An interesting paper on ASUC, highlighting differences between populations In East Asia, even with worse endoscopic severity and lower IFX use: - lower corticosteroid failure (21.5% vs 57.2%) - lower colectomy rates (6.3% vs 29.7%) - fewer readmissions within 12 months #IBD

Obefazimod in mod-severe UC - week 8 induction data presented at #UEGWeek - first in class for IBD 1/🧵 MoA: ⬆️expression of miR-124, which regulates inflammatory response & restores mucosal homeostasis.

How intestinal ultrasound (IUS) changes IBD care – clinical impact, cost savings & greener healthcare 1/ #IBD is rising fast in SE Asia 📈 We need tools that are accurate, patient-friendly, and sustainable. Our SGH pilot study shows #IntestinalUltrasound ticks all 3 boxes ✅

APOLLO-CD A phase 2a induction trial of tulisokibart, an anti-TL1A monoclonal antibody, shows promising efficacy & safety in patients with moderate-to-severe Crohn’s disease (CD) refractory to prior therapies. Key findings from the APOLLO-CD study: [🔗https://doi.org/10.1016/S2468-1253(25)00071-8]

2025 guidelines for IBD from @amcollegegastro.bsky.social Crohn's: journals.lww.com/ajg/fulltext... UC: journals.lww.com/ajg/fulltext... #IBDSky #MedSky #GISky

Checkpoint inhibitor-induced colitis (ICI-colitis): a serious, often under-recognized complication in cancer patients receiving immunotherapy. 1/ ICI-induced colitis 📈 Affects up to 30% of patients on ICIs. 🔬 This study followed 96 patients with 12-month outcomes. www.esmoopen.com/article/S205...

Medical metaphors with ChatGPT #MedSky

BSG 2025 Guidelines: Colorectal Surveillance in IBD gut.bmj.com/content/earl... @bmj.com #GISky #IBDSky

🧵1/ Can IBD meds be safely used after cancer? New prospective data from the SAPPHIRE Registry tackles a key concern: the safety of immunosuppressive therapy in IBD patients with prior malignancy. Let’s break down the findings. #IBDSky #GISky #OncoSky

🧵1/ Can anti-TNF be safely withdrawn in patients with IBD in sustained remission? The EXIT trial (Gut, 2025). A randomized, quadruple-blind, placebo-controlled trial across 33 centers in Spain. #IBDSky #GISky

A post-hoc analysis of the RISK study shows that early anti-TNF therapy can significantly reduce the risk of perianal fistulas — one of the most challenging complications. 📌 Context: 1 in 3 children with Crohn’s develop perianal fistulas (PFCs) #IBDSky #SurgSky #GISky

ADMIT-ASC index for ASUC. Score of ≥3 was 84% predictive of steroid failure - CRP ≥100mg/L (1 point) - albumin ≤25g/L (1 point) - UCEIS ≥4 (1 point) or ≥7 (2 points) Will these pts benefit from early 'salvage' therapy instead of waiting till Day 3? #IBDSky #GISky gut.bmj.com/content/72/3...

SES-CD for Crohn's 4 parameters: - size of ulcers - extent of ulcerated surface - extent of colitis - stenosis 5 segments: - ileum, right, transverse, left colon and rectum Endo remission: ≤2 (or <4) Accessible online calculator: www.e-guide.ecco-ibd.eu/resources/ca... #IBDSky #GISky #SurgSky

Nancy index in UC. 4 grades: Nancy 0 or 1 = histologic remission. - Not a formal target to strive for but gives a good idea about activity. Easy way to remember is: - neutrophils in the mucosa = acute/active inflammation = bad #GISky #IBDSky #PathSky

GRAVITI trial 🧵 Guselkumab is an IL-23 inhibitor. GRAVITI tested fully SC dosing (no IV) for both induction & maintenance in moderate-to-severe Crohn’s. N = 347 adults, randomized 1:1:1 - GUS 400 mg q4w induction → 100 mg q8w - GUS 400 mg q4w induction → 200 mg q4w #IBDSky #GISky #MedSky

Can removing the appendix help prevent relapse in ulcerative colitis? The #ACCURE trial says: Yes. 🧵 ✂️ Pragmatic, open-label RCT across 22 centers (Netherlands, UK, Ireland). Patients in UC remission randomized to: ✅ Appendicectomy + standard medical therapy vs 🧪 Standard medical therapy alone

malcolmtan.substack.com/p/colonprev-... @thelancet.bsky.social #GISky

COLONPREV: FIT vs Colonoscopy in an invitation-to-screen programme.

