diagnosis

Celiac disease is an autoimmune disease that can occur through the lifespan and is characterized by immune-mediated enteropathy in response to dietary gluten.1 Celiac disease affects at least 1% of the global population. Important risk factors are a first-degree relative with celiac disease, carrying specific genetic variants, presence of other autoimmune conditions (eg, type 1 diabetes, Hashimoto thyroiditis), and certain chromosomal disorders (eg, Down syndrome, Turner syndrome, Williams syndrome).

Typical gastrointestinal symptoms include diarrhea (38%), abdominal discomfort (34%), and weight loss from malabsorption (16%).2 Subjective improvement in symptoms with a gluten-free diet has a poor positive predictive value (PPV) for celiac disease (36%), making objective testing essential. Diagnostic guidelines (Table) recommend performing serologic testing in individuals with symptoms and/or signs suggestive of celiac disease while they are consuming a diet containing gluten, which is present in wheat, barley, and rye. Gluten reduction or removal from the diet impairs the diagnostic accuracy of screening.3-7 For patients already following a gluten-free diet, gluten consumption must be resumed prior to screening. However, there is no consensus for the dose or duration of gluten consumption that should be maintained through second confirmatory tests. Of the 2 most recent guidelines, one does not specify a dose or duration4 and one suggests at least 3 g per day for at least 6 weeks.3

Author/s:

MD, Marisa G. Stahl, MSCS, Claire Jansson-Knodel

Diagnosis and management of bronchiectasis

Megan George — Wed, 22 Apr 2026 20:03:10 +0000

Date Added:

April 22, 2026

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

June 19, 2017

URL:

Diagnosis and management of bronchiectasis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.160830

Keywords

MeSH

A concise review of the diagnosis and management of patients with bronchiectasis. James W. Mold, MD, MPH

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Bronchiectasis is a chronic, debilitating respiratory condition that affects people of all ages. It is most prevalent in women and those older than 60 years, and prevalence is increasing. Patients have daily excessive sputum and associated symptoms, recurrent chest infections and impaired health-related quality of life. In North America, management guidelines are lacking. This review discusses best evidence to guide the long-term management of non–cystic fibrosis bronchiectasis in adults, focusing on the two most common single-entity types of bronchiectasis in adults: idiopathic and postinfectious bronchiectasis (Box 1). Table 1 lists all the types of bronchiectasis by cause.

Author/s:

Maeve P. Smith

Acute Abdomen in the Modern Era

Erin Blanchette — Sun, 07 Jul 2024 21:40:31 +0000

Date Added:

July 7, 2024

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

July 3, 2024

Issue:

Volume:

391

Pages:

60-67

URL:

Acute Abdomen in the Modern Era

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMra2304821

Keywords

PMID (1):

38959482

MeSH

Abdomen

Acute

Diagnosis

diagnosis, differential

Appendicitis

emergencies

abdominal pain

A review of the current diagnosis and management recommendations for patients with an acute abdomen. Es W. Mold, MD, MPH

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Acute abdominal pain is one of the most common symptoms in patients presenting to the emergency department and accounts for 5 to 10% of all emergency department visits. Pathophysiological conditions that lead to surgical interventions in such patients are mainly gastrointestinal obstruction, hemorrhage, ischemia, and viscus perforation. Acute abdominal pain can be diffuse or localized (i.e., quadrant-based epigastric pain or pain in the right upper quadrant, left upper quadrant, right lower quadrant, or left lower quadrant)2,4,6 and is associated with but not limited to the following disease processes: perforated viscus, peptic ulcer disease, mesenteric ischemia, acute cholecystitis, appendicitis, diverticulitis, pancreatitis, and intraabdominal hemorrhage. The need for emergency general surgery is an independent risk factor for postoperative complications and death, indicating the severity of the condition. Therefore, timely diagnosis of acute abdominal emergencies is essential. From antiquity to modern times, medical students have been taught that the history and the physical examination are the central components in the evaluation of acute abdominal pain.

