What changed recently

The July 2026 update withdrew the recommendation on serum ferritin testing from the laboratory investigations section for women presenting with heavy menstrual bleeding. NG88 originally replaced the 2007 heavy menstrual bleeding guideline CG44.

ACG replaced its 2021 diverticular disease guideline with a document focused on colonic diverticulitis, formalising selective rather than routine antibiotics for low-risk acute uncomplicated disease and listing the high-risk features (immunocompromise, frailty, unsafe outpatient care) that still warrant them. It also recommends against probiotics, mesalamine and rifaximin for recurrence prevention, drops nut/seed/popcorn avoidance, and limits post-recovery colonoscopy to complicated disease or patients with alarm features or overdue screening.

The 2026 revision of the 2019 adult guideline adds JAK inhibitors as a recommended option (a class absent from the previous version), keeps TNF and IL-17 inhibitors as the preferred first biologics, and advises against IL-23 inhibitors. It also broadens scope with new guidance on nociplastic pain, imaging strategy, bone health and comorbidities, and is accompanied by a first-ever companion guideline for juvenile axial spondyloarthritis.

The task force consolidated the guidance from 11 recommendations down to 9 by merging and deleting items, while keeping methotrexate plus short-term glucocorticoids as the first step and adding a biologic DMARD after 3-6 months of inadequate response. Safety framing was sharpened, with JAK inhibitors requiring explicit assessment of cardiovascular and malignancy risk before use.

Algorithm 2.0 refines the 2025 EASO framework using 62 randomised trials with evidence through 21 November 2025, sharpening the head-to-head comparisons of total body weight loss across available drugs. The liver domain was expanded beyond MASH resolution to include improvement in liver fibrosis as a treatment target.

The AUA replaced its 2021 BPH/LUTS guideline and the targeted 2023 amendment with a full rebuild published in 2026, based on a fresh systematic literature review. The document was restructured into three parts covering presentation and evaluation, medical management, and procedural or surgical management.

The 2026 GINA report's headline addition is a set of four new flowcharts covering assessment, treatment and follow-up of acute asthma and exacerbations in adults, adolescents and children aged 6-11, in both primary and acute care settings. It also adds consensus guidance on which treatment step to start children aged 6-11 at, revised advice on biologics, oxygen saturation targets, SABA dosing and using ICS-formoterol instead of SABA for mild exacerbations, plus a stronger push to minimise oral corticosteroid exposure.

AUA amended the 2022 guideline after a literature review covering July 2021 to December 2024 (29 studies plus a set on artificial intelligence in disease management). The society describes the amendment as refining risk-based management, updating imaging and radiation therapy guidance, and strengthening the shared decision-making statements.

The April 2026 amendment reworked the advice on unscheduled vaginal bleeding while on systemic HRT, changing one recommendation and adding a new one so the guidance lines up with NICE's suspected cancer referral guidance. The preceding November 2024 update had added evidence-based recommendations on cognitive behavioural therapy for menopausal symptoms, on genitourinary symptoms, and on the health outcomes associated with HRT.

ESMO replaced its 2023 metastatic colorectal cancer guideline with the 2026 edition (Cremolini et al., Ann Oncol 37(6):759-776); the 2023 document is now marked superseded in this atlas.

The 2025 parameter abandons the previous edition's structure of working through individual genetic entities and instead organises recommendations into a diagnosis part and a management part. Diagnosis now covers newborn screening for severe combined immunodeficiency, genetic testing and comorbidity surveillance, while management addresses immunoglobulin replacement, antibiotic prophylaxis, haematopoietic stem cell transplantation, precision medicine and quality-of-life assessment.

The 2026 edition expands to 129 statements, 46 of them on questions the 2021 guidelines never addressed, including a conditional recommendation for point-of-care ultrasound to guide resuscitation and new guidance on active fluid removal once initial resuscitation is complete. Of the 38 questions carried over from 2021, only three recommendations actually reversed direction.

The 2026 guideline supersedes the 2018 guideline and its 2019 focused update, placing tenecteplase 0.25 mg/kg on equal footing with alteplase inside the 4.5-hour window, allowing imaging-selected thrombolysis out to roughly 9 hours, widening thrombectomy eligibility to include basilar occlusions and large ischaemic cores, endorsing mobile stroke units and refined EMS triage, and adding the first AHA/ASA recommendations for paediatric acute ischaemic stroke.

The 2026 edition added a new pathophysiology introduction drawing on 40-year DCCT/EDIC follow-up, discussed the eye effects of GLP-1 receptor agonists including NAION and retinopathy progression, added the Ipswich touch test to neuropathy assessment, and revised Rec 12.22 to stress combination therapy for neuropathic pain. Foot care sections now cover home foot-temperature monitoring, expanded WIfI staging, and emerging evidence that GLP-1 RAs may cut lower-extremity amputations.

The 2026 edition added a recommendation to use a dual GIP/GLP-1 receptor agonist in type 2 diabetes with symptomatic heart failure with preserved ejection fraction, and reworked the MASLD/MASH guidance so a GLP-1 RA with proven hepatic benefit is preferred, with pioglitazone or a dual GIP/GLP-1 RA as alternatives. Guidance on continuing GLP-1-based therapy in advanced chronic kidney disease was also expanded.

For insulin-treated diabetes the 2026 edition broadened continuous glucose monitoring to be offered at diagnosis and at any later point (Rec 9.25), and strengthened the recommendation that automated insulin delivery systems be offered to eligible adults. A new recommendation also addresses screening for insulin need and ketoacidosis risk in immune checkpoint inhibitor-associated diabetes.

The January 2026 update to the living EuroGuiDerm atopic eczema guideline re-voted the systemic treatment chapters and redrew the treatment algorithms for adults and for children and adolescents. Azathioprine and alitretinoin recommendations were withdrawn, mycophenolate and omalizumab were moved to past therapies, and new guidance was added on vaccination, switching between drugs, dose interval adjustment, and pregnancy and breastfeeding.

The EuroGuiDerm update revises the 2016 European S3 acne guideline around three priority questions: when to choose isotretinoin over systemic antibiotics, how long antibiotics should run and when to use hormonal therapy or spironolactone, and how to position the newer topicals trifarotene and clascoterone. It also revises advice on benzoyl peroxide safety, choice of systemic antibiotic, treatment in pregnancy and isotretinoin dosing, leaving the rest of the 2016 text in place.

The 2026 EAU urological infections guideline is a limited update of the 2025 edition adding 36 studies across two sections. It revises the diagnostic and antimicrobial treatment recommendations for cystitis, updates antibiotic dosages throughout, strengthens periprocedural antibiotic prophylaxis guidance for prostate biopsy, and adds a new section on the diagnosis and treatment of fungal urinary tract infections.

The 2026 EAU urolithiasis guideline is a full update of the 2025 edition incorporating 126 newly identified studies, with revised recommendations on renal colic management, medical expulsive therapy, antibiotic prophylaxis for shock wave lithotripsy, retrograde and antegrade ureteroscopy, percutaneous nephrolithotomy, management of antithrombotic therapy around stone treatment, and radiation protection in endourology.

The 2026 EAU male LUTS guideline is a full revision of the 2025 edition: it adds a new section on prostate cancer within the diagnostic chapter, changes the strength rating for beta-3 agonists in conservative treatment, expands the surgical chapter with two new subsections emphasising alternative enucleation and ablative techniques, and adds guidance on male urinary incontinence, detrusor underactivity and voiding dysfunction in younger men.

The 2026 living guideline updates the ADA's 2017 statement on potentially malignant oral disorders and now conditionally recommends against vital staining adjuncts such as toluidine blue for deciding on biopsy or referral, warning they can prompt unnecessary procedures or delay diagnosis. Conventional visual and tactile examination plus scalpel or punch biopsy with histopathology is reaffirmed as the standard pathway.

The EAU panel describes the 2026 text as a limited update of the 2025 publication, with revised evidence summaries and recommendations for MRI in biopsy indication and strategy, for staging, and for active surveillance strategy, plus an adapted EAU risk-group table for localised and locally advanced disease.

This living-guideline version bump revisits the evidence base from a February 2026 literature search and issues updated recommendations covering the teclistamab plus daratumumab combination; the preceding 2026.1.0 release had itself replaced the 2019 guideline by adding first-ever guidance on smoldering myeloma and incorporating CAR T-cell, bispecific antibody and antibody-drug conjugate options.

The 2025 update to AACE's 2016 obesity guidance moved diagnosis away from BMI alone toward adiposity-based criteria and complication-driven staging, and reframed treatment success around metabolic health and complication resolution rather than weight loss percentage. It also added explicit hierarchies of preferred medications matched to each obesity-related complication, reflecting the arrival of highly effective incretin-based agents.

This ARIA revision rebuilds the intranasal treatment recommendations around eleven prioritised questions using the GRADE evidence-to-decision framework, drawing on mHealth and pharmacovigilance data and an expert cost survey alongside systematic reviews. It now suggests a fixed combination of intranasal antihistamine plus intranasal corticosteroid ahead of either agent alone, and intranasal corticosteroid ahead of intranasal antihistamine when a single agent is used.

