Actionability = is there something to do. Prevalence = how much of a general GI practice it touches. Stakes = how consequential the decision is. Evidence strength = how far the study design and the result support the action. Novelty = how likely you are not already doing it.
IBDprospective cohort · n=145,125 · Aug 28, 2026 · Clin Gastro Hep · IF 16.2
New evidencebiologicsJAK inhibitorsanti-TNFtherapeutic drug monitoring
Clinical takeawayMinimize corticosteroid duration in IBD, especially in children, and weigh infection risk when considering steroid use in high-risk patients (e.g., prior infections, comorbidities).
What it foundIBD patients on corticosteroids had 3.6-10.2 more serious infections per 100 person-years vs non-users (aHR 4.52-15.86), with highest risk in children and dose-dependent effects.
ContextConfirms and quantifies the known infection risk from corticosteroids in IBD, now with precise estimates across therapies and age groups.
No standard claimed for this paper
Every paper is compared to the standard governing its question. This one is not: either no standard in the corpus matches it, or the comparison did not hold up on review and was withdrawn rather than published unverified. Both are logged.
Forss A … Olén O · Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association · IF 16.2 · PubMed ↗Permalink
IBDprospective cohort · n=462 · Aug 27, 2026 · Clin Gastro Hep · IF 16.2
New evidenceCrohn's diseasebiologicsustekinumabhealth services
Clinical takeawayConsider switching clinically stable Crohn's disease patients on ustekinumab to biosimilars when procurement-driven, as effectiveness and safety appear comparable at 6 months.
What it foundSwitching to ustekinumab biosimilars in Crohn's disease patients in remission showed 92.2% expanded clinical success vs 92.7% with continued reference treatment (risk difference -0.5%, 95% CI -5.9 to 4.9), meeting noninferiority within a 15% margin.
ContextConfirms biosimilar noninferiority in a real-world setting, addressing a gap in controlled evidence for ustekinumab biosimilar switching in Crohn's disease.
Reinforcessuggested applicable standard· American College of Gastroenterology, 'ACG Clinical Guideline: Management of Crohn’s Disease in Adults' (Lichtenstein GR, Loftus EV, Afzali A, et al., Am J Gastroenterol 2025;120(6):1225-1264). DOI 10.14309/ajg.0000000000003465, PMID 40701562.ShowHide
Decision at stakethe use of ustekinumab for induction and maintenance in Crohn's disease
…MILD-TO-MODERATE / LOWER PROGRESSION RISK: Recommend AGAINST oral mesalamine for induction or maintenance (strong, moderate); sulfasalazine should be considered ONLY for symptomatic mild COLONIC CD (key concept). Controlled ileal-release budesonide 9 mg daily for induction of symptomatic remission in mildly-to-moderately active ileocecal CD (strong, moderate), but recommend AGAINST ileal-release budesonide for MAINTENANCE (strong, low).…PERIANAL FISTULIZING: infliximab for induction (strong, moderate); adalimumab (conditional, low); antibiotics added to infliximab or adalimumab (conditional, very low); vedolizumab, ustekinumab, upadacitinib each (conditional, VERY LOW). Drain perianal abscesses and place setons before escalating advanced therapy (key concept).…
From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text. The rest of this standard includes DIAGNOSIS, POST-OPERATIVE, SURGERY/ABSCESS and 2 more.
