Case Based Discussions - Hot takes in Crohn's disease

Session Summary:
Panelists debated three Crohn’s scenarios: uncomplicated ileal disease (many favor IL-23 first line), complicated structuring/penetrating ileal disease (multidisciplinary care with imaging, surgery planning, and anti-TNF—often combo—therapy), and obstructive Crohn’s in pregnancy (nutrition optimization, switch to anti-TNF, close monitoring, surgical readiness).

Moderator:
Vipul Jairath, MD

Panelists:
Charles Bernstein, MD
Prof, Peter Irving, MD
Millie Long, MD
Cathy Lu, MD

Anti TNF in 2025: In whom do I use them and in whom do I not

Session Summary:
Dr. Millie Long reviewes when to use anti-TNFs in UC and Crohn’s, emphasizing imperfect durability and immunogenicity management (combination therapy, TDM, selective HLA-DQA105 testing), key safety counseling (infection/malignancy/CHF), and phenotypes where TNFs remain preferred (EIMs, perianal, post-op, acute severe UC).

Millie Long, MD
University of North Carolina at Chapple Hill, North Carolina, USA

Anti-integrin/trafficking agents in 2025: In whom do I use them and in whom do I not

Session Summary:
Dr. Brian Fagan expores anti-integrin therapy in IBD, structured as a “top 10 reasons to stay with vedolizumab,” focusing on real-world positioning and evidence across efficacy (UC and Crohn’s, including small bowel), extraintestinal manifestations, safety, and additional use cases such as pouchitis, postoperative recurrence, graft-versus-host disease, and checkpoint inhibitor colitis, with brief commentary on treat-to-target endpoints and the limits of network meta-analyses.

Brian Feagan, MD
Western University, London, ON

Anti-interleukins in 2025: In whom do I use them and in whom do I not

Session Summary:
Dr. Matthieu Allex reviews ustekinumab and IL-23 p19 inhibitors in IBD—mechanisms, trial efficacy (including emerging head-to-heads), and strong safety—highlighting practical dosing/administration differences and patient-selection factors (phenotype, comorbidities, preferences), and noted future combination and predictive-response strategies.

Matthieu Allez, MD
McGill University Health Center, Montreal, QC

JAK Inhibitors in 2025: In whom do I use them and in whom do I not

Session Summary:
Dr. Brian Bressler explains how JAK inhibitors—especially upadacitinib—fit wherever anti-TNFs are used, offering rapid symptom control, utility across IMID comorbidities and fistulizing disease, and potential roles in acute severe UC (including rescue/sequential strategies), with emerging real-world/Canadian data suggesting manageable safety and strong efficacy.

Brian Bressler, MD

University of British Columbia, Vancouver, BC

Session 1 - Panel discussion and Q&A

Session Summary:
In a rapid Q&A, faculty debated vedolizumab for microscopic colitis, regional healing differences, JAK-inhibitor acne and peri-anal antibiotic strategies, JAK use post-surgery and CV risk, how to interpret non-neutralizing antibodies, and broader controversies around ORAL trial signals, immunogenicity, and reactive (not proactive) drug-level monitoring.

Putting it all together - How I select Advanced Treatments in 2025

Session Summary:
Prof. Peter Irving, MD argues IBD drug selection is a maze driven as much by cost, access, capacity, and clinician/patient factors as efficacy, cautioning that network meta-analyses are often misused, highlighting sequencing effects and real-world data, and showing how pragmatic constraints can override trial “best drug” conclusions.

Prof. Peter Irving, MD
Guy's and St.Thomas Hospital, King's College, London, UK

My Approach to Managing Pouchitits

Summary:
Dr. Waqqas Afif provides a practical, guideline-informed approach to pouchitis after ileal pouch–anal anastomosis (J-pouch), covering epidemiology, risk factors, clinical presentation and assessment, and stepwise management—from antibiotics and selective probiotics to steroids and biologic/small-molecule therapy for chronic or Crohn’s-like disease of the pouch.

