Trending Topics in Gastroenterology | GastroAGI

Inpatient IBD Care: Practical Guidance From the AGA- Gastroenterology Feb.26

Introduction Despite major advances in outpatient therapies, hospitalisation for inflammatory bowel disease (IBD) remains common and challenging. Outcomes vary widely, with persistent problems such as: hospital-acquired complications, delays in appropriate surgery, and high 30-day readmission rates. To reduce this variability and improve outcomes, the American Gastroenterological Association (AGA) released this Clinical Practice Update to provide clear, pragmatic Best Practice Advice for the inpatient management of adults with ulcerative colitis (UC) and Crohn’s disease (CD). What this document is (and is not) This is an expert review, not a formal guideline. Recommendations are based on best available evidence plus expert consensus. The focus is on real-world inpatient decision-making, not exhaustive literature grading. Core principles that shape inpatient IBD care 1️⃣ Admit early when risk is high Hospitalization should be considered for patients with: severe disease refractory to outpatient therapy, suspected complications (obstruction, abscess, perforation), or significant malnutrition, anemia, or failure to thrive. The modern inpatient population increasingly includes patients failing multiple advanced therapies, not just classic fulminant presentations. 2️⃣ Start with supportive care—but do it well All hospitalised IBD patients should receive: IV fluids and electrolyte correction, anaemia and nutrition assessment (early dietitian involvement), careful pain control (avoid routine opioids), screening for vitamin and iron deficiency. Supportive care is not ancillary—it directly affects outcomes. 3️⃣ Always rule out infection and complications Symptoms in hospitalised IBD patients are frequently driven by: C. difficile, CMV colitis, or structural complications. Early stool testing, cross-sectional imaging when indicated, and targeted endoscopy are essential to avoid inappropriate escalation of immunosuppression. 4️⃣ Use objective disease assessment CRP is emphasised as a real-time inflammatory marker guiding decisions. Endoscopic evaluation (often flexible sigmoidoscopy) should be performed early when feasible, both to assess severity and to obtain biopsies for CMV. Faecal calprotectin may help, but is often delayed in the inpatient setting. 5️⃣ Prevent what is preventable: VTE prophylaxis Hospitalised IBD patients have a markedly increased risk of venous thromboembolism. 👉 All hospitalised IBD patients without contraindications should receive pharmacologic VTE prophylaxis, even in the presence of active bleeding. Disease-specific highlights Acute Severe Ulcerative Colitis (ASUC) IV corticosteroids remain first-line therapy. Response must be assessed within 72 hours using stool frequency and CRP trends. Nonresponse requires early preparation for rescue therapy (infliximab, cyclosporine, or JAK inhibitors) and early surgical consultation. Continuing IV steroids beyond 7 days without response offers no benefit and increases harm. Crohn’s Disease–Related Complications Obstruction: If inflammatory → trial IV steroids. If fibrotic or complicated → surgery. Intra-abdominal abscess: Drainage (when feasible) + antibiotics first. Immunosuppression only after source control. Perianal disease: Requires a multidisciplinary medical–surgical approach from the outset. 6️⃣ Plan discharge early—and deliberately Safe discharge requires: clinical stability (not necessarily normal labs), a clear steroid taper or induction plan, coordination with outpatient providers, and addressing barriers such as insurance approval, transportation, and infusion scheduling. Poor discharge planning is a major driver of readmissions. Why this update matters This document reinforces a shift in inpatient IBD care: from reactive, prolonged hospitalisations to structured, time-bound decision-making with early reassessment, escalation, or surgery. It emphasises that delays—not disease severity alone—often drive poor outcomes. Bottom-line takeaway: High-quality inpatient IBD care depends on early objective assessment, proactive complication management, timely escalation or surgery, and meticulous discharge planning. This AGA update provides a practical roadmap for achieving that consistently. One-line GastroAGI takeaway: In inpatient IBD care, timing and coordination matter as much as therapy choice.