Our full summary of this standardShowHide
DIAGNOSIS: Use fecal calprotectin (cutoff >50-100 μg/g) to differentiate inflammatory from noninflammatory disease OF THE COLON (strong, moderate). Ileocolonoscopy with biopsies for suspected CD; biopsy uninvolved mucosa to define histologic extent; small bowel imaging is part of the initial workup (key concepts, ungraded). CT enterography is comparable to MR enterography for small bowel detection; MRE should be used PREFERENTIALLY in patients younger than 35 years and where serial examinations are likely, because of radiation avoidance, MRE is not a blanket first choice. Intestinal ultrasound is a radiation-free ADJUNCT to diagnosis and to monitoring treatment response (key concept, ungraded, not a graded recommendation). Perform routine endoscopic CRC surveillance in Crohn's colitis (strong, moderate). MILD-TO-MODERATE / LOWER PROGRESSION RISK: Recommend AGAINST oral mesalamine for induction or maintenance (strong, moderate); sulfasalazine should be considered ONLY for symptomatic mild COLONIC CD (key concept). Controlled ileal-release budesonide 9 mg daily for induction of symptomatic remission in mildly-to-moderately active ileocecal CD (strong, moderate), but recommend AGAINST ileal-release budesonide for MAINTENANCE (strong, low). MODERATE-TO-SEVERE / HIGHER RISK: SUGGEST AGAINST requiring failure of conventional therapy before initiating advanced therapy (conditional, LOW, a permission to skip step-up, not a mandate to start advanced therapy upfront). Oral corticosteroids for short-term induction only (strong, low). Recommend AGAINST azathioprine 1.5-2.5 mg/kg/d and 6-mercaptopurine 0.75-1.5 mg/kg/d for INDUCTION (strong, moderate), but SUGGEST the same agents and doses for MAINTENANCE after corticosteroid-induced remission (conditional, low). Check TPMT before starting azathioprine/6-MP (strong, low); measure NUDT15 variants in patients of East Asian ancestry and TPMT variants in all patients prior to thiopurine initiation (strong, moderate). Methotrexate up to 25 mg weekly IM/SC for maintenance after corticosteroid induction (conditional, low). Anti-TNF agents (IV infliximab, SC adalimumab, SC certolizumab pegol) for induction and maintenance (strong, moderate). Recommend COMBINATION IV infliximab + thiopurine over either agent alone in patients naive to both (strong, moderate). Vedolizumab IV for induction and maintenance of symptomatic remission (strong, moderate). Ustekinumab (strong, moderate); risankizumab (strong, moderate), and risankizumab over ustekinumab in prior anti-TNF exposure (conditional, low); mirikizumab (strong, moderate); guselkumab IV-then-SC or all-SC (strong, moderate). Upadacitinib for induction and maintenance in patients PREVIOUSLY EXPOSED TO ANTI-TNF (strong, moderate), the ACG does not endorse it as a first-line biologic-naive option. SC infliximab and SC vedolizumab are maintenance options in responders to IV induction (strong, moderate). PERIANAL FISTULIZING: infliximab for induction (strong, moderate); adalimumab (conditional, low); antibiotics added to infliximab or adalimumab (conditional, very low); vedolizumab, ustekinumab, upadacitinib each (conditional, VERY LOW). Drain perianal abscesses and place setons before escalating advanced therapy (key concept). POST-OPERATIVE: endoscopic assessment at 6-12 months after surgically induced remission over no monitoring (conditional, moderate); in LOW post-op recurrence risk, continued observation rather than immediate medical therapy (conditional, very low); imidazole antibiotics (metronidazole) 1-2 g/d after small intestinal resection (conditional, low); in HIGH-risk CD, anti-TNF to prevent endoscopic recurrence (STRONG, moderate) and vedolizumab (CONDITIONAL, low), these two are not co-equal. SURGERY/ABSCESS: intra-abdominal abscess >2 cm should be treated with antibiotics plus a drainage procedure, and immunosuppression HELD until drainage is achieved (conditional, low). DISEASE MODIFIERS: counsel active smokers to quit; use NSAIDs with caution; assess stress, depression and anxiety as part of comprehensive care (key concepts).
Ribaldone DG … Caviglia GP · Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association · IF 16.2 · PubMed ↗Permalink
IBDprospective cohort · n=82 · Aug 24, 2026 · Dig Liver Dis · IF 4.2
Clinical takeawayScreen fertile young IBD patients (age 18-53) with dyspareunia or heavy menstrual bleeding (HMB) for endometriosis using transvaginal ultrasonography (TVUS), considering the potential limitations and patient discomfort associated with the procedure.
What it foundDyspareunia and heavy menstrual bleeding (HMB) were independent risk factors for endometriosis in IBD patients (OR 4.7 [1.6-13.9] and 4.3 [1.4-12.9], respectively).
ContextEndometriosis, particularly deep infiltrating endometriosis (DIE), is highly underestimated in IBD. This study identifies dyspareunia and HMB as specific symptoms (OR 4.7 [1.6-13.9] and 4.3 [1.4-12.9], respectively) to prompt screening in fertile young IBD patients.
Emergingsuggested applicable standard· ACG Clinical Guideline Update: Ulcerative Colitis in Adults, Am J Gastroenterol 2025;120(6):1187-1224; AGA Living Guideline on Pharmacological Management of Moderate-to-Severe UC, Gastroenterology 2024 (panel review March 2026, no changes)ShowHide
Decision at stakeidentifying endometriosis in IBD patients
No single passage of this standard matched the paper closely enough to quote, so none is shown. The standard is cited above.