The 2025 ASH panel retired the 2020 guideline's split between "intensive" and "non-intensive" therapy, framing recommendations instead around candidacy for antileukaemic therapy, and it now positions venetoclax-based combinations alongside conventional induction and post-remission therapy for older adults with newly diagnosed AML.

The AUA replaced its 2016 surgical stone guideline with a new edition released in November 2025, developed from a GRADE-based review of literature published between 2000 and 2025. It is issued as a three-part series spanning evaluation, treatment and future directions, and covers shock wave lithotripsy, ureteroscopy and both standard and mini percutaneous nephrolithotomy.

The 2026 GOLD report widens the 'exacerbator' label so a single moderate or severe exacerbation in the past year now counts (previously two or more were needed), reframes the ABE assessment around disease activity, stability and control, revises the exacerbation-severity classification, and positions high-flow nasal therapy as a first-line respiratory support option in exacerbations. A new chapter on emerging technology and artificial intelligence in COPD was also added.

The 2025 AASLD/IDSA guideline tackles six GRADE-based questions the 2018 guidance left unresolved, including whether to treat HBsAg-positive people in the immune-tolerant and indeterminate phases, when to withdraw antiviral therapy, and HCC surveillance in HBV coinfection and after HBsAg loss. Recommendations from 2018 that were not revisited remain in force, and an integrated algorithm combines old and new guidance.

The 2025 edition replaces the four separate 2020 Chains of Survival with a single unified six-link chain spanning adult, paediatric and in-hospital arrest, and adds first-time guidance for choking in responsive adults using alternating back blows and abdominal thrusts. It also advises against routine mechanical CPR devices, reserving them for situations where manual compressions are unsafe or impractical, and extends delayed cord clamping in newborns to at least 60 seconds.

The October 2025 antiviral update reframed treatment decisions around preventing hospitalisation rather than death, given higher population immunity. It keeps a strong recommendation for nirmatrelvir/ritonavir in adults at high risk of progression but now suggests against routine antiviral treatment in mild to moderate COVID-19 without risk factors.

Version 13.0 restructured the guidelines into two parts, added a new consolidated Substance Use section covering alcohol, opioid use and chemsex, and extensively rewrote the obesity guidance to cover pharmacotherapy and bariatric surgery. Recommended first-line ART regimens for treatment-naive adults were left unchanged from v12.1, and the lipodystrophy section was retired.

NCCN's published Insights article for this version bump describes the panel's discussion of newly incorporated data in three areas: CD3xCD20 bispecific antibodies and CD19-directed antibodies/antibody-drug conjugates in relapsed or refractory follicular lymphoma, BTK inhibitor-based regimens in TP53-mutated classical mantle cell lymphoma, and bispecific antibodies added to chemoimmunotherapy in relapsed or refractory DLBCL.

The September 2025 revision added a dedicated chapter on cardiovascular and metabolic complications as people with HIV approach normal life expectancy, and retired the standalone statin primary-prevention section in favour of the ACC/AHA multisociety dyslipidaemia guidance. It also revised laboratory monitoring intervals, added subsections on starting ART in early infection and in hospitalised patients, and expanded cost guidance around long-acting injectables.

The 6th edition refreshes the evidence-based chapter with a new set of clinical questions and GRADE-style answers, and substantially rewrites the 'what matters to patients' material using direct input from patient advisors in the EGS Patient Involvement Project, including eight practical communication tips for clinicians.

The AUA, CUA and SUFU amended their 2019 recurrent uncomplicated UTI guideline in September 2025, after the document had been reviewed and its validity confirmed in 2022. The amended version carries 20 recommendations, with revisions concentrated in the evaluation section, including how the diagnosis of recurrent UTI is established and the strength assigned to patient-initiated self-start treatment.

The 2025 guideline replaces the 2021 edition and moves mitral intervention earlier: repair surgery becomes a Class I option in selected asymptomatic primary mitral regurgitation, and transcatheter edge-to-edge repair is upgraded to Class I in symptomatic severe ventricular secondary regurgitation with reduced ejection fraction, with new recommendations added for atrial secondary regurgitation.

Updating the 2021 ESC/EACTS guideline, the 2025 version lowers the age cut-off favouring transcatheter aortic valve implantation in tricuspid aortic stenosis from 75 to 70 years, tightens the echocardiographic criteria for grading stenosis severity, and lowers thresholds for intervening earlier.

The EHA-EMN 2025 guideline replaced the 2021 EHA-ESMO guideline, adopting the R2-ISS staging system and adding minimal residual disease, circulating plasma cells and mass-spectrometry monoclonal protein as prognostic factors, alongside 14 novel EMA/FDA-approved regimens.

Replacing the 2013 CHEST guideline on stage I and II NSCLC, the 2025 version backs minimally invasive resection over open thoracotomy on the strength of a new meta-analysis showing better overall survival, and accepts sublobar resection as equivalent to lobectomy for peripheral tumours of 2 cm or less. It also recommends adjuvant chemotherapy after complete resection of stage II disease and adjuvant targeted therapy for resected stage IB tumours carrying EGFR exon 19 deletion or L858R mutations.

The 2025 ATS guideline reverses the 2019 position that every adult with CAP and a positive influenza test should receive antibiotics, now suggesting antibiotics be withheld in otherwise healthy patients with a positive viral test. It also accepts lung ultrasound as an alternative to chest radiography where the preferred imaging is unavailable and staff are trained, supports stopping empiric antibiotics at 48-72 hours in patients with low procalcitonin and early clinical stability, and splits the steroid advice by severity: against systemic corticosteroids in non-severe inpatient CAP, in favour of them in severe CAP.

2025 focused update of the 2019 ESC/EAS guideline, incorporating newer lipid-lowering trial evidence while retaining risk-based LDL-C goals.

First full US revision since 2017: adopts the PREVENT equations for risk estimation (replacing the Pooled Cohort Equations) and reaffirms a <130/80 mm Hg treatment goal.

Version 8 added two new antibiotic-stewardship recommendations drawn from a meta-analysis of antibiotic use in COVID-19: withhold empirical antibiotics in non-severe COVID-19 when bacterial co-infection is clinically unlikely (strong), and likewise suggest withholding them in severe COVID-19 with low suspicion of co-infection (conditional).

The 2025 ACG guideline moves away from the 2018 step-up model, suggesting against requiring failure of conventional therapy before starting advanced therapy and endorsing early treat-to-target management with therapy chosen by phenotype and prior exposure. It also recommends combination infliximab plus a thiopurine over either agent alone in biologic- and immunomodulator-naive patients.

This update revises the 2019 ACG ulcerative colitis guideline with five years of new trial evidence, expanding and repositioning advanced therapies for moderate-to-severe disease. Etrasimod, an S1P receptor modulator, is newly recommended for both induction and maintenance of remission.

This GRADE-based joint ESO/EANS document replaces the 2014 ESO ICH guideline, answering 37 PICO questions with evidence accumulated from a decade of randomised trials. It supports early intensive blood-pressure lowering mainly for reducing haematoma expansion rather than for proven functional benefit, weighs anticoagulation reversal explicitly against thromboembolic harm, treats minimally invasive evacuation alongside open craniotomy as options for supratentorial haemorrhage, and advises against anti-inflammatory drugs outside trials.

EASL's 2025 hepatitis B guideline shifts from indefinite viral suppression toward personalised, finite therapy with functional cure (sustained HBsAg loss) as the goal. Newer biomarkers including quantitative HBsAg, HBcrAg and HBV RNA are built into disease staging, treatment selection and decisions about safely stopping antivirals.

The 2025 ILAE position paper revises the 2017 operational seizure classification, keeping the four main classes but separating diagnostic classifiers from descriptors, expanding the scheme to 21 seizure types, classifying focal and unknown-onset seizures by whether consciousness is impaired or preserved, and adding negative myoclonus as a recognised generalised seizure type.

The 2025 edition supersedes the December 2022 update that introduced BPaLM, adding a recommendation for a new all-oral six-month regimen (bedaquiline, delamanid, linezolid, levofloxacin and clofazimine) for multidrug- or rifampicin-resistant TB including pre-XDR disease, plus modified nine-month regimens where fluoroquinolone resistance has been excluded. The changes rest on evidence from the BEAT-Tuberculosis and endTB trials.

This guideline replaces Chapter 4 of the 2021 KDIGO glomerular diseases guideline, with most changes affecting treatment. It tightened the definition of infrequently relapsing disease from fewer than four to fewer than three relapses in a 12-month period and aligned its clinical definitions with the International Pediatric Nephrology Association guideline.

The 2025 guideline consolidates the 2013 STEMI, 2014 NSTEMI and 2015 primary-PCI focused update into one document covering the whole ACS spectrum, and refreshes post-infarction antithrombotic and revascularisation guidance, including intracoronary imaging to guide PCI and revised anticoagulant choices.

