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Gastroenterology — Updates Since 2020

Guideline & practice changes since 2020

  • Eosinophilic oesophagitis management is not a PPI-first, corticosteroid- second hierarchy — a dedicated 2024 Australian Prescriber review is explicit that no drug is first-line and choice is patient-preference- driven; orodispersible budesonide tablets (now PBS-listed, specialist- initiated) have largely superseded the old budesonide slurry and are generally continued lifelong, not trialled off after an initial course. See Eosinophilic Oesophagitis.
  • NAFLD/NASH has been renamed MASLD/MASH (June 2023 global consensus). See Fatty Liver / NASH.
  • C. difficile treatment no longer starts with metronidazole — vancomycin/ fidaxomicin are now first-line (2021 IDSA). See Acute Infectious Diarrhoea / Gastroenteritis.
  • Bowel cancer screening age lowered from 50 to 45 (NBCSP, July 2024). See Bowel Cancer Screening.
  • Primary biliary cholangitis gained two new second-line therapies (elafibranor, seladelpar, 2024); obeticholic acid was withdrawn (hepatotoxicity, Sept 2025). See Primary Biliary Cirrhosis/Cholangitis.
  • IBD biologic options expanded (ustekinumab, risankizumab, JAK inhibitors) well beyond infliximab/vedolizumab; acute severe ulcerative colitis now uses the Truelove & Witts/Travis criteria with a day 3–5 steroid-response checkpoint before rescue therapy. See Inflammatory Bowel Disease.
  • POEM is now an established achalasia treatment alongside Heller myotomy. See Achalasia.
  • Ranitidine’s withdrawal is confirmed (still listed in some older GORD notes).
  • Anal fissure management now has a full ladder: fibre/sitz baths → GTN-or-CCB → botulinum toxin → LIS-vs-fissurectomy+anoplasty by sphincter tone. See Anal Fissures.
  • Constipation management now follows the same Rome III→V update already applied to IBS. See Constipation and Irritable Bowel Syndrome.
  • Gallbladder polyps have a size-based referral algorithm on Biliary Colic; IPMN (premalignant pancreatic cystic lesion) on Pancreatic Cancer; median arcuate ligament syndrome on Abdominal Pain; a severe-hypertriglyceridaemia-specific pancreatitis threshold on Pancreatitis.

New pages added

  • Pilonidal Sinus & Abscess (2026-09-01) — recognition (asymptomatic sinus, acute abscess, chronic sinus), general-practice management of the acute abscess, the surgical options a referral will offer (lay open, Karydakis/Bascom/Limberg flaps, EPSiT) with their recurrence-rate trade-offs, and secondary prevention (hygiene, laser vs shaving for hair removal).