American Gastroenterological Association Institute Guidelines for the Diagnosis and Management of Acute Liver Failure.

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 Tlined elsewhere. Briefly, the American Gastroenterological Association Institute (AGA) process for developing clinical practice guidelines incorporates Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology and best practices as outlined by the Institute of Medicine. GRADE methodology was used to prepare the background information for the guideline and the technical review that accompanies it. Optimal understanding of this guideline will be enhanced by reading applicable portions of the technical review. The guideline panel and the authors of the technical review met face-toface on May 20, 2016, to discuss the quality of evidence (Table 1) and consider other factors relevant for the riskbenefit assessment of the recommendations. The guideline authors subsequently formulated the recommendations. Although quality of evidence was a key factor in determining the strength of each recommendation (Table 2), the panel also considered the balance between the benefit and harm of interventions, patients’ values and preferences, and resource utilization. Recommendation 1: In patients presenting with acute liver failure, the AGA suggests against routinely testing all patients for Wilson’s disease. Conditional recommendation; very low quality of evidence. Comments: In a setting of high clinical suspicion, testing for Wilson’s disease can be considered, keeping in mind the low positive predictive value. Although the management and