The 2025 guideline merges the separate 2013 STEMI and 2014 NSTEMI documents (plus the 2015 primary-PCI focused update) into a single guideline spanning unstable angina, NSTE-ACS and STEMI. New positions include a recommendation to use intracoronary imaging to guide PCI, a weak (Class 2b) option for bivalirudin in NSTE-ACS to limit bleeding, and advice against fondaparinux as the sole anticoagulant during PCI.

The February 2025 partial update to the living EuroGuiDerm psoriasis guideline changed recommendations in the viral hepatitis chapter and rewrote the pregnancy and wish-for-child chapter around new data, adding pregnancy content to the main recommendations and decision grid. It also revised the laboratory monitoring advice for deucravacitinib.

NG246 consolidates CG189 and several other NICE obesity products into one guideline covering children as well as adults, and reframes overweight and obesity as chronic conditions needing continuing support rather than episodic weight-loss episodes. It drops the tiered weight-management service model in favour of a range of services, and adds recommendations on non-judgemental language and on the wider determinants of obesity.

The 2025 APA guideline replaces the 2017 edition, which rested on a single systematic review, and instead draws on 15 systematic reviews while weighing outcomes beyond PTSD symptom scores. It gives strong recommendations to cognitive processing therapy, prolonged exposure and trauma-focused CBT as first-line treatment for adults, with EMDR carried as a conditional recommendation.

ATLS 11 shifts the primary survey to an xABCDE sequence that puts control of exsanguinating haemorrhage ahead of the airway, and moves to balanced resuscitation with early 1:1:1 blood component therapy rather than crystalloid-led volume replacement. Glasgow Coma Scale assessment changes from the 10th edition's single total score to combined component and trend scoring, with new emphasis on recognising herniation and preventing secondary brain injury from the primary survey onward.

The 2025 ERC guidelines supersede the 2021 edition, folding CPR-quality and technology guidance into the individual chapters instead of treating it separately and strengthening the message to call emergency services for any unresponsive person before assessing breathing. Advanced life support adds emphasis on effective ventilation and correct pad placement, positions extracorporeal CPR as an option in specialist centres when conventional CPR fails, and addresses sedation for CPR-induced consciousness.

The 2024 diagnostics update to the European melanoma guideline lowered the threshold for whole-body staging: CT or PET-CT combined with brain MRI is now advised from stage IIB/C rather than from stage IIC as in the 2022 version. It also sets out when BRAF V600 mutation testing is indicated and endorses sequential digital dermoscopy, whole-body photography and reflectance confocal microscopy in selected high-risk patients.

The 2025 focused update adds four new recommendations to the 2023-2024 AAD atopic dermatitis guidelines, covering therapies approved after those documents were written: the topicals tapinarof and roflumilast and the biologics lebrikizumab and nemolizumab. Tapinarof 1% cream received a strong recommendation for adults.

The 2025 POAG PPP strengthens the endorsement of selective laser trabeculoplasty as an initial rather than merely adjunctive therapy, drawing on the LiGHT trial's six-year extension data, and newly incorporates evidence on sustained-release drug delivery and minimally invasive glaucoma surgery, macular and ganglion-cell-layer imaging, corneal hysteresis as a risk metric, and more intensive monitoring for rapid progressors.

The 2025 focused update leaves the 2019 LDL-cholesterol targets intact but changes how they are reached, pushing earlier and more aggressive combination therapy (high-intensity statin plus ezetimibe, including during the index acute coronary syndrome admission) and adding recommendations covering bempedoic acid, inclisiran and evinacumab. Risk stratification is refined with SCORE2/SCORE2-OP, lipoprotein(a) and coronary artery calcium scoring.

NG201 updated and replaced the 2008 antenatal care guideline CG62 when it was published in August 2021, and also superseded evidence summary ES20. Revisions since then have been maintenance changes rather than new clinical recommendations, the December 2024 one adding a cross-reference to NICE's guideline on end of life care for adults.

The first joint BTS/NICE/SIGN guideline replaced NICE NG80 and parts of BTS/SIGN 158, ending short-acting beta-agonist monotherapy: every patient with asthma should receive inhaled corticosteroid-containing treatment. For those aged 12 and over the preferred pathway is now anti-inflammatory reliever or MART with combination ICS-formoterol, and the diagnostic pathway was reworked around objective testing.

This revision of the 2014 EAACI food allergy management guideline (which also absorbs the 2018 food immunotherapy guideline) shifts the emphasis from avoidance and watchful waiting to active management, recommending oral, sublingual and epicutaneous immunotherapy for peanut allergy plus oral immunotherapy for egg and milk, and incorporating omalizumab following its US approval for IgE-mediated food allergy from age one. It adds a conditional recommendation for psychological support in patients with significant anxiety and a strong recommendation to keep eating tolerated foods to protect nutrition.

The 2024 ECCO therapeutics update adds strong recommendations for the newer agents risankizumab (maintenance) and upadacitinib (induction and maintenance) in moderate-to-severe Crohn's disease, broadening options beyond anti-TNF and older biologics. It also restructures the guidance into actionable practice points alongside the GRADE recommendations carried over from 2020.

The 2024 WHO update extended scope from severe influenza to non-severe disease and added recommendations on baloxavir marboxil, favipiravir and umifenovir. It advises against oseltamivir in non-severe influenza, conditionally supports early baloxavir only for non-severe patients at high risk of progression, and keeps oseltamivir as a conditional option for severe influenza.

Rising North American clarithromycin and levofloxacin resistance led ACG to drop those regimens as empiric first-line choices unless susceptibility testing supports them. Optimized 14-day bismuth quadruple therapy became the preferred empiric option, alongside newly endorsed rifabutin triple and vonoprazan-based dual or triple regimens.

Replacing the 2017 ESC peripheral arterial diseases guideline and merging it with aortic disease guidance, the 2024 document keeps single antiplatelet therapy as the Class I default in symptomatic peripheral artery disease but adds dual pathway inhibition with low-dose rivaroxaban plus aspirin for patients at high ischaemic and low bleeding risk, including after lower-limb revascularisation.

For the first time the ESC merges its 2014 aortic diseases and 2017 peripheral arterial diseases guidelines into a single document, treating the arterial system as a whole. It sets a Class I threshold of 55 mm maximum aortic diameter for surgery in both tricuspid and bicuspid aortic valve patients, with 50 mm for the bicuspid root phenotype, and pushes management towards experienced multidisciplinary aortic teams.

The 2024 edition explicitly replaces the 2016 U.S. MEC. It adds chronic kidney disease (including nephrotic syndrome and patients on haemodialysis or peritoneal dialysis) as a new condition and revises guidance for several others, among them postpartum and breastfeeding use, postabortion contraception distinguishing medication from procedural abortion, thrombophilia and venous thromboembolism on anticoagulation, sickle cell disease, lupus, and interactions with HIV antiretroviral therapy.

Reorganizes AF management around the patient-centred AF-CARE pathway, foregrounding comorbidity and risk-factor management.

Introduces a new 'Elevated BP' category (120–139/70–89 mm Hg) and a 120–129/70–79 mm Hg on-treatment target for most adults, with a Class I emphasis on out-of-office measurement.

This update of the 2016 EASL-EASD-EASO NAFLD guideline redefines the disease as MASLD, requiring hepatic steatosis plus at least one cardiometabolic risk factor and absence of harmful alcohol intake. It formalises non-invasive case-finding for fibrosis in people with type 2 diabetes, obesity or abnormal liver enzymes, and for the first time recommends considering resmetirom for non-cirrhotic MASH with stage 2 or greater fibrosis.

The 2024 multisociety guideline updates the 2016 AHA/ACC lower extremity peripheral artery disease guideline and reorganises care around four clinical presentations - asymptomatic disease, chronic symptomatic disease, chronic limb-threatening ischaemia and acute limb ischaemia. It adds recommendations on identifying PAD risk amplifiers and health disparities and on structured medical and lifestyle therapy within a team-based care plan.

The updated position statement drops the requirement that patients first fail conventional preventives before receiving CGRP-targeting drugs, placing the anti-CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) and the gepants rimegepant and atogepant alongside older agents as first-line migraine prevention.

The 2024 ACG guideline replaces the 2013 version's aggressive hydration advice with moderately aggressive fluid resuscitation and now specifies lactated Ringer's over normal saline. It also incorporates a decade of newer evidence on preventing post-ERCP pancreatitis, including periprocedural fluid loading.

The 2024 edition revised almost every statement carried over from the 2012 CKD guideline, keeping only a handful unchanged, and added SGLT2 inhibitors, GLP-1 receptor agonists and non-steroidal mineralocorticoid receptor antagonists as proven therapies to slow CKD progression. It also expanded to six chapters with refined GFR assessment and explicit risk-prediction guidance.

ESMO states this edition supersedes the 2019 early breast cancer guideline. It gives gene expression assays and endocrine response assessment a formal role in deciding whether adjuvant chemotherapy is needed when clinicopathological factors are equivocal, and it restricts baseline imaging for distant metastases to stage IIB or higher, high-recurrence-risk or symptomatic patients rather than routine staging.

