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<!DOCTYPE html>
<html dir="ltr" lang="en-US">
<head><title>
ACG Clinical Guideline for the Diagnosis and Management of G... : Official journal of the American College of Gastroenterology | ACG
</title>
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GV4dC8yMDIyLzAxMDAwL2FjZ19jbGluaWNhbF9ndWlkZWxpbmVfZm9yX3RoZV9kaWFnbm9zaXNfYW5kLjE0LmFzcHg/Z2VuZXJhdGVFcHViPUFydGljbGV8YWpnOjIwMjI6MDEwMDA6MDAwMTR8MTAuMTQzMDkvYWpnLjAwMDAwMDAwMDAwMDE1Mzh8IiwiZ2F0aW5nIjpmYWxzZX0sImV2ZW50T3B0aW9ucyI6eyJidWJibGVzIjp0cnVlLCJjYW5jZWxhYmxlIjp0cnVlLCJjb21wb3NlZCI6ZmFsc2V9LCJsb2dpbkRldGFpbCI6eyJpc0xvZ2luT3B0aW9uYWwiOnRydWUsInByb21wdExvZ2luIjpmYWxzZX0sImlzTnVsbCI6ZmFsc2V9HgxkYXRhLXBkZi11cmwFf2h0dHBzOi8vam91cm5hbHMubHd3LmNvbS9hamcvX2xheW91dHMvMTUvb2Frcy5qb3VybmFscy9kb3dubG9hZHBkZi5hc3B4P3RyY2tuZ19zcmNfcGc9QXJ0aWNsZVZpZXdlciZhbj0wMDAwMDQzNC0yMDIyMDEwMDAtMDAwMTRkAgIPZBYCZg8WBh8BBY0BL2FqZy9mdWxsdGV4dC8yMDIyLzAxMDAwL2FjZ19jbGluaWNhbF9ndWlkZWxpbmVfZm9yX3RoZV9kaWFnbm9zaXNfYW5kLjE0LmFzcHg/UHB0PUFydGljbGV8YWpnOjIwMjI6MDEwMDA6MDAwMTR8MTAuMTQzMDkvYWpnLjAwMDAwMDAwMDAwMDE1Mzh8HgNyZWwFCG5vZm9sbG93HgdvbmNsaWNrZBYCZg8VASRFeHBvcnQgQWxsIEltYWdlcyB0byBQb3dlclBvaW50IEZpbGVkAgQPZBYGAgEPDxYCHwJkFgIeBXN0eWxlBQ1kaXNwbGF5Om5vbmU7ZAICDxYCHgpCZWhhdmlvcklEBShlbWFpbFRvQ29sbGVhZ3VlUG9wdXBFeHRlbmRlcl9fOTkxODIxOTI0ZAIDD2QWBAIBD2QWCGYPDxYCHwIFEkVtYWlsIHRvIENvbGxlYWd1ZWRkAgEPZBYCAgEPDxYCHwIFHUNvbGxlYWd1ZSdzIEUtbWFpbCBpcyBJbnZhbGlkZGQCBA8PFgIfAgUSQ29sbGVhZ3VlJ3MgRW1haWw6ZGQCCA8PFgQeCENzc0NsYXNzBVlqcy1zZW5kLWJ1dHRvbiBwcmltYXJ5LWJ1dHRvbiBncmVjYXB0Y2hhLWVtYWlsLWNvbGxlYWd1ZS01MjRmOTVhNTU5ODE0NTllOWExY2NmOTU2MzhkY2U3ZR4EXyFTQgICZGQCAw9kFgICAQ9kFgICAQ8PFgIfAgU6WW91ciBtZXNzYWdlIGhhcyBiZWVuIHN1Y2Nlc3NmdWxseSBzZW50IHRvIHlvdXIgY29sbGVhZ3VlLmRkAgUPZBYGAgEPDxYCHwJkFgIfJQUNZGlzcGxheTpub25lO2QCAg8WAh8mBSNPcGVuRXhwb3J0VG9Qb3B1cEV4dGVuZGVyXzI2Nzk2ODcwM2QCAw9kFgJmD2QWAgIBDxBkDxYDZgIBAgIWAxAFCEVuZCBOb3RlBQdFbmROb3RlZxAFB1Byb2NpdGUFB1Byb2NpdGVnEAURUmVmZXJlbmNlIE1hbmFnZXIFEFJlZmVyZW5jZU1hbmFnZXJnZGQCCQ9kFgYCAg8WBB8EBVpBQ0cgQ2xpbmljYWwgR3VpZGVsaW5lIGZvciB0aGUgRGlhZ25vc2lzIGFuZCBNYW5hZ2VtZW50IG9mIEdhc3Ryb2Vzb3BoYWdlYWwgUmVmbHV4IERpc2Vhc2UfJAUQSGlkZVNsaWRlU2hvdygpO2QCBA9kFgICAQ8WAh8CBV1PZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBBbWVyaWNhbiBDb2xsZWdlIG9mIEdhc3Ryb2VudGVyb2xvZ3kgfCBBQ0cxMTcoMSk6MjctNTYsIEphbnVhcnkgMjAyMi5kAggPFgIfJAVbc2xpZGVTaG93X05hdmlnYXRlVG9VcmwoJy9hamcvcGFnZXMvaW1hZ2VnYWxsZXJ5LmFzcHg/eWVhcj0yMDIyJmlzc3VlPTAxMDAwJmFydGljbGU9MDAwMTQnKWQCCg9kFgYCAQ8PFgIfAmQWAh8lBQ1kaXNwbGF5Om5vbmU7ZAICDxYCHyYFKWVtYWlsVG9Db2xsZWFndWVQb3B1cEV4dGVuZGVyX18xMjczMTc3NDc5ZAIDD2QWBAIBD2QWCGYPDxYCHwIFEkVtYWlsIHRvIENvbGxlYWd1ZWRkAgEPZBYCAgEPDxYCHwIFHUNvbGxlYWd1ZSdzIEUtbWFpbCBpcyBJbnZhbGlkZGQCBA8PFgIfAgUSQ29sbGVhZ3VlJ3MgRW1haWw6ZGQCCA8PFgQfJwVZanMtc2VuZC1idXR0b24gcHJpbWFyeS1idXR0b24gZ3JlY2FwdGNoYS1lbWFpbC1jb2xsZWFndWUtY2YyZTRiMGYwNWM1NDcxYmI3YjdmYmU2ODk5NjFjZmEfKAICZGQCAw9kFgICAQ9kFgICAQ8PFgIfAgU6WW91ciBtZXNzYWdlIGhhcyBiZWVuIHN1Y2Nlc3NmdWxseSBzZW50IHRvIHlvdXIgY29sbGVhZ3VlLmRkBSZnXzU2NWJiNzM4X2RkYjVfNDQ4ZV84ZWViXzg1ZGQ1MGQ5Y2FmMA9kFgJmD2QWAmYPFgIfAGhkBSZnXzhkZmM1MDhlX2NhYjJfNGM2ZF84YjNmXzQ2YWZiYTg5ODM5Zg9kFgJmD2QWCGYPFjIfCgX5AnsiZXZlbnROYW1lIjoiUFBURG93bmxvYWQiLCJldmVudERldGFpbCI6eyJ1cmwiOiJodHRwczovL2pvdXJuYWxzLmx3dy5jb206NDQzL2FqZy9mdWxsdGV4dC8yMDIyLzAxMDAwL2FjZ19jbGluaWNhbF9ndWlkZWxpbmVfZm9yX3RoZV9kaWFnbm9zaXNfYW5kLjE0LmFzcHg/UHB0PUFydGljbGV8YWpnOjIwMjI6MDEwMDA6MDAwMTR8MTAuMTQzMDkvYWpnLjAwMDAwMDAwMDAwMDE1Mzh8IiwiZ2F0aW5nIjpmYWxzZX0sImV2ZW50T3B0aW9ucyI6eyJidWJibGVzIjp0cnVlLCJjYW5jZWxhYmxlIjp0cnVlLCJjb21wb3NlZCI6ZmFsc2V9LCJsb2dpbkRldGFpbCI6eyJpc0xvZ2luT3B0aW9uYWwiOnRydWUsInByb21wdExvZ2luIjpmYWxzZX0sImlzTnVsbCI6ZmFsc2V9HwsFBWZhbHNlHwwFBWZhbHNlHw0FBWZhbHNlHw4FBHRydWUfDwVQY3RsMDBfY3RsMjhfZ184ZGZjNTA4ZV9jYWIyXzRjNmRfOGIzZl80NmFmYmE4OTgzOWZfY3RsMDBfZW1haWxUb0NvbGxlYWd1ZUNvbnRyb2wfEAUEdHJ1ZR8RBYIBQUNHIENsaW5pY2FsIEd1aWRlbGluZSBmb3IgdGhlIERpYWdub3NpcyBhbmQgTWFuYWdlbWVudCBvZi4uLiA6IE9mZmljaWFsIGpvdXJuYWwgb2YgdGhlIEFtZXJpY2FuIENvbGxlZ2Ugb2YgR2FzdHJvZW50ZXJvbG9neSB8IEFDRx8SBQR0cnVlHxNlHxQFBHRydWUfFQUEdHJ1ZR8WBRgwMDAwMDQzNC0yMDIyMDEwMDAtMDAwMTQfFwUEdHJ1ZR8YBUAvYWpnL3BhZ2VzL2ltYWdlZ2FsbGVyeS5hc3B4P3llYXI9MjAyMiZpc3N1ZT0wMTAwMCZhcnRpY2xlPTAwMDE0HxkFZWh0dHBzOi8vam91cm5hbHMubHd3LmNvbS9hamcvRnVsbHRleHQvMjAyMi8wMTAwMC9BQ0dfQ2xpbmljYWxfR3VpZGVsaW5lX2Zvcl90aGVfRGlhZ25vc2lzX2FuZC4xNC5hc3B4HxoFowJ7ImV2ZW50TmFtZSI6IkFkZFRvRmF2b3JpdGVzIiwiZXZlbnREZXRhaWwiOnsiaXRlbXMiOlsiQXJ0aWNsZXxhamc6MjAyMjowMTAwMDowMDAxNHwxMC4xNDMwOS9hamcuMDAwMDAwMDAwMDAwMTUzOHwiXSwiYW4iOiIwMDAwMDQzNC0yMDIyMDEwMDAtMDAwMTQifSwiZXZlbnRPcHRpb25zIjp7ImJ1YmJsZXMiOnRydWUsImNhbmNlbGFibGUiOnRydWUsImNvbXBvc2VkIjpmYWxzZX0sImxvZ2luRGV0YWlsIjp7ImlzTG9naW5PcHRpb25hbCI6ZmFsc2UsInByb21wdExvZ2luIjp0cnVlfSwiaXNOdWxsIjpmYWxzZX0fG2UfHAUEdHJ1ZR8dBQVmYWxzZR8eBQR0cnVlHx8FBHRydWUfIAXTAnsiZXZlbnROYW1lIjoiUERGRG93bmxvYWRJbml0IiwiZXZlbnREZXRhaWwiOnsidXJsIjoiaHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2FqZy9fbGF5b3V0cy8xNS9vYWtzLmpvdXJuYWxzL2Rvd25sb2FkcGRmLmFzcHg/dHJja25nX3NyY19wZz1BcnRpY2xlVmlld2VyJmFuPTAwMDAwNDM0LTIwMjIwMTAwMC0wMDAxNCIsImdhdGluZyI6ZmFsc2V9LCJldmVudE9wdGlvbnMiOnsiYnViYmxlcyI6dHJ1ZSwiY2FuY2VsYWJsZSI6dHJ1ZSwiY29tcG9zZWQiOmZhbHNlfSwibG9naW5EZXRhaWwiOnsiaXNMb2dpbk9wdGlvbmFsIjp0cnVlLCJwcm9tcHRMb2dpbiI6ZmFsc2V9LCJpc051bGwiOmZhbHNlfR8hBYMDeyJldmVudE5hbWUiOiJFUFVCRG93bmxvYWQiLCJldmVudERldGFpbCI6eyJ1cmwiOiJodHRwczovL2pvdXJuYWxzLmx3dy5jb206NDQzL2FqZy9mdWxsdGV4dC8yMDIyLzAxMDAwL2FjZ19jbGluaWNhbF9ndWlkZWxpbmVfZm9yX3RoZV9kaWFnbm9zaXNfYW5kLjE0LmFzcHg/Z2VuZXJhdGVFcHViPUFydGljbGV8YWpnOjIwMjI6MDEwMDA6MDAwMTR8MTAuMTQzMDkvYWpnLjAwMDAwMDAwMDAwMDE1Mzh8IiwiZ2F0aW5nIjpmYWxzZX0sImV2ZW50T3B0aW9ucyI6eyJidWJibGVzIjp0cnVlLCJjYW5jZWxhYmxlIjp0cnVlLCJjb21wb3NlZCI6ZmFsc2V9LCJsb2dpbkRldGFpbCI6eyJpc0xvZ2luT3B0aW9uYWwiOnRydWUsInByb21wdExvZ2luIjpmYWxzZX0sImlzTnVsbCI6ZmFsc2V9HyIFf2h0dHBzOi8vam91cm5hbHMubHd3LmNvbS9hamcvX2xheW91dHMvMTUvb2Frcy5qb3VybmFscy9kb3dubG9hZHBkZi5hc3B4P3RyY2tuZ19zcmNfcGc9QXJ0aWNsZVZpZXdlciZhbj0wMDAwMDQzNC0yMDIyMDEwMDAtMDAwMTRkAgIPZBYCZg8WBh8BBY0BL2FqZy9mdWxsdGV4dC8yMDIyLzAxMDAwL2FjZ19jbGluaWNhbF9ndWlkZWxpbmVfZm9yX3RoZV9kaWFnbm9zaXNfYW5kLjE0LmFzcHg/UHB0PUFydGljbGV8YWpnOjIwMjI6MDEwMDA6MDAwMTR8MTAuMTQzMDkvYWpnLjAwMDAwMDAwMDAwMDE1Mzh8HyMFCG5vZm9sbG93HyRkFgJmDxUBJEV4cG9ydCBBbGwgSW1hZ2VzIHRvIFBvd2VyUG9pbnQgRmlsZWQCBA9kFgYCAQ8PFgIfAmQWAh8lBQ1kaXNwbGF5Om5vbmU7ZAICDxYCHyYFJmVtYWlsVG9Db2xsZWFndWVQb3B1cEV4dGVuZGVyXzgxNzg0MTc0ZAIDD2QWBAIBD2QWCGYPDxYCHwIFEkVtYWlsIHRvIENvbGxlYWd1ZWRkAgEPZBYCAgEPDxYCHwIFHUNvbGxlYWd1ZSdzIEUtbWFpbCBpcyBJbnZhbGlkZGQCBA8PFgIfAgUSQ29sbGVhZ3VlJ3MgRW1haWw6ZGQCCA8PFgQfJwVZanMtc2VuZC1idXR0b24gcHJpbWFyeS1idXR0b24gZ3JlY2FwdGNoYS1lbWFpbC1jb2xsZWFndWUtN2Y3NTdlNGMxZTYzNDNhZjlkNTVjMWVmZTA3NzgxODkfKAICZGQCAw9kFgICAQ9kFgICAQ8PFgIfAgU6WW91ciBtZXNzYWdlIGhhcyBiZWVuIHN1Y2Nlc3NmdWxseSBzZW50IHRvIHlvdXIgY29sbGVhZ3VlLmRkAgUPZBYGAgEPDxYCHwJkFgIfJQUNZGlzcGxheTpub25lO2QCAg8WAh8mBSVPcGVuRXhwb3J0VG9Qb3B1cEV4dGVuZGVyX18xMzkzODYwMTA5ZAIDD2QWAmYPZBYCAgEPEGQPFgNmAgECAhYDEAUIRW5kIE5vdGUFB0VuZE5vdGVnEAUHUHJvY2l0ZQUHUHJvY2l0ZWcQBRFSZWZlcmVuY2UgTWFuYWdlcgUQUmVmZXJlbmNlTWFuYWdlcmdkZAUmZ184ODQ0Njg1Zl9kOWFkXzRkNjZfYWE5NV9mNGZmMjhjYWUzMWUPZBYCAgEPZBYCZg8WAh8EZGQFJmdfMjFlMmMzOTBfYzAyYV80YTUyX2E2ZjVfZGE1MDRjMjYwNTI1D2QWAmYPZBYCZg9kFgJmD2QWCAIBD2QWAgIBDw8WBB8CBS5BcnRpY2xlcyBpbiBQdWJNZWQgYnkgUGhpbGlwIE8uIEthdHosIE1ELCBNQUNHHgtOYXZpZ2F0ZVVybAU6aHR0cDovL3d3dy5uY2JpLm5sbS5uaWguZ292L3B1Ym1lZD90ZXJtPUthdHorUGhpbGlwK08uW2F1XWRkAgMPZBYCAgEPDxYEHykFK2h0dHA6Ly93d3cubmNiaS5ubG0ubmloLmdvdi9wdWJtZWQvMzQ4MDcwMDcfAgUWVGhpcyBhcnRpY2xlIGluIFB1Yk1lZGRkAgUPZBYCAgEPDxYEHwIFNkFydGljbGVzIGluIEdvb2dsZSBTY2hvbGFyIGJ5IFBoaWxpcCBPLiBLYXR6LCBNRCwgTUFDRx8pBTVodHRwOi8vc2Nob2xhci5nb29nbGUuY29tL3NjaG9sYXI/cT1LYXR6JTJjK1BoaWxpcCtPLmRkAgcPZBYCAgEPDxYEHwIFOk90aGVyIGFydGljbGVzIGluIHRoaXMgam91cm5hbCBieSBQaGlsaXAgTy4gS2F0eiwgTUQsIE1BQ0cfKQVQaHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2FqZy9wYWdlcy9hdXRob3IuYXNweD9maXJzdE5hbWU9UGhpbGlwK08uJmxhc3ROYW1lPUthdHpkZAUmZ181ZDM0ZDQ3NF9jY2VjXzQwNTNfYmZhYl9kNmIxMmNlOTE1MGYPZBYCZg9kFgJmD2QWAgIBD2QWAmYPFCsAAg8WBB8GZx8HAv////8PZGRkBSZnX2ZlNWM3ZDM2X2ZhOTBfNDk1N19iYWZkX2JlOTc0Y2U3ZmU4Ng9kFgJmD2QWAmYPDxYCHwBoZBYCAgEPFCsAAmRkZAIJDxYCHwBoFgICBQ9kFgICAw8WAh8AaBYCZg9kFgQCAg9kFgYCAQ8WAh8AaGQCAw8WAh8AaGQCBQ8WAh8AaGQCAw8PFgIeCUFjY2Vzc0tleQUBL2RkAgsPZBYCAgEPDxYCHwBoZGQCFQ9kFgJmD2QWEGYPZBYEZg9kFgoCAQ8WAh8AaBYEAgMPZBYQAgEPFgIfAGgWAgIBDw8WAh8pBZsBaHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2FqZy9zZWN1cmUvcGFnZXMvbXlhY2NvdW50LmFzcHg/Q29udGV4dFVybD0lMmZhamclMmZmdWxsdGV4dCUyZjIwMjIlMmYwMTAwMCUyZmFjZ19jbGluaWNhbF9ndWlkZWxpbmVfZm9yX3RoZV9kaWFnbm9zaXNfYW5kLjE0LmFzcHhkZAIDDxYCHwBoFgICAQ8PFgIfKQW8AWh0dHBzOi8vam91cm5hbHMubHd3LmNvbS9hamcvc2VjdXJlL3BhZ2VzL215YWNjb3VudC5hc3B4P0NvbnRleHRVcmw9JTJmYWpnJTJmZnVsbHRleHQlMmYyMDIyJTJmMDEwMDAlMmZhY2dfY2xpbmljYWxfZ3VpZGVsaW5lX2Zvcl90aGVfZGlhZ25vc2lzX2FuZC4xNC5hc3B4JmVkaXRXZWJQYXJ0PWVkaXRDaGFuZ2VQYXNzd29yZFdQZGQCBQ8WAh8AaBYCAgEPDxYCHykFnQFodHRwczovL2pvdXJuYWxzLmx3dy5jb20vYWpnL3NlY3VyZS9wYWdlcy9teWZhdm9yaXRlcy5hc3B4P0NvbnRleHRVcmw9JTJmYWpnJTJmZnVsbHRleHQlMmYyMDIyJTJmMDEwMDAlMmZhY2dfY2xpbmljYWxfZ3VpZGVsaW5lX2Zvcl90aGVfZGlhZ25vc2lzX2FuZC4xNC5hc3B4ZGQCBw9kFgICAQ8PFgIfKQW2AWh0dHBzOi8vam91cm5hbHMubHd3LmNvbS9hamcvc2VjdXJlL3BhZ2VzL215ZmF2b3JpdGVzLmFzcHg/Q29udGV4dFVybD0lMmZhamclMmZmdWxsdGV4dCUyZjIwMjIlMmYwMTAwMCUyZmFjZ19jbGluaWNhbF9ndWlkZWxpbmVfZm9yX3RoZV9kaWFnbm9zaXNfYW5kLjE0LmFzcHgmY29sbGVjdGlvbj1TYXZlZFNlYXJjaGVzZGQCCw9kFgICAQ8PFgIfKQWTAWh0dHBzOi8vam91cm5hbHMubHd3LmNvbS9hamcvcGFnZXMvcmVnaXN0ZXIuYXNweD9Db250ZXh0VXJsPSUyZmFqZyUyZmZ1bGx0ZXh0JTJmMjAyMiUyZjAxMDAwJTJmYWNnX2NsaW5pY2FsX2d1aWRlbGluZV9mb3JfdGhlX2RpYWdub3Npc19hbmQuMTQuYXNweGRkAg0PZBYCAgEPFgIfAQUZaHR0cDovL2hlYWx0aGpvYnNwbHVzLmNvbWQCDw8WAh8AZxYCAgEPDxYGHykFsAFodHRwczovL2pvdXJuYWxzLmx3dy5jb20vYWpnL3BhZ2VzL2xvZ2luLmFzcHg/Q29udGV4dFVybD0lMmZhamclMmZmdWxsdGV4dCUyZjIwMjIlMmYwMTAwMCUyZmFjZ19jbGluaWNhbF9ndWlkZWxpbmVfZm9yX3RoZV9kaWFnbm9zaXNfYW5kLjE0LmFzcHgmUmVxdWVzdEZvcj1BY3RpdmF0ZVN1YnNjcmlwdGlvbh4HRW5hYmxlZGcfAGdkZAITDxYCHwBoFgICAQ8PFgIfKQWJAWh0dHBzOi8vam91cm5hbHMubHd3LmNvbS9hamcvX2xheW91dHMvMTUvb2Frcy5qb3VybmFscy9sb2dvdXQuYXNweD9Db250ZXh0VXJsPWh0dHBzJTNhJTJmJTJmam91cm5hbHMubHd3LmNvbSUyZmFqZyUyZnBhZ2VzJTJmZGVmYXVsdC5hc3B4ZGQCBQ8WAh8AaBYCAgEPFCsAAmRkZAIDDxYCHwBnZAIED2QWAgIBDw8WCB8nBSB1c2VyLW1lbnVfX2xpbmsganMtcmVnaXN0ZXItbGluax8pBZMBaHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2FqZy9wYWdlcy9yZWdpc3Rlci5hc3B4P0NvbnRleHRVcmw9JTJmYWpnJTJmZnVsbHRleHQlMmYyMDIyJTJmMDEwMDAlMmZhY2dfY2xpbmljYWxfZ3VpZGVsaW5lX2Zvcl90aGVfZGlhZ25vc2lzX2FuZC4xNC5hc3B4HygCAh8AZxYCHgtkYXRhL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