Waqqas Afif, MD
McGill University, Montreal, QC

Prevention of postoperative recurrence

Session Summary:
Dr. Cathy Lu outlines postoperative recurrence prevention in Crohn’s/UC: risk-stratify (any high-risk factor → prophylaxis), start therapy ~4 weeks post-op, monitor with fecal calprotectin (150 at 3 months) and ileocolonoscopy (6–12 months), use RCT-supported anti-TNF/vedolizumab strategies, and treat pouchitis without antibiotic prophylaxis.

Cathy Lu, MD
University of Calgary, Calgary, AB

Session 2 - Panel discussion and Q&A

Session Summary:
Faculty discuss post-op Crohn’s surveillance (incl. capsule endoscopy), pouchitis sequencing after vedolizumab and practical probiotics, skepticism about biomarker-driven therapy, cost vs evidence in treatment choice, and wide variation in post-op prophylaxis and pouch management (Crohn’s of the pouch, dual biologics, treat-to-target, biopsy and prep practices).

Case Based Discussions: Hot takes in ulcerative colitis

Session Summary:
Panelists discuss ulcerative colitis management across scenarios—mild proctitis on 5-ASA, loss of response on ustekinumab, acute severe UC despite adalimumab, and pregnancy on a JAK inhibitor—debating topical escalation, steroid use, monitoring (colonoscopy vs ultrasound), switching mechanisms, infliximab dosing, and colectomy risk.

Moderator:
Nauzer Forbes, MD

Panelists:
Brian Bressler, MD
Brit Christiansen, MD
Prof. Perter Irving, MD
Millie Long, MD
Kerri Novak, MD

Managing Fatigue in IBD

Session Summary:
Dr. Millie Long explains why fatigue is common in IBD and outlines a practical, stepwise approach to assess and manage it (inflammation, meds, anemia/nutrient deficiencies, sleep/psych factors, diet, and exercise).

Millie Long, MD
University of North Carolina at Chapple Hill, North Carolina, USA

Managing depression in IBD

Session Summary:
In this talk, Dr. Laura Targownik explores how anxiety and depression are common and often missed in IBD, worsening symptoms and driving healthcare use independent of inflammation, and—while brief tools (PHQ-2/9, GAD-7) can flag risk—evidence for durable benefit from interventions is mixed, so targeted screening, education, and scalable empathic support are practical next steps.

Laura Targownik, MD
Mount Sinai Hospital, University of Toronto, Toronto, ON

Managing strictures in Crohn's disease

Session Summary:
Dr. Kerri Novak provides a practical update on Crohn’s strictures: definitions, why symptoms/biomarkers can’t reliably track fibrosis, and why cross-sectional imaging (esp. intestinal ultrasound/MR/CT) is essential to distinguish “hot” inflammatory vs “cold” fibrotic disease, guide therapy, balloon dilation, or surgery, and address major unmet needs in antifibrotic treatment.

Kerri Novak, MD
University of Calgary, Calgary, AB

Endoscopic surveillance in IBD: A view from across the pond

Session Summary:
Prof. Peter Irving, MD delivers a pragmatic “across-the-pond” review of IBD colonoscopic surveillance, focusing on colorectal cancer risk, guideline-based risk stratification and intervals, and practical ways to improve dysplasia detection (chromo vs virtual chromo, targeted vs random biopsies, technique/quality factors, and referral pathways) in real-world practice.

Prof. Peter Irving, MD
Guy's and St.Thomas Hospital, King's College, London UK

Acute severe colitis

Session Summary:
Dr. Charles Bernstein provides an experience-based review of inpatient acute severe ulcerative colitis management—early endoscopic assessment and infection workup, IV steroids, and using albumin/CRP to guide prognosis and escalation—comparing infliximab vs cyclosporine, dosing strategies/drug levels, and emerging JAK rescue options while balancing colectomy risk.

Charles Bernstein, MD
University of Calgary, Calgary, AB

Session 4 - Panel discussion and Q&A

Session Summary:

During this live Q&A panel discussion the faculty tackle practical IBD management and surveillance questions—especially using ultrasound to guide treatment vs surgery for Crohn’s strictures, salvage options in acute severe ulcerative colitis, and how to handle dysplasia/pseudopolyps and asymptomatic anastomotic strictures during endoscopic surveillance.