Author/s:

Selwyn O Rogers Jr, Orlando C Kirton

Diagnosis and management of polycystic ovarian syndrome

Erin Blanchette — Mon, 12 Feb 2024 16:38:09 +0000

Date Added:

February 12, 2024

Journal/Publication:

Canadian Medical Association Journal

Publisher:

Canadian Medical Association

Publication Date:

January 28, 2024

Issue:

Volume:

196

Pages:

E85-E94

URL:

Diagnosis and management of polycystic ovarian syndrome

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.231251

Keywords

diagnosis

diagnostic

polycystic ovarian syndrome

PCOS

menstruation

PMID (1):

38286488

MeSH

Polycystic Ovary Syndrome

A concise review of polycystic ovarian syndrome. James W. Mold, MD, MPH

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KEY POINTS

Polycystic ovarian syndrome (PCOS) is a chronic disorder associated with infertility; miscarriage; adverse pregnancy outcomes; and cardiovascular, metabolic, psychological and neoplastic risks.

DIagnosis of PCOS can be made based on the presence of any 2 of menstrual irregularities, clinical or biochemical hyperandrogenism or polycystic ovarian morphology on transvaginal ultrasonography.

Treatment of PCOS may target anovulation, androgen excess, hyperinsulinemia and weight management.

Patients with PCOS should have regular monitoring of their body mass index, blood pressure and metabolic parameters, and should be regularly screened for depression, anxiety and obstructive sleep apnea.

Author/s:

Ebernella Shirin Dason, Olexandra Koshkina, Crystal Chan, Mara Sobel

Diagnosis and management of patients with polyneuropathy

Aubrey Delammermore — Wed, 15 Feb 2023 06:00:00 +0000

Date Added:

February 15, 2023

Journal/Publication:

CMAJ

Publisher:

CMA Impact Inc

Publication Date:

February 13, 2023

Issue:

Volume:

195

Pages:

E227-E233

URL:

Diagnosis and management of patients with polyneuropathy

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.220936

Keywords

PMID (1):

36781195

MeSH

Polyneuropathies* / diagnosis

Polyneuropathies* / therapy

Humans

diabetic neuropathies

Neurologic Examination

A general review of polyneuropathy syndromes noting red flags and a diagnostic algorithm. James W. Mold, MD, MPH

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Polyneuropathy is a common neurologic condition with an overall prevalence in the general population of about 1%–3%, increasing to roughly 7% among people older than 65 years. Polyneuropathy has many causes, and can present in many different ways; thus, it requires a logical clinical approach for evaluation, diagnosis and management. We review the approach to evaluating a patient with polyneuropathy by highlighting important aspects of the history and neurologic examination. We focus on the role of diagnostic investigations for distal symmetric polyneuropathy (DSP), the most common subtype, and an approach to the symptomatic treatment of painful diabetic polyneuropathy (PDN). We draw on practice based guidelines, meta-analyses and systematic reviews, where
possible, as they represent the highest levels of evidence (Box 1).

Author/s:

Mirian, A., Aljohani, Z., Grushka, D., Florendo-Cumbermack, A.

Parkinson disease primer, part 1: diagnosis

Aubrey Delammermore — Sat, 28 Jan 2023 06:00:00 +0000

Date Added:

January 28, 2023

Journal/Publication:

Canadian Family Physician

Publisher:

College of Family Physicians of Canada

Publication Date:

January 1, 2023

Issue:

Volume:

Pages:

20-24

URL:

Parkinson disease primer, part 1: diagnosis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.690120

Keywords

PMID (1):

36693741

MeSH

Canada

Levodopa

Parkinson Disease* / diagnosis

Parkinsonian Disorders*

patients

A review of how to identify patients with Parkinson's Disease. James W. Mold, MPH

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Objective To provide family physicians an updated approach to the diagnosis of Parkinson disease (PD).

Sources of information Published guidelines on the diagnosis and management of PD were reviewed. Database searches were conducted to retrieve relevant research articles published between 2011 and 2021. Evidence levels ranged from I to III.

Main message Diagnosis of PD is predominantly clinical. Family physicians should evaluate patients for specific features of parkinsonism, then determine whether symptoms are attributable to PD. Levodopa trials can be used to help confirm the diagnosis and alleviate motor symptoms of PD. “Red flag” features and absence of response to levodopa may point to other causes of parkinsonism and prompt more urgent referral.

