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for error. Despite our best efforts, some errors may Disclaimer Regarding Direct Purchases persist in print. Drug dosage schedules are, we believe, from Online Retailers accurate and in accordance with current standards. CME and/or MOC for MKSAP 19 is available only to custom- Readers are advised, however, to ensure that the recom- ers who purchase the program directly from ACP. ACP will mended dosages in MKSAP 19 concur with the informa- not set up MKSAP CME/MOC accounts for purchasers of tion provided in the product information material. This is MKSAP sold by unauthorized sellers (e.g., Amazon, eBay), especially important in cases of new, infrequently used, with whom ACP has no relationship. We do not honor third or highly toxic drugs. Application of the information in party sales. CME credits and MOC points cannot be awarded MKSAP 19 remains the professional responsibility of the to those purchasers who have purchased the program from practitioner. non-authorized sellers. The primary purpose of MKSAP 19 is educational. Information presented, as well as publications, technol- Unauthorized Use of This Book ogies, products, and/or services discussed, is intended Is Against the Law to inform subscribers about the knowledge, techniques, and experiences of the contributors. A diversity of pro- Unauthorized reproduction of this publication is unlawful. fessional opinion exists, and the views of the contributors ACP prohibits reproduction of this publication or any of its are their own and not those of the ACP. Inclusion of any parts in any form either for individual use or for distribution.

for error. Despite our best efforts, some errors may Disclaimer Regarding Direct Purchases persist in print. Drug dosage schedules are, we believe, from Online Retailers accurate and in accordance with current standards. CME and/or MOC for MKSAP 19 is available only to custom- Readers are advised, however, to ensure that the recom- ers who purchase the program directly from ACP. ACP will mended dosages in MKSAP 19 concur with the informa- not set up MKSAP CME/MOC accounts for purchasers of tion provided in the product information material. This is MKSAP sold by unauthorized sellers (e.g., Amazon, eBay), especially important in cases of new, infrequently used, with whom ACP has no relationship. We do not honor third or highly toxic drugs. Application of the information in party sales. CME credits and MOC points cannot be awarded MKSAP 19 remains the professional responsibility of the to those purchasers who have purchased the program from practitioner. non-authorized sellers. The primary purpose of MKSAP 19 is educational. Information presented, as well as publications, technol- Unauthorized Use of This Book ogies, products, and/or services discussed, is intended Is Against the Law to inform subscribers about the knowledge, techniques, and experiences of the contributors. A diversity of pro- Unauthorized reproduction of this publication is unlawful. fessional opinion exists, and the views of the contributors ACP prohibits reproduction of this publication or any of its are their own and not those of the ACP. Inclusion of any parts in any form either for individual use or for distribution. material in the program does not constitute endorsement ACP will consider granting an individual permission to or recommendation by the ACP. The ACP does not war- reproduce only limited portions of this publication for his or rant the safety, reliability, accuracy, completeness, or use- her own exclusive use. Send requests in writing to MKSAP* fulness of and disclaims any and all liability for damages Permissions, American College of Physicians, 190 N. and claims that may result from the use of information, Independence Mall West, Philadelphia, PA 19106-1572, or publications, technologies, products, and/or services dis- email your request to mksap_editors@acponline.org. cussed in this program. MKSAP 19 ISBN: 978-1-938245-75-6 Gastroenterology and Hepatology ISBN: 978-1-938245-78-7 Publisher's Information Printed in the United States of America. Copyright © 2021 American College of Physicians. All rights reserved. For order information in the U.S. or Canada call 800-ACP- 1915. All other countries call 215-351-2600 (Monday to This publication is protected by copyright. No part of this Friday, 9 aM - 5 pM ET). Fax inquiries to 215-351-2799 or publication may be reproduced, stored in a retrieval system, email to custserv@acponline.org. or transmitted in any form or by any means, electronic or mechanical, including photocopy, without the express consent of the ACP. MKSAP 19 is for individual use only. Errata and Revisions Only one account per subscription will be permitted for the Errata and Revisions for MKSAP 19 will be available purpose of earning CME credits and MOC points and for through MKSAP 19 Digital at mksap19.acponline.org as other authorized uses of MKSAP 19. new information becomes known to the editors.

material in the program does not constitute endorsement ACP will consider granting an individual permission to or recommendation by the ACP. The ACP does not war- reproduce only limited portions of this publication for his or rant the safety, reliability, accuracy, completeness, or use- her own exclusive use. Send requests in writing to MKSAP* fulness of and disclaims any and all liability for damages Permissions, American College of Physicians, 190 N. and claims that may result from the use of information, Independence Mall West, Philadelphia, PA 19106-1572, or publications, technologies, products, and/or services dis- email your request to mksap_editors@acponline.org. cussed in this program. MKSAP 19 ISBN: 978-1-938245-75-6 Gastroenterology and Hepatology ISBN: 978-1-938245-78-7 Publisher's Information Printed in the United States of America. Copyright © 2021 American College of Physicians. All rights reserved. For order information in the U.S. or Canada call 800-ACP- 1915. All other countries call 215-351-2600 (Monday to This publication is protected by copyright. No part of this Friday, 9 aM - 5 pM ET). Fax inquiries to 215-351-2799 or publication may be reproduced, stored in a retrieval system, email to custserv@acponline.org. or transmitted in any form or by any means, electronic or mechanical, including photocopy, without the express consent of the ACP. MKSAP 19 is for individual use only. Errata and Revisions Only one account per subscription will be permitted for the Errata and Revisions for MKSAP 19 will be available purpose of earning CME credits and MOC points and for through MKSAP 19 Digital at mksap19.acponline.org as other authorized uses of MKSAP 19. new information becomes known to the editors. vii