Stay up to date: Healio recaps pivotal guidelines for GI, liver disease in 2024 (so far)
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Several notable guideline updates have been made in gastroenterology and hepatology for the diagnosis, management and treatment of GI and liver disorders. Wondering what you may have missed?
AGA guidance released early this year promoted the use of fecal microbiota transplantation for recurrent Clostridiodies difficile infection, yet, advised against its use in irritable bowel syndrome or inflammatory bowel disease. More recently, in a clinical practice update, the society highlighted the importance of early recognition of cyclic vomiting syndrome to diagnose and treat patients effectively.
In addition, the ACG provided guidance underscoring the need for a multidisciplinary approach when caring for patients with alcohol use disorder. The society also partnered with ASGE to make three key revisions to quality indicators for colonoscopy, which shed light on the significance of adenoma and sessile serrated lesion detection rates and adequate bowel preparation.
Healio continues to closely monitor clinical practice updates to provide up-to-date guidance for the GI community and improve patient care. In case you missed any, Healio recaps the latest clinical updates, guidelines and recommendations for gastroenterology and hepatology.
AGA guideline endorses FMT for recurrent C. difficile; ‘not yet advised’ for IBS, IBD
Although effective in select patients, the AGA advised against fecal microbiota-based therapies to prevent recurrent Clostridioides difficile infection in severely immunocompromised adults or to treat other gastrointestinal conditions.
“Under each indication we have included expert recommendations to help those who want to implement FMT understand best practices,” Colleen R. Kelly, MD, from Brigham and Women’s Hospital and Harvard Medical School, said in a media briefing. “As simple as it sounds — put dilute stool into a person — there are a lot of questions around making the diagnosis of recurrent CDI, what to do with anti-CDI therapies around FMT, how protocols differ for treatment of recurrent vs. acute severe/fulminant CDI and how to decide when to use an alternative therapy instead.” Read more.
ACG updates guideline for managing H. pylori in treatment-naive, experienced patients
The ACG has released a new clinical practice guideline that summarizes therapy options and recommendations for both treatment-naive and treatment-experienced patients with active Helicobacter pylori infection, as well as testing concerns.
“H. pylori remains one of the most common chronic bacterial infections of humans worldwide,” William D. Chey, MD, FACG, AGAF, FACP, RFF, H. Marvin Pollard Professor of Gastroenterology and chief of gastroenterology and hepatology at Michigan Medicine, and colleagues wrote in The American Journal of Gastroenterology. “It is the leading cause of infection-associated cancer globally and is categorized by the World Health Organization International Agency for Research on Cancer as a group I carcinogen due to its causal association with gastric cancer.” Read more.
New ACG, ASGE quality indicators for colonoscopy include 3 key updates
Revised quality indicators released by the ACG and ASGE highlight the importance of adenoma and sessile serrated lesion detection rates as well as adequate bowel preparation for improving the technical performance of colonoscopy.
“The last update of the ASGE/ACG quality indicators was in 2015 and a lot of new information has since been published,” Douglas K. Rex, MD, MASGE, MACG, Distinguished Professor Emeritus of Medicine at Indiana University School of Medicine and director of endoscopy at Indiana University Hospital, told Healio. Read more.
AGA: ‘Keep both patient and fetus safe’ when managing GI, liver diseases in pregnancy
Multidisciplinary care is key when managing patients with pregnancy-related gastrointestinal and liver diseases, with a “paramount goal” of keeping both the patient and the fetus safe, according to an AGA clinical practice update.
“Pregnancy-related morbidity and mortality are increasing in the United States, particularly for pregnancies that are considered high risk because of chronic or newly diagnosed medical comorbidities,” Shivangi Kothari, MD, assistant professor of medicine and associate director of endoscopy at University of Rochester Medical Center, and colleagues wrote in Gastroenterology. “Recognizing a worsening disease course, triaging the level of maternal health and prescribing appropriate medication and interventions are essential.” Read more.
AGA: ‘Prompt recognition’ is key to diagnosis, management of cyclic vomiting syndrome
The AGA has published a clinical practice update highlighting the need for awareness and “prompt recognition” of cyclical vomiting syndrome to effectively diagnosis and treat patients.