From Treatment to Prevention in IBD - Gastroenterology Feb.26

Introduction Inflammatory bowel disease (IBD) is no longer a condition confined to Western countries. With globalisation, urbanisation, and changing environmental exposures, IBD incidence is rising worldwide, while prevalence in industrialised nations continues to compound. If current trends persist, IBD prevalence may exceed 1% of the population in several countries within the next decade. This consensus-driven paper argues that even modest reductions in incidence could meaningfully reverse long-term prevalence, and that the time has come to shift the IBD paradigm—from reacting to established disease to predicting and preventing it. Why prevention is now realistic Accumulating evidence shows that Crohn’s disease (CD) has a long preclinical phase, marked by: immune activation, gut barrier dysfunction, microbiome alterations, and circulating biomarkers are detectable years before symptoms. These insights mirror earlier breakthroughs in type 1 diabetes, where defining preclinical stages enabled the first approved preventive therapy. The authors argue that IBD is now at a similar inflexion point. The role of the PROMISE Consortium To accelerate progress, PROMISE integrates: prospective cohorts of asymptomatic first-degree relatives (FDRs), large prediagnostic biobanks, and multiomics platforms (genomics, proteomics, microbiome, immune profiling). The goal is not a single biomarker, but integrated risk models that identify individuals most likely to progress to clinical disease—creating a rational entry point for prevention trials. Key challenges that must be solved The workshop identified several critical gaps: 1) Low positive predictive value (PPV) Even strong biomarkers struggle with PPV because IBD prevalence is low. Defining what level of risk justifies intervention—ethically and clinically—remains unresolved. 2) Lack of a preclinical staging system Unlike type 1 diabetes, IBD lacks clearly defined stages before diagnosis. Without staging, it is difficult to time interventions or define trial endpoints. 3) Biological heterogeneity Preclinical pathways may differ by phenotype (ileal vs colonic CD, complicated vs inflammatory disease), demanding phenotype-specific biomarkers. 4) Limited scalable screening tools Most current biomarkers are research-grade. Clinically deployable, reproducible, noninvasive assays are urgently needed. What patients and families think Importantly, patients and unaffected relatives are not resistant to prevention: Most are willing to undergo risk testing, especially blood- or stool-based. Lifestyle-based interventions (diet, exercise, smoking avoidance) are widely acceptable. Acceptance of drug-based prevention depends on perceived risk and benefit. This underscores the need for risk counselling, shared decision-making, and close partnership with patient advocacy groups. A prevention framework for IBD The authors outline a risk-based prevention strategy: Population-level (primordial prevention): Healthy diet, physical activity, smoking avoidance, and reduced antibiotic exposure. High-risk individuals (primary prevention): Targeted lifestyle and dietary interventions in FDRs or genetically susceptible individuals. Preclinical disease (secondary prevention): Trials testing whether immune- or microbiome-targeted therapies can delay or prevent disease onset. Several dietary, microbial, and biologic interception trials are already underway. Call to action The paper concludes with a strong, unified message: Prediction and prevention of IBD will not happen without global coordination. Priorities include: integrating preclinical cohorts worldwide, standardising biomarker platforms, establishing high-risk clinics, designing ethically sound prevention trials, and embedding patients and families at every stage. Bottom-line takeaway: IBD is no longer a disease we must wait to diagnose. With emerging biomarkers, longitudinal cohorts, and lessons from other immune-mediated diseases, prediction and prevention are now scientifically plausible. What’s needed next is coordinated investment, consensus, and courage to rethink how—and when—we intervene. One-line GastroAGI takeaway: The future of IBD care may begin years before symptoms—if we choose to act.

Nutrition management puzzle in IBD- Front. Med. 2026

### Nutritional Management in IBD: Current Insights 1. **Importance of Nutrition in IBD**: - Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is influenced by genetic, immunological, environmental, and gut microbiota factors. - Nutrition plays a critical role in managing IBD, not only to support remission and reduce inflammation but also to prevent complications like malnutrition, osteoporosis, and sarcopenia. 2. **Challenges in Nutritional Management**: - IBD patients often experience malnutrition due to inflammation, dietary restrictions, medication side effects, and rapid weight loss. - Vitamin and mineral deficiencies, particularly vitamin D, are common and can lead to complications such as impaired immune function and bone health issues. 3. **Dietary Interventions**: - **Low-FODMAP Diet**: Combining a low-FODMAP diet with enteral nutrition has been shown to reduce inflammation (e.g., C-reactive protein levels) and improve nutritional markers like albumin. - **IgG-Elimination Diet (IgG-ED)**: This diet has shown promising results in achieving endoscopic remission in IBD patients. - **Protein Intake**: Adequate protein intake is essential to prevent muscle loss and sarcopenia, which can lower the risk of surgical interventions. - **Vitamin D Supplementation**: Maintaining serum levels of 25-hydroxyvitamin D above 75 nmol/L is crucial. Aerosol forms of vitamin D may require lower doses compared to oral supplementation, offering a practical advantage. 4. **Nutritional Risk and Socioeconomic Factors**: - Malnutrition is prevalent in over one-third of IBD patients, with socioeconomic factors such as lower income contributing to higher disease activity. - Nutritional education, socioeconomic support, and regular monitoring of nutritional status are vital components of IBD management. 5. **Preventive and Therapeutic Role of Nutrition**: - Early implementation of enteral nutrition, anti-inflammatory diets, and personalized nutritional strategies can prevent disease progression and alleviate symptoms. - Addressing sarcopenia through dietary and physical interventions can reduce the risk of surgery in IBD patients. 6. **Tailored Nutrition**: - There is no universal diet for IBD, as different clinical goals (e.g., reducing inflammation, improving nutritional status, achieving remission) require individualised approaches. - Comprehensive and personalised nutritional care should be an integral part of IBD therapy.

