Guideline rewind: 10 clinical updates that revamped GI, hepatology practice in 2023 (Healio)

Throughout 2023, gastroenterology societies introduced several significant clinical practice updates for the diagnosis, management, and treatment of various gastrointestinal (GI) disorders, including celiac disease, inflammatory bowel disease, and acute liver failure. These updates emphasized the importance of noninvasive biomarkers, considered alpha-gal syndrome in unexplained GI symptoms, and introduced new recommendations for risk stratification and reversal agents in patients with liver failure on anticoagulants.

Key Updates:

1. Celiac Disease Management: The ACG updated guidelines for evaluating, diagnosing, and managing celiac disease in children and adults, emphasizing strict adherence to a gluten-free diet and lifelong medical follow-up.
2. Acute Lower GI Bleeding: Revised ACG guidelines for managing acute lower GI bleeding include new recommendations for risk stratification and reversal agents for anticoagulant patients.
3. Ulcerative Colitis Management: AGA guidelines now highlight the role of noninvasive biomarkers like fecal calprotectin and C-reactive protein in managing ulcerative colitis.
4. Chronic Constipation Treatment: ACG and AGA jointly released guidelines for chronic idiopathic constipation treatment, including recommendations for magnesium oxide and senna.
5. Biliary Strictures Diagnosis and Management: ACG’s new guideline provides recommendations for diagnosing and managing extrahepatic and perihilar biliary strictures.
6. Alpha-gal Syndrome Awareness: AGA’s clinical practice update focuses on diagnosing and managing alpha-gal syndrome, an emerging food allergy caused by Lone Star tick bites.
7. Acute Liver Failure Treatment: ACG’s new guideline aids in diagnosing and managing acute liver failure, focusing on specific etiologies and disease presentation.
8. Endoscopy Safety with GLP-1 Agonists: GI societies responded to safety concerns about sedation in patients prescribed GLP-1 receptor agonists, encouraging best practices during endoscopy.
9. Exocrine Pancreatic Insufficiency: AGA’s new guidance aims to improve awareness and treatment for exocrine pancreatic insufficiency.
10. Crohn’s Disease Management: AGA recommends using fecal calprotectin and serum C-reactive protein biomarkers to inform Crohn’s disease management.

These updates represent significant strides in gastroenterology and hepatology, offering more comprehensive and effective approaches to managing a range of GI disorders.