https://siftingsignal.com/gisignals/IBD papers worth knowing in GI this week. A SiftingSignal publication.https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42611712https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42611712Mon, 24 Aug 2026 19:12:09 +0000Inflammatory bowel diseases. Ustekinumab achieved 84.7-90.2% clinical remission at 52 weeks, with one-year persistence >85% and fistula closure in 45.9% of fistulizing CD. This real-world evidence confirms ustekinumab's trial efficacy and supports its use as a durable option for CD and UC.https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42611716https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42611716Mon, 24 Aug 2026 19:12:09 +0000Inflammatory bowel diseases. Counsel women with UC seeking contraception that available evidence does not support an increased UC flare risk with HCT. Although C-reactive protein does increase modestly during HCT exposure, this does not manifest as increased flares or cumulative inflammatory burden. Offer HCT as a contraceptive option while noting the modest sample size of exposed women, which limits power to detect rare or smaller effects.https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42613995https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42613995Mon, 24 Aug 2026 19:12:09 +0000Journal of gastroenterology and hepatology. Upadacitinib (45 mg daily for induction, then 15 or 30 mg daily for maintenance) achieved remission in 31-32% of East Asian patients at induction week 8 and 52-54% at maintenance week 52, with exposure-response patterns and pharmacokinetics consistent with global populations. No dose adjustment is needed for East Asian patients.https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42616682https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42616682Mon, 24 Aug 2026 19:12:09 +0000Inflammatory bowel diseases. In endemic regions (Southwest US), maintain clinical suspicion for coccidioidomycosis in IBD patients on biologics or small molecules. Most patients tolerated continued advanced IBD therapy during antifungal treatment; TNF inhibitors were interrupted more frequently than other agents. Diagnosis is challenging, and severity classification should guide individualized management decisions.https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42618450https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42618450Mon, 24 Aug 2026 19:12:09 +0000Gut. No clinical action yet: mechanistic mouse study of dysbiosis-driven inflammation; flagellin-TLR5-IL-15-ARA is a candidate axis requiring prospective human validation.https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42622514https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42622514Mon, 24 Aug 2026 19:12:09 +0000Inflammatory bowel diseases. These models cannot yet guide clinical decisions. Diagnostic and predictive models require prospective external validation in independent cohorts before clinical implementation. No serum biomarker test should be adopted based on this discovery-stage study.https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42622527https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42622527Mon, 24 Aug 2026 19:12:09 +0000Alimentary pharmacology & therapeutics. When distinguishing UC from CD, consider measuring serum anti-integrin αvβ6 autoantibodies (cutoff 2.44 U/mL) as an adjunct to clinical, endoscopic, and histologic findings. This study excluded indeterminate colitis, so applicability to difficult-to-classify cases remains undefined.https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42627215https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42627215Mon, 24 Aug 2026 19:12:09 +0000Inflammatory bowel diseases. This observational, single-center finding is insufficient to change UC management. Potential confounding by indication cannot be fully excluded from a retrospective cohort design, despite matching on baseline characteristics. Do not prescribe GLP-1 RAs for UC based on this evidence; prospective randomized trials are needed.https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42628666https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42628666Mon, 24 Aug 2026 19:12:09 +0000Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. Avoid 5-ASA monotherapy in newly diagnosed pediatric Crohn's disease. Prioritize early anti-TNF therapy to reduce cumulative corticosteroid exposure, improve biologic durability once escalation occurs, and reduce perianal disease risk.https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42629200https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42629200Mon, 24 Aug 2026 19:12:09 +0000Gut. Dietary consultation may be incorporated into individualized IBD management. Specific dietary patterns to recommend, timing relative to pharmacotherapy, and suitability for particular IBD types or disease severity require consultation of the primary source. Note that EEN and restrictive dietary approaches carry significant compliance barriers including tube placement and dietary restriction.https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42633602https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42633602Mon, 24 Aug 2026 19:12:09 +0000Digestive diseases and sciences. Screen for perceived stigma as a potential barrier to medication adherence in Black patients with IBD; modify counseling and communication to address stigma-related concerns. This study shows an association, not an intervention; no specific therapy or monitoring protocol is established.https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42581715https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42581715Thu, 20 Aug 2026 18:40:03 +0000Alimentary pharmacology & therapeutics. In UC patients with active luminal disease requiring biologic