The PIONIR Trial - Gut Jan. 2026

The PIONIR (Preventing IBD ONset in Individuals at Risk) trial, as described in the study published in *Gut*, January 2026, focuses on evaluating whether the Tasty&Healthy diet can reduce the risk of developing Crohn’s disease (CD) in first-degree relatives (FDRs) of CD patients. This trial is significant because FDRs are at a higher genetic and environmental risk of developing CD. The study also addresses the challenge of identifying the optimal preclinical stage of CD for enrolling participants in prevention trials. In the pre-PIONIR screening stage, faecal calprotectin, a biomarker of intestinal inflammation, was measured in asymptomatic FDRs aged 6–38 years. Of the 950 individuals approached, 331 (35%) participated in the screening. Persistent elevation of calprotectin (>70 µg/g in at least two tests) was observed in 63 individuals (19% of those screened). Further diagnostic evaluations (via panenteric video capsule-endoscopy or ileocolonoscopy) revealed that 9 individuals (2.7%) had endoscopic findings consistent with presymptomatic CD. Another 33 individuals (17.9% of those screened) were categorized as having "potential pre-CD" based on non-specific mucosal changes or histological inflammation. The study demonstrated that calprotectin levels >225 µg/g were highly predictive of presymptomatic CD, with an area under the receiver operating characteristic curve of 0.97, sensitivity of 89%, and specificity of 94%. Additionally, the findings underscored the variability in single calprotectin measurements, with 22% of cases normalizing upon repeat testing. In conclusion, the PIONIR trial highlights the utility of faecal calprotectin as a tool for identifying at-risk individuals and emphasizes the importance of early detection in designing preventive strategies for CD. The findings pave the way for future prevention trials targeting high-risk populations.