The 2024 AAD guideline replaced the 2016 version with 18 graded recommendations plus five good practice statements, adding the newer topical agent clascoterone as a conditional option and giving strong support to benzoyl peroxide, topical retinoids, topical antibiotics and oral doxycycline. It pushed multimodal combination therapy and advised against topical antibiotic monotherapy for antibiotic stewardship reasons.

The update added a concrete glucocorticoid tapering target of about 5 mg prednisolone equivalent daily by four to five months, and incorporated avacopan as a steroid-sparing strategy in granulomatosis with polyangiitis and microscopic polyangiitis. Rituximab was recommended for remission maintenance in GPA/MPA, and mepolizumab was added for relapsing or refractory eosinophilic GPA.

This update adds a conditional recommendation for a four-month rifapentine-moxifloxacin regimen (two months of isoniazid, rifapentine, pyrazinamide and moxifloxacin followed by two months of isoniazid, rifapentine and moxifloxacin) in people aged 12 and over with drug-susceptible pulmonary TB, as an alternative to the six-month isoniazid/rifampin/pyrazinamide/ethambutol standard carried over from 2016. The shorter regimen also sidesteps the ocular toxicity risk of ethambutol, and the update extends to shorter regimens for drug-resistant disease.

The 2024 revision of the 2019 Diabetic Retinopathy PPP folds in the evidence accumulated since 2019 on intravitreal anti-VEGF therapy for centre-involving diabetic macular oedema and for reducing retinopathy severity in proliferative disease, adds a caution that rapid tightening of glycaemic control with newer agents such as semaglutide can precipitate early worsening of retinopathy, and reinforces topical povidone-iodine antisepsis before every intravitreal injection.

Superseding the 2015 practice parameter, the 2023 update revises the diagnostic criteria for anaphylaxis and defines distinct patterns of the reaction, elevates serum tryptase measurement as a route to diagnosis and to detecting underlying mast cell disorders, and flags age-specific presentations in infants and toddlers. It also softens the old caution on beta-blockers and ACE inhibitors, judging that for most indications stopping them carries more risk than continuing, and recommends considering bone marrow biopsy after severe insect-sting or recurrent idiopathic anaphylaxis in adults.

The 2024 update to the 2017 ATS guideline adds conditional recommendations in favour of corticosteroids, venovenous ECMO in selected severe ARDS, and neuromuscular blockade in early severe ARDS, all of which the 2017 document had left unresolved. It also now favours higher PEEP without recruitment manoeuvres in moderate-to-severe ARDS and recommends strongly against prolonged recruitment manoeuvres, which meta-analysis suggested increase mortality.

The October 2023 update revised two recommendations: clinicians are reminded that jaundice-related skin colour change is harder to detect in babies with darker skin, and routine urine culture was withdrawn so that it is now considered only where urinary tract infection is clinically suspected.

The acceptable maintenance prednisone ceiling was lowered from 7.5 mg/day to 5 mg/day, and the guidance now pushes earlier addition of immunosuppressants or a biologic for anyone not responding to hydroxychloroquine or unable to taper below that steroid dose. Anifrolumab was added alongside belimumab as an option, and combination regimens with belimumab or voclosporin were endorsed for lupus nephritis; the recommendations were condensed to 13.

The 2023 European BCC update was triggered by a new clinical classification and by therapies that postdated the 2019 guideline, notably electrochemotherapy and immunotherapy. It positions hedgehog pathway inhibitors as first-line systemic treatment for locally advanced and metastatic BCC and adds anti-PD-1 immunotherapy as a second-line option for patients who progress on, cannot tolerate, or have a contraindication to them.

The 2023 ESC edition upgraded antibiotic prophylaxis before invasive dental procedures in high-risk patients to a Class I recommendation, added a revised diagnostic algorithm built around multimodality imaging, and endorsed switching stabilised, uncomplicated patients to outpatient parenteral or oral antibiotic therapy. It also formalised management by a multidisciplinary Endocarditis Team based at heart valve centres.

Following STRONG-HF, the 2023 focused update adds a Class I recommendation that patients hospitalised for heart failure have evidence-based therapy rapidly up-titrated before discharge with close follow-up over the first six weeks, replacing the more permissive post-discharge approach of the 2021 guideline.

The 2023 focused update strengthens intravenous iron repletion with ferric carboxymaltose or ferric derisomaltose for iron-deficient patients with reduced or mildly reduced ejection fraction to reduce heart failure hospitalisation, and adds guidance on comorbidities such as chronic kidney disease and diabetes on top of the 2021 four-pillar therapy.

Acting on EMPEROR-Preserved and DELIVER, the 2023 focused update gives dapagliflozin or empagliflozin a Class I recommendation in preserved and mildly reduced ejection fraction to cut heart failure hospitalisation and cardiovascular death, a treatment the 2021 guideline could not recommend.

The 2023 ESC guideline supersedes the separate 2017 STEMI and 2020 NSTE-ACS documents and treats long-term management after hospital discharge as an integral part of ACS care, with updated antithrombotic and secondary-prevention guidance across the whole spectrum.

For the first time the ESC covers the entire ACS spectrum in a single document, replacing the separate 2017 STEMI and 2020 NSTE-ACS guidelines. It rebuilds guidance on initial diagnosis and risk stratification, antithrombotic therapy, and the timing of invasive assessment and revascularisation.

The 2023 edition extends the 2018 international guideline, most visibly by allowing serum anti-Mullerian hormone as an alternative to ultrasound for defining polycystic ovarian morphology in adults (using one test, not both, to limit overdiagnosis) and by raising the ultrasound follicle threshold. It also gives more weight to cardiovascular risk, sleep apnoea and psychological screening, and addresses newer weight-management drugs.

Replaces the 2014 guideline and 2019 focused update: introduces a four-stage AF classification, emphasizes early rhythm control, and positions catheter ablation as first-line in selected patients.

The 2023 amendment was the first update to the AUA/SUFU 2017 female stress urinary incontinence guideline, incorporating literature published through February 2022. Revisions were concentrated in the surgical treatment sections, while the patient evaluation and cystoscopy or urodynamics sections were left unchanged and patient counselling was only minimally revised.

The 2023 AASLD guidance adopts the new MASLD/MASH nomenclature agreed by multisociety Delphi consensus in place of NAFLD/NASH, and makes noninvasive tests such as FIB-4 and elastography the primary route for identifying moderate-to-advanced fibrosis rather than liver biopsy. It also expands the use of noninvasive markers for risk prediction and follow-up of treatment response.

The April 2023 update revised the recommendations on when clinicians should offer placental growth factor (PlGF)-based blood testing to help rule out pre-eclampsia, bringing the guideline into line with NICE's separate diagnostics guidance on PlGF testing. NG133 itself had earlier replaced the 2010 hypertension in pregnancy guideline CG107.

The sixth edition condenses the guideline into 39 recommendations grouped behind key decision points along the bleeding patient's timeline, citing only the highest-quality evidence rather than an exhaustive literature review as earlier editions did. Clinically it takes an explicitly neutral position on prehospital blood product transfusion, advises against routine point-of-care platelet function testing, and retains restrictive volume replacement targeting a systolic pressure of 80-90 mmHg until bleeding is controlled.

The fourth edition is the first revision since 2006 and condenses guidance into 16 graded recommendations covering anorexia nervosa, bulimia nervosa and binge-eating disorder. New elements include routine screening for eating disorders during initial psychiatric evaluation, individualised weight goals in anorexia, eating-disorder-focused psychotherapy as the core treatment, and family-based therapy for adolescents; avoidant/restrictive food intake disorder is discussed but left without recommendations for lack of trial data.

This focused update replaces the toxicology section of the 2010 AHA CPR and ECC Guidelines, expanding narrow antidote advice into poison-specific pathways covering beta-blockers, calcium channel blockers, cyanide, digoxin, local anaesthetics, opioids, organophosphates, sodium channel blockers and sympathomimetics. It newly positions venoarterial ECMO for refractory poisoning-induced shock or arrest and clarifies that specific antidotes are most valuable before arrest occurs, being largely unproven once the patient arrests.

The 2023 UKKA update revised the 2020 hyperkalaemia guideline after an MHRA safety review of calcium gluconate, changing the dose and infusion rate advice for intravenous calcium salts. It also widened the role of the newer potassium binders sodium zirconium cyclosilicate and patiromer to moderate as well as severe acute hyperkalaemia, dropped calcium resonium from acute treatment, and modified blood glucose monitoring after the insulin-glucose regimen.

The 2023 ESE S3 guideline replaces the society's 2006 quality guidelines for endodontic treatment with formally graded recommendations for apical periodontitis, covering diagnostic accuracy, root canal instrumentation, irrigation and intracanal medicaments, aseptic technique and structured re-evaluation during and after treatment.

The 2023 ESE S3 guideline supersedes the society's 2006 quality guidelines for endodontic treatment, replacing consensus-based standards with graded, evidence-based recommendations. It shifts pulpitis management toward vitality preservation, covering deep caries management with and without pulp exposure and setting out treatment pathways for vital versus non-vital teeth alongside instrumentation, irrigation and filling material choices.