Conclusion Access to neurologists and specialized clinics varies, and Canadian family physicians can be important players in facilitating early and accurate diagnosis of PD. Applying an organized approach to diagnosis and considering motor and nonmotor symptoms can greatly benefit patients with PD. Part 2 in this series will review management of PD.

Parkinson disease (PD) is the fastest growing neurodegenerative condition, with prevalence predicted to double from more than 6 million globally in 2015 to more than 12 million by 2040.1 Recognizing parkinsonism and having knowledge of the presentation, diagnosis, and management of motor and nonmotor symptoms of PD are increasingly important, particularly as access to neurologists and specialized clinics is limited in many parts of Canada.2 Family physicians are well placed to identify symptoms, participate in diagnosis, and collaborate with specialty clinics in management of patients through the course of the disease.

Author/s:

Frank, C., Chiu, R., Lee, J.

A Review on Lumps, Bumps, and Birthmarks: When and Why to Refer

Aubrey Delammermore — Thu, 12 Jan 2023 06:00:00 +0000

Date Added:

January 12, 2023

Journal/Publication:

Pediatric Annals

Publisher:

SLACK

Publication Date:

January 1, 2023

Issue:

Volume:

Pages:

e23-e30

URL:

A Review on Lumps, Bumps, and Birthmarks: When and Why to Refer

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.3928/19382359-20221114-07

Keywords

PMID (1):

36625801

MeSH

diagnosis, differential

Skin Diseases* / therapy

Skin Diseases* / diagnosis

skin

child

A review of common childhood skin lesions and when to refer for subspecialty care. James W. Mold, MD, MPH

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Skin lesions of the face, trunk, and extremities are commonly seen in the pediatric population. Although most of these lesions are benign, they can be locally destructive or interfere with normal development. Recognition and diagnosis of these lesions allow for timely workup and referral; treatment, if needed; and facilitation of parental discussions. The purpose of this article is to review common pediatric skin and soft-tissue lesions-or "lumps, bumps, and birthmarks"-to assist with diagnosis, workup, and guidelines for referral to pediatric plastic surgery. [Pediatr Ann. 2023;52(1):e23-e30.].

Author/s:

Brown, K. W., Lucas, E., Hoppe, I. C., Humphries, L. S.

Diagnosis and Management of Hereditary Hemochromatosis

Aubrey Delammermore — Sat, 12 Nov 2022 06:00:00 +0000

Date Added:

November 12, 2022

Journal/Publication:

JAMA

Publisher:

Massachusetts Medical Society

Publication Date:

November 8, 2022

Issue:

Volume:

328

Pages:

1862-1863

URL:

Diagnosis and Management of Hereditary Hemochromatosis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2022.17727

Keywords

Hemochromatosis Protein

diagnosis

Hereditary hemochromatosis

management

diagnosis and management

PMID (1):

36346422

MeSH

liver

Hemochromatosis* / diagnosis

Hemochromatosis* / genetics

Hemochromatosis* / therapy

Hemochromatosis Protein

A updated summary of the pathophysiology, diagnosis, and treatment of hemochromatosis. James W. Mold, MD, MPH

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Hereditary hemochromatosis (HH) is a heterogeneous genetic disorder that results in unregulated and excessive intestinal iron absorption leading to overabundance of iron deposition in tissue. HH is most common in people of northern European ancestry, for whom the prevalence is 1 case per 300 people.1-3

Author/s:

Cabrera, E., Crespo, G., VanWagner, L.B.

A “no-biopsy” approach to diagnosing celiac disease

Aubrey Delammermore — Tue, 25 Oct 2022 05:00:00 +0000

Date Added:

October 25, 2022

Journal/Publication:

Journal of Family Practice

Publisher:

Frontline Medical Communications

Publication Date:

October 1, 2022

Issue:

Volume:

Pages:

359-361

URL:

A “no-biopsy” approach to diagnosing celiac disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.12788/jfp.0485

Keywords

celiac disease

Gastroenterology

diagnosis

Predictive Value of Tests

MeSH

World Health Organization

This antibody test is almost as good as a biopsy for diagnosing celiac disease. James W. Mold, MD, MPH

