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Patients benefit when GIs partner with pathologists

A good pathologist can be a gastroenterologist’s best friend. A good GI pathologist, that is.

Rish K. Pai, MD, PhD

“Effective patient management requires close communication with pathologists and a close understanding of what the pathologist is saying in the report,” said Rish K. Pai, MD, PhD, associate professor of pathology at the Mayo Clinic Hospital, Phoenix, AZ. “Talking to your pathologist, having a close connection with your pathologist, can help patient management.”

Dr. Pai will moderate the annual Rodger C. Haggitt Gastrointestinal Pathology Society Symposium on Sunday. The AGA Clinical Symposium, which is titled Getting the Most Out of Your Pathologist: Three Illustrative Cases, brings together three pathologists and three gastroenterologists to examine three case studies. The subtext: GI disease is not always what it appears to be.

“Take polyposis, the subject of a case with Carole Burke, MD, the president of the American College of Gastroenterology,” Dr. Pai said. “Every gastroenterologist can probably identify polyposis, but the pathologist plays an important role in determining which polyposis syndrome is present. That definitive diagnosis, which relies heavily on pathology, is really what guides the gastroenterologist in discussing the appropriate genetic testing and risk assessment for colon cancer.”

IBD is another condition that can benefit from a good pathology review. John Hart, MD, president of the Gastrointestinal Pathology Society, will review a case that looks like classic IBD. But on closer inspection, one or two elements seem out of line with the diagnosis.

The last case study involves celiac disease. Recent guidelines that updated biopsy methods for celiac can help confirm an initial diagnosis, but up to 40 percent of patients have atypical symptoms that can delay proper diagnosis, sometimes for years.

“There are a lot of conditions that can mimic celiac, sometimes very closely,” Dr. Pai said. “This is another very common area where the pathologist can help steer the gastroenterologist to a more accurate diagnosis. It’s easy to say celiac, but it can pay off to consider other conditions that might fit the patient’s symptoms a little more closely.”

Gastroenterologists who spend most of their time in inpatient and academic settings generally have a solid appreciation for gastrointestinal pathologists, Dr. Pai said. Clinicians in community practice may not have had an opportunity to see the differences that skilled pathology can make in patient care.

“We are in this together, the pathologist and the gastroenterologist,” Dr. Pai said. “The pathologist is there to help the gastroenterologist help the patient. In many cases, the gastroenterologist is relying on the pathologist to make the diagnosis. This symposium will be a unique opportunity to watch the back and forth between gastroenterologists and pathologists that leads to solutions for difficult clinical problems. That same degree of communication is just as important when it comes to diagnoses that look like a slam dunk but aren’t.”

Please refer to the DDW Mobile App or the Program section in Sunday’s DDW Daily News for additional details on this and other DDW® events.

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