UNIFIED (TRIPARTITE) RESEARCH AGENDA

for the

Philippine Society of Gastroenterology

Philippine Society of Digestive Endoscopy

Hepatology Society of the Philippines

2016-2021

INTRODUCTION

THE PSG-PSDE-HSP UNIFIED RESEARCH AGENDA

Research occupies a pivotal role in the Mission-Vision statements of the three societies engaged in gastrointestinal

and hepatic diseases, namely the Philippine Society of Gastroenterology, Philippine Society of Digestive Endoscopy and

Hepatology Society of the Philippines. A Unified Research Agenda (URA) was formulated to help achieve these goals. The

URA will help steer GI research in an organized manner in the direction envisioned by the three societies. A Research Agenda structures a prioritization process so that an organization can systematically weigh factors in its consideration of

research projects and activities. Henceforth, the Research Agenda shall serve as a guide to maximize resource utilization

and minimize duplication of research efforts. It shall identify the research priorities in the next 3-5 yrs.

The National Unified Health Research Agenda (NUHRA), a major document produced by the Research Agenda

Committee of the Philippine National Health Research System, serves as the country’s template for health research and

development efforts. (Philippine National Health Research System. National Unified Health Research Agenda. 20112016.

Pdf accessed July 2016). The Unified Research Agenda of PSG/PSDE/HSP was formulated in alignment with the NUHRA

goals on general health research and development.

THE RESEARCH TEAM

Involved in the preparation and formulation of the URA are the following:

1. Section Chiefs, Training Officers and Research Coordinators of the 13 training institutions

2. Joint Research and Research Education

3. Board representatives for research from PSG, PSDE and HSP 4. Representative from the Accreditation

Board

PREPARATION FOR THE FORMULATION OF URA

Strategic Planning and Focus Group Discussions (FGDs)

Prior to the formulation of the URA, FGDs were held to review and reassess the status of GI research in the country and identify related issues. All training institutions and above-mentioned groups of gastroenterologists were duly

represented. Dr. Raul Destura, an established research specialist both local and international, served as facilitator and

mentor. (Highlights of the meetings are attached in the Appendix).

A. 1st FGD

The 1st FGD was held last September 21, 2015. Past performance based on the research goals identified in

the 2010 PSG Strategic Planning was reviewed and assessed. Gap Mapping and Gap Analysis were done, including identification of strengths, weaknesses, opportunities and treats. Discussion also included defining the roles of the

Research Coordinators of the training institutions and JRRE, and how they can proactively share responsibilities.

Finally, the essential components of a research infrastructure namely: a) new office b) Research Development Unit (RDU) c) website and d) research funding mechanism, were identified as future needs.

B. 2nd FGD

On the 2nd FGD held last Feb 7, 2016, Dr. Destura elaborated on the Concept of Research Agenda: its

importance to all the stakeholders, priority setting tools and processes to be followed in formulating the research

agenda, including the Five Steps in priority setting per disease.

The group benchmarked the state of GI research in the Philippines and concluded an average of 3/10. On brainstorming, issues identified were lack of warm research bodies from training institutions and the need for an

engaging research environment. Consultants should be encouraged to actively participate in research

conceptualization up to completion to ensure high quality of research outputs. There is a call to re-educate

consultants involved in training and research. Issues on lack of enthusiasm and interest need to be examined and

solved. Lastly, as reflected also in the 1st FGD, it is essential to revisit the current training programs for a paradigm shift in leveraging research as an integral component of subspecialty training.

The group agreed that creation of a Unified Tripartite Research Agenda shall enable the three societies to

produce rational research outputs using cross- disciplinary/integrated approach and shall minimize confusion in

allocation of funds.

RESEARCH AGENDA PROPER

The Research Team met last May 7, 2016 to formulate the Unified Tripartite Research Agenda. All training institutions were duly represented. The JRRE members and research representatives from the three societies were present. Dr. Raul Destura served as external facilitator. The team followed the standard procedures required to formulate a research agenda.