Our full summary of this standardShowHide
Confirm ulcerative colitis with endoscopy showing continuous colonic inflammation from the rectum plus histology, after excluding infection with two-step CDI testing. Treat mild-moderate disease with 5-ASA by route and extent (suppository for proctitis, enema for left-sided, oral plus rectal for extensive); if 5-ASA fails, treat as moderate-to-severe rather than stepping up gradually. Position advanced therapy by EFFICACY TIER, not by an anti-TNF-first rule. Advanced-therapy-naive, higher efficacy: infliximab, vedolizumab, ozanimod, etrasimod, upadacitinib, risankizumab, guselkumab; intermediate: golimumab, ustekinumab, tofacitinib, filgotinib, mirikizumab; lower: adalimumab. PREVIOUSLY TNF-EXPOSED, higher efficacy: tofacitinib, upadacitinib, ustekinumab; lower: adalimumab, vedolizumab, ozanimod, etrasimod - S1P modulators are weakest in exactly this group. Do not cycle within the anti-TNF class after primary non-response; switch mechanism. Apply treat-to-target (STRIDE-II) to endoscopic improvement (MES 0-1). Screen for acute severe UC by Truelove-Witts and admit for IV steroids. Begin CRC surveillance 8-10 years after DIAGNOSIS for extensive or left-sided disease; isolated proctitis follows average-risk screening.
Neri B … Biancone L · Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver · IF 4.2 · PubMed ↗Permalink
IBDretrospective · n=6,593 · Aug 27, 2026 · Dig Liver Dis · IF 4.2
New evidenceCrohn's diseaseperianal diseaseIBD surgeryepidemiology
Clinical takeawayConsider enhanced monitoring strategies for perianal disease progression in Crohn's patients, such as regular clinical assessments and imaging, as surgical intervention rates are rising despite biologics.
What it foundIntestinal surgery rates for Crohn's disease remained stable (5.9 vs 6.0/100,000 Austrians), while perianal surgeries rose from 5.0 to 7.5/100,000 (5.2% annual increase) from 2011-2019, despite increased use of biologics.
ContextConfirms stable intestinal resection rates but highlights a growing need for perianal disease management, contrasting with some prior reports of declining surgery rates with biologics.
Reinforcessuggested applicable standard· American College of Gastroenterology, 'ACG Clinical Guideline: Management of Crohn’s Disease in Adults' (Lichtenstein GR, Loftus EV, Afzali A, et al., Am J Gastroenterol 2025;120(6):1225-1264). DOI 10.14309/ajg.0000000000003465, PMID 40701562.ShowHide
Decision at stakethe need for advanced therapies in Crohn's disease
…PERIANAL FISTULIZING: infliximab for induction (strong, moderate); adalimumab (conditional, low); antibiotics added to infliximab or adalimumab (conditional, very low); vedolizumab, ustekinumab, upadacitinib each (conditional, VERY LOW). Drain perianal abscesses and place setons before escalating advanced therapy (key concept).…
From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text. The rest of this standard includes DIAGNOSIS, POST-OPERATIVE, SURGERY/ABSCESS and 3 more.
Our full summary of this standardShowHide
DIAGNOSIS: Use fecal calprotectin (cutoff >50-100 μg/g) to differentiate inflammatory from noninflammatory disease OF THE COLON (strong, moderate). Ileocolonoscopy with biopsies for suspected CD; biopsy uninvolved mucosa to define histologic extent; small bowel imaging is part of the initial workup (key concepts, ungraded). CT enterography is comparable to MR enterography for small bowel detection; MRE should be used PREFERENTIALLY in patients younger than 35 years and where serial examinations are likely, because of radiation avoidance, MRE is not a blanket first choice. Intestinal ultrasound is a radiation-free ADJUNCT to diagnosis and to monitoring treatment response (key concept, ungraded, not a graded recommendation). Perform routine endoscopic CRC surveillance in Crohn's colitis (strong, moderate). MILD-TO-MODERATE / LOWER PROGRESSION RISK: Recommend AGAINST oral mesalamine for induction or maintenance (strong, moderate); sulfasalazine should be considered ONLY for symptomatic mild COLONIC CD (key concept). Controlled ileal-release budesonide 9 mg daily for induction of symptomatic remission in mildly-to-moderately active ileocecal CD (strong, moderate), but recommend AGAINST ileal-release budesonide for MAINTENANCE (strong, low). MODERATE-TO-SEVERE / HIGHER RISK: SUGGEST AGAINST requiring failure of conventional therapy before initiating advanced therapy (conditional, LOW, a permission to skip step-up, not a mandate to start advanced therapy upfront). Oral corticosteroids for short-term induction only (strong, low). Recommend