“Most patients with cyclic vomiting syndrome (CVS) can benefit substantially from currently available treatments, but this disorder remains poorly recognized by clinicians,” David J. Levinthal, MD, PhD, director of the Neurogastroenterology & Motility Center and assistant professor at University of Pittsburgh School of Medicine, told Healio. “Thus, there remains a very large ‘treatment gap’ for adults who continue to suffer needlessly without access to effective therapy.” Read more.
ACG recommends full patient workup, evaluation to differentiate focal liver lesions
In a new clinical practice guideline, the ACG has provided evidence-based recommendations for the diagnosis and management of the most common focal liver lesions among individuals without known liver disease.
“With the continued dramatic rise in the widespread role of imaging in diagnosis and management of patients, there is a resultant rise in detection of asymptomatic incidental liver lesions,” Catherine Frenette, MD, of Family Health Centers of San Diego, and colleagues wrote in the American Journal of Gastroenterology. “It is critical to understand appropriate management of incidentally detected benign focal liver lesions because they have differing clinical implications from malignant lesions such as hepatocellular carcinoma, intrahepatic cholangiocarcinoma and metastatic disease.” Read more.
ACG, ASGE update quality indicators for ‘delivery of high-quality’ GI endoscopy
The ACG and ASGE have released an updated quality indicators document, intended to serve as a framework to improve performance of endoscopic procedures.
“The field of endoscopy has evolved substantially in recent years, with advances in procedural capabilities, technologies and delivery models,” B. Joseph Elmunzer, MD, MSc, the Peter B. Cotton Professor of Medicine & Endoscopic Innovation at the Medical University of South Carolina, and colleagues wrote in the American Journal of Gastroenterology and Gastrointestinal Endoscopy. “One constant, however, has been the commitment of professional societies, including the ASGE and the ACG — the two cosponsors of this series — to the delivery of high-quality endoscopic care.” Read more.
AGA recommends endoscopic eradication vs. surveillance for BE with high-grade dysplasia
In a new clinical practice guideline, the AGA provides evidence-based recommendations for use of endoscopic eradication therapy in the management of Barrett’s esophagus, accounting for the presence of dysplasia and other scenarios.
“The advent of endoscopic eradication therapy (EET) for treatment of dysplasia and early-stage cancer has revolutionized the management of Barrett’s esophagus, reducing the morbidity and mortality related to esophagectomy and ultimately preventing esophageal adenocarcinoma mortality,” Joel H. Rubenstein, MD, MSc, professor and director of the Barrett’s Esophagus Program at Michigan Medicine and research scientist at the VA Center for Clinical Management Research in Ann Arbor, and colleagues wrote in Gastroenterology. Read more.
ACG: ‘Early aggressive hydration’ essential to avoid complications in acute pancreatitis
A new ACG guideline published in The American Journal of Gastroenterology underscored that early management “is essential” to prevent complications such as organ failure and pancreatic necrosis in patients with acute pancreatitis.
“Acute pancreatitis is a very heterogenous disease and highly unpredictable,” Scott Tenner, MD, MPH, JD, FACG, director of The Greater New York Endoscopy Surgical Center and clinical professor of medicine at State University of New York, told Healio. “Patients with acute pancreatitis must be observed very carefully for the first 24 to 48 hours. Many patients, almost one-fifth, who initially present with what appears to be mild disease will develop a myriad of complications, including organ failure and/or pancreatic necrosis.” Read more.
ACG publishes new guideline for management of alcohol-associated liver disease
A new clinical guideline published in the American Journal of Gastroenterology underscored the need to overcome barriers to alcohol use disorder treatment and expand multidisciplinary care for patients with alcohol-associated liver disease.
“I think the most important reason why the American College of Gastroenterology wanted to revise this guideline is there has been impetus and recognition that control of the risk factor of alcohol use disorder seems to be the way forward in managing and controlling the magnitude and burden of this disease,” Ashwani K. Singal, MD, MS, FACG, FAASLD, AGAF, guideline author and professor of medicine at the University of Louisville, told Healio. “The second reason is that we wanted to bring out a stronger recommendation to consider early liver transplantation in these patients.” Read more.
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