ACG CxA cheat sheet

Celiac disease: tissue transglutaminase IgA is the preferred screening serology; confirm with duodenal biopsy showing villous blunting and intraepithelial lymphocytosis while on a gluten-containing diet.

Hepatitis B serology: HBsAg indicates infection; isolated anti-HBc IgG indicates prior infection or occult carriage; anti-HBs alone indicates vaccination.

Acute pancreatitis diagnosis requires two of three: characteristic epigastric pain radiating to the back, lipase or amylase greater than three times the upper limit of normal, and imaging findings.

Serum lipase is more specific than amylase for pancreatitis and remains elevated longer (roughly 4 to 8 days versus 2 to 5 days).

Hereditary hemochromatosis: transferrin saturation above 45% plus elevated ferritin warrants HFE genotyping, most commonly for C282Y homozygosity.

Wilson disease: low ceruloplasmin, elevated 24-hour urinary copper, Kayser-Fleischer rings, and Coombs-negative hemolytic anemia are classic features.

Whipple disease is diagnosed by small-bowel biopsy showing PAS-positive macrophages laden with Tropheryma whipplei, typically with weight loss, diarrhea, and arthralgias.

Gastroesophageal varices are screened at index endoscopy in cirrhosis; nonselective beta-blockers or variceal band ligation are used for primary prophylaxis of bleeding.

Colonoscopy quality: a withdrawal time of at least 6 minutes in a normal colon and an adenoma detection rate of at least 25% are benchmark standards for screening colonoscopy.

Split-dose bowel preparation is superior to same-day preparation for colon cleanliness; the second dose is completed within 4 to 6 hours of the procedure.

Post-polypectomy surveillance intervals depend on polyp number, size, and histology; high-risk findings (adenomas ≥10 mm, ≥3 adenomas, or villous/high-grade dysplasia) shorten the interval.

Conscious sedation with midazolam plus an opioid requires continuous pulse oximetry and capnography; reversal agents are flumazenil for benzodiazepines and naloxone for opioids.

Percutaneous endoscopic gastrostomy is generally avoided in the first 30 days after placement of a peritoneal dialysis catheter and in uncorrected coagulopathy.

Endoscopic retrograde cholangiopancreatography carries a post-procedure pancreatitis risk of roughly 3% to 10%; rectal indomethacin and periprocedural hydration reduce this risk.

Cholangitis during ERCP is treated with biliary decompression; antibiotic prophylaxis before ERCP is indicated only for patients with anticipated incomplete drainage or ongoing cholangitis.

Informed consent for endoscopy must document the indication, alternatives, and specific risks including bleeding, perforation, sedation complications, and infection.

Ulcerative colitis involves the rectum and extends proximally in a continuous pattern limited to the colon; Crohn disease can affect any segment of the GI tract with skip lesions and transmural inflammation.

Fecal calprotectin is a noninvasive marker of intestinal inflammation; values below 50 mcg/g generally suggest remission, while values above 250 mcg/g suggest active inflammation.

Acute severe ulcerative colitis is defined by the Truelove and Witts criteria: ≥6 bloody stools per day plus signs of systemic toxicity such as fever, tachycardia, anemia, or elevated ESR.

Corticosteroids are not maintenance therapy; patients requiring repeated steroid courses should be transitioned to immunomodulators or biologics.

Anti-TNF therapy requires screening for latent tuberculosis and hepatitis B before initiation because of reactivation risk.

Tofacitinib and other JAK inhibitors carry boxed warnings for serious infection, malignancy, and thrombosis; use is generally avoided in patients over 65 with cardiovascular risk factors.

Colorectal cancer surveillance in colitis begins 8 to 10 years after diagnosis and uses dye-spray chromoendoscopy or high-definition white-light with targeted biopsies.

Toxic megacolon is a medical emergency with colonic dilation greater than 6 cm plus systemic toxicity; contraindicated interventions include antimotility agents and colonoscopy.

Model for End-Stage Liver Disease (MELD) uses bilirubin, INR, creatinine, and sodium; higher scores predict 90-day mortality and prioritize transplant allocation.

Child-Pugh classification uses bilirubin, albumin, INR, ascites, and encephalopathy to stratify cirrhosis into classes A, B, and C.