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PRACTICE CHANGER
CONSIDER A “NO-BIOPSY” APPROACH BY EVALUATING SERUM IMMUNOGLOBULIN (IG) A ANTI-TISSUE TRANSGLUTAMINASE (TTG-IGA) ANTIBODY TITERS IN ADULT PATIENTS WHO PRESENT WITH SYMPTOMS CONCERNING FOR CELIAC DISEASE (CD). AN INCREASE OF ≥ 10 TIMES THE UPPER LIMIT OF NORMAL (ULN) FOR TTG-IGA HAS A POSITIVE PREDICTIVE VALUE (PPV) OF ≥ 95% FOR DIAGNOSING CD WHEN COMPARED WITH ESOPHAGOGASTRODUODENOSCOPY (EGD) WITH DUODENAL BIOPSY—THE CURRENT GOLD STANDARD.

Author/s:

Mott, T., Gray, C., Storey, J.

Chronic anal pain: A review of causes, diagnosis, and treatment

Saige Blanchard — Tue, 14 Jun 2022 05:00:00 +0000

Date Added:

June 14, 2022

Journal/Publication:

Cleveland Clinic Journal of Medicine

Publisher:

Cleveland Clinic Journal of Medicine

Publication Date:

June 1, 2022

Issue:

Volume:

Pages:

336-343

URL:

Chronic anal pain: A review of causes, diagnosis, and treatment

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.3949/ccjm.89a.21102

Keywords

PMID (1):

35649568

MeSH

Levator syndrome

Pudendal Neuralgia

diagnostic tests, routine

Syndrome

pain

A nice review of the causes of chronic anal pain. James W. Mold, MD, MPH

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Chronic anal pain is diffi cult to diagnose and treat, especially with no obvious anorectal cause apparent on clinical examination. This review identifi es 3 main diagnostic
categories for chronic anal pain: local causes, functional
anorectal pain, and neuropathic pain syndromes. Conditions covered within these categories include proctalgia
fugax, levator ani syndrome, pudendal neuralgia, and coccygodynia. The signs, symptoms, relevant diagnostic tests,
and main treatments for each condition are reviewed.

Author/s:

Knowles, C. H., Cohen, R. C.

Diagnosis and Treatment of Pulmonary Arterial Hypertension: A Review

Saige Blanchard — Thu, 14 Apr 2022 05:00:00 +0000

Date Added:

April 14, 2022

Journal/Publication:

Journal of the American Medical Association

Publisher:

American Medical Association

Publication Date:

April 12, 2022

Issue:

327

Volume:

Pages:

1379-1391

URL:

Diagnosis and Treatment of Pulmonary Arterial Hypertension: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2022.4402

Keywords

Pulmonary Arterial Hypertension

diagnosis

treatment

PAH

PMID (1):

35412560

MeSH

Humans

infant, newborn

Hypertension, Pulmonary

treprostinil

Epoprostenol

A review of the management of patients with pulmonary hypertension. James W. Mold, MD, MPH

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Importance: Pulmonary arterial hypertension (PAH) is a subtype of pulmonary hypertension (PH), characterized by pulmonary arterial remodeling. The prevalence of PAH is approximately 10.6 cases per 1 million adults in the US. Untreated, PAH progresses to right heart failure and death.

Observations: Pulmonary hypertension is defined by a mean pulmonary artery pressure greater than 20 mm Hg and is classified into 5 clinical groups based on etiology, pathophysiology, and treatment. Pulmonary arterial hypertension is 1 of the 5 groups of PH and is hemodynamically defined by right heart catheterization demonstrating a mean pulmonary artery pressure greater than 20 mm Hg, a pulmonary artery wedge pressure of 15 mm Hg or lower, and a pulmonary vascular resistance of 3 Wood units or greater. Pulmonary arterial hypertension is further divided into subgroups based on underlying etiology, consisting of idiopathic PAH, heritable PAH, drug- and toxin-associated PAH, pulmonary veno-occlusive disease, PAH in long-term responders to calcium channel blockers, and persistent PH of the newborn, as well as PAH associated with other medical conditions including connective tissue disease, HIV, and congenital heart disease. Early presenting symptoms are nonspecific and typically consist of dyspnea on exertion and fatigue. Currently approved therapy for PAH consists of drugs that enhance the nitric oxide-cyclic guanosine monophosphate biological pathway (sildenafil, tadalafil, or riociguat), prostacyclin pathway agonists (epoprostenol or treprostinil), and endothelin pathway antagonists (bosentan and ambrisentan). With these PAH-specific therapies, 5-year survival has improved from 34% in 1991 to more than 60% in 2015. Current treatment consists of combination drug therapy that targets more than 1 biological pathway, such as the nitric oxide-cyclic guanosine monophosphate and endothelin pathways (eg, ambrisentan and tadalafil), and has shown demonstrable improvement in morbidity and mortality compared with the previous conventional single-pathway targeted monotherapy.

