🚨 Acute severe ulcerative colitis (ASUC) remains one of the most challenging emergencies in gastroenterology. This comprehensive review in @FrontGastro_BMJ discusses current best practice in the management of ASUC while exploring emerging therapies and future directions that could improve outcomes for patients. Read the full paper here: fg.bmj.com/content/early/202… #UlcerativeColitis #IBD #AcuteSevereUlcerativeColitis #Gastroenterology #MedicalEducation #ClinicalPractice @BritSocGastro @my_UEG @AmCollegeGastro @DDWMeeting @ESGE_news @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman

“Disease clearance” (symptomatic remission and mucosal healing) with tulisokibart (anti-TL1A) in ulcerative colitis #DDW2026 @DDWMeeting

#DDW2026 @DDWMeeting #FUZION The 1st ph2 RCT for #Perianal CD since IFX! After abscess drainage, GUS 🔺28% wk24 Clinical+Radiologic remission 🔺Significant response at wk12 (can guide timing of Seton removal) 💬Does this change your practice?IFX, UPA or GUS 1st or 2nd line?

New #GUTOnline #GUTRecentAdvancesInClinicalPractice paper by Zhang et al on "Gut microbiome in IBD: past, present and the future" via bit.ly/4oKr9Gl @Siew_C_Ng @CUHKMedicine @wingyanjoyce #IBD #Microbiome

IUS Primer Meeting: Current Status and Future Directions of Intestinal Ultrasound in Asia Asian Organization for Crohn's & Colitis Date: Thursday, September 25, 2025 Time: 8:00 PM - 9:20 PM (UTC+9) Login URL: us06web.zoom.us/j/8766546556… 04GplfWTS7bi0XYMxF9bP.1

Our new study reveals - A healthy gut enables probiotic engraftment that builds powerful, lasting vaccine immunity through beneficial metabolites. nature.com/articles/s41522-0… @magic_limited @CUHKMedicine @Siew_C_Ng @FrancisKLChan @Shilan_Wang @drwong_martin @Nature_NPJ

Efficacy and Safety of Vedolizumab & Tofacitinib (VETO) Combination Therapy in Refractory UC Unresponsive to Anti-TNF and Second-Line Advanced Therapy: A Prospective Cohort Nested Within a Randomised Trial by @DrRupaBanerjee1 @pardus125 @gut_rp @APandT onlinelibrary.wiley.com/doi/…

New online! Understanding the therapeutic toolkit for inflammatory bowel disease bit.ly/3Cw8zyS

Our letter published in @Gut_BMJ comparing the 4 RCTs of anti-TNF withdrawal in #IBD in light of the EXIT trial. @ShahidaDin1 @TakuKobayashiM1 @AaronBancil @PlevrisN gut.bmj.com/cgi/rapidpdf/gut…

IBD Treatment Paradigms: past, present and future by @IBDMD #DDW2025 What is a treatment paradigm? Established approaches and strategies used in medical care for specific diseases or conditions Involves a combination of therapies (surgery, medications and other interventions like diet) to achieve optimal patient outcomes Traditional strategies that define treatment paradigms • Sequential monotherapy • Step up and combo therapy • Targeted therapy • Precision medicine • Combination therapies • Immunotherapies OPTIMAL PATIENT OUTCOMES IN IBD 1. Unrestricted high QoL 2. Sustained control of bowel inflammation 3. Unencumbered personal and professional functioning 4. Healthcare that is affordable General forces and factors in the development of treatments for IBD · We do not know the cause and do not have medical cures · Recognition of the chronic nature of IBD and phases of managements · Development of outcomes of interest: short-term and long-term · Evidence-based medicine · Development of regulatory pathways for drug approval · Advancements in technology · Market forces and competition Treatment paradigms in IBD Desperation Sequential monotherapy Step-up Top-down Treat to target Combination therapies Biomarker driven Cellular immunotherapy The era of desperation in IBD marked by a multitude of evidence-free therapies: including horse serum, artificial fever therapy, hot water enemas, tincture of iodine and intracolonic insufflation of oxygen Early surgical approaches in IBD: presumed “parasympathetic overactivity” or central nervous system causation; thymectomy in UC and bypassed loops of bowel in CD Early approaches to diet in IBD: including elimination of raw fruits and vegetables, hyperalimentation with protein hydrolysates, bowel rest, fish oil SEQUENTIAL MONOTHERAPY, STEP UP Fail first, complications, delayed treatments Treatment breakthroughs Prontosil rubrum (1935, the source of sulfanilamide) Antibiotics Sulfasalazine (Professor Nanna Svartz, Karolinska) Steroids Mesalamine Infliximab – taught us a lot about disease biology Early step-up strategies – Pyramids – staircases and lots of failures Top-down – early effective therapy This is the superior strategy for patients with Crohn’s disease Proliferation of new therapies Head-to-head studies in CD and UC – more are needed; the only trials that really change treatment practice / sequencing Despite options and data, uptake by clinicians is not happening (Siegel CA Clin Trans Gastro 2020) TREAT TO TARGET Adjusting therapies until goal achieved Challenges with treat to target Crohn’s only – Optimisation of one therapy, not sequencing to other MoA Timing : how long to wait btwn assessments How far to go Need pragmatic research – verdict in UC, perianal, post-op COMBINATIONS THERAPIES – Breaking the therapeutic ceiling Practical considerations • Due to inadequate response • Treatment of multiple diseases Mechanistic considerations • Additive efficacy • Synergy 8 Durability Safety considerations Cost considerations On-going combo studies • DUET UC and CD • EXPLORER 2.0 • ExiGEM • Various diet studies BIOMARKER DRIVEN elusive but promising ? will finally come of age with the biomarker in the TL1A studies Consider clinical clues – cytokine-based strategies The presence of other IMIDS gives clues to dominant biological process and therefore clues to treatment target FUTURE CONSIDERATIONS Emerging endpoints of interest • Transmural healing • Disease clearance • Collateral remission (rheumatology) 0or functional remission In progress STRIDE III (end 2025 / 26) New(er) and novel treatments - Improving existing MoAs - New MoAs – novel small molecules, mucosal healing agents, cellular immunotherapy - Pulse and de-escalation strategies - Biome-based strategies - Dietary strategies – elimination; modification