Ascites: a serum-ascites albumin gradient (SAAG) of 1.1 g/dL or greater indicates portal hypertension; a lower gradient suggests peritoneal carcinomatosis, tuberculosis, or pancreatitis.

Spontaneous bacterial peritonitis is diagnosed when ascitic fluid polymorphonuclear cell count exceeds 250 cells/mm3; empiric therapy is a third-generation cephalosporin.

Hepatorenal syndrome type 1 is defined by rapid creatinine rise in cirrhosis without other causes, unresponsive to volume expansion; treatment includes albumin plus a vasoconstrictor such as terlipressin.

Hepatitis C is now curable with direct-acting antivirals; sustained virologic response is defined as undetectable HCV RNA 12 weeks after completing therapy.

Nonalcoholic fatty liver disease is the most common chronic liver disease; advanced fibrosis screening uses FIB-4, transient elastography, or the NAFLD fibrosis score.

Hepatocellular carcinoma surveillance in cirrhosis uses ultrasound with or without alpha-fetoprotein every 6 months.

Irritable bowel syndrome (Rome IV) requires recurrent abdominal pain at least 1 day per week in the last 3 months, associated with defecation or change in stool form or frequency.

Functional dyspepsia is defined by bothersome postprandial fullness, early satiation, epigastric pain, or burning for at least 3 months with onset at least 6 months prior.

Gastroparesis is diagnosed by delayed gastric emptying on a 4-hour scintigraphy scan; retained radiotracer greater than 10% at 4 hours is abnormal.

Achalasia shows absent or impaired lower esophageal sphincter relaxation with absent peristalsis on high-resolution manometry; treatment includes pneumatic dilation, Heller myotomy, or POEM.

Gastroesophageal reflux disease with alarm features (dysphagia, weight loss, anemia, or GI bleeding) warrants prompt upper endoscopy rather than empiric acid suppression.

Chronic constipation is managed in a stepwise manner: lifestyle and fiber, then osmotic laxatives, then stimulant laxatives, then secretagogues or pelvic floor biofeedback for dyssynergic defecation.

Rumination syndrome is characterized by regurgitation within minutes of eating without retching, often improving with diaphragmatic breathing and behavioral therapy.

Cyclic vomiting syndrome is defined by stereotyped episodes of severe nausea and vomiting lasting hours to days with symptom-free intervals between attacks.

Quality metrics in endoscopy include cecal intubation rate of at least 90% in screening colonoscopy, adenoma detection rate benchmarks, and appropriate sedation monitoring.

Documentation of informed consent, procedure indication, findings, and pathology follow-up is required for compliance and reimbursement.

Prior authorization requirements vary by payer and procedure; failure to obtain authorization before elective endoscopy can result in claim denial and financial loss.

Health equity: colorectal cancer screening rates are lower among uninsured, rural, and racial and ethnic minority populations; targeted outreach and patient navigation improve uptake.

Meaningful use and quality reporting programs (such as MIPS) tie reimbursement to performance on measures like screening colonoscopy follow-up and appropriate use of imaging.

Interpreter services are legally required for limited-English-proficiency patients under Title VI of the Civil Rights Act and improve informed consent comprehension.

Infection control for endoscopy requires high-level disinfection of reusable endoscopes and adherence to manufacturer reprocessing protocols.

Burnout and workforce shortages in gastroenterology are addressed through workload management, team-based care, and advanced practice provider integration.

Celiac disease: tissue transglutaminase IgA is the preferred screening serology; confirm with duodenal biopsy showing villous blunting and intraepithelial lymphocytosis while on a gluten-containing diet.

Hepatitis B serology: HBsAg indicates infection; isolated anti-HBc IgG indicates prior infection or occult carriage; anti-HBs alone indicates vaccination.

Acute pancreatitis diagnosis requires two of three: characteristic pain, lipase or amylase greater than three times the upper limit of normal, and imaging findings.

Serum lipase is more specific than amylase for pancreatitis and remains elevated longer (roughly 4 to 8 days versus 2 to 5 days).

Hereditary hemochromatosis: transferrin saturation above 45% plus elevated ferritin warrants HFE genotyping, most commonly for C282Y homozygosity.

Wilson disease: low ceruloplasmin, elevated 24-hour urinary copper, Kayser-Fleischer rings, and Coombs-negative hemolytic anemia are classic features.