Selection Criteria

Topics were evaluated according to the following criteria:

1. Is the agenda “doable”? Do we have the data?

2. Topic addresses multiple goals in the strategic plan?

3. Will the study’s output move the existing knowledge forward?

4. Will the study impact the fellows-in training, the three societies and the country as a whole?

5. Can we use prior studies to leverage this study?

6. How much new information will the study provide?

Prioritization Process

The areas for research were categorized as follows:

1. Quick wins (high impact, short term time frame, 0-12 months)

2. Stars (high impact, long term time frame 12-24 months)

3. Building Blocks (low impact, short term time frame, 0-12 months)

4. Back Burners (Low impact, long term time frame 12-24 months)

Each participant voted for their choice of topics.

Top Priority Areas For Research:

GERD

Peptic Ulcer Disease

Enteric Infections

Gallstones

GI Bleeding

Gastro-Intestinal TB

Hepatitis B

NAFLD

Liver Cirrhosis

Colorectal Cancer

Liver Cancer

Pancreatitis

Among the topics mentioned above, the following were chosen to be the Top Ranking Areas for Research:

1st – Hepatitis B

2nd – Peptic Ulcer Disease

3rd – Colorectal Cancer

4th – Enteric infections

5th – NAFLD and GI TB

6th – Liver cancer

RESEARCH AGENDA PRIORITIES

TOPIC “QUICK WINS”

High impact

Short term time frame (0-

12 months)

“STARS”

High impact

Long term time frame (12-24

months)

“BUILDING

BLOCKS”

Low impact Short

term time frame

(0-12 months)

“BACK

BURNERS”

Low impact Long

term time frame

(12-24 months)

GERD Relapse rate after 4 weeks of PPI for symptomatic GERD and 8 weeks for Erosive Esophagitis

PPI complications (short & long

term)

National Data

base/prevalence

using a validated

questionnaire

Surveillance strategy

for Barrett’s

PEPTIC ULCER

DISEASE

Endoscopic features of H.

pylori Infection

Antibiotic resistance in naïve

patients

Prevalence of H.

pylori infection in

the general

population and

in PUD

Incidence of gastric cancer in patients with initial metaplasia, gastric atrophy, nonNSAID, non- H. pylori

ENTERIC

INFECTIONS

Epidemiology/Susceptibilit y pattern of enteric infections in the Phils: Acute (<2wks)

Acute persistent (2-4 wks)

Chronic (>4weeks)

C difficile toxin: diagnostic

utility/accuracy in

antibiotic-associated

diarrhea (AAD)

Clinical outcomes of AAD

Policy development for

clearance of food handlers

Luminal amoebicides

Prevalence of protozoal infections in

asymptomatic

patients

Concentration

technique for stool

sample of food

handlers (screening)

GALLSTONES Prevalence of gallstone

complications

Medical stone dissolution

Criteria development (scoring

system) for diagnosis of

symptomatic gallstones

Histopathologica

l and radiologic

correlation in

symptomatic

patients

Clinical outcomes of

patients with

adenomyomatosis

GI BLEEDING Use of vasoactive drugs vs

standard of care

Risk of bleeding of novel

antiplatelets/anti-coagulants

Adherence of MDs to practice guidelines

Etiologies of

UGIB/LGIB

Outcome of

adherence vs

nonadherence to

initial scoring

LIVER

CIRRHOSIS

Prevalence of

complications of Portal

Hypertension

Hepatoprotectants/antioxidant

s for the prevention of

decompensation or

development of complications

(adjunct to standard of care)

Etiologies of

cirrhosis

Time for diagnosis to

any outcome

HEPATITIS B Prevalence of e-positive and e-negative for treatment

National sero-

prevalence/incidence of

Hep B born 1991 and above

Cost effectiveness of hepatitis vaccination (0-5 yrs old post vaccination)

Comparison of treatment

outcomes between specialist vs

generalist treatment in

consultation/coaching through

skype

Isolate core antigen-positive in patients to undergo immunosuppression

NAFLD Prevalence all types Lean NAFLD: Risks profile

Non- cirrhotic HCC due to

NAFLD

Use of

hepatotropics in

NAFLD

Association with

DM type 1 & NAFLD

CRC Right vs left -sided colon

cancer profile

Genomics of CRC in the young

(index patient)