Honoured to be part of this global effort! This consensus sets a bold agenda for IBD research—rooted in equity, innovation, and collaboration across disciplines and borders. Proud to work alongside inspiring colleagues around the world. @NatRevGastroHep

#DDW2025 Bring back the porcelaine dishes ! Could #microplastic (MP) increase risk of #IBD across generations? #PLANET 🔺11 🤰🏻, 4 with Crohns 🔺MP detected in all 💩 during 3rd trimester 🔺Higher MP count correlated with FCP, indicative of intestinal inflammation

Informative presentation on the PIANO registry data from @AKohli_MD on Infant outcomes after Exposure to biologics/ immunomodulator. 👶🏻N=438 4-17 yrs follow-up ➡️44% c section (higher than National average due to active disease/Perianal disease). ➡️71% breast fed- no linked to serious infection ➡️4.6% congenital malformation (=Nat Ave.) ➡️1% autism . ❌No malignancy ❌No serious infection ❗️*Pre-term birth linked to higher infection rates* ✅Continuing IBD medication is recommended though-out all 3 trimesters (USA model differs to European). . . #ddw2025 #IBDandpregnancy #pianoregistry @DDWMeeting @UmaMahadevanIBD #UCSFIBD @AmerGastroAssn #ibdresearch #crohnsdisease #ulcerativecolitis

Fatigue and IBD - by Ailsa Hart Assessment • Fatigue assessment scale • FACIT score • VAS (0-10) Assessment checklist: inflammatory status, lab tests and screening for co-morbid conditions Then “Do you Sleep?” Is sleep interrupted by symptoms, or early waking due to depression? Fatigue with insomnia Non-pharmacological measures: • Low alcohol and caffeine • regular wake time and avoid daytime sleeping • increase "pressure" on seeep through increased activity during day and sunlight exposure • graded exercise Pharmacological measures: • mirtazapine (15mg nocte for insomnia only, 30-45mg if depressed) & assess in 2-3m • avoid benzodiazepines Fatigue without insomnia – much harder Avoid Boom and bust cycles Plan – prioritise and pace If appropriate use SSRI / SNRIs Assess for depression with PHQ9 – anyone 10 or more has significant clinical depression Modafinil for fatigue in IBD Wakefulness promoting agent affecting specific brain regions (hypothalamus) and neurotransmitters (incl dopamine) Supported by Maudsley guidelines in psychiatry and support by meta-analysis

