Diagnosis and Management of Hemochromatosis: 2011 Practice Guideline by the American Association for the Study of Liver Diseases

Bruce R Bacon,¹ Paul C Adams,² Kris V Kowdley,³ Lawrie W Powell,⁴ and Anthony S Tavill⁵

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This guideline has been approved by the American Association for the Study of Liver Diseases (AASLD) and represents the position of the association.

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Preamble

These recommendations provide a data-supported approach to establishing guidelines. They are based on the following: (1) a formal review and analysis of the recently published world literature on the topic; (2) the American College of Physicians Manual for Assessing Health Practices and Designing Practice Guidelines¹; (3) guideline policies including the AASLD Policy on the Development and Use of Practice Guidelines and the American Gastroenterological Association's Policy Statement on the Use of Medical Practice Guidelines²; and (4) the experience of the authors in regard to hemochromatosis.

To more fully characterize the available evidence supporting the recommendations, the AASLD Practice Guidelines Committee has adopted the classification used by the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) workgroup with minor modifications (Table 1).³ The strength of recommendations in the GRADE system are classified as strong (class 1) or weak (class 2). The quality of evidence supporting strong or weak recommendations is designated by one of three levels: high (level A), moderate (level B), or low-quality (level C).

Table 1

Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)

Intended for use by physicians, these recommendations suggest preferred approaches to the diagnostic, therapeutic, and preventive aspects of care. They are intended to be flexible in contrast to standards of care, which are inflexible policies to be followed in every case. Specific recommendations are based on relevant published information.³^,⁴