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What is Adenoma Detection Rate (ADR)?

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For decades, the screening colonoscopy has been recognized as the most effective modality to prevent and detect colorectal cancer. By identifying and  removing precancerous polyps (adenomas), colonoscopies save thousands of  lives each year. Regularly-scheduled screening colonoscopies are crucial for  adults aged 45 and older.  

However, it’s important to note that the effectiveness and quality of each colonoscopy varies from doctor to doctor. Different levels of education,  experience, and methodologies have been found to influence the “success” of a medical practitioner at performing screening colonoscopies. These case-by-case disparities ultimately led to a need for a standard of quality, a numerical  framework. In 2002, a Multi-Society Task Force was assembled to create just that: the adenoma detection rate, or ADR. ADR gives a percentage value to  each doctor’s levels of safety, quality, and thoroughness when performing a  colonoscopy.  

How does ADR work? ADR measures the average rate of precancerous polyps that a doctor identifies and removes in each colonoscopy. In the U.S., it has been  established that at least 30% of men and 20% of women aged 50+ should have  one or more adenoma found in a colonoscopy. It has been found that doctors  that meet or exceed these national quality benchmarks are generally more likely to prevent colorectal cancer, including advanced-stage or fatal cancer. In fact, even a marginally higher ADR can indicate a significant improvement in outcome. Likewise, doctors with lower-than-average ADRs have been connected with the  failure to identify cases of colorectal cancer.  

While the ADR is considered the “gold-standard” of evaluating endoscopic quality, it is not the only measure of a doctor’s ability to identify polyps. Other well-regarded quality metrics include practices such as: the quality of bowel  preparation; patient assessments; compliance rates with general screening  guidelines; rate of complications; cecal intubation rate; withdrawal time (the  amount of time a doctor should spend withdrawing the colonoscope at the end of  the procedure, which should be at least 6 minutes); and documentation of  informed consent. 

By meeting and exceeding these standards of safety and thoroughness, your doctor directly improves your chance of identifying or preventing colorectal  cancer. Therefore, it’s not rude or uncommon to ask about your doctor’s ADR,  withdrawal time, or other procedures that ensure a quality colonoscopy. These  are serious, relevant questions that can aid in your decision to choose a gastroenterologist.  

Our board-certified team of gastroenterologists has addressed many common concerns related to colonoscopies on our website. Click on any of the questions below to see complete answers: 

  1. When should I get a colonoscopy? Isn’t 45 too young?
  2. What should I expect from my colonoscopy? How should I prepare for it? What happens during and after?
  3. Where can I read about someone else’s experience with colon cancer? 
  4. I tend to be constipated. How should I prepare for my colonoscopy?
  5. Why should I get a colonoscopy instead of other screening tests? What makes it more effective? (Video)
  6. What’s the difference between a screening colonoscopy, Cologuard, and other screening tests? (Video)

The experienced team of medical professionals at Gastroenterology Health Partners is committed to making every patient’s experience with a colonoscopy as easy and effective as possible. For more information or to schedule an appointment, contact Gastroenterology Health Partners today at a location near you.

Understanding the Connection Between Exercise and Gastrointestinal Health

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While we all know that the foods we consume have a significant impact on gut health, very little is often said for the influence of exercise and activity on the GI system. People usually exercise to get fit, lose weight, or socialize, unaware of the deeper functional benefits of regular activity.

Recent studies have only just begun to unlock insight into the powerful role of exercise in promoting digestion, gastrointestinal health, metabolic capacity, disease prevention, and long-term wellbeing.

Maintaining Regular Exercise is Key

A study conducted at the University of Illinois in 2018 found that regular exercise alters the entire gut microbiome. In the study, previously sedentary participants engaged in daily endurance activities for six weeks. Across the board, participants experienced an increase in both diversity and metabolic capacity of the gut microbiome.

Furthermore, scientists found a widespread increase in short-chain fatty acids (SCFAs), a subset of fatty acids that are produced by the gut microbiota. SCFAs are known to reduce inflammation, boost the metabolism, improve the immune system, improve neurogenesis and fight insulin resistance. In short—the more, the better!

After the study ended, participants stopped exercising. Interestingly, within weeks, their gut composition reverted back to how it was before the study. The effects of the exercise did not last. This proves that maintaining regular exercise is vital to improve and upkeep gut health.

The benefits of regular exercise were again reaffirmed in a 2019 study. In this study, insulin response in male participants was tested after no exercise, after one day of exercise, and again after three consecutive days of exercise. Research found that maintaining exercise over three days was significantly more effective at improving insulin response. A single day of isolated exercise had almost no benefit.

Exercise Can Help Prevent Colon Cancer

Regular exercise can also play a role in preventing colon cancer. In one study, exercise was reported to decrease the total number of intestinal polyps by 50% and the number of large polyps by 67%. Another study found that the risk of colon cancer decreased 40% in those who exercised more than 7 hours a week. In turn, over 40% of those diagnosed with colon cancer already suffered from a comorbid disease, such as diabetes, obesity, chronic obstructive pulmonary disease, and heart failure. The influence of exercise on preventing colon cancer cannot be overstated.

