Best tweet of the night

"Let it be told to the future world, that in the depth of winter, when nothing but hope and virtue could survive, that the city and the country, alarmed at one common danger, came forth to meet and to repulse it."
-- Thomas Paine, The American Crisis (#1)

Fellows, cozy up with your coffee and join us this Saturday morning for the 10th Annual IBD NOW Summit for Fellows! Looking forward to a great morning with this crew. No flights ✈️, just insights 💭

Upadacitinib was linked to a lower risk of treatment failure than five other advanced therapies for #ulcerativecolitis, especially among patients who had used an advanced therapy in the previous 12 months, in a new study from @AGA_CGH.

➡️ow.ly/G8bh5101nEg

newsnetwork.mayoclinic.org/discussion/a-d… Over 1500 patients treated with CAR-T at the 3 Mayo sites

newsnetwork.mayoclinic.org/discussion/com… @MayoClinicGIHep

Appreciate @dakotanews_now for highlighting our launch of clinical trials in Sioux Falls that aim to offer IBD patients access to novel therapies & avenues to improve their quality of life. My genuine admiration to Tyler for being a courageous & strong advocate for IBD patients!

No defecatory disorders in Madrid apparently—good technique

Pearls of management and approach to the refractory IBD. Dr. Rubin @IBDMD #IBDSUMMIT

Coverage of GLP-1 by “Medicare net spending fell in every scenario, with cumulative savings of $21.2 - 27.1 billion, including $31.9 billion in diabetes drug price savings. Return on investment was 117 - 216% for Medicare and 198 - 346% for society.” x.com/davearicks/sta…

💊 Vedolizumab's mechanism… in a once-daily pill?

📍 SWIFT (phase 2, #UEGWeek2026 late-breaker): emvistegrast, Gilead's oral α4β7 integrin inhibitor, in 238 adults with moderate–severe UC

🎯 Week 12 clinical response (primary): 66% vs 37% placebo (200 mg)

✅ Clinical Endoscopic improvement: 39% vs 12%

🛡️ AEs 36% vs 37%; serious AEs 2%, none drug-related

⏳ 25 & 75 mg data not yet disclosed; phase 3 planned for 2027

👇 The data in one image

🔗 fiercebiotech.com/biotech/gilead…

@my_ueg

#MedTwitter #GITwitter #MedEd #IBD #UlcerativeColitis #OralTherapy

For readers interested in CAR-T cell therapies for autoimmune diseases, here's a Review on the promise and pitfalls nature.com/articles/s4157…
rdcu.be/47FDbGDbA9Na

Have you registered for @GuildConference Caribbean or Maui yet? What are you waiting for?
✅APP Scholarships to Caribbean (10) Deadline November 3
✅GI Fellow Scholarships to Maui (10) Deadline December 2
Register here: guildconference.com

Is proximal small bowel Crohn worse than distal bcs the Tx is less effective there?
Well, No...
In our @sheba_medical #capsule study now published in @AGA_CGH , biologics induced similar mucosal healing in proximal vs distal SB.
@OffirU @HelmsleyTrust
cghjournal.org/article/S1542-…

My heart is full 💜 Honored to be named the 2026 Medical Champion of Hope by the @CCfdnMinnesota.

Grateful to our patients who inspire me every day, and to everyone who celebrated with us this weekend.

Support the foundation: my.onecause.com/event/organiza…

Skyrizi OBI induction now FDA approved!! news.abbvie.com/2026-10-23-U-S…

#IBD @MRegueiroMD @DCharabaty @ibdgijami @JosephHabibi_MD @EdwardLoftus2 @IBD_FloMD

Direct-to-consumer microbiome tests prove wide variability news.gastro.org/issues/2026/ap…
Buyer beware! Sounds “evidence-based” but perhaps not ready for prime time? @AmerGastroAssn

STRIDE-III is a long, careful review. Its core fits on one figure and one table, so here it is on two cards.

The big idea is a good one. Targets are now sorted by what you do when you miss them.
• Actionable targets (clinical response and remission, CRP and calprotectin, ustify a change of treatment once the current one has been properly optimised.
• Adjunctive targets guide optimisation and closer monitoring, but are not on their own a reason to switch.
• Patient-centred targets (quality of life, disability and fatigue) are handled by shared decision.

That sorting gets a lot right.
• Calprotectin gets sharper numbers (STRIDE-II said 100–250 µg/g): under 200 µg/g is the acceptable range, under 100 µg/g goes with transmural remission in Crohn's and histological remission in UC, and 100 to 200 is a grey zone, so test serially.
• Endoscopic remission in UC is now Mayo 0, with Mayo 1 accepted as an interim target. Histology in UC and transmural healing in Crohn's become adjunctive long-term targets, which fits the evidence, VERDICT included, and histology is not a target in Crohn's at all.
• Urgency is new: no urgency (NRS 2 or less) is a short-term target, but an adjunctive one, so missing it means optimise, not switch.
• In resource-limited settings the targets stay the same and only the tools change.

Card 2 is the one to keep in clinic: how long each drug should take to reach response, remission and normal biomarkers, as windows to reassess rather than hard failure points.

Note: STRIDE-III covers medically managed luminal disease, not perianal disease, pouchitis, extraintestinal manifestations or postoperative care.

The final paragraph is noteworthy. Future versions could move beyond a simple yes or no on hitting a target, towards longitudinal, multidomain approaches, with AI tools and multi-omics biomarkers in the mix. That's where I think the next big questions are: how we hold these targets over a lifetime, and how we deliver them for whole populations, not one patient at a time.

And that’s a great introduction to our work, with much more to come.

Mayo Clinic in Rochester is again recognized as the #1 Smart Hospital in the world by @Newsweek and Statista on their 2027 World’s Best Smart Hospitals list. rankings.newsweek.com/worlds-best-sm…

Obefazimod in UC: the phase 3 maintenance data, from two talks @my_ueg

580 people with moderate to severe ulcerative colitis who responded to 8 weeks of obefazimod, a once-daily oral medicine, were re-randomised for 44 more weeks. Placebo here meant stopping a drug that had Clinical remission at week 52 was 39 percentage points higher than placebo on 25 mg and 40 points higher on 50 mg.

It works across the secondary endpoints too. On endoscopic improvement, endoscopic remission (Mayo 0), histo-endoscopic mucosal improvement, steroid-free remission, sustained remission, clinical response and symptomatic remission, the delta over placebo ran from 31 to 53 points, every one at p<0.0001.

It works with and without prior advanced-therapy (AT) failure. In AT-naive patients the delta in clinical remission was 45-48%; after AT failure it was 28-33%; smaller, but still large.

And it was well tolerated. Serious adverse events were within 2 points of placebo on either dose, fewer people stopped for an adverse event on drug than on placebo, and there were no deaths. Two cancers outside the skin, both on 50 mg, were judged unlikely to be related.

What next: @Abivax_ plans to file in the US by the end of 2026, and the full phase 3 paper(s) are still to come. The first Crohn's data, from the phase 2b ENHANCE-CD trial, are due in mid-2027.