AGAINST azathioprine 1.5-2.5 mg/kg/d and 6-mercaptopurine 0.75-1.5 mg/kg/d for INDUCTION (strong, moderate), but SUGGEST the same agents and doses for MAINTENANCE after corticosteroid-induced remission (conditional, low). Check TPMT before starting azathioprine/6-MP (strong, low); measure NUDT15 variants in patients of East Asian ancestry and TPMT variants in all patients prior to thiopurine initiation (strong, moderate). Methotrexate up to 25 mg weekly IM/SC for maintenance after corticosteroid induction (conditional, low). Anti-TNF agents (IV infliximab, SC adalimumab, SC certolizumab pegol) for induction and maintenance (strong, moderate). Recommend COMBINATION IV infliximab + thiopurine over either agent alone in patients naive to both (strong, moderate). Vedolizumab IV for induction and maintenance of symptomatic remission (strong, moderate). Ustekinumab (strong, moderate); risankizumab (strong, moderate), and risankizumab over ustekinumab in prior anti-TNF exposure (conditional, low); mirikizumab (strong, moderate); guselkumab IV-then-SC or all-SC (strong, moderate). Upadacitinib for induction and maintenance in patients PREVIOUSLY EXPOSED TO ANTI-TNF (strong, moderate), the ACG does not endorse it as a first-line biologic-naive option. SC infliximab and SC vedolizumab are maintenance options in responders to IV induction (strong, moderate). PERIANAL FISTULIZING: infliximab for induction (strong, moderate); adalimumab (conditional, low); antibiotics added to infliximab or adalimumab (conditional, very low); vedolizumab, ustekinumab, upadacitinib each (conditional, VERY LOW). Drain perianal abscesses and place setons before escalating advanced therapy (key concept). POST-OPERATIVE: endoscopic assessment at 6-12 months after surgically induced remission over no monitoring (conditional, moderate); in LOW post-op recurrence risk, continued observation rather than immediate medical therapy (conditional, very low); imidazole antibiotics (metronidazole) 1-2 g/d after small intestinal resection (conditional, low); in HIGH-risk CD, anti-TNF to prevent endoscopic recurrence (STRONG, moderate) and vedolizumab (CONDITIONAL, low), these two are not co-equal. SURGERY/ABSCESS: intra-abdominal abscess >2 cm should be treated with antibiotics plus a drainage procedure, and immunosuppression HELD until drainage is achieved (conditional, low). DISEASE MODIFIERS: counsel active smokers to quit; use NSAIDs with caution; assess stress, depression and anxiety as part of comprehensive care (key concepts).
Wisniowski K … Austrian IBD Study Group (ATISG) · Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver · IF 4.2 · PubMed ↗Permalink
IBDreview · Aug 27, 2026 · Inflamm Bowel Dis · IF 4.5
New therapybiologicsCrohn's diseaseulcerative colitisbasic science
Clinical takeawayNo clinical action yet: phase 3 trials are ongoing, and these therapies are not yet approved for use in IBD.
What it foundPhase 2 trials of anti-TL1A monoclonal antibodies (tulisokibart, afimkibart, duvakitug) achieved clinical remission rates of 26%-48% in ulcerative colitis (placebo-adjusted differences 15-26 percentage points) and endoscopic response rates of 26%-48% in Crohn's disease.
ContextThis review highlights emerging evidence for TL1A inhibitors as a novel therapeutic class targeting both inflammation and fibrosis in IBD, with phase 3 results expected in 2026-2027.
No standard claimed for this paper
Every paper is compared to the standard governing its question. This one is not: either no standard in the corpus matches it, or the comparison did not hold up on review and was withdrawn rather than published unverified. Both are logged.
Quraishi MN … Al-Bawardy B · Inflammatory Bowel Diseases · IF 4.5 · PubMed ↗Permalink
IBDprospective cohort · n=8,273 · Aug 27, 2026 · Inflamm Bowel Dis · IF 4.5
Clinical takeawayNo direct clinical action yet: this is an epidemiological study highlighting disparities in trial representation. Consider advocating for diversity action plans in trial design.
What it foundFemale participants were underrepresented in pediatric IBD trials (EIR 0.91, 95% CI 0.87-0.95), most markedly in CD trials (EIR 0.82, 95% CI 0.78-0.88). Black (EIR 0.55, 95% CI 0.42-0.71) and Hispanic (EIR 0.46, 95% CI 0.28-0.76) participants were underrepresented, while Asian/Pacific Islander participants were overrepresented (EIR 1.78, 95% CI 1.37-2.30).
ContextThis study confirms and quantifies known disparities in pediatric IBD trial representation, showing persistent underrepresentation of female, Black, and Hispanic children relative to disease burden.