Whipple disease is diagnosed by small-bowel biopsy showing PAS-positive macrophages laden with Tropheryma whipplei.

Gastroesophageal varices are screened at index endoscopy in cirrhosis; nonselective beta-blockers or variceal band ligation are used for primary prophylaxis.

Colonoscopy quality: withdrawal time of at least 6 minutes in a normal colon and adenoma detection rate of at least 25% are benchmark standards.

Split-dose bowel preparation is superior to same-day preparation; the second dose is completed within 4 to 6 hours of the procedure.

Post-polypectomy surveillance intervals depend on polyp number, size, and histology; high-risk findings shorten the interval.

Conscious sedation with midazolam plus an opioid requires continuous pulse oximetry and capnography; reversal agents are flumazenil and naloxone.

Percutaneous endoscopic gastrostomy is generally avoided in the first 30 days after peritoneal dialysis catheter placement and in uncorrected coagulopathy.

ERCP carries a post-procedure pancreatitis risk of roughly 3% to 10%; rectal indomethacin and periprocedural hydration reduce this risk.

Antibiotic prophylaxis before ERCP is indicated only for patients with anticipated incomplete drainage or ongoing cholangitis.

Informed consent for endoscopy must document the indication, alternatives, and specific risks including bleeding, perforation, sedation complications, and infection.

Ulcerative colitis involves the rectum and extends proximally in a continuous pattern limited to the colon; Crohn disease can affect any segment with skip lesions and transmural inflammation.

Fecal calprotectin below 50 mcg/g generally suggests remission, while values above 250 mcg/g suggest active inflammation.

Acute severe ulcerative colitis is defined by Truelove and Witts criteria: ≥6 bloody stools per day plus systemic toxicity such as fever, tachycardia, anemia, or elevated ESR.

Corticosteroids are not maintenance therapy; patients requiring repeated courses should transition to immunomodulators or biologics.

Anti-TNF therapy requires screening for latent tuberculosis and hepatitis B before initiation because of reactivation risk.

JAK inhibitors carry boxed warnings for serious infection, malignancy, and thrombosis and are generally avoided in patients over 65 with cardiovascular risk factors.

Colorectal cancer surveillance in colitis begins 8 to 10 years after diagnosis using dye-spray chromoendoscopy or high-definition white-light with targeted biopsies.

Toxic megacolon is a medical emergency with colonic dilation greater than 6 cm plus systemic toxicity; antimotility agents and colonoscopy are contraindicated.

MELD uses bilirubin, INR, creatinine, and sodium; higher scores predict 90-day mortality and prioritize transplant allocation.

Child-Pugh classification uses bilirubin, albumin, INR, ascites, and encephalopathy to stratify cirrhosis into classes A, B, and C.

A serum-ascites albumin gradient of 1.1 g/dL or greater indicates portal hypertension; a lower gradient suggests carcinomatosis, tuberculosis, or pancreatitis.

Spontaneous bacterial peritonitis is diagnosed when ascitic fluid polymorphonuclear cell count exceeds 250 cells/mm3; empiric therapy is a third-generation cephalosporin.

Hepatorenal syndrome type 1 is defined by rapid creatinine rise in cirrhosis unresponsive to volume expansion; treatment includes albumin plus a vasoconstrictor such as terlipressin.

Hepatitis C is curable with direct-acting antivirals; sustained virologic response is undetectable HCV RNA 12 weeks after completing therapy.

Nonalcoholic fatty liver disease is the most common chronic liver disease; fibrosis screening uses FIB-4, transient elastography, or the NAFLD fibrosis score.

Hepatocellular carcinoma surveillance in cirrhosis uses ultrasound with or without alpha-fetoprotein every 6 months.

Irritable bowel syndrome (Rome IV) requires recurrent abdominal pain at least 1 day per week in the last 3 months, associated with defecation or change in stool form or frequency.

Functional dyspepsia is defined by bothersome postprandial fullness, early satiation, epigastric pain, or burning for at least 3 months with onset at least 6 months prior.

Gastroparesis is diagnosed by delayed gastric emptying on 4-hour scintigraphy; retained radiotracer greater than 10% at 4 hours is abnormal.

Achalasia shows absent or impaired lower esophageal sphincter relaxation with absent peristalsis on high-resolution manometry; treatment includes pneumatic dilation, Heller myotomy, or POEM.

