2022’s Top 10 Gastroenterology Publications
David A. Johnson, MD
‘Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis’
The WATERFALL study was an early weight-based comparison of aggressive vs nonaggressive goal-directed fluid resuscitation in the initial phase of acute pancreatitis. Patients were randomly assigned to receive intravenous (IV) fluids (lactated Ringer solution) of either aggressive (IV bolus of 20 mL/kg of body weight over 2 hours, followed by 3 mL/kg per hour) or moderate resuscitation (1.5 mL/kg per hour). In this latter group, those who were hypovolemic also received a bolus of 10 mL/kg, whereas no bolus was given in those who were euvolemic.
There was no difference in progressive severity of pancreatitis; however, there was a major difference in the primary safety outcome of fluid overload. The incidence of fluid overload was 20.5% in the aggressive resuscitation arm and 6.3% in the moderate resuscitation arm, resulting in an adjusted relative risk of 2.85 in favor of the latter arm. This prompted the data and safety monitoring board to stop the study.
In an October commentary, I delved further into the details of this landmark trial following its publication in The New England Journal of Medicine, and why it will probably establish new profiles for fluid management in acute pancreatitis.
‘ACG Clinical Guideline: Gastroparesis’
Gastroparesis is increasingly encountered in clinical practice. This makes the arrival of these guidelines from ACG such a welcome addition to the year’s GI publications.
The authors provide evidence-based recommendations on the risk factors, diagnosis, and management of this condition. They also notably point out that these are the preferred, but not the only, approaches to this condition.
For those interested in learning more, I recommend you also review this April commentary in which I offer a how-to-guide for managing gastroparesis.
‘ACG Monograph on GI Diseases and Endoscopy in Pregnancy and Postpartum Period: An Introduction’
This ACG monograph includes nine focused articles by experts from fields including gastroenterology, hepatology, obstetrics/gynecology, maternal-fetal medicine, and nutrition. Their collaborative work addresses GI disease states in the setting of pregnancy and postpartum periods, leading to best practice recommendations for each of these topics.