The 2022 Council Recommendation widened the EU screening framework beyond the breast, cervical and colorectal cancers covered in 2003, adding lung, prostate and gastric cancer for feasibility assessment. It also extended the breast screening age band to roughly 45-74 and made HPV testing the preferred cervical screening method for women aged 30-65.

The 2022 guideline updates the 2010 thoracic aortic disease guideline and, for the first time, covers the thoracic and abdominal aorta in one document. In experienced multidisciplinary centres it lowers the repair threshold for sporadic root and ascending aneurysms to 5.0 cm in selected patients, and formalises body-size indexed measures such as aortic size index and aortic height index for smaller or taller patients.

Of the 15 recommendations, eight were carried over unchanged and three had wording changes, while the biologic/targeted-synthetic DMARD indication was revised to require an ASDAS of at least 2.1 after failure of two NSAIDs. Two entirely new recommendations were added: one on choosing drugs according to extra-musculoskeletal manifestations such as uveitis, inflammatory bowel disease and psoriasis, and one on re-checking the diagnosis and comorbidities when treatment fails.

The 2022 consensus report replaced the 2018 report and its 2019 update, raising weight management to equal standing with glycaemic control in the treatment algorithm and recommending SGLT2 inhibitors or GLP-1 receptor agonists for cardiorenal protection independent of HbA1c or metformin use. It also added explicit attention to social determinants of health, health system factors, sleep and physical activity.

The 2022 ELN revision reworked genetic risk stratification: the FLT3-ITD allelic ratio was dropped as a classifier and FLT3-ITD without NPM1 mutation moved out of the adverse group, in-frame bZIP CEBPA mutations were accepted as favourable whether mono- or biallelic, and myelodysplasia-related gene mutations were added as adverse regardless of any prior MDS history.

Maastricht VI keeps most Maastricht V diagnostic indications but adds explicit third- and fourth-line eradication strategies and high-dose PPI plus amoxicillin dual therapy, and pushes molecular testing for H. pylori and its antibiotic susceptibility. It also strengthens the case for eradication as gastric cancer prevention at any adult age.

The 2022 guidelines lower the haemodynamic definition of pulmonary hypertension from a mean pulmonary artery pressure of at least 25 mmHg to above 20 mmHg, and add a pulmonary vascular resistance threshold above 2 Wood units to define pre-capillary disease. Risk assessment moves from the 2015 three-strata model to a four-strata approach at follow-up, and PAH with venous/capillary involvement (PVOD/PCH) and persistent pulmonary hypertension of the newborn are folded into group 1.

Updating the 2015 ESC guideline, the 2022 version gives catheter ablation a larger role, including in patients without structural heart disease and in stable coronary disease with only mildly reduced ejection fraction, and moves risk stratification beyond ejection fraction alone by adopting disease-specific risk calculators for laminopathy and long QT syndrome alongside the existing hypertrophic cardiomyopathy score.

The 2022 statement explicitly replaces the 2016 USPSTF statin recommendation and, after re-reviewing the trial evidence, retained the same structure: a B grade for adults aged 40-75 with at least one risk factor and 10-year cardiovascular risk of 10% or more, a C grade at 7.5% to under 10%, and an I statement for adults 76 and older.

The 2022 AAP revision raised the bilirubin thresholds for both phototherapy and exchange transfusion in infants of 35 or more weeks' gestation, on evidence that the 2004 curves led to substantial overtreatment. Studies applying the new curves retrospectively found roughly half of infants treated under the old thresholds would no longer qualify, without more severe hyperbilirubinaemia.

Replacing the 2013 EFNS/MDS-ES recommendations, this first GRADE-based European guideline covers invasive therapy specifically: subthalamic deep brain stimulation is the best-supported option for advanced disease with fluctuations inadequately controlled on oral drugs and may also be offered when fluctuations appear early, but should not be used in early disease without fluctuations, while levodopa-carbidopa intestinal gel and apomorphine infusion are alternatives and MRI-guided focused ultrasound is restricted to registry use.

NG222 updates and replaces CG90, abandoning the 2009 stepped-care model in favour of a two-category split into less severe and more severe depression, with a menu of treatment options that patients choose from through shared decision-making rather than a fixed intensity ladder. It also newly covers further-line treatment, chronic depression, depression with coexisting personality disorder and psychotic depression, and adds guidance on reviewing and stopping antidepressants.

The 2022 EHF update promotes anti-CGRP monoclonal antibodies from the third-line position they held in 2019 (after failure of two other preventive classes) to a first-line option, and newly advises pausing treatment after 12-18 continuous months with restart as needed, citing head-to-head data favouring erenumab over topiramate.

The 2022 edition replaced the 2014 NOF Clinician's Guide and introduced a distinct 'very high fracture risk' category, for which osteoanabolic agents such as teriparatide, abaloparatide or romosozumab are recommended as initial therapy rather than being reserved for bisphosphonate failure. It also added explicit guidance on treatment sequencing and on following an anabolic course with an antiresorptive to preserve gains.

The 2022 revision of the 2015 ICH guideline downgraded several long-standing practices, stating that graduated compression stockings, prophylactic antiseizure drugs and steroids are of uncertain or no benefit, while adding new recommendations on regional systems of care with rapid transfer to neurocritical/neurosurgical centres, on anticoagulation reversal, on minimally invasive haematoma evacuation, and on using imaging and clinical markers to anticipate haematoma expansion.

The 2022 update revises the radiological and histopathological criteria for IPF by consensus and adds evidence-based recommendations on transbronchial lung cryobiopsy, genomic classifier testing, antacid medication and antireflux surgery. It also extends beyond IPF for the first time by defining and giving guidance on progressive pulmonary fibrosis in other interstitial lung diseases.

The 2022 guideline replaces the 2013 guideline and its 2017 focused update, adds SGLT2 inhibitors to standard therapy, and broadens the document with new sections on cardiac amyloidosis, cardio-oncology, comorbidity management and advanced (stage D) therapies.

Replacing the 2013 guideline and 2017 focused update, the 2022 document redefines the heart failure stages around 'at risk' and 'pre-heart failure', formalises the mildly reduced ejection fraction category, and for the first time gives SGLT2 inhibitors a positive recommendation in preserved and mildly reduced ejection fraction.

The 2022 guideline replaces the 2013 ACCF/AHA heart failure guideline and its 2017 focused update, and expands guideline-directed medical therapy for reduced ejection fraction to four drug classes by adding SGLT2 inhibitors alongside renin-angiotensin system inhibition or ARNI, beta blockers and mineralocorticoid receptor antagonists.

The 2022 update reassesses the 2013 guideline against 18 new systematic reviews and 27 randomised trials, keeps the bar against tube insertion for a single effusion episode lasting under three months, requires a hearing evaluation once effusion persists three months or before surgery, and adds a new strong recommendation that the surgeon or a designee re-examine the child's ears within three months of insertion and set expectations for periodic follow-up.

The task force reworked the 2014 EAACI anaphylaxis guideline using AGREE II and GRADE, and set out weight-banded adrenaline autoinjector prescribing: 0.15 mg for children from roughly 7.5 kg up to 25-30 kg and at least 0.3 mg above that, including for adolescents and adults at risk. It also asks manufacturers to publish device pharmacokinetic data and adds recommendations on structured patient training, simulation training for clinicians and aligning school policies with anaphylaxis guidance.

The 2021 revision keeps the six-week cut-off separating acute from chronic urticaria but compresses the treatment algorithm from four steps to three, with explicit guidance on updosing and treatment duration at each step. Second-generation H1-antihistamines remain first line, omalizumab is second line starting at 300 mg every four weeks with updosing or interval shortening for partial responders, and ciclosporin 3.5-5.0 mg/kg is reserved as third line for severe refractory disease.

The 2022 ESHRE guideline replaced the 2014 version and demoted diagnostic laparoscopy from a gold standard to an option reserved mainly for symptomatic patients with negative imaging. It also revised medical therapy, positioning GnRH antagonists as a second-line option for endometriosis-associated pain while dropping danazol and antiprogestins, and added new sections on adolescents, menopause and fertility preservation.

The 2022 ECCO therapeutics guideline drops methotrexate for maintenance after the MERIT-UC trial showed no benefit over placebo, and incorporates evidence for vedolizumab, ustekinumab and tofacitinib. Rigid treatment hierarchies were moved out of the recommendations into the supporting text so new agents can be slotted in.

The 2022 ACG guideline kept the 8-week empiric PPI trial but added a strong recommendation to dose PPIs 30-60 minutes before a meal and a conditional endorsement of on-demand or intermittent PPI therapy in non-erosive reflux disease. It also substantially rewrote guidance on extraesophageal symptoms, refractory GERD, and antireflux surgical and endoscopic options.

The second edition revised more than 80% of the previous recommendations and widened the covered population from age 65 and older down to 55 and older. It dropped the earlier reservation about the posterior surgical approach for femoral neck fracture, newly favours cemented femoral stems for displaced femoral neck fractures and cephalomedullary devices for unstable intertrochanteric fractures, backs tranexamic acid to cut blood loss, and extends interdisciplinary care from dementia patients to all hip fracture patients.