GERD with alarm features such as dysphagia, weight loss, anemia, or GI bleeding warrants prompt upper endoscopy rather than empiric acid suppression.

Chronic constipation is managed stepwise: lifestyle and fiber, then osmotic laxatives, then stimulant laxatives, then secretagogues or pelvic floor biofeedback for dyssynergic defecation.

Rumination syndrome is characterized by regurgitation within minutes of eating without retching, often improving with diaphragmatic breathing and behavioral therapy.

Cyclic vomiting syndrome is defined by stereotyped episodes of severe nausea and vomiting lasting hours to days with symptom-free intervals between attacks.

Quality metrics in endoscopy include cecal intubation rate of at least 90% in screening colonoscopy, adenoma detection rate benchmarks, and appropriate sedation monitoring.

Documentation of informed consent, procedure indication, findings, and pathology follow-up is required for compliance and reimbursement.

Prior authorization requirements vary by payer and procedure; failure to obtain authorization before elective endoscopy can result in claim denial.

Colorectal cancer screening rates are lower among uninsured, rural, and racial and ethnic minority populations; patient navigation improves uptake.

MIPS and other quality reporting programs tie reimbursement to performance on measures such as screening colonoscopy follow-up and appropriate use of imaging.

Interpreter services are legally required for limited-English-proficiency patients under Title VI of the Civil Rights Act and improve informed consent comprehension.

Infection control for endoscopy requires high-level disinfection of reusable endoscopes and adherence to manufacturer reprocessing protocols.

Burnout and workforce shortages in gastroenterology are addressed through workload management, team-based care, and advanced practice provider integration.

Celiac disease: tissue transglutaminase IgA is the preferred screening serology; confirm with duodenal biopsy showing villous blunting and intraepithelial lymphocytosis while on a gluten-containing diet.

Hepatitis B serology: HBsAg indicates infection; isolated anti-HBc IgG indicates prior infection or occult carriage; anti-HBs alone indicates vaccination.

Acute pancreatitis diagnosis requires two of three: characteristic pain, lipase or amylase greater than three times the upper limit of normal, and imaging findings.

Serum lipase is more specific than amylase for pancreatitis and remains elevated longer (roughly 4 to 8 days versus 2 to 5 days).

Hereditary hemochromatosis: transferrin saturation above 45% plus elevated ferritin warrants HFE genotyping, most commonly for C282Y homozygosity.

Wilson disease: low ceruloplasmin, elevated 24-hour urinary copper, Kayser-Fleischer rings, and Coombs-negative hemolytic anemia are classic features.

Whipple disease is diagnosed by small-bowel biopsy showing PAS-positive macrophages laden with Tropheryma whipplei.

Gastroesophageal varices are screened at index endoscopy in cirrhosis; nonselective beta-blockers or variceal band ligation are used for primary prophylaxis.

Colonoscopy quality: withdrawal time of at least 6 minutes in a normal colon and adenoma detection rate of at least 25% are benchmark standards.

Split-dose bowel preparation is superior to same-day preparation; the second dose is completed within 4 to 6 hours of the procedure.

Post-polypectomy surveillance intervals depend on polyp number, size, and histology; high-risk findings shorten the interval.

Conscious sedation with midazolam plus an opioid requires continuous pulse oximetry and capnography; reversal agents are flumazenil and naloxone.

Percutaneous endoscopic gastrostomy is generally avoided in the first 30 days after peritoneal dialysis catheter placement and in uncorrected coagulopathy.

ERCP carries a post-procedure pancreatitis risk of roughly 3% to 10%; rectal indomethacin and periprocedural hydration reduce this risk.

Antibiotic prophylaxis before ERCP is indicated only for patients with anticipated incomplete drainage or ongoing cholangitis.

Informed consent for endoscopy must document the indication, alternatives, and specific risks including bleeding, perforation, sedation complications, and infection.

Ulcerative colitis involves the rectum and extends proximally in a continuous pattern limited to the colon; Crohn disease can affect any segment with skip lesions and transmural inflammation.

Fecal calprotectin below 50 mcg/g generally suggests remission, while values above 250 mcg/g suggest active inflammation.

