Flurry of early GI care updates may set pace for 2023: What you may have missed

In 2023, there have already been several updates to guidelines and recommendations in gastroenterology care from ACG and AGA, including managing celiac disease, acute lower GI bleeding, ulcerative colitis and diagnosing biliary strictures.

Additionally, the ACG revamped recommendations for management of subepithelial GI lesions and, most recently, published a clinical practice update on management of patients with alpha-gal syndrome, which manifests with common GI symptoms and is caused by Lone Star tick bites.

Healio has closely followed the latest in ACG and AGA clinical updates, guidelines and recommendations. Guidelines are constantly changing, making it a challenge to keep up with the latest updates and recommendations. If you have missed any of these, we have compiled a list of the current ACG and AGA developments.

AGA: Consider alpha-gal syndrome for unexplained GI symptoms in Lone star tick territory

The AGA has published a new clinical practice update on the diagnosis and management of patients with alpha-gal syndrome, an emerging food allergy that manifests with common gastrointestinal symptoms and is caused by Lone Star tick bites.

“We wrote the update to heighten gastroenterologists’ awareness of alpha-gal syndrome,” Sarah K. McGill, MD, MSc, associate professor of gastroenterology and hepatology at the University of North Carolina at Chapel Hill and co-author of the update, told Healio. “Patients with alpha-gal syndrome can present with chronic or recurrent GI symptoms without rash or anaphylaxis, so they can end up in GI clinicians’ offices seeking relief.” Read more.

ACG focuses on diagnosis, drainage of biliary strictures in new clinical guideline

A new ACG clinical guideline provides evidence-based recommendations for the diagnosis and management of patients with extrahepatic and perihilar biliary strictures, according to a report in The American Journal of Gastroenterology.

“The appropriate diagnosis and management of biliary strictures has important implications in endoscopic, surgical and oncological decision-making, and despite advances in care, remains a major clinical challenge,” Jennifer Maranki, MD, MSc, FASGE, professor of medicine and director of endoscopy at Penn State Hershey Medical Center, told Healio. “We sought to provide guidance to gastroenterologists based the available body of literature, with key shifts in diagnosis and management based on currently available modalities and tools.” Read more.

ACG updates guidance for celiac disease diagnosis, management in children, adults

The ACG has published updated guidelines for the evaluation, diagnosis and management of children and adults with celiac disease.

“Celiac disease (CD) is defined as a permanent immune-mediated response to gluten present in wheat, barley and rye. CD has a wide spectrum of clinical manifestations that resemble a multisystemic disorder rather than an isolated intestinal disease,” Alberto Rubio-Tapia, MD, director of the Celiac Disease Program at the Cleveland Clinic and assistant professor of medicine at the Mayo Clinic, and colleagues wrote in The American Journal of Gastroenterology. “Current treatment of CD requires strict adherence to a gluten-free diet and lifelong medical follow-up.” Read more.

ACG revamps guidelines for managing acute lower GI bleeding, ‘more data is needed’

The ACG has issued revised guidelines for the management of patients with acute lower GI bleeding, which include new recommendations for risk stratification and reversal agents for patients on anticoagulants.

“Lower gastrointestinal bleeding is one of the leading causes of hospitalization in the United States due to a digestive disorder,” Neil Sengupta, MD, associate professor of gastroenterology at University of Chicago Medicine, told Healio. “The prior ACG guideline on this topic was published in 2016, and since that time there have been several updates to this field. The ACG felt it important to provide an updated, evidence-based clinical practice guideline on this topic for practicing clinicians.” Read more.

ACG guides diagnosis, management of subepithelial GI lesions with new recommendations

The ACG has developed a clinical guideline to aid physicians in the diagnosis and management of patients with GI subepithelial lesions, which recently was published in The American Journal of Gastroenterology.

“The term subepithelial lesion (SEL) is used to describe a mass or mass-like structure that typically projects into the gastrointestinal lumen and arises from a non-mucosal layer within the GI tract wall,” Brian C. Jacobson, MD, MPH, FACG, director of program development for gastroenterology at Massachusetts General Hospital, and colleagues wrote. “SEL may be non-neoplastic, neoplastic but benign, neoplastic with malignant potential or malignant. When small, SEL rarely cause signs or symptoms and are typically incidental findings. However, depending on their location and size, some may cause symptoms such as dysphagia, overt or occult GI bleeding and chronic anemia. Read more.

Updated AGA guidelines urge use of biomarkers for the management of UC

New AGA clinical practice guidelines highlight the role of noninvasive biomarkers, including fecal calprotectin, fecal lactoferrin and C-reactive protein, for the management of patients with UC

“Despite the fact that early proactive assessment of bowel inflammation is associated with superior long-term outcomes, there is significant variability in utilization,” Siddharth Singh, MD, assistant professor of medicine at the University of California, San Diego, and colleagues wrote in Gastroenterology. “Moreover, in routine clinical practice, repeated endoscopic assessment is invasive, expensive and may be impractical.” Read more.