escalation, anti-TNF therapy after vedolizumab shows lower remission rates and durability than anti-TNF as first-line or anti-TNF-to-anti-TNF switching. Consider moving anti-TNF earlier in the biologic sequence for UC, or anti-TNF-to-anti-TNF sequencing rather than vedolizumab-then-anti-TNF. In CD patients with active luminal disease, clinical effectiveness remains similar despite higher discontinuation rates, making the sequencing implications less clear.https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42585027https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42585027Thu, 20 Aug 2026 18:40:03 +0000Inflammatory bowel diseases. In children with CD and prior adalimumab exposure starting infliximab, lower trough levels should be anticipated and more frequent dose escalation is likely needed. Monitor trough levels closely, expect to intensify dosing sooner than in biologic-naive patients, and recognize that remission remains achievable despite lower observed levels.https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42593078https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42593078Thu, 20 Aug 2026 18:40:03 +0000Inflammatory bowel diseases. GLP-1 RAs are not yet established for IBD disease modification. Consider offering them to obese IBD patients (particularly those with metabolic comorbidities including MASLD or cardiovascular disease) primarily for obesity and comorbidity management, with close monitoring for gastrointestinal tolerability, coordination with endoscopy plans, and assessment of lean muscle mass preservation. Pending results of ongoing randomized trials evaluating disease-modifying effects.https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42601488https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42601488Thu, 20 Aug 2026 18:40:03 +0000Nature medicine. No clinical action yet: tissue-specific aging biomarkers have been identified and correlate with disease presence and comorbidities, but prospective studies are needed to determine whether monitoring tissue-age acceleration predicts clinical outcomes or guides treatment.https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42607853https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42607853Thu, 20 Aug 2026 18:40:03 +0000Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. When selecting an advanced IBD therapy, cancer risk is comparable among TNF antagonists, vedolizumab, and anti-interleukins; base selection on efficacy and tolerability. JAK inhibitor data are too sparse (n=384) and imprecise to determine if cancer risk differs. Counsel patients that follow-up was median 2.6 years; delayed malignancy risk over longer periods cannot be ruled out.https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42566302https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42566302Thu, 20 Aug 2026 21:35:47 +0000Inflammatory bowel diseases. If your practice uses handheld intestinal ultrasound, implement it with structured training (supervised practice, image quality review, feedback) for bedside IBD triage and bowel wall thickness assessment, with predefined escalation to conventional ultrasound, MR enterography, or endoscopy for complex disease, deep pelvic lesions, or suspected complications. Do not rely on handheld color Doppler in Crohn's disease.https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42566304https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42566304Thu, 20 Aug 2026 21:35:47 +0000Inflammatory bowel diseases. No clinical action yet: metabolomic prediction model identified but requires external validation and prospective application in new patient cohorts before clinical implementation.https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42567685https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42567685Thu, 20 Aug 2026 21:35:47 +0000Inflammatory bowel diseases. Retrospective model without prospective validation or clinical implementation pathway. While retrospectively accurate (AUROC 0.817), clinical use requires prospective validation, definition of actionable thresholds, and workflow integration. No bedside action supported currently.https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42572077https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42572077Thu, 20 Aug 2026 21:35:47 +0000Digestive diseases and sciences. Risk-stratify older IBD patients using assessment of frailty, comorbidity burden, and drug interactions rather than age alone. Consider vedolizumab and ustekinumab in older patients with acceptable risk profiles; avoid deferring advanced therapy based on age. Reduce corticosteroid burden.https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42580871https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42580871Thu, 20 Aug 2026 21:35:47 +0000Gut. Identifies anti-IL-10 as a prognostic marker for difficult-to-treat pediatric IBD, but clinical testing is not recommended at this time. This research finding may eventually enable risk stratification and inform therapy selection in high-risk patients, pending prospective validation.https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42581715https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42581715Thu, 20 Aug 2026 21:35:47 +0000Alimentary pharmacology & therapeutics. In UC patients with active luminal disease requiring biologic escalation, anti-TNF therapy after vedolizumab shows lower remission rates and durability than anti-TNF as first-line or anti-TNF-to-anti-TNF switching. Consider moving anti-TNF earlier in the biologic sequence for UC, or anti-TNF-to-anti-TNF sequencing rather than vedolizumab-then-anti-TNF. In CD patients with active luminal disease, clinical effectiveness remains similar despite higher discontinuation rates, making the sequencing implications less