Biological and chronic pouchitis (AP&T) - Jan,2026

I am unable to provide information from the future (e.g., January 2026) as my training data only includes content up to October 2023. However, I can provide you with detailed insights into the role of biologics in chronic pouchitis based on current knowledge and the provided context. ### Chronic Pouchitis Overview: Chronic pouchitis is a persistent inflammation of the ileal pouch created during ileal pouch-anal anastomosis (IPAA) surgery, typically performed in patients with ulcerative colitis (UC) who require colectomy. While pouchitis is a common complication after IPAA, chronic pouchitis refers to cases that are resistant to conventional treatment, such as antibiotics, and require long-term management strategies. Chronic pouchitis can significantly impair a patient's quality of life and poses a therapeutic challenge due to its refractory nature. ### Role of Biologics in Chronic Pouchitis: Biological therapies have emerged as a critical option for managing chronic pouchitis, especially in cases where conventional therapies fail. Biologics target specific components of the immune system to reduce inflammation and improve symptoms. The two biologics discussed in the study you provided are **ustekinumab** and **vedolizumab**, both of which have distinct mechanisms of action. 1. **Ustekinumab**: - **Mechanism of Action**: Ustekinumab is a monoclonal antibody that targets interleukin (IL)-12 and IL-23, key cytokines involved in the inflammatory pathways of autoimmune diseases, including inflammatory bowel disease (IBD). - **Efficacy in Chronic Pouchitis**: According to the study, ustekinumab was associated with significantly lower relapse rates, a longer time to relapse, reduced hospitalization, and decreased need for steroids or antibiotics compared to vedolizumab. These findings suggest that ustekinumab may be more effective in controlling inflammation and maintaining remission in chronic pouchitis. 2. **Vedolizumab**: - **Mechanism of Action**: Vedolizumab is an integrin inhibitor that specifically targets the gut by blocking α4β7 integrin, which prevents lymphocyte trafficking to the intestinal mucosa. This gut-specific mechanism makes vedolizumab a preferred option for some IBD patients. - **Efficacy in Chronic Pouchitis**: While vedolizumab is effective for some patients, the study indicates that it may not be as effective as ustekinumab in reducing relapse rates and preventing hospitalizations in chronic pouchitis. However, no differences were observed in surgery rates or therapy switching between the two drugs. ### Summary of Findings: - Ustekinumab appears to offer advantages over vedolizumab in managing chronic pouchitis, with better outcomes in terms of relapse prevention, reduced hospitalizations, and decreased dependency on steroids or antibiotics. - Both biologics are valuable options, but patient-specific factors, including disease severity, prior treatment response, and comorbidities, should guide therapy selection. ### Future Directions: Research into biologics for chronic pouchitis is ongoing. Future studies may explore: - Long-term safety and efficacy of ustekinumab and vedolizumab. - Head-to-head comparisons with other biologics (e.g., anti-TNF agents like infliximab or adalimumab). - Biomarkers to predict response to biologic therapy. - Combination therapies or adjunctive treatments to enhance outcomes. If you have further questions or need clarification on specific aspects of biologics in chronic pouchitis, feel free to ask!

SHINE -1 - Mirikizumab in UC

The SHINE-1 trial was a multicentre, open-label, non-randomised phase 2 study designed to evaluate the efficacy, safety, and pharmacokinetics of mirikizumab in paediatric participants aged 2 to <18 years with moderately-to-severely active ulcerative colitis (UC). Mirikizumab is a humanised immunoglobulin G4 monoclonal antibody that targets the p19 subunit of IL-23, a cytokine implicated in inflammatory pathways. The study enrolled 26 participants from Canada, Israel, Japan, South Korea, and the USA who had inadequate response, loss of response, or intolerance to corticosteroids, immunomodulators, biologics, or JAK inhibitors. Participants received intravenous mirikizumab induction doses at weeks 0, 4, and 8, followed by subcutaneous maintenance doses for responders. At week 12, 69.2% of participants achieved clinical response by modified Mayo score (mMS), with 38.5% achieving clinical remission. By week 52, 53.8% maintained mMS-based clinical response, while 38.5% achieved clinical remission without corticosteroid use or UC-related surgery. Endoscopic remission, histologic-endoscopic mucosal improvement, and symptomatic remission were also observed. Mirikizumab demonstrated a favourable safety profile, with most adverse events being mild or moderate. Serious adverse events occurred in 12% of participants, with one leading to study discontinuation. These findings support further investigation of mirikizumab for paediatric UC treatment.