The 2021 document upgrades the 2011 ERS statement on non-CPAP therapies into a full GRADE-based clinical guideline, answering eight clinical questions on bariatric surgery, mandibular advancement devices, hypoglossal nerve stimulation, myofunctional therapy, maxillomandibular osteotomy, drug treatment and positional therapy. Hypoglossal nerve stimulation is newly covered as a therapy that entered practice after 2011, while isolated soft palate surgery was left out for lack of new evidence.

This update to the earlier (2003, 2008 and 2015) consensus documents moved late-night salivary cortisol to the front line for screening and recurrence detection, advised measuring dexamethasone levels alongside cortisol to cut false-positive suppression tests, and incorporated newly approved medical therapies such as osilodrostat and mifepristone into the treatment algorithm. It also set an expectation of lifelong monitoring for recurrence and persistent comorbidity after surgery.

NG209 consolidated eight separate NICE tobacco publications into one guideline covering prevention of uptake, quitting and treatment of dependence in everyone aged 12 and over, with reworked recommendations on harm reduction, smoking in pregnancy, school-based prevention and retailer compliance. The February 2025 revision added cytisinicline (cytisine) as a stop-smoking pharmacotherapy option.

This update of the AAN's 2002 practice parameter on initiating Parkinson treatment re-evaluates levodopa, dopamine agonists and MAO-B inhibitors as initial therapy, concluding that levodopa gives greater motor benefit than dopamine agonists and that although it carries a higher dyskinesia risk, severe or disabling dyskinesia is uncommon in the first five years of treatment.

The 2021 guideline covered complement-mediated glomerular disease for the first time and incorporated newer targeted and immunosuppressive agents unavailable in 2012. For lupus nephritis it cut the cumulative intravenous methylprednisolone dose and moved to a lower, more rapidly tapered oral prednisone start.

This revision of the 2011 BSG guideline moved oral iron replacement to a lower, once-daily (or alternate-day) dosing schedule rather than the older two-to-three-times-daily regimens, and reworked the diagnostic pathway for who needs bidirectional endoscopy and coeliac serology in confirmed iron deficiency anaemia.

The 2021 ESC prevention guideline replaced the SCORE fatal-event chart used since 2016 with SCORE2 and SCORE2-OP, which estimate combined fatal and non-fatal cardiovascular risk, are calibrated to four European risk regions and for the first time cover adults over 69. It also introduced age-specific risk thresholds and a stepwise, shared-decision approach to intensifying lipid, blood pressure and glucose treatment.

Superseding the 2013 ESC/EHRA pacing guideline, the 2021 version adds an entirely new section on conduction system pacing (His bundle and left bundle branch area pacing), expands and revises the CRT indications in line with the heart failure task force, and adds recommendations for preventing pacing-induced cardiomyopathy plus guidance on MRI, irradiation and remote monitoring.

The second CHEST update revises the 2016 VTE guideline with four new questions and eight substantially modified statements, and defines anticoagulation phases explicitly - an initiation phase of about 5 to 21 days followed by a treatment phase of roughly 12 weeks - to structure decisions on drug choice and duration.

This second update revises the 2016 CHEST VTE guideline, adding four previously unaddressed questions and substantially modifying eight earlier statements across 32 guidance statements. It also introduces explicit phase-of-anticoagulation nomenclature, separating an initiation phase of about 5 to 21 days from a treatment phase of roughly 12 weeks.

The 2021 CDC guidelines replaced dual therapy for uncomplicated gonorrhoea (ceftriaxone 250 mg plus azithromycin) with a single 500 mg intramuscular dose of ceftriaxone, reflecting declining cephalosporin susceptibility and stewardship concerns about azithromycin. Doxycycline for seven days became the preferred chlamydia regimen and is added only when chlamydial co-infection has not been excluded.

The 2021 guideline reversed the earlier acceptance of low-dose prednisone as bridging therapy, advising against it because patients frequently stay on steroids far longer than intended, and it reaffirmed methotrexate as the anchor drug while conditionally preferring hydroxychloroquine or sulfasalazine for low disease activity. It also added new topics absent from 2015, including methotrexate use in pulmonary disease and fatty liver disease, and treatment alongside nontuberculous mycobacterial lung infection.

Bulletin 228 replaced the 2008 leiomyoma bulletin No. 96 and brought in treatment options that did not exist in the earlier edition, notably oral GnRH antagonists such as elagolix with hormonal add-back for bleeding associated with fibroids, capped at about two years because of bone-loss risk, and laparoscopic radiofrequency ablation as a uterine-preserving option with counselling about limited reproductive-outcome data.

The 2021 secondary-prevention guideline reorganised recommendations around the specific cause of the index stroke or TIA, added a new requirement to complete the diagnostic work-up within 48 hours of symptom onset, endorsed percutaneous PFO closure in selected younger patients with non-lacunar stroke, and advised against angioplasty/stenting as first-line therapy for severe intracranial stenosis in favour of aggressive medical management plus short-term dual antiplatelet therapy.

The Task Force lowered the age to begin average-risk colorectal cancer screening from 50 to 45, citing rising incidence in younger adults, and graded screening at 45-49 as a B recommendation while screening at 50-75 stays grade A. The grade B rating still triggers insurance coverage requirements for the newly included age band.

The 2021 ACG guideline withdrew the 2012 suggestion that pre-endoscopic PPI may be considered, making no recommendation either way after meta-analysis showed no effect on rebleeding or mortality. It also widened the very-low-risk group eligible for discharge from the emergency department to a Glasgow-Blatchford score of 0-1 (previously 0) and specified twice-daily PPI for two weeks after endoscopic hemostasis in high-risk ulcers, while keeping the restrictive 7 g/dL transfusion threshold.

The 2021 ESGE update issues a strong recommendation against urgent endoscopy within 12 hours, since trial evidence showed no outcome advantage over early endoscopy performed within 24 hours of haemodynamic resuscitation. It also refreshes guidance on cap-mounted clips and topical haemostatic powders as salvage options when standard haemostasis fails.

The 2021 statement replaces the 2015 USPSTF recommendation and keeps the A grades for behavioural counselling and pharmacotherapy in non-pregnant adults and for behavioural interventions in pregnancy, but newly issues an I statement on electronic cigarettes as a cessation aid because the evidence on their effectiveness and harms was judged insufficient.

The 2021 WHO guidelines moved away from purely syndromic care: where quality-assured molecular assays are available, treatment should be directed by laboratory diagnosis, while resource-limited settings use a modified syndromic algorithm. Treatment recommendations across the five common STI syndromes were also rewritten to account for rising antimicrobial resistance, especially in Neisseria gonorrhoeae.

The 2021 update revised the 2018 focused update mainly on the strength of the KATHERINE trial, adding adjuvant ado-trastuzumab emtansine for HER2-positive patients left with residual invasive disease after neoadjuvant chemotherapy plus HER2-directed therapy instead of continuing trastuzumab. A 2024 rapid recommendation update subsequently folded in adjuvant CDK4/6 inhibitors for high-risk hormone receptor-positive disease.

Superseding the 2014 guideline and 2017 focused update, the 2020 guideline expands the role of transcatheter mitral repair and directs complex mitral surgery to comprehensive valve centres, while restructuring intervention thresholds around valve-related symptoms, ventricular consequences and life expectancy.

Replacing the 2014 guideline and its 2017 focused update, the 2020 document reframes the choice between surgical and transcatheter aortic valve replacement around patient age and life expectancy rather than surgical risk category, extends transcatheter replacement to selected bicuspid valve stenosis, and introduces primary and comprehensive valve centre requirements.

The December 2020 update added new recommendations on continuous glucose monitoring and flash glucose monitoring in pregnancy for women with type 1 diabetes, dropped glibenclamide because the drug had been discontinued, and added referral advice to the NHS Diabetes Prevention Programme after gestational diabetes.

Rather than rewriting EPR-3, the 2020 report issued GRADE-based updates in six priority areas: intermittent inhaled corticosteroids and single maintenance-and-reliever ICS-formoterol therapy, add-on long-acting muscarinic antagonists, fractional exhaled nitric oxide testing, indoor allergen reduction, subcutaneous and sublingual immunotherapy, and bronchial thermoplasty. FeNO is newly recommended as an adjunct when the asthma diagnosis or the choice of controller is uncertain in patients aged 5 and over.

The third edition replaces the 2004 guideline and reframes it around graded evidence-based statements, recommending clozapine for treatment-resistant schizophrenia and where suicide risk persists despite other treatment, and suggesting it where aggression persists. It also gives long-acting injectable antipsychotics a defined role for patients who prefer them or have poor or uncertain adherence, reflecting second-generation LAI formulations unavailable in 2004.

This edition supersedes the 2018 EASL recommendations and is declared the last of the series, reflecting how standardised DAA therapy has become. It endorses simplified treatment with pangenotypic sofosbuvir/velpatasvir or glecaprevir/pibrentasvir without genotyping in eligible patients, using non-invasive fibrosis assessment rather than biopsy before therapy.