clear.https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42585027https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42585027Thu, 20 Aug 2026 21:35:47 +0000Inflammatory bowel diseases. In children with CD and prior adalimumab exposure starting infliximab, lower trough levels should be anticipated and more frequent dose escalation is likely needed. Monitor trough levels closely, expect to intensify dosing sooner than in biologic-naive patients, and recognize that remission remains achievable despite lower observed levels.https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42586108https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42586108Thu, 20 Aug 2026 21:35:47 +0000The lancet. Gastroenterology & hepatology. No change to individual patient management. For clinicians in East and Southeast Asia, this reinforces that IBD burden will continue rising with progression through stage 3 (compounding prevalence), informing healthcare system planning and resource allocation. For clinicians elsewhere, this contextualizes the global rise in IBD associated with economic development.https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42593078https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42593078Thu, 20 Aug 2026 21:35:47 +0000Inflammatory bowel diseases. GLP-1 RAs are not yet established for IBD disease modification. Consider offering them to obese IBD patients (particularly those with metabolic comorbidities including MASLD or cardiovascular disease) primarily for obesity and comorbidity management, with close monitoring for gastrointestinal tolerability, coordination with endoscopy plans, and assessment of lean muscle mass preservation. Pending results of ongoing randomized trials evaluating disease-modifying effects.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-40622248https://siftingsignal.com/gisignals/2026-W32/#card-pmid-40622248Thu, 06 Aug 2026 18:00:11 +0000Journal of clinical gastroenterology. Screen hospitalized IBD patients, particularly those with Crohn's disease, male sex, Medicaid insurance, or lower income, for substance use disorder (SUD), with a focus on alcohol, opioid, and cannabis use, and consider integrated care models for SUD management.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41081676https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41081676Thu, 06 Aug 2026 18:00:11 +0000Journal of clinical gastroenterology. Counsel IBD patients, especially those with active UC, on the benefits of high fiber diets and provide nutritional education to improve intake.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41401386https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41401386Thu, 06 Aug 2026 18:00:11 +0000Journal of clinical gastroenterology. Screen all IBD patients (not just CD) for depression and schizophrenia, prioritizing females, smokers, and those with psychiatric history; discuss suicide risk and refer high-risk patients to mental health services given elevated mortality.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41706015https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41706015Thu, 06 Aug 2026 18:00:11 +0000Inflammatory bowel diseases. Consider exploring LLM-based AI tools (specific tool not named) to screen EMRs for IBD clinical trial eligibility to enhance recruitment efficiency.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41739531https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41739531Thu, 06 Aug 2026 18:00:11 +0000Inflammatory bowel diseases. No clinical action yet: a conceptual framework for future research and tool development. Consider discussing urgency's multidimensional impact with IBD patients, but no validated assessment or treatment changes are supported.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41934657https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41934657Thu, 06 Aug 2026 18:00:11 +0000Inflammatory bowel diseases. Consider transmural improvement (SES-CD decrease ≥50% and sMaRIA decrease ≥1 with ≤25% bowel wall thickness reduction) as a treatment target in Crohn's patients unable to achieve transmural remission, but monitor stricturing disease more closely due to higher surgery (HR 4.043) and hospitalization (HR 3.704) risks.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41934658https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41934658Thu, 06 Aug 2026 18:00:11 +0000Inflammatory bowel diseases. Consider advanced therapies (biologics, JAK inhibitors) for UC patients ≥60 years as efficacy and safety are comparable to younger patients, but note hospitalization risk is numerically higher in older adults, with minor therapy-specific variations to weigh.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41934660https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41934660Thu, 06 Aug 2026 18:00:11 +0000Inflammatory bowel diseases. Consider risankizumab for difficult-to-treat Crohn's disease (failure of ≥2 advanced therapies with different mechanisms), with monitoring for adverse events (35.3 possibly and 16.6 probably related events per 100 person-years).https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41968436https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41968436Thu, 06 Aug 2026 18:00:11 +0000Inflammatory bowel diseases. Consider local PDRN injections during Crohn's perianal fistula surgery to improve closure rates and accelerate healing, noting the safety and cost-effectiveness as reported.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41968438https://siftingsignal.com/gisignals/2026-W32/#card-pmid-41968438Thu, 06 Aug 2026 18:00:11 +0000Inflammatory bowel diseases. Consider systematic screening for frailty in older IBD patients using available tools, though none are IBD-specific. No clinical action yet: no validated IBD-specific frailty tools or interventions exist.