Exercise Doesn’t Have To Be Hard

Many people think that exercise needs to be high-intensity to really count. They push themselves too hard, and then get injured or burned out. We’ve all seen it before—your friend’s New Year’s resolution to go to the gym dissipating within days after they discover they don’t enjoy Pilates or bench pressing.

Exercise doesn’t have to be a big ordeal or a fancy gym membership. As the studies listed above have shown, what matters more than anything is consistency. Whether it be consistently walking 30 minutes a day, doing yoga poses in the morning, or jogging around your neighborhood—all that matters is that you keep it up. Long-term health and wellbeing comes from committing to an active lifestyle, above all else.

For more information about gastrointestinal health or to schedule an appointment with a board-certified gastroenterologist, contact Gastroenterology Health Partners today. Schedule an appointment by calling a location near you. For additional details, visit our contact us page.

How Kentucky’s Lifestyle and Genetics Are Contributing To High Colon Cancer Rates

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Dr. Whitney Jones was recently featured in a Bowling Green Daily News article about how Kentucky’s lifestyle and genetics are contributing to high colon cancer rates.

The article highlights some alarming statistics. According to the Centers for Disease Control and Prevention, Kentucky has the highest rate of colorectal cancer in the nation, and it is the third leading cause of cancer death in women and men.

Lifestyle Causes of Colorectal Cancer Include

  • Lack of exercise
  • Diet high in processed red meat and low in fruits and vegetables
  • Obesity
  • Excessive alcohol consumption
  • Tobacco use

The Centers for Disease Control and Prevention ranks Kentucky as the second highest state in the nation for tobacco use. What’s more, over two-thirds of adults in Kentucky are overweight, less than a tenth eat enough fruits and vegetables, and more than a third do not exercise regularly.

In addition to harmful lifestyle habits, a family history of colorectal cancer puts patients at a higher risk for developing the disease themselves.

Dr. Whitney Jones, a gastroenterologist with Gastroenterology Health Partners in Louisville is a national expert and frequent speaker on early-age onset colorectal cancer prevention, as well as genetic GI cancer syndrome testing, risk management and communication strategies for population-based cancer prevention.

Founder of the Colon Cancer Prevention Project, an organization dedicated to colon cancer prevention, Dr. Jones is an advocate for utilizing genetic testing to improve patient outcomes and lower cancer-related societal outcomes. The article notes a bill recently passed by Kentucky legislators that requires health insurance to cover genetic tests for cancer when recommended by licensed medical professionals.

DNA testing can help expose those with genetic risks for colorectal cancer and determine the appropriate age for them to begin screening. In his work, Dr. Jones recognizes a correlation between low screening rates and high incidences of colon cancer and mortality rates. “Only one in 10 people get genetic testing before developing cancer. If you know you were going to have a car wreck next Thursday, what would you do?”

Read the full article here:

 

Dr. Whitney Jones Discusses Colorectal Cancer

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Dr. Whitney Jones is a national expert and frequent speaker on early-age onset colorectal cancer prevention, genetic GI cancer syndrome testing and risk management, and communication strategies for population-based cancer prevention.

On this episode of KET’s Kentucky Health, Dr. Jones explains how we can decrease incidents and mortality rates of colorectal cancer.

Colorectal cancer is the second cause of death due to cancer in the United States. Prior to 2004, Kentucky had one of the highest death rates from colon cancer. One major factor was a lack of screenings. However, now the mortality rate has decreased by more than 20% and we have gone from being 49th in the U.S. for people being screened for colon cancer to a current ranking of 20th.

This is due in large part to the development in 2003 of the Colon Cancer Prevention Project by Dr. Whitney Jones; an organization dedicated to spreading the message of colon cancer.

While the rates are decreasing for those over the age of 55, for reasons unknown, rates of colorectal cancer, specifically rectal cancer, have increased in those under the age of 55. Genetics and lifestyle habits could be prominent factors in this increase. Early screening is an important preventive tool as these rates are projected to continue to rise. 

Causes of Colorectal Cancer

  • Obesity
  • Tobacco use
  • Diets high in red processed meat and low in fresh fruits or veggies
  • Lack of exercise 
  • A family history
  • Excessive or ongoing alcohol use

Symptoms of Colorectal Cancer

  • Rectal bleeding
  • Change in bowel habits
  • Weight loss
  • Unexplained abdominal pain

However, the most common symptom of colon cancer is no symptom at all. It is known as the silent killer and early onset colon cancer has an average 6 month delay from the time a person has symptoms until they see a doctor. 

Screenings

Those with a family history should start screening a decade before their family history indicates, even as early as one’s twenties. 20% of those with a family history of colorectal cancer are at more of a risk themselves. 

