Society guidelines for GI and liver conditions.

15 topics · 18 versions · 3 high-yield

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Acute pancreatitis

acute-pancreatitis · society: ACG

The 2024 ACG guideline updates the management of acute pancreatitis with an evidence-based approach to diagnosis, risk stratification, fluid resuscitation, ERCP, antibiotics, nutrition, and management of necrosis. Major shifts from prior versions include endorsement of moderate (rather than aggressive) lactated Ringer’s resuscitation, near-universal use of rectal indomethacin plus periprocedural fluids for ERCP prophylaxis, early oral low-fat solid feeding in mild disease, no prophylactic antibiotics for sterile necrosis, and delayed minimally invasive step-up necrosectomy for infected necrosis.

C. difficile infection ⭐

c-difficile · high-yield

IDSA/SHEA 2021 focused update on management of Clostridioides difficile infection (CDI) in adults, addressing the use of fidaxomicin and bezlotoxumab. Fidaxomicin is now preferred over vancomycin for both initial and recurrent CDI episodes (conditional recommendations), reflecting lower recurrence rates. Bezlotoxumab is suggested as an adjunct to standard-of-care antibiotics for patients with recurrent CDI within the past 6 months, especially those with additional risk factors for recurrence.

Celiac disease

celiac · society: ACG

2023 ACG update to the 2013 celiac disease guideline covering diagnosis, management, monitoring, and follow-up in adults and children. Confirms TTG IgA with total IgA as first-line serologic screen on a gluten-containing diet, with EGD and duodenal biopsy (1-2 bulb + ≥4 distal duodenum) to confirm diagnosis in most patients. Newly endorses a nonbiopsy diagnostic pathway in selected children (TTG IgA >10× ULN + confirmatory EMA) and discusses gluten-free diet adherence, mucosal healing, pneumococcal vaccination, oats, probiotics, and refractory disease.

Cirrhosis — ascites / SBP / HRS ⭐

cirrhosis-ascites · society: AASLD · high-yield

AASLD 2021 practice guidance on diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis (SBP), and hepatorenal syndrome (HRS) in chronic liver disease, replacing the 2012 guideline. Updates include expanded AKI/HRS-AKI terminology and algorithms, refined hyponatremia management with albumin, broader antibiotic guidance reflecting MDRO emergence, simultaneous liver-kidney transplant eligibility, and a new pediatric section. Recommendations are consensus-based given limited RCT evidence.

Crohn’s disease

crohns · society: ACG

ACG 2018 guideline on management of adult Crohn’s disease covers diagnosis, disease activity assessment, induction and maintenance therapy, fistulizing disease, and postoperative prevention. Therapy is stratified by disease severity and risk for progression, with emphasis on objective monitoring (endoscopy, cross-sectional imaging, fecal calprotectin, CRP) rather than symptoms alone. Anti-TNF agents (especially combination with thiopurine) are the cornerstone for moderate-to-severe disease, while 5-ASAs are largely discouraged. Vedolizumab and ustekinumab are endorsed as effective biologic alternatives, and biosimilars of infliximab/adalimumab are accepted for induction and maintenance.

GERD

gerd · society: ACG

The ACG 2022 GERD guideline updates the 2013 version with evidence-based recommendations spanning diagnosis, pharmacologic and lifestyle therapy, refractory disease, extraesophageal symptoms, and surgical/endoscopic interventions. PPIs remain first-line medical therapy, but the document emphasizes stricter criteria for diagnosing GERD before chronic acid suppression, more rigorous workup of “refractory” symptoms (since most are not truly reflux-related), and provides reassurance regarding the safety of long-term PPI use based on the COMPASS trial. New attention is given to magnetic sphincter augmentation (MSA), transoral incisionless fundoplication (TIF), and the limited role of surgery for extraesophageal symptoms.

H. pylori / peptic ulcer

h-pylori · society: ACG

ACG 2024 guideline on H. pylori treatment in North America, replacing the 2017 version in response to rising clarithromycin/levofloxacin resistance and FDA approval of vonoprazan-based regimens. Bismuth quadruple therapy (BQT) for 14 days is preferred first-line when susceptibility is unknown; rifabutin triple therapy or vonoprazan-amoxicillin dual therapy are alternatives. Clarithromycin- and levofloxacin-containing regimens should be reserved for cases with documented susceptibility. Universal post-treatment test of cure is required.

Hepatocellular carcinoma

hcc · society: AASLD

AASLD 2023 Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma updates prior recommendations to reflect ultrasound plus AFP for surveillance, expanded surgical indications (including selected BCLC-B and minimally invasive resection with mild portal hypertension), incorporation of immune checkpoint inhibitor-based combinations (atezolizumab/bevacizumab, durvalumab/tremelimumab) as preferred first-line systemic therapy, and explicit recommendations for multidisciplinary care and advance care planning. The BCLC 2022 framework is endorsed for staging, and LI-RADS is the recommended imaging diagnostic algorithm in at-risk patients.

