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

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This presentation reviews practical updates in inflammatory bowel disease (IBD) management, emphasizing risk stratification, a treat-to-target strategy, and current AGA/ACG guideline positioning for therapies in Crohn’s disease (CD) and ulcerative colitis (UC). It outlines key elements of a focused history, including stool frequency/consistency, bleeding, nocturnal symptoms, pain, urgency/tenesmus, systemic symptoms, perianal complications, weight/appetite changes, and screening for extra-intestinal manifestations (EIMs). EIMs are common (up to ~47%), may precede intestinal symptoms, and can involve joints, skin, eyes, hepatobiliary disease (e.g., PSC), pancreas, and thromboembolism—so they should be assessed at every visit.<br /><br />Diagnostic and monitoring tools are compared: fecal calprotectin and CRP (useful but nonspecific), CBC/albumin (reflect disease burden), cross-sectional imaging (CTE/MRE for small bowel disease), colonoscopy for diagnosis/extent and monitoring, capsule endoscopy (small bowel), and intestinal ultrasound (promising but limited availability). The talk highlights the “window of opportunity” in early CD where tight control may prevent progressive bowel damage (strictures, fistulas, surgery). It distinguishes disease activity (current inflammation) from disease severity (overall course/prognosis).<br /><br />STRIDE II targets are summarized: short-term symptom response, intermediate biomarker improvement (CRP/calprotectin), and long-term endoscopic healing and quality-of-life normalization (with transmural healing in CD and histologic healing in UC as aspirational). A safety “pyramid” stresses steroid minimization (induction only, never maintenance; always have an exit plan) and notes that undertreatment is itself harmful; surgery can be appropriate in select cases.<br /><br />A key update is evaluating “treatment failure” with objective inflammation and therapeutic drug monitoring to differentiate mechanistic failure from pharmacokinetic failure (immune vs non-immune), guiding whether to switch mechanism, switch within class, or escalate dose. Final pearls stress shared decision-making, matching therapy to patient risk, safety, delivery preference, and EIMs (e.g., IL-23 for skin disease, JAK inhibitors for joint symptoms).

Asset Subtitle

Amy Stewart, CRNP

Keywords

inflammatory bowel disease management

Crohn's disease

ulcerative colitis

risk stratification

treat-to-target strategy

STRIDE II targets

extra-intestinal manifestations

fecal calprotectin and CRP monitoring

endoscopic healing

therapeutic drug monitoring