(https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00145-X/abstract)

malcolmtan.substack.com

Real-world 12 month outcomes of anti-TNF vs UST vs VDZ in ulcerative colitis. UST group has 90% who are bio-experienced compared to VDZ and anti-TNF group (30+%), leading to: 1. High 'persistence' cos lack of options 2. 'Lower' efficacy of UST #IBDSky #GISky academic.oup.com/ecco-jcc/adv...

Colorectal cancer screening: - FIT is non-inferior to colonoscopy for CRC-related deaths at 10 years n= 57404 Participation rates higher for FIT (39.9%) vs scope (31.8%) CRC-deaths similar: FIT (0.24%) vs scope (0.22%) #GISky #SurgSky @thelancet.bsky.social www.thelancet.com/journals/lan...

Primary Sclerosing Cholangitis - higher risk of colorectal Ca, biliary Ca and cirrhosis - dx: MRC, histology, ALP/GGT, IBD - no proven therapy, UDCA can be considered for high-risk patients #LiverSky #GISky www.nature.com/articles/s41...

Granuloma in histology: Tuberculosis vs Crohn's? TB: - necrotizing (caseating), >400 microns, multiple (>5/hpf), submucosa, confluent Crohn's: - non-necrotizing, <200 microns, infrequent, mucosa, non-confluent tl;dr: TB granulomas are larger, 'deeper' and more extensive. #IBDSky #GISky #IDSky

Positioning of advanced therapies in IBD, 2025 Crohn's 1st line: anti-TNF (+IM), RZK 2nd line: RZK, UPA UC 1st line: VDZ, IFX, anti-p19 2nd line: UPA, TOFA, IFX, UST, anti-p19 @amergastroassn.bsky.social #IBDSky #GISky

Defunctioning stomas are used to treat refractory Crohn's disease - most are permanent (low rates of successful reversal) - some go on to have proctectomy for perianal disease - successful reversal is a/w anti-TNF treatment #IBDSky #SurgSky pubmed.ncbi.nlm.nih.gov/39887905/

Useful article on how to handle IBD medications peri-operatively. - IBD vs non-IBD surgery - biologics vs small molecules - risk of complications - urgency of surgery - post-op IBD treatment plans #GISky #IBDSky #SurgSky www.cghjournal.org/article/S154... @amergastroassn.bsky.social

Guidelines for Hepatitis B Virus reactivation - anti-integrin and anti-cytokines classified as "high risk" (>10% HBVr in HBsAg+) - VDZ and UST would be "high risk" --> but VDZ classified as "gut specific anti-T cell rx" --> did not expect UST to be "high risk" #IBDSky #LiverSky

HELIOS trial (neoplasia detection in IBD) - high-def segmental re-inspection is not inferior to high-def chromoendoscopy (10.3% vs 13.1%, non-inferiority margin of 10%) - 'benefit' of chromoendoscopy might be due to withdrawal/inspection time - overall neoplasia rate was low (10.5%) #IBDSky

"JAKne" or JAK-inhibitor induced acne - ~5-20% of pts on JAK-inh - absence of comedones, pruritic, widespread (back/chest) - usually manageable with topical treatments (retinoids, topical abx, benzoyl peroxide) #IBDSky #DermSky @amcollegegastro.bsky.social

Ulcerative colitis in pts with PSC (compared to UC w/o PSC) - more extensive (pancolitis) - milder disease course - heavier disease burden on right - rectal sparing + ileitis - higher risk of dysplasia and colorectal cancer (annual screening) #IBDSky #LiverSky #GISky @natrevgastrohep.bsky.social

Crohn's disease in pts with PSC (compared to CD w/o PSC). - isolated ileal disease is rare (3-6%) - milder inflammation - lower rates of B2/B3 - ?rectal sparing - ?higher disease burden on the right #IBDSky #LiverSky

Pouch disorders are challenging to manage: - antibiotics still the mainstay rx for acute/chronic pouchitis - budesonide or topical steroids - anti-TNF, vedolizumab for chronic antibiotic-refractory pouchitis or Crohn's-like disease of the pouch #IBDSky @natrevgastrohep.bsky.social