The global burden of inflammatory bowel diseases (IBD) continues to rise, placing increasing demands on primary care and specialty practices alike. Beyond disease control, patients with IBD face heightened risks related to chronic inflammation and long-term immunosuppressive therapy, including infection, cancer, bone loss, nutritional deficiencies, and mental health disorders. Proactive, structured health care maintenance encompassing vaccination, cancer screening, bone and cardiometabolic health, nutrition, and psychosocial well-being is essential to optimize long-term outcomes. Effective delivery of this care depends on close collaboration and clearly defined shared responsibilities between gastroenterologists and primary care physicians. This review outlines evidence-based strategies for health care maintenance in the outpatient management of adults with IBD.

Obstructive sleep apnea (OSA) is a common but frequently undiagnosed condition. Symptoms include loud snoring, nocturnal awakening, and daytime sleepiness. Treating OSA can meaningfully improve symptoms and achieve modest reductions in blood pressure. Although OSA care has traditionally been limited to sleep specialists, technologies are available that allow primary care clinicians to diagnose OSA and initiate treatment. Treatments include positional therapy, weight management, application of external positive airway pressure, mandibular advancement devices, and surgical interventions. Inpatient identification and management of OSA is also feasible and is an evolving area of research and practice.

Interhospital transfers are essential to ensure access to appropriate levels of care, yet many transfers are potentially avoidable, leading to unnecessary resource use and patient burden.

A comprehensive overview of the cost-effectiveness of pharmacologic treatments for overweight or obesity is lacking.

Overweight and obesity are closely linked to diseases such as type 2 diabetes, coronary heart disease, and stroke and have been shown to increase mortality risk.

Updated U.S. and international hypertension guidelines reflect new studies and analyses that support changes in hypertension management. The 2025 U.S. guideline for prevention, detection, evaluation, and management of high blood pressure (BP) recommends lower BP targets, greater use of out-of-office BP for diagnosis and medication titration, and a different approach to severe hypertension presenting without acute or evolving cardiovascular disease symptoms or signs. New treatments for resistant hypertension are recommended. Trial evidence supports benefit from tighter BP control to prevent mild cognitive impairment and dementia, further emphasizing the importance of lower BP goals.

The growing involvement of private equity in the health care sector raises important questions about its effect on cost, quality, access, and the physician workforce. Private equity investment in health care is associated with increased costs and, in some settings, adverse effects on care delivery and outcomes. Rising costs, administrative burdens, workforce shortages, and declining reimbursement have made independent practice increasingly difficult, contributing to physician transitions to corporate ownership models. Physicians employed by private equity-owned health care organizations may also experience challenges due to the evolving dynamics of their work environment. State and federal regulators, as well as lawmakers, should consider implementing policy interventions to address these challenges. Although corporate investment may improve efficiency and, in limited instances, care delivery, private equity in this sector raises important questions about its role and effects. This American College of Physicians (ACP) position paper builds on the previous ACP position paper on financial profit in medicine, which explored the growing influence of corporate interests and private equity investment in the health care industry. This paper examines the effect of private equity investment on clinical autonomy, health care costs, quality, access, equity, and innovation. It emphasizes the need for more vigorous enforcement of regulatory measures and policy solutions to preserve the quality of patient care and protect the physician workforce. It also offers recommendations to strengthen oversight, transparency, and accountability related to private equity's effects on clinical autonomy, care delivery, and organizational decision making. Finally, it discusses the potential opportunities and challenges associated with private equity investment in health care, including increased consolidation and corporatization.

Giant cell arteritis is a relapsing large-vessel vasculitis affecting the aorta and its branches. It is the most common vasculitis in persons 50 years of age and older. Vision loss occurs in 18% of patients and is preventable with prompt recognition, evaluation, and treatment. Large-artery complications include stenosis, aortic aneurysms, or dissections. Glucocorticoid therapy is effective, but nearly 50% of patients experience relapse. Tocilizumab and upadacitinib are efficacious glucocorticoid-sparing therapies. Patients require long-term monitoring for aortic aneurysms, a late disease complication, even after therapy is discontinued.