Acute severe ulcerative colitis is defined by Truelove and Witts criteria: ≥6 bloody stools per day plus systemic toxicity such as fever, tachycardia, anemia, or elevated ESR.

Corticosteroids are not maintenance therapy; patients requiring repeated courses should transition to immunomodulators or biologics.

Anti-TNF therapy requires screening for latent tuberculosis and hepatitis B before initiation because of reactivation risk.

JAK inhibitors carry boxed warnings for serious infection, malignancy, and thrombosis and are generally avoided in patients over 65 with cardiovascular risk factors.

Colorectal cancer surveillance in colitis begins 8 to 10 years after diagnosis using dye-spray chromoendoscopy or high-definition white-light with targeted biopsies.

Toxic megacolon is a medical emergency with colonic dilation greater than 6 cm plus systemic toxicity; antimotility agents and colonoscopy are contraindicated.

MELD uses bilirubin, INR, creatinine, and sodium; higher scores predict 90-day mortality and prioritize transplant allocation.

Child-Pugh classification uses bilirubin, albumin, INR, ascites, and encephalopathy to stratify cirrhosis into classes A, B, and C.

A serum-ascites albumin gradient of 1.1 g/dL or greater indicates portal hypertension; a lower gradient suggests carcinomatosis, tuberculosis, or pancreatitis.

Spontaneous bacterial peritonitis is diagnosed when ascitic fluid polymorphonuclear cell count exceeds 250 cells/mm3; empiric therapy is a third-generation cephalosporin.

Hepatorenal syndrome type 1 is defined by rapid creatinine rise in cirrhosis unresponsive to volume expansion; treatment includes albumin plus a vasoconstrictor such as terlipressin.

Hepatitis C is curable with direct-acting antivirals; sustained virologic response is undetectable HCV RNA 12 weeks after completing therapy.

Nonalcoholic fatty liver disease is the most common chronic liver disease; fibrosis screening uses FIB-4, transient elastography, or the NAFLD fibrosis score.

Hepatocellular carcinoma surveillance in cirrhosis uses ultrasound with or without alpha-fetoprotein every 6 months.

Irritable bowel syndrome (Rome IV) requires recurrent abdominal pain at least 1 day per week in the last 3 months, associated with defecation or change in stool form or frequency.

Functional dyspepsia is defined by bothersome postprandial fullness, early satiation, epigastric pain, or burning for at least 3 months with onset at least 6 months prior.

Gastroparesis is diagnosed by delayed gastric emptying on 4-hour scintigraphy; retained radiotracer greater than 10% at 4 hours is abnormal.

Achalasia shows absent or impaired lower esophageal sphincter relaxation with absent peristalsis on high-resolution manometry; treatment includes pneumatic dilation, Heller myotomy, or POEM.

GERD with alarm features such as dysphagia, weight loss, anemia, or GI bleeding warrants prompt upper endoscopy rather than empiric acid suppression.

Chronic constipation is managed stepwise: lifestyle and fiber, then osmotic laxatives, then stimulant laxatives, then secretagogues or pelvic floor biofeedback for dyssynergic defecation.

Rumination syndrome is characterized by regurgitation within minutes of eating without retching, often improving with diaphragmatic breathing and behavioral therapy.

Cyclic vomiting syndrome is defined by stereotyped episodes of severe nausea and vomiting lasting hours to days with symptom-free intervals between attacks.

Quality metrics in endoscopy include cecal intubation rate of at least 90% in screening colonoscopy, adenoma detection rate benchmarks, and appropriate sedation monitoring.

Documentation of informed consent, procedure indication, findings, and pathology follow-up is required for compliance and reimbursement.

Prior authorization requirements vary by payer and procedure; failure to obtain authorization before elective endoscopy can result in claim denial.

Colorectal cancer screening rates are lower among uninsured, rural, and racial and ethnic minority populations; patient navigation improves uptake.

MIPS and other quality reporting programs tie reimbursement to performance on measures such as screening colonoscopy follow-up and appropriate use of imaging.

Interpreter services are legally required for limited-English-proficiency patients under Title VI of the Civil Rights Act and improve informed consent comprehension.

Infection control for endoscopy requires high-level disinfection of reusable endoscopes and adherence to manufacturer reprocessing protocols.

Burnout and workforce shortages in gastroenterology are addressed through workload management, team-based care, and advanced practice provider integration.