Hepatitis B

hepatitis-b · society: AASLD

AASLD 2018 guidance updates the 2016 Hepatitis B Treatment Guidelines, adding tenofovir alafenamide (TAF) as a preferred first-line NA and elevating tenofovir disoproxil fumarate (TDF) to preferred therapy for prevention of mother-to-child transmission. It covers screening, counseling, prevention, virological assays, monitoring of untreated patients, and management in special populations (HCV/HDV/HIV coinfection, immunosuppression, acute HBV, pregnancy, cirrhosis, transplant recipients, children). Preferred antivirals remain peg-IFN, entecavir, TDF, and TAF; TAF offers improved renal and bone safety vs TDF with comparable efficacy.

Hepatitis C

hepatitis-c · society: AASLD/IDSA

AASLD/IDSA simplified HCV “test and treat” algorithm for initial and follow-up visits in treatment-naive patients without cirrhosis or other complicating conditions. Outlines point-of-care HCV RNA testing, pretreatment labs, criteria triggering specialist referral, and post-treatment SVR assessment. Patients with prior DAA treatment, HBsAg positivity, HCC, or decompensated cirrhosis require specialist referral rather than simplified treatment.

Irritable bowel syndrome

ibs · society: ACG

First-ever ACG GRADE-based clinical guideline on IBS management addressing 25 PICO questions (9 diagnostic, 16 therapeutic). Endorses positive symptom-based diagnosis over diagnosis of exclusion, with targeted serologic and fecal testing to rule out celiac disease and IBD in IBS-D. Recommends low-FODMAP diet, soluble fiber, secretagogues (linaclotide, plecanatide, lubiprostone, tegaserod) for IBS-C; rifaximin, alosetron, eluxadoline for IBS-D; TCAs and gut-directed psychotherapy across subtypes. Recommends against routine food allergy testing, PEG monotherapy for global IBS-C symptoms, and FMT.

MASLD (formerly NAFLD)

masld · society: AASLD

AASLD 2023 Practice Guidance updates the 2018 NAFLD document, emphasizing noninvasive risk stratification (FIB-4, VCTE, ELF, MRE) to identify “at-risk” NASH (NASH with ≥F2 fibrosis) and management of metabolic comorbidities. It highlights newer therapeutics with potential NASH benefit (semaglutide, pioglitazone, vitamin E) while noting no agent is FDA-approved for NASH. Pediatric NAFLD and NAFLD-in-diabetes are addressed in separate documents.

Portal hypertension / varices

portal-hypertension

AASLD 2024 Practice Guidance on risk stratification and management of portal hypertension and varices in cirrhosis updates the 2017 guidance and harmonizes with Baveno VII. Major changes include adoption of compensated advanced chronic liver disease (cACLD) as a noninvasive surrogate for cirrhosis, codification of noninvasive criteria (LSM + platelets, “Rule of Five”) to identify clinically significant portal hypertension (CSPH), and a paradigm shift toward early nonselective beta-blocker (preferably carvedilol) therapy in CSPH to prevent first decompensation. New sections address preemptive TIPS in high-risk acute variceal hemorrhage, cardiofundal gastric varices, portal hypertensive gastropathy, and endoscopy prior to TEE/antineoplastic therapy.

Ulcerative colitis

ulcerative-colitis · society: ACG

ACG 2025 update to the 2019 UC guideline addresses diagnosis, disease activity assessment, induction/maintenance therapy across mild to severe UC, positioning of newer biologics and small molecules (S1P modulators, JAK inhibitors, IL-23p19 inhibitors), and management of acute severe UC. New features include a defined role for intestinal ultrasound, an updated ACG UC Disease Activity Index, a positioning/sequencing section, and incorporation of bowel urgency as a key patient-reported outcome. Histologic remission is acknowledged as prognostic but not a required target; treat-to-target emphasizes endoscopic improvement (MES 0-1) plus symptomatic remission.

Upper GI bleeding ⭐

upper-gi-bleeding · society: ACG · high-yield

ACG 2021 guideline on management of overt upper GI bleeding, focused on initial resuscitation, risk stratification, pre-endoscopic management, endoscopic hemostasis for ulcer bleeding, and post-endoscopic antisecretory therapy. Updates from the 2012 guideline include expanded discharge criteria (GBS ≤1 instead of 0), inclusion of intermittent high-dose PPI regimens, new endoscopic modalities (TC-325, over-the-scope clips, APC, soft monopolar electrocoagulation), addition of twice-daily oral PPI through day 14 in high-risk patients, and a preference for transcatheter arterial embolization over surgery when endoscopy fails.

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