Gastroenterology & Hepatology

August 2018 - Volume 14, Issue 8

Letter from the Editor: New ACG Guideline for the Management of Crohn’s Disease 


Have you read the new guideline from the American College of Gastroenterology for managing adult patients with Crohn’s disease? The complete guideline—all 60 recommendations and 53 summary statements—can be found online at, as well as in the April issue of The American Journal of Gastroenterology. In the Advances in IBD column in this month’s issue of Gastroenterology & Hepatology, I discuss highlights of the guideline, which I worked on with 5 other gastroenter-ologists. The column focuses on guideline recommendations regarding diagnosis and the use of endoscopy, medical treatment (including the role of combination therapy and the use of therapeutic drug monitoring), surgical treatment, and postoperative management.

Our coverage of Crohn’s disease continues with the first of a 2-part series on perianal fistulas in Crohn’s disease patients. In this part, Dr Stephanie L. Gold, Dr Shirley Cohen-Mekelburg, Dr Yecheskel Schneider, and Dr Adam Steinlauf discuss perianal fistula anatomy and classification (with helpful visual representations) and focus on the medical management of perianal fistulas, including the use of antibiotics, immunomodulators, biologic agents, and intrafistulous biologic injections. 

Another feature article examines whether allergy testing has a role in identifying foods that lead to eosinophilic esophagitis. Along with related issues, Dr Adjoa Anyane-Yeboa, Dr Wenfei Wang, and Dr Robert T. Kavitt discuss the role that allergies play in the pathogenesis of eosinophilic esophagitis, the various types of allergy testing that are currently available, the use of empiric diets and diets guided by allergy testing, and technologies being developed for food allergy testing.  

Our third feature article this month focuses on the economics of different screening strategies for hepatitis C virus. Dr Sammy Saab, Mr Timothy Ahn, Ms Terina McDaniel, Dr Beshoy Yanny, and Dr Myron J. Tong compare the costs of screening for hepatitis C virus using enzyme-linked immunosorbent assay followed by polymerase chain reaction testing with using polymerase chain reac-tion testing alone. 

Our Advances in Hepatology column explores the use of statins in cirrhotic patients. Among other issues, Dr David E. Kaplan discusses the concerns that have been traditionally associated with statin use in this patient population, the types of effects that statins may produce in cirrhotic patients, how the severity of liver disease might impact the effect of statins on survival, and whether doctors should prescribe statins to all cirrhotic patients who need them. 

In our Advances in GERD column, Dr Herbert C. Wolfsen examines the use of radiofrequency ablation (RFA) to treat patients who have Barrett esophagus with low-grade dysplasia. His discussion includes the main advantages and disadvantages of RFA in this patient population, how RFA compares to other modalities for reducing the progression to high-grade dysplasia, how effective RFA is for eradicating low-grade dysplasia, and how often disease may recur following RFA. 

Finally, this issue includes a Clinical Update column based on a Product Theater presentation from the recent Digestive Disease Week meeting. In this column, Mr Jay Kreger and Dr Mitchel Guttenplan discuss hemorrhoidal banding (including the ideal candidate, the training process, and how the procedure is performed) and anesthesia (including reimbursement issues), as well as the benefits and limitations of adding these ancillary services to gastroenterology practices. 

I hope that you find these articles interesting and clinically useful. 


Gary R. Lichtenstein, MD, AGAF, FACP, FACG

Millennium Medical Publishing, Inc