastroenterology Assembly for the Medical Group Managers Association, National and State GI representative to the Medicare Carrier Advisory Committee, Chairman of Colorectal Cancer Task Force at the Cincinnati Chapter of the American Cancer Society, Chairman of the Medical Advisory Committee for the Cincinnati Crohn’s and Colitis Foundation chapter, National CCFA young investigator training course , Medical Director of the Christ Hospital Center for Swallowing Disorders, and many others. Dr. Mangels graduated from the Medical College of Ohio in Toledo and completed his Residency in Internal Medicine at the University of Cincinnati. His Gastroenterology Fellowship was also completed at the University of Cincinnati. He is the co-chairman of the Gastroenterology Section at Bethesda North Hospital and has been awarded Cincinnati Magazine’s “Top Doctor” recognition. He has presented lectures at medical conferences on a variety of topics such as Gastrointestinal Bleeding. Dr. Mangels is a Fellow of the American College of Gastroenterology and is Board Certified in Gastroenterology. Dr. Stephen P. Martin Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Pancreaticobiliary (ERCP) and therapeutic endoscopy, Capsule endoscopy “Pillcam”, Pancreatic and biliary disorders Hospital GI leadership Local Not-for-profit organization leadership Dr. David Mangels, FACG Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Gastroesophageal Reflux Disease (GERD) Dr. Martin graduated from the University of Cincinnati College of Medicine and completed his Residency in Internal Medicine at the University Hospitals of Cleveland/Case Western Reserve University. His Gastroenterology Fellowship, which was completed at the University of Pittsburgh, included a focused year of pancreaticobiliary endoscopy and pancreatic physiology training. He is the Chief of Endoscopy at Mercy Hospital Fairfield and has been awarded Cincinnati Magazine’s “Top Doctor” and Cincy Magazine’s “Best Doctor” recognitions. Dr. Martin is Board Certified in Gastroenterology. Dr. Terrance O’Toole Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Gastroesophageal Reflux Disease (GERD), Barrett’s therapy, Clinical outcomes Dr. O’Toole graduated from the Ohio University College of Osteopathic Medicine in Athens, Ohio. He completed his Internal Medicine residency training at the University of Cincinnati. He continued his training at the University of Cincinnati, where he completed his Gastroenterology Fellowship. Dr. O’Toole has lectured on numerous topics such as Barrett’s, Gastroparesis, and Refractory celiac disease. Dr. O’Toole is Board Certified in Internal Medicine and Gastroenterology. Dr. Kris Ramprasad Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Gastroesophageal Reflux Disease (GERD) Dr. Ramprasad graduated from Madras Medical School, Madras, India. He completed his Residency in Internal Medicine at the Veteran’s Administration Hospital and at Wright State University, both in Dayton, Ohio. His Gastroenterology Fellowship was completed at the University of Cincinnati. Dr. Ramprasad is the Gastroenterology section head at Mercy Hospital Western Hills. He is a clinical teacher of Gastroenterology Fellows at the University of Cincinnati and has been awarded Cincinnati Magazine’s “Top Doctor” recognition. Dr. Ramprasad is Board Certified in Internal Medicine and Gastroenterology. Dr. Ravi Ravinuthala, Member of the Royal College of Physicians (UK) Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Hepatology, Mind-Body interaction Clinical Research Three decades experience Involvement in the leading edge of GI therapies Availability of alternative treatments for patients We have been involved in clinical research for nearly thirty years. Our research division, Consultants for Clinical Research (www.ccrstudy.com), has conducted over 350 gastroenterology and hepatology clinical trials. We have participated in numerous pivotal clinical trials that now form the basis of advanced treatment in many GI disorders such as: Crohn’s disease, ulcerative colitis, irritable bowel syndrome, GERD, Hepatitis B, Hepatitis C, Peptic Ulcer Disease, eradication of Helicobacter pylori, and others. Our involvement in clinical research trials provides us with an increased level of experience and knowledge regarding new treatments and related pharmacology as well as the ability to offer treatment alternatives to patients that would otherwise not be available to them. Dr. Ravinuthala graduated from Rangaraya Medical College in India. He completed his Internal Medicine Residency, Gastroenterology Fellowship and Transplant Hepatology Fellowship at Henry Ford Hospital, Detroit, Michigan. He is Board Certified in Internal Medicine, Gastroenterology, and Transplant Hepatology and is UNOS approved for liver transplantation. Dr. Z. A. Saeed, FACG Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Pancreaticobiliary (ERCP) and therapeutic endoscopy, Endoscopic ultrasound-guided biopsies (EUS), Hemorrhoidal band ligation, Pancreatic and biliary disorders Dr. Saeed graduated from King Edward Medical College, Lahore, Pakistan. He completed his Residency in Internal Medicine at Texas Tech University, Amarillo. He received Fellowship training in Gastroenterology and Hepatology at Georgetown University, Washington, D.C., followed by clinical and basic research training at The National Institutes of Health, Bethesda, Maryland. He also completed a Fellowship in Advanced Therapeutic