AGA Unveils List of Treatments Doctors, Patients Should Question

Lawrence R. Kosinski, MD, MBA, AGAF, chair, AGA Institute Practice Management and Economics Committee, represented AGA at a press conference in Washington, DC, announcing the campaign to patients, consumer advocacy groups and government organizations. Media coverage from the campaign includes articles in The New York Times, USA Today and The Washington Post.

“The AGA feels this list focuses on issues of importance to disease prevention,” stated Dr. Kosinski during the press conference. “We feel our patients will benefit from the fact that we are using accepted guidelines to tell them when to have procedures done, by whom to have the procedures done, and when they should come back, even to the point to tell them ‘no, it’s not time for you to come back yet.’”

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1. For pharmacological treatment of patients with gastroesophageal reflux disease (GERD), long-term acid suppression therapy (proton pump inhibitors or histamine2 receptor antagonists) should be titrated to the lowest effective dose needed to achieve therapeutic goals.
2. Do not repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals.
3. Do not repeat colonoscopy for at least five years for patients who have one or two small (< 1 cm) adenomatous polyps, without high-grade dysplasia, completely removed via a high-quality colonoscopy.
4. For a patient who is diagnosed with Barrett’s esophagus, who has undergone a second endoscopy that confirms the absence of dysplasia on biopsy, a follow-up surveillance examination should not be performed in less than three years as per published guidelines.
5. For a patient with functional abdominal pain syndrome (as per ROME III criteria) computed tomography (CT) scans should not be repeated unless there is a major change in clinical findings or symptoms.

AGA’s list was created by a work group that included members from the AGA Institute Clinical Practice and Quality Management Committee, chair of the AGA Institute Practice Management and Economics Committee, the chief medical officer for the AGA Digestive Health Outcomes Registry®and members of the AGA Institute Governing Board.

Download AGA’s list of five things, with evidentiary statements, resources and information on how the list was created. Learn more about Choosing Wisely and read all nine lists at www.ChoosingWisely.org.