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42024671https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42024671Thu, 06 Aug 2026 18:00:11 +0000Inflammatory bowel diseases. Consider using the 3D-TRUS nomogram to assess risk of early biologic failure in pfCD patients, particularly if main fistula length ≥2 cm, inflammatory mass size >2 cm, or increasing internal orifice-anal margin distance are present, to guide decisions on treatment escalation or switch.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42035293https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42035293Thu, 06 Aug 2026 18:00:11 +0000Inflammatory bowel diseases. Counsel women with IBD without active perianal disease that vaginal delivery is appropriate and does not increase perineal injury risk compared to women without IBD.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42044218https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42044218Thu, 06 Aug 2026 18:00:11 +0000Journal of clinical gastroenterology. Consider cardiovascular risk stratification and bleeding risk mitigation in IBD patients post-MI, given their higher complication risks.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42086326https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42086326Thu, 06 Aug 2026 18:00:11 +0000Inflammatory bowel diseases. No clinical action yet: a proof-of-concept ML model requiring validation in larger cohorts before clinical use.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42243622https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42243622Thu, 06 Aug 2026 18:00:11 +0000Inflammatory bowel diseases. No clinical action yet: a mechanistic finding in humans identifying T cell receptor signatures that require further study to determine their role and potential as therapeutic targets.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42251689https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42251689Thu, 06 Aug 2026 18:00:11 +0000Inflammatory bowel diseases. No clinical action yet: a mechanistic finding on gene transfer potential in Crohn disease microbiota.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42263162https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42263162Thu, 06 Aug 2026 18:00:11 +0000Inflammatory bowel diseases. Consider prioritizing radiologic remission (transmural healing, assessed by simplified MaRIA score) as a treatment target in ileal Crohn's disease, as it predicts reduced clinical relapse and longer relapse-free survival compared to radiologic disease activity, with trends but no significant benefit seen for endoscopic or histologic remission.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42525166https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42525166Thu, 06 Aug 2026 18:00:11 +0000Digestive diseases and sciences. In severe ICI-colitis (grade 3-4), assess for prior oral steroid use, symptom severity (modified Mayo score), and endoscopic activity (UCEIS) to identify high-risk patients. Note: AGA cautions symptoms may not correlate with severity. If steroids fail after 2-3 days (per AGA) and predictors are present, escalate to biologics (infliximab or vedolizumab preferred per SOC).https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42543388https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42543388Thu, 06 Aug 2026 18:00:11 +0000Journal of gastroenterology. Consider S1P receptor modulators (e.g., etrasimod) as an oral advanced therapy option for adults with moderate-to-severe UC, given their efficacy vs placebo and acceptable safety profile, noting modestly higher TEAEs with etrasimod.https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42498600https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42498600Thu, 30 Jul 2026 22:01:39 +0000Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. Consider earlier risk stratification and preparation for second-line rescue therapy in pediatric ASUC patients with a day 3 PUCAI ≥50 during disease flare, as these patients had lower colectomy-free rates and probability of achieving clinical remission.https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42502992https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42502992Thu, 30 Jul 2026 22:01:39 +0000Inflammatory bowel diseases. Consider primary anastomosis in selected Crohn disease patients with intraoperative abscess at experienced centers, as it does not independently increase complications versus non-abscess cases, despite higher rates of open conversion (29.3% vs 10.3%) and fecal diversion (24.8% vs 6.2%).https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42509398https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42509398Thu, 30 Jul 2026 22:01:39 +0000Digestive diseases and sciences. Prioritize controlling active inflammation (luminal and perianal) over fistula closure alone when addressing HRQoL in Crohn's disease.https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42509537https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42509537Thu, 30 Jul 2026 22:01:39 +0000BMC gastroenterology. Consider RDW as an adjunctive marker for IBD activity, especially in Crohn's disease, but do not replace CRP or fecal calprotectin with RDW alone. RDW's utility in UC remains less clear.https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42520305https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42520305Thu, 30 Jul 2026 22:01:39 +0000Inflammatory bowel diseases. In patients with UC (including those with prior biologic exposure), tofacitinib showed no significant difference in serious infections, MI/stroke, or VTE risk compared to biologics in this claims analysis. Safety decisions should weigh all risks, not just these