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What you need to know from the ACG hepatic encephalopathy (HE) guidelines: HE can be subtle; lactulose is good (as is rifaximin); ammonia is not very helpful.
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ACG Clinical Guideline: Hepatic Encephalopathy. Am J Gastroenterol. 2026 Mar 1;121(3):588-618. doi: 10.14309/ajg.0000000000003899. Epub 2026 Mar 3. PMID: 41773757.
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For patients in the ED with upper GI bleeding (UGIB) the AIMS65 score best predicted mortality, but none of the scores were accurate enough to be clinically useful.
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Mortality prediction among ED patients with upper gastrointestinal bleeding: Comparison of NEWS-2 and conventional risk scores. Am J Emerg Med. 2025 Dec 21;101:14-21. doi: 10.1016/j.ajem.2025.12.020. Epub ahead of print. PMID: 41448104.
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When using a midline approach to paracentesis, there were no instances of hemorrhage compared to lateral. However, there is fine print to consider before changing your practice…
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Lateral Versus Midline: A Retrospective Review of Paracentesis Site Location and Risk of Hemorrhagic Complication. Crit Care Med. 2025 Dec 1;53(12):e2698-e2705. doi: 10.1097/CCM.0000000000006883. Epub 2025 Sep 26. PMID: 41020659.
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For lower GI bleeds, the Oakland and SALGIB risk stratification scores performed well in predicting adverse events and severe bleeding and in identifying patients safe for discharge, but none of the 5 scoring systems reliably predicted need for intervention.
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Predictive value of clinical risk scores for adverse outcomes and safe discharge in acute lower gastrointestinal bleeding. Am J Emerg Med. 2026 Jan;99:370-375. doi: 10.1016/j.ajem.2025.10.051. Epub 2025 Oct 25. PMID: 41175440.
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This prospective study of Crohn’s disease patients showed a high correlation between point-of-care intestinal ultrasound (IUS) and ileo-colonoscopy.
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Correlation of Point-of-Care Intestinal Ultrasound With Endoscopic Disease Severity in Crohn’s Disease. JGH Open. 2025 Jul 31;9(8):e70231. doi: 10.1002/jgh3.70231. PMID: 40747353; PMCID: PMC12311311.
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Giving kids ondansetron to take home after an ED visit for vomiting due to gastroenteritis significantly reduced the risk of developing moderate-to-severe disease.
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Multidose Ondansetron after Emergency Visits in Children with Gastroenteritis. N Engl J Med. 2025 Jul 17;393(3):255-266. doi: 10.1056/NEJMoa2503596. PMID: 40673584.
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In cirrhotic upper GI bleeding (UGIB) patients, guidelines recommending routine 5–7 days of prophylactic antibiotics did not lower mortality compared with shorter courses, or no antibiotics, in a contemporary Bayesian meta-analysis.
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Prophylactic Antibiotics for Upper Gastrointestinal Bleeding in Patients With Cirrhosis: A Systematic Review and Bayesian Meta-Analysis. JAMA Intern Med. 2025 Aug 11:e253832. doi: 10.1001/jamainternmed.2025.3832. Epub ahead of print. PMID: 40788637; PMCID: PMC12340683.
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This American Diabetes Association (ADA) consensus report addresses how to improve screening and early intervention for metabolic-dysfunction-associated steatotic liver disease (MASLD) in patients with prediabetes or type 2 diabetes.
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Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in People With Diabetes: The Need for Screening and Early Intervention. A Consensus Report of the American Diabetes Association. Diabetes Care. 2025 Jul 1;48(7):1057-1082. doi: 10.2337/dci24-0094. PMID: 40434108
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The European and North American Societies for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN and NASPGHAN) released recommendations for the treatment of functional abdominal pain (FAP) and irritable bowel syndrome (IBS).
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ESPGHAN/NASPGHAN guidelines for treatment of irritable bowel syndrome and functional abdominal pain-not otherwise specified in children aged 4-18 years. J Pediatr Gastroenterol Nutr. 2025 May 30. doi: 10.1002/jpn3.70070. Epub ahead of print. PMID: 40444524
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GLP-1 receptor antagonists likely increase the risk of cholelithiasis and GERD when compared to placebo, but this meta-analysis of RCTs suggests that the risk of pancreatitis, cholecystitis, and intestinal obstruction may be lower than previous studies.
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Glucagon-Like Peptide-1 Receptor Agonists and Gastrointestinal Adverse Events: A Systematic Review and Meta-Analysis. Gastroenterology. 2025 Jun 9:S0016-5085(25)00845-5. doi: 10.1053/j.gastro.2025.06.003. Epub ahead of print. PMID: 40499738