Registry

Adenoma

detection rate

LIVER CA Validation of scoring

system or create a new

scoring system

Registry Changing

epidemiology of

HCC over the

past 30 years

Tissue and serum

repository

PANCREATITIS

Clinical profile of non-gallstone,

non-alcoholic pancreatitis

Clinical

significance of

chronic

pancreatitis

detected by EUS

for chronic

abdominal pain

GI TB Updated prevalence of TB

including location,

radiologic & clinical

correlation

Registry- hepatobiliary and colon TB (tissue and serum repository)

RCT of treatment for 6,9,12

months

Criteria of IBD vs TB

Incidence of MDRTB

Metal stenting in TB

strictures

IMPLEMENTATION OF THE UNIFIED RESEARCH AGENDA

The PSG, PSDE and HSP Board shall give the final approval prior to implementation of the Unified

Research Agenda.

Prepared by:

MA. TERESITA Z. CABREIRA, MD

PSG Board of Director

Chair, Committee on Research and Research Education

Noted by:

Peer Review Chairpersons: RUTH URSULA C. CINCO, MD

JANUS P. ONG, MD

JRRE Chair: ROBERTO N. DE GUZMAN JR., MD

RESEARCH FACILITATOR: RAUL DESTURA, MD

Dated July 12, 2016

THE RESEARCH TEAM

1. Eda Jo D. Amatong, MD- Representative, Veterans Memorial Medical Center 2. Rona Marie A. Ata, MD - Representative Cardinal Santos Medical Center 3. Sarah Jean C. Bellido, MD - Representative St Luke's Medical Center Quezon City 4. Joseph C. Bocobo, MD -Training Officer, St. Luke’s Medical Center Global 5. Ma. Teresita Z. Cabreira, MD– PSG Board representative 6. Ruth Ursula C. Cinco, MD- Research Coordinator, Veterans Memorial Medical Center 7. Marie Michelle S. Cloa, MD- PSDE Board representative 8. Arsenio L. Co, MD- Training Officer, Chinese General Hospital and Medical Center 9. Ian Homer Y. Cua, MD - Research Coordinator, St Luke's Medical Center Quezon City 10. Roberto N. De Guzman Jr., MD - Chair, JRRE 11. Gentry A. Dee, MD- Training Officer, Cardinal Santos Medical Center 12. Evelyn B. Dy, MD- Chief Section, Manila Doctors Hospital 13. Norberto I. Estanislao IV. MD- Member, JRRE 14. Enjel A. Gabriel, MD- Research Coordinator, Cebu Doctors University Hospital 15. Roel Leonardo R. Galang, MD - Training Officer, Makati Medical Center 16. Lovell B. Gatchalian, MD -Research Coordinator, East Avenue Medical Center 17. Wilmyr H. Hababag, MD- Research Coordinator, Veterans Memorial Medical Center 18. Anne Marie Geraldine J. Javier, MD- Chair, Accreditation Board 19. Jo-ann Y. Khow, MD- Research Coordinator, Metropolitan Hospital 20. Marie Antoinette DC. Lontok, MD - Research Coordinator, St. Luke’s Medical Center Global 21. Roberto N. Lopez, MD -Training Officer, Metropolitan Hospital 22. Therese C. Macatula, MD- Representative, UP- PGH 23. Mara Maan V. Mañgio-Manansala, MD - Member, JRRE 24. Jonathan Angelo M. Miguel, MD- Member, JRRE 25. Bernadette A. Moscoso, MD- Chief Section, Cebu Doctors University Hospital 26. Karla Maria P. Nomorosa-Suzara, MD - Member, JRRE 27. Janus P. Ong, MD- Research Coordinator, UP- PGH 28. Arlinking K. Ong-Go, MD -Member, JRRE 29. Benjamin Gerardo A. Perez, MD- Chair, PSDE Research Coordinator 30. Rommel P. Romano, MD - Research Coordinator, University of Sto Tomas Hospital 31. Estrellita J. Ruiz, MD - Chief Section, University of Sto Tomas Hospital 32. Marilyn C. Talingdan-Te, MD - Representative, Manila Doctors Hospital