Case 1: Early Control in High-Risk UC

Talat Bessissow, MD

McGill University Health Center, Montreal, QC

Summary:

Dr. Bessissow delivers a practical, case-based walk-through of a newly diagnosed, bio-naïve ulcerative colitis patient with severe pancolitis (Mayo 3). The discussion focuses on what defines “high-risk” disease (extent, ulceration, anemia, low albumin, elevated CRP), when to escalate beyond steroids/5-ASA, and how treat-to-target monitoring should unfold from 8–12 weeks through 6–12 months—culminating in why endoscopic healing matters.

Case 2: Top-Down at Diagnosis and the Late Stricture Curveball ​

Brian Bressler, MD

University of British Columbia, Vancouver, BC

Summary:

Dr. Bressler leads a case-based discussion in ulcerative colitis highlighting:

1. Why disease extension signals a higher-risk “progressive” course that warrants earlier optimization of advanced therapy.

2. Why ongoing symptoms (especially urgency) can persist despite endoscopic remission due to structural/functional bowel damage—shaping how to assess targets and manage patients over time.

Q & A Session

Summary:

The Q&A digs into an emerging nuance in ulcerative colitis: even if inflammation remains treatable later, prolonged disease may leave persistent functional symptoms that are harder to reverse. The speakers explore whether tools like intestinal ultrasound can capture subtle fibrosis, then pivot to a real-world barrier—how to secure early advanced therapy for high-risk patients—and what advocacy lessons Quebec offers for shifting payer policy.