Conclusions and relevance: Pulmonary arterial hypertension affects an estimated 10.6 per 1 million adults in the US and, without treatment, typically progresses to right heart failure and death. First-line therapy with drug combinations that target multiple biological pathways are associated with improved survival.

Author/s:

Ruopp, N. F., Cockrill, B. A.

Diagnosis of Lyme Disease

Saige Blanchard — Thu, 10 Mar 2022 06:00:00 +0000

Date Added:

March 10, 2022

Journal/Publication:

Journal of the American Medical Association

Publisher:

American Medical Association

URL:

Diagnosis of Lyme Disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2022.0081

Keywords

MeSH

While there have been very few documented cases of Lyme disease in Oklahoma, diagnostic testing is often considered. This is a concise summary of the evidence regarding diagnostic tests for Lyme disease and how and when to use or not use them. James W. Mold, MD, MPH

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Lyme disease is the most common tick-borne illness in the US, occurring predominantly in the Northeast, the upper Midwest, and Northern California, with increasing incidence and geographic range.1 Lyme disease can cause a skin lesion at the site of the initial tick bite as well as disseminated disease, including neuropathy, meningitis, acute myocarditis/pericarditis (often with associated conduction abnormalities), and arthritis. Accurate diagnosis is the first step in the optimal management of Lyme disease.

Author/s:

Pitrak, D, Nguyen, C. T., Cifu, A. S.

Diagnosis and management of postural orthostatic tachycardia syndrome

Saige Blanchard — Thu, 10 Mar 2022 06:00:00 +0000

Date Added:

March 22, 2022

Journal/Publication:

Canadian Medical Association Journal

Publisher:

Canadian Medical Association

Publication Date:

March 14, 2022

Issue:

Volume:

194

Pages:

E378-E385

URL:

Diagnosis and management of postural orthostatic tachycardia syndrome

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.211373

Keywords

POTS

diagnosis

management

Postural Orthostatic Tachycardia Syndrome

PMID (1):

35288409

MeSH

female

Adult

quality of life

Postural Orthostatic Tachycardia Syndrome

Orthostatic Intolerance

A concise review of the diagnosis and management of Postural Orthostatic Tachycardia Syndrome (POTS). James W. Mold, MD, MPH

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Postural orthostatic tachycardia syndrome (POTS) is a chronic multisystem disorder; the cardinal feature is orthostatic tachycardia.

Patients with POTS have symptoms of orthostatic intolerance that improve with recumbence.

Girls and women are more commonly affected with POTS, beginning in puberty and through early adulthood.

Postural orthostatic tachycardia syndrome can lead to marked functional disability, often limiting work or schooling.

Treatments for POTS can improve symptoms and function, and can be initiated in primary care.

The main characteristic of postural orthostatic tachycardia syndrome (POTS) is tachycardia when standing, without a drop in blood pressure. Patients describe lightheadedness and palpitations when upright, particularly when standing, which sometimes leads to syncope. Patients may experience impaired quality of life and functional disability, which can be economically devastating.1–3 The syndrome is more common in girls and young women and has been associated with other disorders, like migraine and Ehlers–Danlos syndrome.4 We discuss the diagnosis of POTS, conditions to consider in the differential diagnosis, associated disorders and the pharmacologic and nonpharmacologic management of patients with POTS, based on original research, narrative reviews and consensus statements

Author/s:

Raj, S. R., Fedorowski, A., Sheldon, R. S.

Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of Physicians

Saige Blanchard — Wed, 19 Jan 2022 06:00:00 +0000

Date Added:

January 19, 2022

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

January 18, 2022

URL:

Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of Physicians

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M21-2710

Keywords

diagnosis

Clinical Guideline

American College of Physicians

Acute Left-Sided Colonic Diverticulitis

PMID (1):

35038273

MeSH

Adult

Diverticulitis, Colonic

abscess

drainage

tomography, x-ray computed

anti-bacterial agents

hospitalization

Abdominal CT is probably the test of choice when the diagnosis of acute left-sided diagnosis is in doubt and important. We still don’t know whether it is necessary to treat uncomplicated left-sided diverticulitis with antibiotics (probably not), and if so, which antibiotics to choose. James W. Mold, MD, MPH

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Description: The American College of Physicians (ACP) developed this guideline to provide clinical recommendations on the diagnosis and management of acute left-sided colonic diverticulitis in adults. This guideline is based on current best available evidence about benefits and harms, taken in the context of costs and patient values and preferences.

Methods: The ACP Clinical Guidelines Committee (CGC) developed this guideline based on a systematic review on the use of computed tomography (CT) for the diagnosis of acute left-sided colonic diverticulitis and on management via hospitalization, antibiotic use, and interventional percutaneous abscess drainage. The systematic review evaluated outcomes that the CGC rated as critical or important. This guideline was developed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology.

Target audience and patient population: The target audience is all clinicians, and the target patient population is adults with suspected or known acute left-sided colonic diverticulitis.

Author/s:

Qaseem, A., Etxeandia-Ikobaltzeta, I., Lin, J. S., Fitterman, N., Shamliyan, T., Wilt, T. J., Clinical Guidelines Committee of the American College of Physicians

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Essentials of Diagnosis and Management

Saige Blanchard — Mon, 03 Jan 2022 06:00:00 +0000

Date Added:

January 3, 2022

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Elsevier

Publication Date:

August 25, 2021

Issue:

Volume:

Pages:

2861-2878

URL:

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Essentials of Diagnosis and Management

Format:

Article

DOI (1):

10.1016/j.mayocp.2021.07.004

Keywords

Myalgic Encephalomyelitis

Chronic Fatigue Syndrome

diagnosis

management

PMID (1):

34454716

MeSH

Humans

fatigue syndrome, chronic

quality of life

COVID-19

National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division

RPR Commentary: A nice review of the diagnosis and management of patients with chronic fatigue syndrome. James W. Mold, MD, MPH

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Despite myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) affecting millions of people worldwide, many clinicians lack the knowledge to appropriately diagnose or manage ME/CFS. Unfortunately, clinical guidance has been scarce, obsolete, or potentially harmful. Consequently, up to 91% of patients in the United States remain undiagnosed, and those diagnosed often receive inappropriate treatment. These problems are of increasing importance because after acute COVID-19, a significant percentage of people remain ill for many months with an illness similar to ME/CFS. In 2015, the US National Academy of Medicine published new evidence-based clinical diagnostic criteria that have been adopted by the US Centers for Disease Control and Prevention. Furthermore, the United States and other governments as well as major health care organizations have recently withdrawn graded exercise and cognitive-behavioral therapy as the treatment of choice for patients with ME/CFS. Recently, 21 clinicians specializing in ME/CFS convened to discuss best clinical practices for adults affected by ME/CFS. This article summarizes their top recommendations for generalist and specialist health care providers based on recent scientific progress and decades of clinical experience. There are many steps that clinicians can take to improve the health, function, and quality of life of those with ME/CFS, including those in whom ME/CFS develops after COVID-19. Patients with a lingering illness that follows acute COVID-19 who do not fully meet criteria for ME/CFS may also benefit from these approaches.

Author/s:

Bateman, L., Bested, A., Bonilla, H., Chheda, B., Chu, L,, Curtin, J. M., Dempsey, T. T., Dimmock, M. E., Dowell, T. G., Felsenstein, D., Kaufman, D. L., Klimas, N. G., Komaroff, A. L., Lapp, C. W., Levine, S. M., Montoya, J. G., Natelson, B. H., Peterson, D. L., Podell, R. N., Rey, I. R., Ruhoy, I. S., Vera-Nunez, M. A., Yellman, B. P.