Gastroenterology

2025 ACG guideline reshapes adult Crohn’s disease management strategy

The 2025 American College of Gastroenterology guideline for adult Crohn’s disease emphasizes structured treat-to-target management and objective inflammation control. It highlights early use of biologic and small-molecule therapies in moderate-to-severe disease rather than prolonged steroid or thiopurine use. The guideline incorporates therapeutic drug monitoring to optimize biologic dosing and manage loss of response. Recommendations aim to integrate endoscopic and cross-sectional imaging targets into routine care while balancing safety and cost. 1

Mailed FIT outreach and patient navigation most effectively boost CRC screening

This network meta-analysis pooled 76 randomized trials comparing eight strategies to increase colorectal cancer screening uptake. Patient navigation produced the largest improvement over usual care (RR 1.58, 95% CI 1.23-2.02). Mailed FIT outreach also significantly increased participation (RR 1.36, 95% CI 1.07-1.74) and outperformed colonoscopy outreach (RR 1.35, 95% CI 1.11-1.63). In settings with baseline uptake under 30%, mailed FIT outreach tripled screening rates (RR 3.12, 95% CI 1.70-5.71). Educational multimedia and reminder-only strategies had modest or uncertain effects, with overall evidence quality ranging from moderate to low. 2

Fecal hemoglobin level enables precision post-polypectomy surveillance in FIT programs

This large FIT-based screening cohort included 89,771 post-polypectomy participants with baseline fecal hemoglobin ≥20 μg/g and complete colonoscopy. Colorectal cancer incidence increased stepwise with higher fecal hemoglobin, from 2.2 to 4.0 per 1,000 person-years across categories. Modelled surveillance intervals were shortened for higher fecal hemoglobin and lengthened for lower values within existing risk strata. Adopting fecal hemoglobin–guided intervals could reduce colonoscopy demand by 9.8% compared with current U.S. guideline schedules without increasing modeled CRC risk. These data support integrating quantitative fecal hemoglobin into surveillance policies within organized FIT screening programs. 3

Transmural improvement yields substantial clinical benefit in Crohn’s disease

This retrospective study evaluated 411 Crohn’s patients with paired endoscopic and MRI enterography assessments. Patients achieving transmural improvement had markedly lower surgery rates than those without improvement (0.8% vs 46.8%). Hospitalization, steroid use, treatment changes, and phenotype progression were also significantly reduced with transmural improvement versus no improvement. Multivariate analyses showed transmural improvement independently decreased risks of surgery, hospitalization, and treatment escalation. Among patients with transmural improvement, stricturing phenotype remained a strong predictor for surgery and hospitalization, suggesting more aggressive targets may be needed. 4