Emergingsuggested applicable standard· American College of Gastroenterology, 'ACG Clinical Guideline: Management of Crohn’s Disease in Adults' (Lichtenstein GR, Loftus EV, Afzali A, et al., Am J Gastroenterol 2025;120(6):1225-1264). DOI 10.14309/ajg.0000000000003465, PMID 40701562.ShowHide
Decision at stakeensuring equitable therapeutic benefit in pediatric IBD trials
No single passage of this standard matched the paper closely enough to quote, so none is shown. The standard is cited above.
Our full summary of this standardShowHide
DIAGNOSIS: Use fecal calprotectin (cutoff >50-100 μg/g) to differentiate inflammatory from noninflammatory disease OF THE COLON (strong, moderate). Ileocolonoscopy with biopsies for suspected CD; biopsy uninvolved mucosa to define histologic extent; small bowel imaging is part of the initial workup (key concepts, ungraded). CT enterography is comparable to MR enterography for small bowel detection; MRE should be used PREFERENTIALLY in patients younger than 35 years and where serial examinations are likely, because of radiation avoidance, MRE is not a blanket first choice. Intestinal ultrasound is a radiation-free ADJUNCT to diagnosis and to monitoring treatment response (key concept, ungraded, not a graded recommendation). Perform routine endoscopic CRC surveillance in Crohn's colitis (strong, moderate). MILD-TO-MODERATE / LOWER PROGRESSION RISK: Recommend AGAINST oral mesalamine for induction or maintenance (strong, moderate); sulfasalazine should be considered ONLY for symptomatic mild COLONIC CD (key concept). Controlled ileal-release budesonide 9 mg daily for induction of symptomatic remission in mildly-to-moderately active ileocecal CD (strong, moderate), but recommend AGAINST ileal-release budesonide for MAINTENANCE (strong, low). MODERATE-TO-SEVERE / HIGHER RISK: SUGGEST AGAINST requiring failure of conventional therapy before initiating advanced therapy (conditional, LOW, a permission to skip step-up, not a mandate to start advanced therapy upfront). Oral corticosteroids for short-term induction only (strong, low). Recommend AGAINST azathioprine 1.5-2.5 mg/kg/d and 6-mercaptopurine 0.75-1.5 mg/kg/d for INDUCTION (strong, moderate), but SUGGEST the same agents and doses for MAINTENANCE after corticosteroid-induced remission (conditional, low). Check TPMT before starting azathioprine/6-MP (strong, low); measure NUDT15 variants in patients of East Asian ancestry and TPMT variants in all patients prior to thiopurine initiation (strong, moderate). Methotrexate up to 25 mg weekly IM/SC for maintenance after corticosteroid induction (conditional, low). Anti-TNF agents (IV infliximab, SC adalimumab, SC certolizumab pegol) for induction and maintenance (strong, moderate). Recommend COMBINATION IV infliximab + thiopurine over either agent alone in patients naive to both (strong, moderate). Vedolizumab IV for induction and maintenance of symptomatic remission (strong, moderate). Ustekinumab (strong, moderate); risankizumab (strong, moderate), and risankizumab over ustekinumab in prior anti-TNF exposure (conditional, low); mirikizumab (strong, moderate); guselkumab IV-then-SC or all-SC (strong, moderate). Upadacitinib for induction and maintenance in patients PREVIOUSLY EXPOSED TO ANTI-TNF (strong, moderate), the ACG does not endorse it as a first-line biologic-naive option. SC infliximab and SC vedolizumab are maintenance options in responders to IV induction (strong, moderate). PERIANAL FISTULIZING: infliximab for induction (strong, moderate); adalimumab (conditional, low); antibiotics added to infliximab or adalimumab (conditional, very low); vedolizumab, ustekinumab, upadacitinib each (conditional, VERY LOW). Drain perianal abscesses and place setons before escalating advanced therapy (key concept). POST-OPERATIVE: endoscopic assessment at 6-12 months after surgically induced remission over no monitoring (conditional, moderate); in LOW post-op recurrence risk, continued observation rather than immediate medical therapy (conditional, very low); imidazole antibiotics (metronidazole) 1-2 g/d after small intestinal resection (conditional, low); in HIGH-risk CD, anti-TNF to prevent endoscopic recurrence (STRONG, moderate) and vedolizumab (CONDITIONAL, low), these two are not co-equal. SURGERY/ABSCESS: intra-abdominal abscess >2 cm should be treated with antibiotics plus a drainage procedure, and immunosuppression HELD until drainage is achieved (conditional, low). DISEASE MODIFIERS: counsel active smokers to quit; use NSAIDs with caution; assess stress, depression and anxiety as part of comprehensive care (key concepts).