Top 11 Practice Changers in Gastroenterology: 2016

David A. Johnson, MD


December 28, 2016

Colonoscopy Surveillance After Colorectal Cancer Resection: Recommendations of the US Multi-Society Task Force on Colorectal Cancer

Kahi CJ, Boland CR, Dominitz JA, et al; United States Multi-Society Task Force on Colorectal Cancer
Gastroenterology. 2016;150:758-768.e11

This guideline was developed to provide healthcare providers with evidence-based recommendations for the surveillance of patients after colorectal cancer resection with curative intent. It is recommended for all who interface with these patients.


ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults

Riddle MS, DuPont HL, Connor BA
Am J Gastroenterol. 2016;111:602-622

Acute diarrhea is a common problem in the United States and worldwide. In this must-read guideline, a panel of experts presents an evidence-based approach to the diagnosis, prevention, and treatment of acute diarrheal infections that is applicable to both US-based and travel settings.


Drug Safety and Risk of Adverse Outcomes for Pregnant Patients With Inflammatory Bowel Disease

Mahadevan U, McConnell RA, Chambers C
Gastroenterology. 2016 Oct 18. [Epub ahead of print]

The management of inflammatory bowel disease in a pregnant patient has potential significant implications for both the mother and the fetus. This review by one of the leading experts on this topic is another must-read for all who counsel these patients on treatment options and their effectiveness and risks.


ACG Clinical Guideline: Liver Disease and Pregnancy

Tran TT, Ahn J, Reau NS
Am J Gastroenterol. 2016;111:176-194

One of the most daunting challenges for me is to consult on a pregnant patient and enter into a health management strategy that affects both the patient and the fetus. This guideline provides an evidence-based approach to common diagnostic and treatment challenges of liver disease in pregnant women, and is recommended to those who see these patients.


The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults

Fallone CA, Chiba N, van Zanten SV, et al
Gastroenterology. 2016;151:51.e14-69.e14

This evidence-based consensus from experts has changed the treatment paradigms for Helicobacter pylori. Optimal treatment of H pylori infection requires careful attention to local antibiotic resistance and eradication patterns. Resistance to the standard drug, clarithromycin, has risen from 1%-8% to 16%-24%. Metronidazole resistance, which was initially relatively high, has remained relatively stable, at 20%-40%. Tetracycline resistance and amoxicillin resistance have remained unchanged, at < 1% and 1%-3%, respectively.

The quadruple therapies of a PPI, amoxicillin, metronidazole, and clarithromycin (PAMC) or a PPI, bismuth, metronidazole, and tetracycline (PBMT) should play a more prominent role in the eradication of H pylori infection. The new standard is for all treatments to be given for 14 days, and the newly recommended first-line strategies include concomitant nonbismuth quadruple-therapy PAMC or traditional bismuth quadruple-therapy PBMT. Of particular note, the previous standard of PPI triple therapy (PPI, clarithromycin, and either amoxicillin or metronidazole) should be restricted to areas with known low clarithromycin resistance or high eradication success with these regimens—although in practice, we do not routinely (if ever) check resistance patterns. This article is important for all who treat patients with H pylori.



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