Articles related to GUIDELINES/RECOMMENDATIONS

Updated recommendations include EGD with multiple duodenal biopsies, setting intestinal healing as the goal for gluten-free diet, and use of gluten-free oats in some populations. There wasn’t evidence to support routine use of probiotics or use of gluten detection devices.

The American Journal of Gastroenterology published the ACG clinical guideline on the management of IBS in January 2021. Lead author gastroenterologist Brian E. Lacy, MD, PhD, says that to diagnose IBS, clinicians should take a careful history, perform a careful physical exam, use Rome IV criteria, and perform limited diagnostic testing (complete blood count, C-reactive protein, and possibly celiac serologies and fecal calprotectin, depending on symptoms). Regardless of whether a patient has constipation-predominant symptoms, diarrhea-predominant symptoms, or a combination of constipation and diarrhea, the first step is to classify the patient into a mild, moderate, or severe IBS category.

A layered approach to care is described with lifestyle interventions being a key feature of the updated recommendations. The recommendations now include therapies proven to improve cardiovascular and kidney outcomes in patients with diabetes and CKD.

Beyond the strong recommendation for bisphosponates as initial medical therapy in postmenopausal women with osteoporosis, the updated guidelines also suggest (not recommend) denosumab as second line therapy in women, bisphosphonates for osteoporosis in men, and romosozumab in women with very high risk of fractures. For the complete updated guideline, see Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults: A Living Clinical Guideline From the American College of Physicians.

The updated ADA standards have several significant changes. These include: A revised definition of HTN to match that of the ACC and AHA New recommendations for statin use Changes to recommendations around CKD treatment Revised weight loss goals Use of diabetes technology And much more

The updated AAP guidance “recommends programmatic consideration of providing more than 5 consecutive doses of palivizumab depending on the duration of the current RSV surge in a given region of the country.”