Guideline rewind: 10 clinical updates that revamped GI, hepatology practice in 2023
Click Here to Manage Email Alerts
Throughout 2023, gastroenterology societies made several significant clinical practice updates to guide diagnosis, management and treatment of various GI disorders such as celiac disease, inflammatory bowel disease and acute liver failure.
Updated guidance included underscoring the importance of noninvasive biomarkers for the management of patients with ulcerative colitis and Crohn’s disease, consideration of alpha-gal syndrome among those with unexplained GI symptoms as well as new recommendations for risk stratification and reversal agents for patients on anticoagulants with liver failure.
Most notably, AGA, AASLD, ACG, ASGE and NASPGHAN came together in response to safety concerns surrounding sedation for patients prescribed glucagon-like peptide-1 receptor agonists to encourage GIs to follow “best practices” during endoscopy procedures.
Healio continues to closely monitor clinical practice updates to provide up-to-date guidance for the GI community and to better patient care. In case you missed it, Healio recaps the latest clinical practice updates in gastroenterology and hepatology below.
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 gastrointestinal 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.
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 ulcerative colitis.
“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.
ACG, AGA guideline first to recommend magnesium oxide, senna for chronic constipation
The ACG and AGA have released a joint clinical practice guideline with 10 evidence-based recommendations for the pharmacological management of adults with chronic idiopathic constipation, the first to include magnesium oxide and senna.
The expert panel made strong recommendations for the use of polyethylene glycol, sodium picosulfate, linaclotide, plecanatide and prucalopride, while conditional recommendations were made for fiber, lactulose, senna, magnesium oxide and lubiprostone. 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.
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.
New ACG guideline highlights treatment, transplant considerations for acute liver failure
The ACG has created a new clinical guideline based on existing data and expert opinion to aid clinicians in the diagnosis and management of patients with acute liver failure, with a focus on specific etiologies and disease presentation.
“Acute liver failure (ALF) is a life-threatening condition that occurs in patients with no preexisting liver disease and is characterized by liver injury, coagulopathy and hepatic encephalopathy,” Alexandra Shingina, MD, MSc, assistant professor of medicine in the division of gastroenterology, hepatology and nutrition at Vanderbilt University Medical Center, and colleagues wrote in the American Journal of Gastroenterology. “It has a multitude of etiologies and a variety of clinical presentations that can affect virtually every organ system. It is imperative for clinicians to recognize ALF early in patient presentation because initiation of treatment and transplant considerations could be lifesaving.” Read more.
GI societies: ‘Little or no data’ linking GLP-1 agonists to safety issues during endoscopy
In response to safety concerns surrounding sedation for patients prescribed glucagon-like peptide-1 receptor agonists, the AGA, AASLD, ACG, ASGE and NASPGHAN encourage gastroenterologists to follow “best practices” for endoscopy procedures.
The use of glucagon-like peptide-1 (GLP-1) receptor agonists for diabetes and weight loss management – including semaglutide (Ozempic/ Rybelsus/ Wegovy, Novo Nordisk), tirzepatide (Mounjaro, Eli Lilly), exenatide (Byetta, AstraZeneca), liraglutide (Saxenda, Novo Nordisk), albiglutide (Tanzeum, GlaxoSmithKline), dulaglutide (Trulicity, Eli Lilly) and lixisenatide (Adlyxin, Sanofi) – have been linked to adverse GI events such as abdominal pain, constipation, diarrhea, nausea and vomiting. Read more.
AGA: Early diagnosis, treatment ‘essential’ in exocrine pancreatic insufficiency
Citing an “urgent need” for best practice updates to improve awareness and treatment for exocrine pancreatic insufficiency, the AGA has published new guidance to aid clinicians in evaluation and management of the disease.
“EPI is frequently underdiagnosed and, as a result, patients are often not treated appropriately,” David C. Whitcomb, MD, PhD, of the division of gastroenterology, hepatology and nutrition at the University of Pittsburgh, and colleagues wrote in Gastroenterology. “There is an urgent need to increase awareness of and treatment for this condition.” Read more.
AGA recommends use of fecal calprotectin, serum CRP to inform Crohn’s disease management
Fecal calprotectin and serum C-reactive protein biomarkers can inform disease management for patients with asymptomatic or symptomatic Crohn’s disease, according to an updated clinical practice guideline from the AGA.
“In the CALM (Effect of Tight Control Management on Crohn’s Disease) trial comparing a symptom-based therapeutic strategy with a biomarker-based strategy, the use of frequent biomarker measurement to guide therapy escalation was associated with improved patient outcomes over 2 years,” Ashwin N. Ananthakrishnan, MBBS, MPH, a gastroenterologist at Massachusetts General Hospital and Harvard Medical School, and colleagues wrote in Gastroenterology. Read More.