Etrasimod for the symptomatic relief of ulcerative colitis

Etrasimod is a novel oral medication approved for the treatment of moderately to severely active ulcerative colitis (UC). It is a selective sphingosine 1-phosphate (S1P) receptor modulator that targets S1P receptors 1, 4, and 5, which play a role in regulating immune cell migration and inflammation. By modulating these receptors, etrasimod helps reduce inflammation in the gastrointestinal tract, leading to symptomatic relief for patients with UC. ### Key Findings from the ELEVATE UC Clinical Programme: The efficacy of etrasimod for UC was evaluated in the phase III ELEVATE UC clinical trials, which included the ELEVATE UC 52 and ELEVATE UC 12 studies. These trials assessed the impact of etrasimod on key patient-reported symptoms, including stool frequency (SF), rectal bleeding (RB), bowel urgency, and abdominal pain. These symptoms are critical to address, as they significantly impair the quality of life and contribute to treatment dissatisfaction among UC patients. #### Study Design: - **Participants**: Adults with moderately to severely active UC. - **Treatment Groups**: Patients were randomized in a 2:1 ratio to receive either etrasimod 2 mg once daily or a placebo. - **Endpoints**: - **Symptomatic remission**: Normalization of RB and SF scores. - **Symptomatic response**: Significant improvement in RB and SF scores. - **Complete symptomatic remission**: Resolution of all symptoms, including bowel urgency and abdominal pain. #### Results: 1. **Rapid and Sustained Symptom Relief**: - Etrasimod provided significant improvements in symptoms compared to placebo as early as weeks 2 to 4. - Benefits were sustained through week 52, demonstrating the durability of its therapeutic effects. 2. **Improvement in Key Symptoms**: - Rapid reductions in rectal bleeding (RB) and stool frequency (SF) were observed in patients treated with etrasimod. - Clinically meaningful reductions in bowel urgency and abdominal pain were achieved, with higher rates of remission for these symptoms at weeks 12 and 52. 3. **Consistency Across Patient Subgroups**: - The benefits of etrasimod were observed regardless of baseline disease severity, prior exposure to biologics or JAK inhibitors, or corticosteroid use. - However, treatment-naïve patients (those who had not received prior biologic or advanced therapy) experienced more pronounced responses. 4. **Impact on Patient Well-Being**: - By addressing key symptoms like bowel urgency and abdominal pain, etrasimod significantly improved patient well-being and treatment satisfaction. ### Clinical Implications: Etrasimod represents a promising treatment option for UC patients due to its ability to provide rapid, durable, and clinically meaningful symptom relief. Its oral, once-daily administration is convenient for patients, and its efficacy in reducing debilitating symptoms such as bowel urgency, rectal bleeding, and abdominal pain can lead to improved quality of life. ### Summary: Etrasimod is a highly effective therapy for achieving symptomatic relief in patients with moderately to severely active ulcerative colitis. The results from the ELEVATE UC trials underscore its ability to deliver rapid and sustained improvements in key symptoms, making it a valuable addition to the therapeutic landscape for UC. Its consistent efficacy across diverse patient populations further supports its role in improving treatment outcomes and patient satisfaction.

Cardiovascular events observed among patients in the etrasimod clinical programme

The cardiovascular events observed among patients in the etrasimod clinical program were evaluated as part of an integrated safety analysis, focusing on treatment-emergent adverse events (TEAEs) associated with etrasimod. Here are the detailed findings: ### 1. **Bradycardia**: - Bradycardia (slower than normal heart rate) occurred more commonly in patients treated with etrasimod compared to placebo. - These events were generally mild or moderate in severity. - Bradycardia was most often observed on the first day of treatment initiation. - The events were transient and typically resolved without requiring medical intervention. - Serious conduction abnormalities related to bradycardia were rare. ### 2. **Atrioventricular (AV) Block**: - AV block (a type of heart block affecting electrical conduction between the heart's chambers) was also more frequent in the etrasimod group. - Similar to bradycardia, these events were mild or moderate, transient, and primarily occurred shortly after starting treatment. - Serious AV block events were rare. ### 3. **Hypertension**: - Hypertension-related events (elevated blood pressure) were slightly more common with etrasimod than with placebo. - These events were generally manageable and classified as non-serious. - Hypertension-related events did not lead to treatment discontinuation. ### 4. **Major Cardiovascular Events (CAD and CVD)**: - The analysis also monitored for major cardiovascular events such as coronary artery disease (CAD) and cerebrovascular disease (CVD). - The incidence rates of CAD and CVD were very low across all study cohorts, including both etrasimod-treated and placebo groups. ### Summary of Cardiovascular Safety: - Overall, cardiovascular-related TEAEs were infrequent in the etrasimod clinical program. - Most events were mild to moderate, transient, and resolved without intervention. - Serious cardiovascular events, including conduction abnormalities, were rare. - The results suggest that etrasimod has a favorable cardiovascular safety profile in patients with moderately to severely active ulcerative colitis. ### Conclusion: The study supports the continued use of etrasimod in this patient population, with appropriate clinical monitoring to manage cardiovascular risks, particularly during the initial stages of treatment.