Updating the 2008 rhinitis practice parameter, the 2020 version keeps intranasal corticosteroids as preferred monotherapy for persistent allergic rhinitis but now recognises added benefit from combining them with intranasal antihistamines in both allergic and non-allergic rhinitis. It also advises against food allergy testing in the routine rhinitis workup, highlights cough as a common symptom of both allergic and non-allergic rhinitis, and reviews the newer concept of local allergic rhinitis.

Bulletin 222 formally replaced Practice Bulletin No. 202 from December 2018. Its interim update carried focused corrections to the platelet-count thresholds and to the boxed diagnostic criteria for preeclampsia and for preeclampsia with severe features.

Treat-to-target dosing of urate-lowering therapy against serial serum urate measurements, targeting under 6 mg/dL, was upgraded to a strong recommendation on the strength of trials published since 2012. Allopurinol became the explicitly preferred first-line urate-lowering drug for everyone including patients with chronic kidney disease, partly on cost and febuxostat cardiovascular safety concerns, with HLA-B*5801 screening advised first in higher-risk ancestry groups.

The guideline abandoned the stepwise treatment pyramid of 2012 in favour of combining modalities throughout the disease course, and promoted self-efficacy programmes, tai chi, topical and oral NSAIDs and intra-articular steroids from conditional to strong recommendations. Balance exercise for knee and hip OA and duloxetine for knee OA were newly added, while transcutaneous electrical nerve stimulation is now strongly recommended against on evidence of no benefit.

The 2020 clinical report consolidates the two separate 2007 AAP reports on evaluation and on management into a single document and reframes practice around acting before a formal diagnosis, urging developmental surveillance at every well-child visit and autism-specific screening at 18 and 24 months with intervention started for identified delays without waiting for diagnostic confirmation. It also updates prevalence, genetic contributions, co-occurring medical and behavioural conditions, and the evidence base for interventions accumulated since 2007.

The 2020 focused update substantially revises 35 recommendations from the 2015 guideline and adds 13 new ones, reflecting newly approved buprenorphine formulations and a targeted evidence review. Among the additions is explicit guidance that all FDA-approved medications for opioid use disorder be available to people in criminal justice settings, with medication choice driven by the individual treatment plan.

The joint AAD-NPF series was the first rewrite of the 2008-2011 AAD psoriasis guidelines in over a decade, produced with the National Psoriasis Foundation. It devoted a dedicated section to biologic agents with updated timelines for judging treatment response, and broadened the scope to comorbidity screening, paediatric psoriasis, phototherapy, non-biologic systemics and topical therapy.

The 2020 AAP report replaced the 2006 algorithm with a single unified surveillance-and-screening framework covering developmental, behavioural, social-emotional, autism-specific, motor and psychosocial concerns rather than separate parallel pathways. It sets out a new clinical algorithm, a comparison table of validated screening instruments, and explicit linkage from a positive screen into ongoing care and early intervention referral.

This report updates the 2010 International Consensus Report, regrading evidence published 2009-2018 and incorporating the newer agents (notably thrombopoietin receptor agonists) into the adult, paediatric and pregnancy treatment pathways, alongside new sections on quality of life.

The 2019 ASH update replaced the 2011 guideline: corticosteroids (prednisone or dexamethasone) became the preferred first-line drug therapy in children over IVIg or anti-D, observation was favoured for children with no or mild bleeding, and thrombopoietin receptor agonists moved earlier in the second-line sequence ahead of rituximab and splenectomy.

The 2019 AAP guideline replaced the 2011 version with mostly incremental changes, the main substantive addition being a new key action statement requiring clinicians to screen for and manage coexisting emotional, behavioural, developmental and physical conditions in children evaluated for ADHD. Parent training in behaviour management remains first-line for preschoolers aged 4 to 6.

NG87 replaced CG72 with new recommendations spanning recognition, information and support, non-pharmacological management, medication choice, adherence, follow-up and planned discontinuation, and aligned diagnosis with the current DSM criteria. The September 2019 amendment clarified that a pre-treatment ECG is unnecessary before stimulants, atomoxetine or guanfacine when cardiovascular history and examination are normal.

The 2019 ESC/ERS update replaced the 2014 guideline, making direct oral anticoagulants the preferred agents for acute and long-term treatment of most pulmonary embolism patients, tightening the diagnostic algorithm around clinical probability and D-dimer (including a dedicated pathway for pregnancy), and adding structured follow-up for post-PE symptoms and chronic thromboembolic disease.

Updating the 2014 ESC guideline, the 2019 version makes direct oral anticoagulants the first-line treatment (Class I) except in severe renal impairment, pregnancy or antiphospholipid syndrome, supports early discharge and home treatment for carefully selected low-risk patients, and adds a structured 3 to 6 month follow-up pathway to detect post-PE dyspnoea and chronic thromboembolic pulmonary hypertension.

The 2019 WSES document upgrades the 2014 WSES position paper into full consensus guidelines agreed at the 2018 World Congress of Emergency Surgery, covering diagnosis, antibiotic use, intensive care, operative management and the open abdomen. It reinforces nonoperative management of sterile necrosis and reserves percutaneous, endoscopic or surgical intervention mainly for infected necrosis.

ASGE tightened its risk stratification for suspected choledocholithiasis: the high-probability group is now limited to ascending cholangitis, a stone seen on imaging, or bilirubin above 4 mg/dL together with a dilated bile duct, while acute pancreatitis and bilirubin of 1.8-4 mg/dL were dropped as predictors and the intermediate category was consolidated. The result is markedly higher specificity and fewer patients sent straight to diagnostic ERCP, with more directed first to EUS, MRCP or intraoperative cholangiography.

The 2019 CHEST update adds a weak recommendation for initial combination therapy with ambrisentan plus tadalafil in treatment-naive WHO functional class II-III patients to improve six-minute walk distance, and introduces consensus statements on integrating palliative care and supervised exercise training into PAH management. A visual treatment algorithm was added to make the 78 recommendations easier to apply at the bedside.

The 2019 ESCEO/IOF guidance updated the 2013 European guidance by replacing a two-tier risk split with a three-tier FRAX-based stratification into low, high and very high fracture risk, with decision algorithms that direct very-high-risk women toward more potent or parenteral therapy up front. It also set explicit calcium (800-1200 mg/day) and cholecalciferol (800-1000 IU/day) intake targets for women at increased fracture risk.

The 2019 AAP guideline updates the 2011 version for DSM-5 and adds a new key action statement requiring clinicians to screen for and address coexisting conditions, since most children with ADHD have at least one comorbidity and around 18 percent have three or more. Other recommendations were adjusted only incrementally, with specific guidance retained for preschool-aged children and adolescents across ages 4 to 18.

The 2019 AAD guideline replaced the 2011 version, realigning staging with the updated AJCC system and reworking how biopsy, pathology reporting and sentinel lymph node biopsy findings feed into management. It also revised the use of laboratory, molecular and imaging tests during initial work-up and follow-up of asymptomatic patients.

The 2019 update completely rewrote the 2006 KDOQI vascular access guideline around an individualised ESKD Life-Plan rather than a fistula-first default, and set revised targets for arteriovenous fistulas, grafts and central venous catheters after review of trials published since 2006.

The 2019 EAPD update moves away from the lower-concentration paste previously advised for the youngest children and now recommends twice-daily brushing with 1000 ppm fluoride toothpaste from eruption of the first tooth, dosed by age - a rice-grain amount up to age two and a pea-sized amount from two to six. It also stresses that parents supervise or perform brushing until at least age seven.

The 2018 IDSA update was the first revision since before the 2009 H1N1 pandemic. It moved diagnosis toward rapid molecular assays instead of antigen-based rapid tests, incorporated peramivir as a parenteral antiviral option, broadened the recognised risk factors for severe disease, and clarified that antiviral treatment is optional rather than automatic for low-risk outpatients presenting within two days of onset.

NG116 updates and replaces the 2005 CG26 guideline, adding new recommendations on access to care, transitions between services, care principles and information-giving, and support for people with complex needs such as coexisting conditions. It also sets age-specific rules absent from the earlier version, restricting EMDR in 7- to 17-year-olds to those who do not respond to or engage with trauma-focused CBT, and ruling out drug treatment for PTSD in under-18s.

Replacing the 2013 ACC/AHA cholesterol guideline, the 2018 version reintroduces LDL cholesterol thresholds to trigger treatment intensification - roughly 70 mg/dL in very high-risk secondary prevention - and endorses adding ezetimibe first and then a PCSK9 inhibitor to maximally tolerated statin. It also adds risk-enhancing factors and coronary artery calcium scoring to refine statin decisions in intermediate-risk primary prevention.

This is the first US guideline devoted specifically to bradycardia and conduction delay; it supersedes the pacemaker recommendations of the 2008 ACC/AHA/HRS device-based therapy guideline and its 2012 focused update, reorganising them around evaluation of the bradycardic patient rather than around device indications.