In response to the COVID-19 pandemic, federal policymakers temporarily lifted long-standing restrictions on telemedicine, resulting in an unprecedented and rapid expansion of virtual care across video, audio, and asynchronous modalities. When integrated into longitudinal care relationships, telemedicine can increase access, reduce patient burden, and support continuity for people facing geographic, mobility, or socioeconomic barriers. However, telemedicine also introduces new clinical, regulatory, equity, and safety challenges that require deliberate policy design. Beyond its clinical considerations, telehealth offers environmental and logistical benefits, including reduced travel time and cost, decreased fuel consumption, lower transportation expenses, and lower greenhouse gas emissions. In this position paper, the American College of Physicians updates its previous policy paper on telemedicine to reflect changes in payment policy, licensure, prescribing authority, and utilization patterns that have occurred over the past decade and accelerated during the COVID-19 public health emergency. This paper focuses on access, payment policy, licensure, prescribing practices, equity, and patient safety across federal and state programs and private payers and emphasizes the conditions under which telemedicine should be integrated into clinical practice. Key developments addressed include the expansion and partial lapse of Medicare telemedicine waivers, evolving U.S. Drug Enforcement Administration rules governing prescribing, increased reliance on interstate practice, and normalization of telemedicine by private payers.

Migraine headaches are considered chronic when they occur on 15 or more days per month. Newer medications are available for prevention.

Migraine is a chronic condition that affects about 15% of the population in the United States and is characterized by recurrent, debilitating headache that lasts somewhere between 4 and 72 hours. Only 1 performance measure for migraine is currently in use in pay-for-performance programs. Although the American College of Physicians (ACP) broadly supports the role of performance measurement in performance improvement, this support is based on the principle that only measures that are evidence-based and meet high standards of methodological soundness are appropriate given their potential impact on patient care. ACP's Performance Measurement Committee reviews performance measures using a rigorous process to recognize high-quality performance measures, address gaps and areas for improvement in performance measures, and help reduce reporting burden. This article presents a review of 1 performance measure that includes migraine and considers a potential core performance measure using ACP's process to inform physicians, payers, and policymakers.

The purpose of this updated guidance statement is to guide internal medicine physicians and other clinicians on screening for breast cancer in asymptomatic, average-risk adult females.

Incretin-based therapies induce substantial weight loss and are widely prescribed; disproportionate losses in fat-free mass (FFM) and skeletal muscle are a concern.

During 2025, new data emerged that are important to internal medicine specialists and subspecialists who frequently encounter and manage patients with common cardiovascular conditions. Among these conditions, the landscape of therapy is changing with regard to hypertension, heart failure, and anticoagulation in atrial fibrillation. Management of acute cardiovascular diseases often involves collaboration between specialists and generalists. The choice of initial imaging modality in patients with suspected coronary artery disease, whether β-blockers are routinely indicated after myocardial infarction, and the role of invasive versus conservative management in older patients after myocardial infarction are all addressed in this article. Also reviewed are articles highlighting groundbreaking therapies in more specialized areas, such as obstructive hypertrophic cardiomyopathy and advanced treatment of hyperlipidemia. As these newer therapies become more widely disseminated, generalists will need to know about them. Finally, regarding a topic of perennial interest to many physicians and patients, an article addresses coffee drinking in patients with atrial fibrillation and suggests that it might be safer than previously believed.