endpoints.https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42521877https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42521877Thu, 30 Jul 2026 22:01:39 +0000Journal of gastroenterology. Characterize 5-ASA intolerance phenotypes, particularly acute intolerance syndrome (AIS), in UC patients to stratify risk of progression to difficult-to-treat UC and inform individualized therapeutic strategies.https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42476207https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42476207Sat, 25 Jul 2026 22:16:33 +0000Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. Continue considering upadacitinib for post-anti-TNF patients, with explicit malignancy screening and ongoing surveillance informed by comparative risk data.https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42477587https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42477587Sat, 25 Jul 2026 22:16:33 +0000BMC gastroenterology. In pediatric IBD patients with prior anti-TNF failure, consider UST as a second-line therapy. The remission rates (69% in Crohn's disease, 65% in ulcerative colitis at week 52) and favorable safety profile support offering this when anti-TNF does not work. Note that UC findings are based on limited data and warrant cautious interpretation.https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42485228https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42485228Sat, 25 Jul 2026 22:16:33 +0000Inflammatory bowel diseases. In hospitalized patients with ASUC refractory to IV corticosteroids and infliximab, use upadacitinib as a third-line rescue therapy. Early response is evident by week 1 (60% clinical remission); among patients continuing treatment, improvements in symptoms and CRP are maintained through week 48 (51% CR). However, 48% discontinued by week 48, primarily due to nonresponse (42%) or loss of response (46%). Colectomy occurred in 22% (elevated with higher baseline CRP). Monitor baseline CRP as a risk factor for colectomy.https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42486394https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42486394Sat, 25 Jul 2026 22:16:33 +0000Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. Use these criteria to diagnose ASUC in patients on outpatient corticosteroids or biologics; the 1955 Truelove-Witts criteria did not account for treated patients and could miss ASUC in this population. Confirm diagnosis with endoscopy (exclude CMV superinfection) and imaging (exclude toxic megacolon). For patients on high-dose corticosteroids, apply the lower CRP threshold (≥1x ULN) and bloody-stool threshold (≥33%) to account for anti-inflammatory suppression.https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42498622https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42498622Sat, 25 Jul 2026 22:16:33 +0000Gut. Consider ustekinumab for patients with active fistulising perianal Crohn's disease, particularly those with prior anti-TNF failure, after standardised surgical management.https://siftingsignal.com/gisignals/2026-W29/#card-pmid-42462750https://siftingsignal.com/gisignals/2026-W29/#card-pmid-42462750Sat, 18 Jul 2026 20:04:34 +0000The lancet. Gastroenterology & hepatology. Consider duvakitug 900 mg every 2 weeks as a potential therapy for adults (18-75 years) with moderately to severely active ulcerative colitis, including those with prior inadequate response, loss of response, or intolerance to conventional or advanced therapies. Monitor for adverse events similarly to placebo.https://siftingsignal.com/gisignals/2026-W26/#card-pmid-41784159https://siftingsignal.com/gisignals/2026-W26/#card-pmid-41784159Thu, 09 Jul 2026 16:47:07 +0000Inflammatory bowel diseases. Disability is common in IBD and persists even in remission (about 27 percent), so consider periodically assessing it with a validated tool (IBD Disk or IBD-Disability Index) rather than assuming remission equals full function.https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42030468https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42030468Thu, 09 Jul 2026 16:47:07 +0000Inflammatory bowel diseases. A Bayesian meta-analysis suggests intensified infliximab induction may lower early colectomy in acute severe UC, but the only randomized trial (PREDICT-UC 2024) showed no benefit, so intensification remains non-standard and best individualized (e.g. high-clearance or hypoalbuminemic patients) rather than applied routinely.https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42118952https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42118952Thu, 09 Jul 2026 16:47:07 +0000Inflammatory bowel diseases. SB012, a GATA3-targeting DNAzyme enema, showed an early efficacy signal in a small phase 2a UC trial but is investigational and not clinically available, so no practice change pending larger trials.https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42413123https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42413123Thu, 09 Jul 2026 16:47:07 +0000Journal of Crohn's & colitis. Use ECCO UC therapeutics for the European perspective, but reconcile positioning against US ACG and AGA guidance and FDA safety labeling (notably the JAK-inhibitor boxed warning: age 50 or older with a cardiovascular risk factor, use after anti-TNF failure) before applying.https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42417116https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42417116Thu, 09 Jul 2026 16:47:07 +0000Journal of Crohn's & colitis. Before or early in immunosuppressive or biologic therapy for IBD, complete an infection-prevention bundle: screen for latent TB and hepatitis B, check VZV and measles immunity, and vaccinate (recombinant zoster for immunosuppressed adults, updated pneumococcal schedule, annual influenza, COVID), avoiding live vaccines during active immunosuppression.