The update restructured the guidance into five overarching principles and ten recommendations and made topical NSAIDs the preferred topical agent and the pharmacological first choice ahead of oral drugs. It also took clearer negative positions than the 2007 version, discouraging conventional and biological DMARDs in hand osteoarthritis and advising against routine intra-articular glucocorticoid injection except in limited circumstances.

The 2018 statement added five-yearly high-risk HPV testing alone as an alternative to three-yearly cytology for women aged 30 to 65, which the 2012 statement had not endorsed as a stand-alone strategy. Advice against screening under 21, over 65 after adequate prior screening, and after hysterectomy was carried over unchanged.

This update of the 2004 AAN guideline on new-onset epilepsy re-graded the second- and third-generation antiseizure drugs, concluding that lamotrigine should be considered for reducing seizure frequency in adults with new-onset focal epilepsy, that levetiracetam and zonisamide may be considered, and that in patients aged 60 and over lamotrigine should and gabapentin may be considered.

The AAN retired its 2002 disease-modifying therapy guideline in April 2018 and replaced it with this document, which covers the far larger modern DMT armamentarium and, unlike its predecessor, gives explicit recommendations on starting therapy after a first demyelinating event with MRI lesions, on monitoring adherence and tolerability, on switching agents when breakthrough disease activity occurs, and on when discontinuation may be discussed.

Bulletin 190 replaced the 2013 gestational diabetes bulletin No. 137 and hardened ACOG's stance on drug therapy: insulin is named the preferred first-line agent when nutrition therapy fails, and glyburide is no longer endorsed as a first-choice alternative, a reversal of the earlier position that glyburide and insulin were broadly equivalent.

NG87 replaces CG72 and technology appraisal TA98, and changes adult pharmacotherapy by making lisdexamfetamine or methylphenidate the first-line choice and moving atomoxetine out of the second-line position it held in 2008. For children aged 5 and over methylphenidate remains first-line, with lisdexamfetamine, dexamfetamine and then atomoxetine as sequential alternatives after inadequate six-week trials, and new sections cover recognition, information and support, adherence, and medication review and discontinuation.

The 2017 guideline replaces the 2006 ACC/AHA/ESC ventricular arrhythmia guideline, and also supersedes the ICD indication sections of the 2008 device-based therapy guideline and updates the sudden-death prevention advice in the 2011 hypertrophic cardiomyopathy guideline, consolidating ventricular arrhythmia and sudden cardiac death management in one document.

NG69 updates and replaces the 2004 CG9 guideline on the back of a much larger evidence base, naming specific psychological therapies rather than the largely non-specific advice of 2004. For adults with anorexia nervosa it offers a choice of eating-disorder-focused CBT, MANTRA or specialist supportive clinical management, and CBT-ED becomes the recommended treatment for bulimia nervosa, binge-eating disorder and OSFED.

The 2017 guideline replaced the 2007 drug-first approach with non-pharmacological treatment as the first-line option for acute, subacute and chronic low back pain. Acetaminophen, endorsed in 2007, was dropped after a placebo-controlled trial showed no pain benefit, leaving NSAIDs as the first drug choice and tramadol or duloxetine as second-line for chronic pain.

The 2017 guideline merges and replaces the 2005 practice parameters on indications for polysomnography and the 2007 clinical guideline on unattended portable monitors, setting out when home sleep apnoea testing is acceptable versus when polysomnography is required. It restricts home testing to uncomplicated patients with clinical signs of increased risk of moderate-to-severe OSA, specifies minimum technical requirements for home testing devices, and adds guidance on repeat testing after a negative or inconclusive study.

A new ICO task force reworked the 2014 diabetic eye care guidelines around resource setting, tiering screening, referral and follow-up schedules separately for high-resource versus low- and intermediate-resource countries, and adding guidance on optical coherence tomography for diabetic macular oedema plus intravitreal anti-VEGF therapy plus corticosteroids in selected cases alongside laser photocoagulation.

The 2016 ATA guidelines replaced the 2011 ATA/AACE hyperthyroidism guidelines, giving third-generation TSH-receptor antibody testing a central role in establishing the cause of thyrotoxicosis and in deciding whether antithyroid drugs can be stopped or should be continued. They also revised antithyroid drug management in pregnancy and added preoperative assessment and repletion of calcium and vitamin D before thyroidectomy.

The update moved urate-lowering therapy much earlier, advising it be considered from the first presentation of gout rather than after repeated flares, and set explicit serum urate targets of under 6 mg/dL, or under 5 mg/dL in severe disease. It also brought in agents unavailable in 2006, naming febuxostat as an alternative when allopurinol fails to reach target, interleukin-1 blockade for frequent flares with contraindications to standard drugs, and pegloticase for refractory gout.

The 2016 revision dropped healthcare-associated pneumonia as a separate category, on the reasoning that recent healthcare contact is a poor predictor of multidrug-resistant organisms and that those patients belong in the community-acquired pneumonia pathway. It also moved to GRADE methodology, pushed institutions to use local antibiograms to narrow empiric MRSA and double gram-negative coverage, and favoured noninvasive sampling with semiquantitative cultures over invasive quantitative techniques.

The 2016 IDSA/SHEA guidelines replaced the broad 2007 blueprint for what a stewardship programme should look like with GRADE-rated recommendations for specific interventions, notably preauthorisation and/or prospective audit with feedback as core activities. They also added syndrome-specific strategies, antibiotic time-outs, allergy delabelling and use of rapid diagnostics and procalcitonin to shorten therapy.

The 2016 IDSA update revised the 2009 guideline by promoting echinocandins to preferred initial therapy for candidaemia in non-neutropenic patients, with fluconazole demoted to an alternative for selected, less critically ill patients because of azole resistance. Oropharyngeal candidiasis retained topical agents or oral fluconazole as first line, while echinocandins were positioned as intravenous options for oesophageal disease when oral therapy is not possible.

The 2015 AHA statement dropped adjunctive gentamicin from native-valve Staphylococcus aureus endocarditis regimens, since combination therapy added nephrotoxicity without clear benefit, leaving six weeks of single-agent anti-staphylococcal therapy. It also updated the epidemiology to reflect the rise of healthcare-associated and staphylococcal disease and reinforced early echocardiography plus at least three separately drawn blood culture sets.

The fifth edition kept most fourth-edition criteria but changed several postpartum and HIV-related recommendations: progestogen-only pills and implants in the first six weeks after birth moved from category 3 to category 2, the levonorgestrel IUD was cleared for insertion within 48 hours of delivery or from four weeks, and new guidance was added for women at high risk of HIV and for those on antiretroviral therapy using hormonal contraception.

The 2015 ATA guidelines revised the 2009 edition, introducing sonographic pattern-based risk categories that set size thresholds for fine-needle aspiration so that many nodules under 1 cm no longer warrant biopsy, and adding guidance on molecular marker testing for indeterminate cytology. Overall management shifted toward risk-adapted, less aggressive care to limit overdiagnosis and overtreatment.

CG185 updates every section of the 2006 CG38 guideline, and following a 2011 network meta-analysis narrows first-line treatment of acute mania to antipsychotics such as haloperidol, olanzapine, quetiapine or risperidone, demoting the wider range of options including valproate that CG38 had listed alongside them. It also bars valproate in girls and women of childbearing potential and keeps the prohibition on antidepressant monotherapy, requiring an antipsychotic if mania or hypomania emerges on an antidepressant.

The 2014 parameter substantially rewrites the 2006 version and folds in developments since the 2010 NIAID guidelines, adding entirely new material on delayed mammalian meat allergy caused by alpha-gal, component-resolved diagnostic testing, food additive and genetically modified food reactions, and recommendations aimed at preventing food allergy rather than only managing it.

CG178 updates and replaces CG82, broadening the scope from schizophrenia alone to psychosis generally, so that schizoaffective, schizophreniform and delusional disorder are covered. It restructures the recommendations so psychological intervention and antipsychotic medication are presented in parallel rather than sequentially, with CBT and family intervention offered to all patients alongside any drug treatment.

The 2014 IDSA update abandoned the 2005 layout of antibiotic lists organised by spectrum of activity in favour of short empiric regimens selected by infection type and severity, supported by an algorithm keyed to whether the infection is purulent. It was aligned with the IDSA MRSA guideline and added substantial new guidance on skin and soft tissue infections in immunocompromised patients.

The 2013 ADA recommendations update the 2006 recommendations on professionally applied topical fluoride and broaden the scope to prescription-strength home-use products. They endorse 2.26% fluoride varnish or 1.23% APF gel, or home-use 0.05% fluoride gel/paste or 0.09% fluoride rinse, for patients at elevated caries risk aged six and over, while for children under six only 2.26% varnish is recommended.

CG113 updates and replaces the 2004 CG22 anxiety guideline and tightens the position on benzodiazepines, which are no longer acceptable as an adjunct to antidepressant treatment for generalised anxiety disorder and are restricted to short-term use during a crisis. It sets out a stepped-care structure running from education and active monitoring through low-intensity self-help to high-intensity CBT or applied relaxation, with SSRIs as the first-choice drug treatment.