Endoscopy and Endoscopic Research at Baylor College of Medicine, Houston, Texas, and received formal training in endoscopic ultrasound procedures at Institut Paoli-Calmette, Marseilles, France. Dr. Saeed is a Fellow of the American College of Gastroenterology and has been awarded Cincinnati Magazine’s “Top Doctor” recognition. Dr. Saeed is Board Certified in Internal Medicine and Gastroenterology. Education Patients and the public Physicians Medical students and residents Nurses With the enormous amount of medical information available, Ohio GI recognizes the importance of educating physicians, students, medical residents, patients, and the public at large. Many of our physicians present lectures to medical audiences on state-of-the-art topics during medical conferences and hospital grand rounds in town and around the country. Ohio GI conducts an annual CME conference (usually held in February) for approximately one hundred primary care providers to hear talks on the latest breakthroughs in the field. We frequently provide lectures to community groups in a variety of settings on requested topics, such as: inflammatory bowel disease, irritable bowel syndrome, reflux, colon cancer prevention, liver disease, and others. Through our involvement with the American Cancer Society, programs have been brought to the area reaching tens of thousands of people with information and education about colon cancer prevention. We are involved in teaching GI fellows, medical residents, Some of the procedures we perform: • EGD with related therapies • Colonoscopy with related therapies • Endoscopic Ultrasound (EUS) for GI and non-GI (pulmonary) lesions • Fine needle aspiration during EUS • ERCP, sphincterotomy, pancreatic and biliary stent placement, manometry • Choledochoscopy • Esophageal, small bowel, pancreatobiliary, and colonic dilation • Esophageal and colonic stenting • Pancreatic pseudocyst drainage. • Endoscopic mucosal resection (EMR) • Celiac plexus block under endoscopic ultrasound guidance • Argon plasma coagulation of polyps and vascular lesions • Percutaneous endoscopic gastrostomy and jejunostomy • Hydrogen breath testing for small bacterial overgrowth and carbohydrate intolerance • Endoscopic banding for internal hemorrhoids • Small bowel wireless capsule endoscopy “pill cam” • Liver biopsy • Esophageal Manometry • Esophageal catheter and BRAVO pH testing • Esophageal impedance • Halo Ablation of Barrett’s esophagus Dr. Alan V. Safdi, FACG Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), Clinical research Dr. Alan Safdi graduated from the University of Cincinnati College of Medicine (with distinction being nominated to the honorary medical society of AOA) and completed his Residency in Internal Medicine at the University of California at San Diego. He did his undergraduate education at Northwestern University and was inducted into the honorary society, Phi Beta Kappa. His Gastroenterology Fellowship was completed at the University of Cincinnati. Dr. Safdi lectures nationally on IBD, colonoscopy preparation, esophageal reflux, and a variety of gastrointestinal disorders. He has authored many articles, reviews and updates related to Gastroenterology. He is actively involved in clinical research in internal medicine and digestive disease disorders. Dr. Safdi has been awarded Cincinnati Magazine’s “Top Doctor” recognition. He has been the director of the Gastroenterology section at Deaconess Hospital and was past Chairman of the Cincinnati Crohn’s and Colitis Medical Advisory Committee. Dr. Alan Safdi is a Fellow of the American College of Gastroenterology and is Board Certified in Internal Medicine and Gastroenterology. Dr. Michael A. Safdi, MACG, FACP Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Hemorrhoidal band ligation, Gastroesophageal Reflux (GERD), Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), Peptic Ulcer Disease, Clinical research Dr. Michael Safdi graduated from the University of Cincinnati College of Medicine and completed his Residency in Internal Medicine at the University of California at San Diego. His Gastroenterology Fellowship was also completed at the University of California at San Diego. He has served on numerous local, regional and national boards and committees with the American College of Gastroenterology and other organizations. He is actively involved in clinical research of new medications for digestive disorders and with training young CCFA investigators. Dr. Safdi has been awarded Cincinnati Magazine’s “Top Doctor” recognition. Dr. Safdi is a Master of the American College of Gastroenterology, a Fellow of the American College of Physicians, and is Board Certified in Internal Medicine and Gastroenterology. Dr. Jeffrey D. Stotz Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Gastroesophageal reflux (GERD), Inflammatory bowel disease (IBD) Dr. Stotz graduated from The Ohio State University College of Medicine and completed his Internal Medicine Residency and his Gastroenterology Fellowship at University Hospitals of Cleveland/Case Western Reserve University. Dr. Stotz has recently lectured to a medical audience on Celiac Disease. He is Board Certified in Internal Medicine and Gastroenterology. Dr. George Waissbluth Consultative gastroenterology, endoscopy, colonoscopy • Special Interest: Irritable bowel syndrome (IBS) Dr. Waissbluth graduated from the Universidad de Chile in Santiago, Chile, and completed his Residency in Internal Medicine at Jewish