ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day Two) | March 2026-Updates in Inflammatory Bowel Disease

Video Transcription

Video Summary

The talk reviews current approaches to inflammatory bowel disease (IBD) management, emphasizing structured assessment, risk stratification, and treat-to-target care. At every visit, clinicians should document specific symptoms (bowel movement frequency, stool consistency, bleeding details, nocturnal stools, pain, urgency/tenesmus, incontinence), systemic symptoms, weight/appetite changes, perianal drainage, and extraintestinal manifestations (joints, skin, eyes, mouth). Because symptoms often poorly correlate with inflammation—especially in Crohn’s—objective monitoring with fecal calprotectin, CRP (noting some patients never mount a CRP response), hemoglobin/albumin trends, endoscopy, and imaging (MRE/CTE, capsule with patency testing, intestinal ultrasound) is essential.<br /><br />Treatment principles highlight an early “window of opportunity” to prevent cumulative bowel damage, supporting early advanced therapy for moderate–severe disease and high-risk patients. High-risk features include young age, extensive disease, deep ulcers, perianal disease, stricturing/penetrating behavior, prior surgery, hospitalization, low albumin, and elevated inflammatory markers. STRIDE-2 treat-to-target goals progress from symptom and biomarker improvement to endoscopic healing and restored quality of life.<br /><br />Safety messaging stresses steroids as most harmful long-term; untreated disease is also dangerous. Guidelines de-emphasize mesalamine for Crohn’s; thiopurines/methotrexate are mainly adjuncts. Biologics (anti-TNF, vedolizumab, IL-12/23 or IL-23 agents) and small molecules (JAK, S1P) are positioned based on efficacy, speed, comorbidities, EIMs, pregnancy, and therapeutic drug monitoring to distinguish mechanistic vs pharmacokinetic failure. A case illustrates how joint involvement (peripheral vs axial) can shift drug choice (e.g., “IL-23 for skin, JAK for joints”).

Asset Subtitle

Amy Stewart, CRNP

Keywords

inflammatory bowel disease management

treat-to-target STRIDE-2

risk stratification high-risk Crohn’s

objective monitoring fecal calprotectin CRP

endoscopic healing and imaging MRE CTE

biologics anti-TNF vedolizumab IL-23

small molecules JAK inhibitors S1P modulators