OBESITY AND IBD by @EdwardLoftus2 Obesity is a chronic inflammatory statue Adipose tissue is not biologically inert (TNFa, IL-6, IL-8, leptin, adiponectin) Postulated role in the pathogenesis of IBD Potential risk factor for adverse outcomes Trends in BMI among IBD patients at diagnosis in Olmsted County, Doubling of obesity rates in 20 years in CD and UC (Johnson AM JCC 2021 and J Clin Gastro 2024) Obese patients more likely to have a colonic phenotype; no associations in UC No consistent relationship between BMI and disease complications in CD But in UC there was associated increased risk of needed steroids and hospitalisation, but no impact on surgery California study showed no associated between BMI on hospitalisation or surgery or serious infection (Gu P Am J Gastro 2022) How does obesity impact IBD therapy? Not all meds are weight-based Obese patients less likely to receive optimal weight-appropriate therapy IFX 4mg/kg vs 7.9mg/kg AZA 1.1mg/kg vs 1.7mg/kg Higher IFX levels may be required for patients with higher visceral adipose tissue (Yarur A et al Am J Gastro 2023 Nov:118) Higher VAT ass with reduced rates of clinical and endoscopic remission (Yarur Gastro 2023) VAT may be more informative measure than BMI Bariatric surgery is acceptably safe in obese IBD patients (Bazerbachi F Obes Surg 2018) 790 patients among >300k who had bariatric surgery De novo IBD following bariatric surgery – case study of 42 patients (Braga Net MB et al JCC) and Kochhar GS AP&T 2020 – (lower rates of IBD afterwards) Impact of bariatric surgery on long-term course of existing IBD Endoscopic bariatric therapies may be effective in obese IBD patients Anti-obesity meds maybe effective in obese IBD patients Pham JT am j gastro 2024 No increased risk of AE’s in obese IBD patients GLP-1 R agonists No difference in efficacy Safety appears similar Can they reduce the inflammatory burden in IBD? Indirect effects: weight loss, glucose metabolism Direct effects: reduction in pro-inflammatory cytokines (decr IL-6 and TNFa; blockade of NFkB signalling; incr Treg activity Murine models: GLP-1RA decreased colonic inflamation in DSS colitis; ? through modulation of gut microbiota (incr lactobacillus reuteri; decr enteropathogenic staphlycoccus) 5 observational studies published (see figure) 3/5 show decreases risk of adverse IBD outcomes, flare, surgery 2/5 no difference in IBD outcomes Lily are planning RCTs of Munjaro plus Mirikizumab in UC and in CD - watch this space! #DDW2025

Over a decade since I collaborated with world-class epidemiologist @gilkaplan and his team, here is our long awaited paper out in @Nature reporting for the first time evolution of #ibd across 4 stages @HelmsleyTrust @IOIBD1 @CUHKMedicine @IBD_GIVES21 nature.com/articles/s41586-0…

Mild Crohn's disease to kick off day 2 @ryanungaro Approx 30% patients will present with mild Crohn's disease, of whom the majority will maintain a mild phenotype over time Mild activity and mild severity But some will progress, so it is important to keep a close eye. So treat with induction therapy (see figure from Elmasry and Ha;l CGH 2023) and monitor Escalate if monitoring indicates transition to moderate or severe disease

#CGH4ALL @AGA_CGH 📣 🎯PCABs (vonoprazan) are more potent than PPIs, but long-term safety data are lacking📈 ✅After 5 year, this study revealed that Vonoprazan does not increase malignant gastric mucosal changes in healed EE ✅Similar safety profile to lansoprazole 📚Read more: 🔗 doi.org/10.1016/j.cgh.2024.0… Reported by @RaghavBassiMD @CamilleLupianez @stevenbollipo @shifaumarMD @MN_GIMD @Samir_Grover @drKumarGI @NeilBhogalMD @FaresAyoubMD @ReenaChokshiMD @SalihSamo @WalterChanMD @john_damianosMD @dunleavy_katie @Schablaney

🏆 An FG favourite - how should you go about investigating abnormal liver blood tests in patients with inflammatory bowel disease? A MUST-READ for all post-graduates. 🧠 fg.bmj.com/content/15/6/516 With thanks to the Authors: Jennifer Amy Scott, Christopher Mysko, Huw Purssell and Varinder S Athwal. @PhilSmithIsBack @OTavabie @dr_aditi_kumar @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @DrLChina @acv69cardenas @GeriKeane @jamesbmaurice @drobeirne #IBD #LiverFunctionTests #InflammatoryBowelDisease #LiverDisease #Gastroenterology #IBD #MedTwitter #GIHealth #IBDResearch #LiverDisease #Hepatology

Outcomes After Dose Intensification of #Risankizumab for #Crohn’s Disease - Clinical Gastroenterology and Hepatology cghjournal.org/article/S1542… 💊Dose⬆️of risa to q4w or q6w recaptured clin response for 64% of pts with LOR to q8w dosing 💊Dose⬆️of risa➡️clin remission for 45%