Practice Guidance

IBD and Bowel Disorders

AGA clinical guidance, including Clinical Practice Updates (CPUs), are intended to inform clinicians, payors and other interested parties of AGA’s concerning areas of clinical practice and/or technologies that are widely available or new to the practice of gastroenterology. CPUs present the current state-of-the-art and by definition will include a combination of strong, evidence-based information, and when not available, best consensus opinion.

Maureen M. Leonard, Benjamin Lebwohl, Alberto Rubio-Tapia and Federico Biagi review studies and provide the best practices to aid in diagnosis and management of patients with suspected celiac disease, but have received negative results for serologic tests. 

Ashwin N. Ananthakrishnan, Geoffrey C. Nguyen and Charles N. Bernstein review studies and provide the best practices to assess diagnosis, general principle treatments and health maintenance of older patients experiencing difficulties with IBD.

Lisa A. Boardman, Eduardo Vilar, Y. Nancy You and Jewel Samadder review studies and provide expert opinion on evidence-based risk factors for young adult-onset colorectal cancer. 

Sonia S. Kupfer, Samir Gupta, Jeffrey N. Weitzel and Jewel Samadder review studies and provide expert opinion on CRC and PDAC risk and screening strategies to help physicians and BRCA1/2 carriers make informed screening decisions.

David T. Rubin, Joseph D. Feuerstein, Andrew Y. Wang and Russell D. Cohen rapidly review the emerging evidence and provide timely expert recommendations regarding the management of patients with IBD during the coronavirus disease 2019 pandemic.

Laura Raffals, MD, Geoffrey Nguyen, MD and David Rubin, MD, AGAF discuss the need to disseminate information about biosimilars and their approval process to increase the comfort levels of gastroenterologists, as the initial biologic therapies introduced to treat inflammatory bowel disease nearly 20 years ago, near the end of their patents and biosimilars emerge as an increasingly common treatment of IBD. Biosimilars have been introduced in hopes of lowering the cost of biologic therapy through increased competition and treatment options.

Steffen Husby, MD, PhD, Joseph Murray, MD, AGAF and David Katzka, MD address the importance of clinicians familiarizing themselves with the diagnostic options and uncertainties related to diagnosis and follow-up of celiac disease (CD). CD has risen in significance in recent years, with increased public concern about the effects of gluten on health and increased awareness about the symptoms and systemic effects of CD. It is also disease that has a strong genetic link and is seen as a common disease among both adults and children.

Jean-Frederic Colombel, MD, Andrea Shin, MD and Peter Gibson, MD discuss how physicians should familiarize themselves with the evaluation and management of functional gastrointestinal symptoms in patients with IBD. Functional bowel disorders, like IBS, are usually diagnosed based on possible overlapping symptoms associated with IBD. This is critical because overtreatment of intestinal inflammation for symptoms due to functional pathophysiology may increase the risk of significant adverse side effects while providing the patient with no symptomatic benefit.

Bloating is a common presenting complaint to health care providers, but is often difficult to evaluate and manage. Amrit K. Kamboj, MD, Amy S. Oxentenko, MD, AGAF, propose an innovative acronym BLOATING to capture the various mechanisms responsible for bloating, including bowel disturbance, liquid, obstruction, adiposity, thoracic, increased sensitivity, neuromuscular and gas.

In this Clinical Practice Update, Laurie Keefer and colleagues describe the structure and efficacy of two major classes of psychotherapy—cognitive behavior therapy and gut-directed hypnotherapy. They focus on the impact of these brain–gut psychotherapies on gastrointestinal symptoms, as well as their ability to facilitate improved coping, resilience, and self-regulation.

Description of the key principles in the use of surgical interventions and device-aided therapy for managing fecal incontinence and defecatory disorders.

Summary of expert opinion of the existing evidence on the management of Clostridium difficile infection in patients with underlying IBD.

Summarizes the most recent data on novel drugs for narcotic bowel syndrome.

Patient Companions

Having Clostridium difficile, C. diff, infection and inflammatory bowel disease, or IBD, at the same time is more serious than having either condition alone.