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Obesity Pharmacotherapy in 2026: How EASO's Complication-First Framework Changes the Way You Choose a Drug

Obesity Pharmacotherapy in 2026: How EASO's Complication-First Framework Changes the Way You Choose a Drug

Your patient has a BMI of 34, MASLD on ultrasound, and an HbA1c of 6.8%. You reach for a GLP-1 - but which one? For what endpoint? And what counts as treatment success? Until recently, the default answer was "the one that causes the most weight loss." The EASO 2026 framework formally dismantles that logic.

May 18, 2026•GastroAGI Team
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H. pylori Treatment in 2026: Choosing the Right First-Line Regimen When Clarithromycin Is No Longer the Default

H. pylori Treatment in 2026: Choosing the Right First-Line Regimen When Clarithromycin Is No Longer the Default

Your patient tests positive for H. pylori - straightforward PPI + clarithromycin + amoxicillin, right? Not anymore. Clarithromycin resistance has crossed 15–20% in most urban centres, and PPI triple therapy now fails in roughly one in four patients before you even factor in CYP2C19 metabolism. The 2026 ACG guideline has moved the goalposts on first-line treatment, and if you're still reaching for the old triple automatically, this post is for you.

May 13, 2026•GastroAGI Team
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DDW 2026 Highlights: Day-by-Day Conference Insights for Gastroenterologists

DDW 2026 Highlights: Day-by-Day Conference Insights for Gastroenterologists

You couldn't be everywhere at DDW 2026. Four days, hundreds of sessions, thousands of attendees across McCormick Place - and the signal-to-noise ratio was unforgiving. This post cuts straight to what mattered: the clinical themes that surfaced repeatedly, the practice-changing debates, and the takeaways that will follow you into clinic long after the Chicago wind fades. Day by day.

May 11, 2026•GastroAGI Team
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Daraxonrasib in Previously Treated RAS-Mutated Pancreatic Cancer: What the NEJM Phase 1/2 Data Actually Means

Daraxonrasib in Previously Treated RAS-Mutated Pancreatic Cancer: What the NEJM Phase 1/2 Data Actually Means

A 61-year-old woman with metastatic pancreatic ductal adenocarcinoma has progressed through FOLFIRINOX. Her KRAS mutation is G12D - not G12C, which means sotorasib and adagrasib are off the table. Until recently, your only option was nanoliposomal irinotecan plus 5-FU or enrollment in a clinical trial, with an expected median overall survival of five to seven months. The Phase 1/2 daraxonrasib trial published in the New England Journal of Medicine in May 2026 changes the calculus.The second-line treatment landscape for pancreatic ductal adenocarcinoma (PDAC) has been defined by futility for decades. Fewer than 10% of patients respond to second-line chemotherapy, and median survival after progression on first-line therapy sits at five to seven months. KRAS inhibitors disrupted this ceiling in lung cancer, but pancreatic cancer posed a harder problem - the mutations are different, they're more heterogeneous, and KRAS drives PDAC in its active, GTP-bound "on" state rather than the inactive state targeted by earlier inhibitors. Daraxonrasib is the first RAS(ON) multi-selective inhibitor to enter clinical trials for PDAC, and the results out of this first-in-human trial represent the most credible survival signal this disease has seen in a very long time.

May 8, 2026•GastroAGI Team
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(2026) Selective Decontamination of the Digestive Tract in Mechanically Ventilated Adults: What the Updated Bayesian Meta-Analysis Actually Tells You

(2026) Selective Decontamination of the Digestive Tract in Mechanically Ventilated Adults: What the Updated Bayesian Meta-Analysis Actually Tells You

A patient on day 3 of mechanical ventilation develops a fever, worsening oxygenation, and a tracheal aspirate growing Klebsiella pneumoniae. You prevented the last three VAPs on your unit with SDD. Your colleague stopped it last year citing antimicrobial resistance concerns. Both of you are reading the same literature - and reaching opposite conclusions. This post resolves that tension with the updated Bayesian evidence.

May 6, 2026•GastroAGI Team
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Hepatic Encephalopathy: West Haven Grading, Identifying the Precipitant, and Step-by-Step Management

Hepatic Encephalopathy: West Haven Grading, Identifying the Precipitant, and Step-by-Step Management

A 58-year-old man with known Child-Pugh B cirrhosis is brought in by his family - he has been sleeping through the day, missing meals, and said something bizarre at dinner last night. His ammonia is elevated, but so is everyone's with decompensated cirrhosis. The real question is not whether this is hepatic encephalopathy - it almost certainly is. The question is what triggered it, what grade it is, and what you do in what order. This post gives you a structured answer to all three.Hepatic encephalopathy management trips up even experienced clinicians not because the individual steps are difficult, but because the decisions happen in parallel - you are grading, hunting for precipitants, and initiating treatment simultaneously, often in a busy ward or emergency bay. The West Haven Criteria give you the language. The precipitant hunt gives you the lever. The management algorithm gives you the sequence. Miss any one of these, and you are treating a symptom rather than the episode. What makes this harder still is that ammonia levels correlate poorly with grade - a patient can have grade III HE with a modestly elevated ammonia, and a compensated cirrhotic can have a markedly elevated ammonia with minimal clinical findings. The clinical examination, not the lab value, grades the encephalopathy.