During 2025, gastroenterology and hepatology experienced advances in treatment and surveillance of common diseases. Technological innovations have been reported that may positively affect patients worldwide. New drug options for treatment of metabolic dysfunction-associated steatohepatitis are emerging, and old drugs have new indications and patterns of use for common gastroenterologic diseases. The 9 articles featured here were selected because they represent important information for clinicians who are not gastroenterologists but who often diagnose, treat, and follow patients with gastroenterologic conditions. Two randomized trials address potential overtreatment of patients with Barrett esophagus without high-grade dysplasia and patients with severe alcohol-associated hepatitis. For clinicians who care for patients with malignant gastric outlet obstruction, 2 new randomized trials now provide evidence that a new endoscopic approach is a good alternative to traditional surgical gastroenterostomy or duodenal stenting. Aspirin is emerging as promising adjuvant therapy for patients with colorectal cancer that is positive for PI3K pathway alterations, and fecal microbiota transplantation has been shown to be noninferior to standard vancomycin for patients with a first episode of Clostridioides difficile infection. Finally, a randomized trial showed that structured exercise and training for patients with colon cancer after surgery and adjuvant oncologic treatment reduce recurrence and increase survival.

Cirrhosis affects millions of U.S. adults and costs the U.S. health care system upward of $6 billion annually. Cirrhosis is underrecognized, and the only cure is transplantation. Complications, including bleeding, infection, ascites, and renal injury, contribute to high rates of hospitalization, readmission, and mortality in this population. Evidence-based practices and guidelines offer quality recommendations for clinicians, but many of these guidelines have changed recently. This article provides an update on the current guidelines for the inpatient management of cirrhosis.

This article highlights some important nephrology studies published in 2025 that are relevant for many nonnephrologist physicians. Two studies examined aspects of acute kidney injury (AKI), including the use of sodium bicarbonate infusion to treat severe metabolic acidemia and the use of artificial intelligence models to predict AKI onset, severity, and complications. Three studies examined factors that may influence kidney function, including high-intensity long-term physical exercise, pregnancy, and the combined use of finerenone and empagliflozin. Three studies examined interventions to address common problems among patients receiving maintenance dialysis, including cognitive behavioral therapy for chronic pain, factor Xa inhibitors for atrial fibrillation, and fish oil for cardiovascular events.

Oncology care increasingly necessitates collaboration with physicians in other specialties. This article highlights 10 studies published in 2025 that we believe are important for nononcologists who participate in the care of patients with cancer. The articles selected provide updates on advancements that influence the full spectrum of oncology care. Several studies present therapeutic developments for lung, colorectal, and breast cancer. A major theme of the 2025 literature is evidence-based de-escalation, including reducing mammographic surveillance in older breast cancer survivors and omitting autologous stem cell transplant in patients with multiple myeloma who achieve measurable residual disease negativity. Another study addresses reduced-dose apixaban for extended cancer-associated thrombosis management and the validation of elinzanetant for nonhormonal management of vasomotor symptoms. These studies collectively move the field toward highly personalized, biomarker-driven interventions that require integrated care models to optimize patient outcomes.

This article highlights clinical trials on infectious diseases published in 2025 that we believe are highly relevant to internal medicine physicians who are not infectious diseases specialists. Selected studies address prevention and treatment strategies across infectious diseases. We highlight 2 studies of sexually transmitted infections (STIs): one examining the effectiveness of treating male partners to reduce recurrence of bacterial vaginosis and another study of doxycycline as postexposure prophylaxis against bacterial STI. A strategy for using methanamine hippurate to prevent recurrent urinary tract infections (UTIs) in older women is included in our review. We review the updated evidence supporting the effectiveness of COVID-19, respiratory syncytial virus, and influenza vaccines for the 2025-2026 season, and a modified messenger RNA influenza vaccine, which showed superior efficacy with an acceptable safety profile. In HIV care, a study of dual antiretroviral maintenance therapy showed that dolutegravir and lamivudine was noninferior to triple therapy at 48 weeks. A meta-analysis supporting shorter antibiotic courses for pyelonephritis and complicated UTIs provides important information for antibiotic stewardship strategies. In serious infections, dalbavancin was noninferior to standard therapy for Staphylococcus aureus bacteremia, whereas cefiderocol expanded treatment options for gram-negative bloodstream infections without clear superiority, particularly in carbapenem-resistant pathogens. Finally, a study found that elevated C-reactive protein identifies patients most likely to benefit from adjunctive corticosteroids in community-acquired pneumonia.