Hospital, Cincinnati. His Gastroenterology Fellowship was completed at the University of Cincinnati. Dr. Waissbluth is Board Certified in Internal Medicine and Board Eligible in Gastroenterology. Hospital Coverage: Bethesda Hospital Children’s Hospital Medical Center* Christ Hospital Jewish Hospital Mercy Fairfield Hospital Mercy Western Hills Hospital Mercy Mt Airy Hospital* West Chester Medical Center Adams County Hospital* VA Hospital* * Limited to outpatient coverage Endoscopic/Therapeutic Services Proven high standards and superior results Experts with high volume of experience All of our physicians are experts in the performance of endoscopy and colonoscopy. Additional subspecialization within our group includes physicians who have had specific and extensive experience and training in more advanced endoscopic procedures such as: endoscopic ultrasound (EUS) with fine needle aspiration (FNA), Endoscopic Retrograde Cholangiopancreatography (ERCP), and endoscopic mucosal resection (EMR). We were the first in the area to perform small bowel wireless capsule endoscopy with the “Pillcam”. Liver biopsies are performed by one of our Hepatologists in our endoscopy centers. Experts in esophageal disorders perform a variety of specialized esophageal testing. Our pathologist, an expert in gastrointestinal pathology, evaluates biopsy material from our endoscopy centers. OUR WORK PHYSICIAN ASSISTANTS Outpatient Convenient locations Individualized care Expedited visits Close communication with referring doctors With offices located throughout Cincinnati, Fairfield and surrounding suburbs and counties, we are able to offer convenience to our patients. We provide outpatient consultation and follow-up care and see patients on a timely basis. For urgent outpatient care, appointments with our physicians and physician assistants can usually be made within 24 hours. We emphasize close communication with referring physicians by direct discussion for more urgent or serious conditions and always with prompt written reports of patient encounters. Other modalities such as voice mail, fax referral forms, and email have also been developed to enhance communication. Inpatient Always available Rapid consultation and endoscopic response Ohio GI physicians work at most hospitals within the Greater Cincinnati area where we provide inpatient services and are available on a 24 hr/7 day per week/365 day per year basis. When we receive a consultation request we see patients quickly and provide thoughtful and expedited endoscopic services. We are the primary providers of GI services and our physicians are directors of the GI divisions or endoscopy committees at many of the hospitals. Jennifer Acosta, PA-C, MPAS • Special Interest: Outpatient digestive care, Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), Hepatitis Ms. Acosta graduated from South University with a Bachelor Degree in Physician Assistant Studies. She received her Master’s Degree in PA Studies from the University of Nebraska. Jennifer is Board Certified by the National Commission on Certification of Physician Assistants. Laurie Einwald, PA-C, MPAS • Special Interest: Inpatient and outpatient digestive care, Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), Hepatitis Ms. Einwald graduated from the University of Dayton with a Bachelor Degree in pre-medicine. She received her Master’s Degree in Physician Assistant Studies from Marquette University. Laurie is Board Certified by the National Commission on Certification of Physician Assistants. James Fry, PA-C, MS • Special Interest: Outpatient digestive care, Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), Hepatitis, Clinical research Mr. Fry received his Physician Assistant training while serving in the US Air Force and then obtained his Master’s Degree from Alderson-Broaddus College. Prior to being recruited to Ohio GI, he was a professor in the PA programs at the University of Kentucky and Marietta College. He has been chairman of the education council of the American Academy of Physician Assistants and VP of the Ohio Association of Physician Assistants. Jim is Board Certified by the National Commission on Certification of Physician Assistants. Jim is a Distinguished Fellow of the American Academy of Physician Assistants. CONTACT US Patient Referrals Ohio GI Administration Please see our map on the back cover. Dan Walker - Chief Operating Officer Phone - 513-569-1310 Email: [email protected] RoseAnn Maher - Office Manager Phone - 513-569-1300 Email: [email protected] Research Division Billing Consultants for Clinical Research Phone - 513-872-4549 www.ccrstudy.com Phone - 513-872-4555 Table of Contents Our Work OHIO GI LEADERSHIP AND QUALITY REPORT Outpatient Inpatient Hospital Coverage Endoscopic/Therapeutic Services Clinical Research Education Leadership Our Patients Patient Encounters Specific Disease Encounters Our Endoscopy Centers Our Commitment to Quality www.ohiogi.com Endoscopy Center Complication Rate Colorectal Cancer Prevention Studies Patient Satisfaction Surveys Inflammatory Bowel Disease Irritable Bowel Syndrome Liver Disease Women’s Digestive Health Endoscopic Ultrasound Endoscopic Retrograde Cholangiopancreatography Esophageal Disorders Small Bowel Evaluation Pancreatic Disorders Endoscopic Mucosal Resection Our Research Division Consultants for Clinical Research Our Physicians 2925 Vernon Place • Suite 100 • Cincinnati, Ohio 45219 www.ohiogi.com Physicians Physician Assistants Contact Us
