Several articles ago, I mentioned “clinical pearls” as a tool used in medical education. Many such pearls are in the eye of the beholder and are pearls (of wisdom) only because someone somewhere thought they were and declared them “pearls.” On the legitimate, scientific side of thinking, however, are pearls that really are pearls; they are a conclusion, or a deduction, reached by scientific experimentation and study that actually make a difference in the recognition and treatment of the disease in question.
The first of these recent “pearls” has a huge impact on patients with colorectal cancer, and the effect of exercise on outcomes. A program of structured exercise initiated after adjuvant chemotherapy was associated with significantly longer disease-free survival and overall survival compared to those who don’t exercise. Many cancer patients incorrectly assumed they were not supposed to exercise, and because of that, lost muscle mass. The loss of muscle mass contributes to the general decline cancer patients experience. Patients with cancer are encouraged to do both aerobic exercise and resistance training. Exercise is safe and really helpful, and actually lessens treatment-related side effects, so doctors recommend exercise during treatment for patients who are still able to do so.
The second recent “pearl” is important to the treatment of GERD (acid reflux disease) and non-erosive reflux disease. Proton pump inhibitors, PPI’s, are the drugs of choice for GERD, but often end up being taken chronically because they relieve symptoms quickly and effectively. Patients with reflux symptoms should be treated with PPI’s for 8 weeks only. If symptoms recur, the patient should have an upper endoscopy, and if they have erosive esophagitis, should then have pH monitoring to assess if excess acid is causing the problem. If it is, the results determine the need for taking a PPI long term. If the PPI relieves the symptoms, the 8 week limit should be the standard of care. That prevents patients from being on PPI’s long term and thus avoiding long term PPI consequences. Some patients, though, do require chronic therapy.
Dr. G’s Opinion: There you have it; two recent clinical pearls! One: exercise is good for chemotherapy patients. Two: PPI’s for acid reflux should be limited to 8 weeks and if acid reflux symptoms recur, more evaluation is indicated. These are good examples of “pearls” for you to cite. Thousands more exist but now you have a better understanding of the meaning of “pearls.”
Reference: Watto MF, Willams PN. The Curbsiders’ 2025 Recap: Clinical Pearls That Changed our Practice Medscape 2026 January 6.
