ACG Guidelines Overview
The American College of Gastroenterology (ACG) publishes evidence-based clinical practice guidelines across numerous gastrointestinal conditions to guide clinical decision-making. Based on the available evidence, here are the major ACG guidelines currently available:
Key ACG Guidelines by Clinical Area
Inflammatory Bowel Disease
Ulcerative Colitis (2025): The most recent ACG guideline addresses pharmacologic management of UC in adults, covering both mild-to-moderate disease 1, 2 and moderate-to-severe disease 3, 2. The 2025 update provides comprehensive recommendations on 5-ASA therapy, biologics, small molecules, and combination therapy strategies.
Crohn's Disease (2025): The AGA (not ACG, but relevant) published a living guideline on pharmacologic management of moderate-to-severe Crohn's disease 4, providing tiered recommendations based on prior treatment exposure.
Helicobacter pylori Infection
- H. pylori Treatment (2024): The ACG guideline addresses first-line and salvage therapy regimens 5, 6. Bismuth quadruple therapy for 14 days is the preferred empiric first-line regimen when antibiotic susceptibility is unknown 6. The guideline emphasizes avoiding clarithromycin-based triple therapy in areas with >15% resistance and provides specific salvage options including rifabutin triple therapy.
Diverticular Disease
- Acute Diverticulitis (2022): The ACP (American College of Physicians, not ACG) guideline recommends selective rather than routine antibiotic use for uncomplicated diverticulitis 7, 8. CT imaging should be used when diagnostic uncertainty exists 7. Colonoscopy after resolution is suggested to exclude malignancy if recent high-quality examination hasn't been performed 9, 8.
Gastroesophageal Reflux Disease
- GERD (2022): The ACG guideline provides evidence-based recommendations for diagnosis and management, including PPI therapy, lifestyle modifications, and surgical/endoscopic interventions 10.
Other Conditions
- Gastrointestinal Subepithelial Lesions (2023): Addresses EUS evaluation and management of SEL, including GIST 11
- Irritable Bowel Syndrome (2002): Older guideline addressing pathophysiology and management 12
Guideline Quality Considerations
The ACG uses GRADE methodology for most recent guidelines, which means:
- Recommendations are graded as strong or conditional
- Evidence quality is rated as high, moderate, low, or very low
- Approximately 75% of recommendations across major GI guidelines are based on low or very low-quality evidence 13
Key Limitations
The evidence shows that most guideline recommendations (75%) are conditional and based on low-quality evidence 13. This reflects the reality that high-quality randomized controlled trials are lacking for most clinical questions in gastroenterology. Guidelines may inadvertently promote overutilization when expert panels make "best guess" recommendations in evidence-poor areas 13.
Accessing Guidelines
ACG guidelines are published in The American Journal of Gastroenterology and are freely available on the ACG website. The most clinically impactful recent updates are the 2025 UC guideline 2 and 2024 H. pylori guideline 6.
For specific clinical questions, identify which condition you're managing and reference the corresponding guideline using the publication years noted above to ensure you're using the most current recommendations.