May 4, 2026•GastroAGI Team
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Aspirin After Colon Cancer Surgery: Who Actually Benefits in 2026?

Aspirin After Colon Cancer Surgery: Who Actually Benefits in 2026?

Your patient has just completed resection for stage III colon cancer. Chemotherapy is finished. The oncology team has signed off. And someone in the room asks: "Should we start aspirin?" It's a deceptively simple question with a nuanced, mutation-specific answer - and getting it wrong in either direction has real consequences. This post walks through exactly what the evidence says and the molecular subgroup where aspirin's postoperative benefit is now difficult to ignore.The challenge with aspirin in colorectal cancer is not a lack of data - it's a lack of precision. Decades of observational studies show population-level benefits. But routine use in all CRC patients post-surgery isn't supported, and for good reason: the benefit is not evenly distributed. What has crystallised from recent prospective data is that aspirin after colon cancer surgery in patients with PI3K/PTEN pathway mutations represents a pharmacologically coherent, increasingly evidence-backed adjuvant strategy. Approximately 37% of all CRC patients carry these alterations. That is not a niche subgroup. Understanding the mechanism - and the trials - is now part of the informed gastroenterologist's toolkit.

May 2, 2026•GastroAGI Team
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H. Pylori Treatment in 2026: Choosing the Right Regimen Based on Local Resistance Patterns

H. Pylori Treatment in 2026: Choosing the Right Regimen Based on Local Resistance Patterns

Your patient finishes a 14-day course of PPI-clarithromycin-amoxicillin. Breath test at 4 weeks: still positive. You prescribe again - bismuth quad this time - and they eradicate. That sequence was backwards. In India in 2026, empiric clarithromycin triple therapy should not be your opening move.The core problem governing H. pylori treatment guidelines in 2026 in India is not a lack of options - it is a mismatch between the regimen prescribed and the antibiotic resistance landscape the organism actually lives in. Clarithromycin triple therapy has underpinned first-line eradication for decades, yet the data are unambiguous: national resistance to clarithromycin in India now sits at 35.64% overall, with the picture substantially worse in South India, Gujarat, and Kashmir. A ten-year trend analysis across South Asian countries confirms clarithromycin resistance has climbed from 21% in 2003 to 30% by 2022 - and continues to rise. Prescribing clarithromycin empirically when local resistance exceeds 15–20% is what drives the treatment failures filling your endoscopy list.Yet no pan-India susceptibility atlas exists. Most Indian gastroenterologists are making regimen decisions blind to local culture data, relying on clinical intuition or outdated textbook algorithms. The decision framework below cuts through that ambiguity.

April 29, 2026•GastroAGI Team
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APASL 2026 Istanbul: Key Clinical Takeaways Every Hepatologist Needs to Know

APASL 2026 Istanbul: Key Clinical Takeaways Every Hepatologist Needs to Know

You walked out of Istanbul having sat through four days of world-class hepatology - or you didn't attend and you're now trying to piece together what shifted. Either way, APASL 2026 was not a conference of small refinements. Across 60-plus topics, several fault lines in clinical hepatology were exposed, debated, and - in some cases - resolved. This post gives you the high-yield clinical signal without the noise.The 35th Annual Meeting of the Asian Pacific Association for the Study of the Liver (APASL 2026) ran April 22–25, 2026 at the Istanbul Lütfi Kırdar International Convention and Exhibition Centre. The scientific program was dense - spanning viral hepatitis, metabolic liver disease, liver transplantation, portal hypertension, endohepatology, and the rapidly expanding territory of AI in hepatology. The challenge after any major conference is not finding information - it's filtering it. What follows are the APASL 2026 hepatology conference highlights that carry the most direct relevance to clinical decision-making.

April 28, 2026•GastroAGI Team
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Rome V in 2026: What Changed in the Diagnosis and Management of Disorders of Gut–Brain Interaction

Rome V in 2026: What Changed in the Diagnosis and Management of Disorders of Gut–Brain Interaction

A 34-year-old woman presents to your clinic with recurring epigastric fullness after meals, loose stools three to four times a week, and intermittent cramping that partially resolves with defecation. She meets Rome IV criteria for both functional dyspepsia - postprandial distress subtype - and IBS with predominant diarrhea. Prior workup is unremarkable. She's been dismissed twice with "irritable bowel" and sent home without a clear plan. Rome V, published in May 2026, gives you the language, the framework, and the therapeutic roadmap to do better.The release of Rome V represents the most substantive revision to the disorders of gut–brain interaction (DGBI) classification since Rome III introduced postprandial distress syndrome and epigastric pain syndrome as distinct entities. The update spans a decade of evidence - from the microbiome-gut-brain axis to pharmacogenomics to cross-cultural epidemiology - and restructures both nomenclature and diagnostic thresholds to close the gap between what the research criteria define and what clinicians actually encounter. For gastroenterologists managing patients daily, this is not an academic update. It changes how you diagnose, how you explain, and increasingly, how you treat.

April 27, 2026•GastroAGI Team
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