If no warning signs or family history exist, screenings should being at the age of 45.

All colonoscopy screenings are covered in the state of Kentucky due to the Affordable Care Act. For those who don’t want a colonoscopy,  there are other options available. However, colonoscopies are still the gold standard of screenings as they remove polyps and the removal of polyps help prevent cancer from developing.

Knowing Your Family History

Genetic medical grade testing is an important proactive tool in diagnosing colorectal cancer. It is now more affordable and accessible than ever before.

Lynch syndrome for example is the most common genetic trait for colorectal cancer. Polyps in the colon develop into cancer faster for persons with Lynch syndrome than those with other genetic predispositions. Those who have it are also at an increased risk of ovarian cancer, endometrial cancer, and pancreatic cancer, among several others. 

Other Preventative Measures

  • Increase the amount of veggies in your diet.
  • Aspirin has been known to reduce the formation of polyps, but has it’s side effects.
  • If you have had polyps in the past, keep up with your follow up surveillance.

Watch the full episode of Dr. Whitney Jones on Kentucky Health here: 


Dr. Whitney Jones is a practicing Gastroenterologist, former therapeutic endoscopist and Clinical Professor at the University of Louisville from 1994 until 2017. He joined GHP in 2017 cofounding its new east Louisville division, Gastroenterology & Endoscopy Associates, PLLC, alongside Drs. Ashok Kapur and Laszlo Makk.

Dr. William Evans Discusses Pancreatitis

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Dr. William Evans offers diagnostic and therapeutic care for conditions involving the GI tract, pancreas, and liver.  He provides his patients with comprehensive care that has been honed through years of specialized training and experience.

On this episode of KET’s Kentucky Health, Dr. Evans thoroughly discusses the pancreas as well as pancreatitis.

What is the Pancreas?

The pancreas is an organ that aids in the digestion of food. Located behind the stomach and deep in the abdomen, inflammation of the pancreas can affect all the important organs that surround it and even cause paralysis of the intestines. The two main functions of the pancreas are to regulate blood sugar and to make a enzyme fluid that helps digest any proteins or fats that are consumed. Pancreatitis is a disease that occurs when the pancreas becomes inflamed.

Causes of Pancreatitis 

  • Excessive Alcohol Abuse
  • Certain Medications
  • High Cholesterol
  • Gallstones or Gallbladder Disease (The most common cause.)
  • Virus or Traumatic Injury: (While not very common, viruses or traumatic injuries can result in pediatric cases of pancreatitis.) 
  • Distended Belly or Bloating (Present in more significant cases due to inflammation.)

Symptoms of Pancreatitis 

  • Abdominal Pain (Severe and focused on one’s back, especially triggered when eating.)
  • Nausea or Vomiting

Acute Vs. Chronic Pancreatitis 

Anyone can have acute pancreatitis. The most common cause of acute pancreatitis is trapped gallstones blocking the flow of pancreatic juice. In acute pancreatitis, inflammation can be so profound that the organ digests itself. Long term complications include a severe episode where one must be admitted to a hospital and kept for a few days, the death of the pancreas itself, a build up fluid that can become infected, as well as an impact on multiple other organs.

Chronic pancreatitis is most commonly associated with risk factors such as regular alcohol or tobacco use. Chronic pancreatitis can take months to develop and is often asymptomatic. In chronic pancreatitis cases, scar tissue builds up in the pancreas surrounding the nerves and causing pain. Overtime, one can lose function of the gland as well as the ability to digest food, and are at an increased risk for diabetes as well as pancreatic cancer. 

Pancreatic cancer is the 4th leading cause of cancer related deaths in the United States affecting those 45 or older. Signs of pancreatitis cancer include unexplained weight loss, a history of smoking, no obvious cause of pancreatitis, and a family history of the disease.   

Diagnosing & Treating Pancreatitis

Diagnosing pancreatitis often involves a basic exam, medical history, lab work and imaging. A CT scan of the abdomen can show if a stone is causing blockage or if a tumor is present. If a gallstone is a factor, an endoscopy may be required. With little if any food intake, pancreatitis usually takes 3-5  days to resolve, and an additional 6 weeks for the pancreas itself to normalize.

In order to avoid pancreatitis, abstaining from smoking and drinking is recommended. Educating one’s self on gallstones is also a helpful resource in preventative care, as one can have them removed if they become problematic.

Watch the full episode of Dr. William Evans on Kentucky Health here: 


Dr. William Evans earned his Medical degree from St. George’s University School of Medicine in Grenada, West Indies.  He completed his clinical training at the University of Louisville, where he completed an Internship, a Residency in Internal Medicine, and Fellowship in Gastroenterology.  During his fellowship training, Dr. Evans also earned a Masters in Science & Clinical Investigation at the University of Louisville School of Public Health & Information Sciences.  Dr. Evans went on to complete a second Fellowship in Therapeutic Endoscopy at the University of Florida College of Medicine in Gainesville, Florida.