Huntington, W.V.-based Marshall University's Joan C. Edwards School of Medicine's Chief of Gastroenterology Akash Ajmera, MD, weighed in on the future of gastroenterology, colorectal cancer screenings and more.
Note: Responses have been lightly edited for clarity and style.
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Question: How do you see gastroenterology changing over the next five to 10 years?
Dr. Akash Ajmera: Gastroenterology has been an ever evolving field. The gamut of endoscopic interventions have expanded rapidly in the last decade or two. I do see this expansion continuing in the next decade as well; more successful interventions in using endoscopic ultrasound, new weight loss procedures, evolving endoscopic submucosal dissection techniques and more.
Decreased reimbursements for regular endoscopies (upper endoscopy and colonoscopy) seems to pose a challenge of its own. Medicare seems bent on continuing to pay less and less, which may make financial logistics difficult for gastroenterologists to even perform regular screening or diagnostic endoscopies. I particularly worry about this situation getting worse in the next few years.
Q: What brought you to the field of gastroenterology?
AA: The nature of the field with a flexible combination of medical and "noninvasive surgery" where one can focus on variety of subdivisions of the field (hepatology, IBD and motility) combined with the high demand for the field made it very enticing for me.
Q. What is your view on the American Cancer Society lowering the colorectal cancer screening age to 45? How do you encourage your patients to get screened?
AA: [Physicians should start screening at 45 because] I believe there [have been] a significant number of solitary colorectal cancer[cases] found in men and women younger than 50 years. For [that] reason it is prudent to start earlier than [age] 50 for colorectal cancer screening
I always [ask my patients] about colonoscopies [they] have had regardless of the reason for the consultation. I ask about family history of colon cancer or polyps and, if deemed appropriate, recommend colonoscopy. Resistant patients get information about how getting colonoscopies at recommended intervals reduces colorectal cancer risk by over 90 percent and that [colonoscopy] is a very low risk procedure. I try to relieve anxiety surrounding taking the prep and give suggestions to keep it less unpleasant.