Articles related to Gastroenterology

New research into intermittent fasting has found that the practice is generally safe, producing few gastrointestinal, neurologic, hormonal, or metabolic effects. Additionally, the research found that intermittent fasting is on par with traditional calorie-restricted diets for weight loss.

The US Food and Drug Administration (FDA) has said “no” to Akebia Therapeutics’ drug application for vadadustat, a therapy to treat anemia due to chronic kidney disease. Vadadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor designed to mimic the physiologic effect of altitude on oxygen availability. The FDA cited safety concerns as the main reason for it rejecting the application.

New guidelines recommend that internists treat uncomplicated diverticulitis in an outpatient setting without the use of antibiotics. The new guidelines on diagnosis and management of patients with diverticulitis have been published by the Annals of Internal Medicine. And they are stirring up debate among physicians.

Sixty patients with EGFR-amplified gastroesophageal adenocarcinoma(GEA) received EGFRi, including 31 of 60 patients (52%) with concurrent chemotherapy. Across treatment lines, patients achieved a 43% objective response rate with a median PFS of 4.6 months. Typical OS with first-line initiation of non-EGFRi therapy in patients with EGFR-amplified GEA is 11.2 months, as determined by analysis of a deidentified clinicogenomic database. Despite this benefit, analysis of that database for January 2011 through December 2020 suggests that only 5% of patients with EGFR-amplified GEA received EGFRi.

A potentially practice-changing clinical trial for first line therapy is the first to show that the combination of two immunotherapy medications is an effective treatment for hepatocellular carcinoma (HCC). The HIMALAYA study evaluated combination immunotherapy (IO-IO), durvalumab with tremelimumab, as frontline therapy in patients with unresectable HCC. Overall survival was significantly improved with the IO-IO combination compared with sorafenib monotherapy (16.4 vs 13.8 months; hazard ratio [HR], 0.78; 96% CI, 0.65-0.92; P =.0035). Early results of the phase three LAUNCH trial are also promising. This trial compared the combination of lenvatinib with transarterial chemoembolization (TACE) to lenvatinib alone in an Asian population with advanced HCC. The lenvatinib-TACE group achieved a higher median overall survival (17.8 vs. 11.5 months and median progression-free survival (10.6 vs. 6.4 months). Muhammad Shaalan Beg, MD, director for GI Medical Oncology at UT Southwestern Medical Center in Dallas summarizes these and other takeaways from emerging research on advanced HCC presented at the recent ASCO GI Symposium.

A 56-year-old man has had right-upper-quadrant abdominal pain for several months but is otherwise healthy. He does not drink alcohol, has not been exposed to other hepatotoxins, and takes no medications. On physical examination, vital signs are normal. Abdominal examination reveals hepatosplenomegaly. The remainder of the physical exam is normal. What would you do?