QUOTIENT Trial: Treat-to-Target Endoscopic Remission in IBD on Advanced Therapies

The QUality Outcomes Treating IBD to Target (QUOTIENT) trial is a significant, pragmatic, open-label, multicentre randomised controlled study that addresses a critical question in the management of inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis. It focuses on the "treat-to-target" approach, specifically targeting endoscopic or radiological remission in patients who are already on advanced therapies. ### Objective: The trial investigates whether switching advanced therapies in asymptomatic patients with persistent subclinical inflammation (as seen on endoscopy or radiology) improves long-term outcomes. Persistent inflammation in these patients is linked to higher risks of disease relapse, complications, increased healthcare utilisation, and reduced quality of life. The study compares two treatment strategies: 1. **Continuing the current advanced therapy (index therapy).** 2. **Switching to an alternative advanced therapy.** The trial's overarching goal is to determine if switching therapies can help achieve endoscopic or radiological remission and improve patient outcomes in the long term, without adding harm or treatment burden. --- ### Study Design: - **Type of Study:** Pragmatic, open-label, multicentre randomised controlled trial. - **Participants:** Approximately 250 adult patients with Crohn’s disease or ulcerative colitis across the USA and Canada. - Inclusion criteria: Patients must be in corticosteroid-free symptomatic remission but have moderate-to-severe endoscopic or radiological inflammation. - **Randomisation:** Participants are randomised 1:1 to either continue their current advanced therapy or switch to an alternative advanced therapy. - **Duration:** Follow-up for 104 weeks in routine clinical practice. --- ### Primary Endpoint: The primary endpoint is **time to treatment failure**, which is a composite outcome including: - Symptomatic relapse requiring treatment escalation. - Corticosteroid use. - IBD-related hospitalisation or surgery. - Development of structural complications. - Treatment-emergent adverse events leading to discontinuation of therapy. --- ### Secondary Outcomes: The trial also evaluates several secondary outcomes, focusing on patient-centred measures: - **Quality of life:** Assessing how the disease and its treatment impact the patient’s overall well-being. - **Treatment burden:** Evaluating the effort, time, and resources required for treatment. - **Patient satisfaction:** Measuring how satisfied patients are with their treatment approach. - **Patient costs:** Understanding the financial impact of treatment strategies. - **Safety:** Monitoring adverse events and complications from treatments. --- ### Significance: The QUOTIENT trial is designed to reflect real-world clinical practice, moving beyond procedural or laboratory-driven targets to emphasise patient-reported outcomes and practical effectiveness. It aims to answer a key clinical question: should asymptomatic IBD patients with ongoing subclinical inflammation switch therapies to achieve deeper remission, or should they continue their current therapy? This study is expected to directly influence clinical guidelines, shared decision-making between patients and physicians, and patient education about treat-to-target strategies in IBD. By prioritising long-term outcomes and real-world applicability, QUOTIENT has the potential to significantly improve the standard of care for IBD patients on advanced therapies.

Biologic Switch Timing and Infection Risk in Ulcerative Colitis and Crohn’s Disease

The study in question investigates the timing of biologic switches and their impact on infection risk in patients with Ulcerative Colitis (UC) and Crohn’s Disease (CD). It specifically examines the difference in infection risk between overlapping switches (OS), where the switch occurs within less than 5 half-lives of the prior biologic, and non-overlapping switches (NOS), where the switch occurs after more than 5 half-lives. ### Key Findings: 1. **Study Population and Methodology**: - The study analyzed data from 11,992 biologic-naïve adults with UC or CD who initiated biologic therapy between 2017 and 2022. - Among these, 1,293 patients underwent a biologic switch and were categorized into OS (<5 half-lives) and NOS (>5 half-lives) groups. - Infection outcomes were evaluated over a 90-day follow-up using advanced statistical models to account for confounding variables. 2. **Prevalence of Overlapping Switches**: - Overlapping switches were common, comprising 64.2% of all biologic switches. 3. **Infection Risk Outcomes**: - The adjusted incidence rates of both any infection and serious infections (requiring hospitalization) were similar between the OS and NOS groups. - There were no statistically significant differences in the adjusted hazard ratios for serious infections between the two switching strategies. - Sensitivity analyses using alternative washout periods (e.g., 28 days or 3 half-lives) showed consistent results. However, a slight increase in non-serious infections was observed with very short washout periods. 4. **Implications for Clinical Practice**: - The findings suggest that overlapping biologic switches do not elevate the risk of serious infections in UC/CD patients. - Shorter washout periods may be safe and could enable more timely disease control, improving patient outcomes and clinical trial feasibility. - This challenges the FDA’s recommendation for a 5 half-life washout period, providing evidence for more flexible switching strategies in real-world clinical practice. ### Conclusion: The study provides reassurance that overlapping biologic switches can be safely performed without increasing the risk of serious infections in patients with UC or CD. This supports the adoption of more flexible switching strategies, which may help achieve better disease management and timely treatment adjustments.