Spotlight: Pharmacologic Management of Moderate-to-Severe Crohn’s Disease

An Often-Forgotten Complication of Upadacitinib

Comparative Efficacy of Advanced Therapies for Management of Moderate-to-Severe Crohn’s Disease: 2025 AGA Evidence Synthesis.

For Summary press comment 👇

AGA November 2025

Ascitic fluid analysis ( SAAG )

Adapting dose of DOACs in liver or kidney failure.

Safety of uninterrupted anticoagulation in the setting of routine colonoscopy

Summary 👇

GIE December 2025

HIV infection cycle within a host cell.

HIV first binds to CD4 and CCR5 receptors (1), followed by membrane fusion (2). Once inside, viral RNA is converted into DNA by reverse transcriptase (3), which integrates into the host genome (4). The proviral DNA is transcribed (5) and translated (6) into viral proteins. New viral components assemble near the cell membrane (7) and are released as mature infectious virions.

Each step is a therapeutic target, with antiretroviral drugs designed to block viral replication and prevent immune system destruction.

Chronic Non-bloody Diarrhea and abdominal pain in conjunction with normal appearing colonic mucosa on colonoscopy are hallmarks of microscopic colitis (MC). Although the exact etiology remains unknown, MC is associated with a number of risk factors, such as age > 50 years, female sex, certain medications, smoking, and a history of autoimmune conditions (e.g., celiac disease, rheumatoid arthritis, type 1 diabetes mellitus). The diagnosis is typically confirmed on biopsy, which shows intraepithelial lymphocytic infiltrates in lymphocytic MC or thick, subepithelial collagen bands in collagenous MC. About 50% of patients with MC also present with mild anemia and increased inflammatory markers. Treatment usually consists of management of risk factors (e.g., smoking cessation, discontinuation of any triggering medications) and symptomatic therapy (e.g., loperamide for diarrhea), followed by therapy escalation with corticosteroids.

Cholecystitis is usually caused by the passage of gallstones into the cystic duct. Cystic duct obstruction can lead to gallbladder inflammation with symptoms of right upper quadrant abdominal pain, nausea, and fever, as seen in this patient. Cholescintigraphy (HIDA scan) typically shows delayed or absent uptake of radioactive tracer in the gallbladder; a HIDA scan is primarily used to diagnose cystic duct obstruction if RUQ ultrasound fails to show gallstones. In uncomplicated cholecystitis, cholestasis parameters (i.e., ALP, GGT, and bilirubin) are typically normal or only mildly elevated because there is usually no obstruction of the hepatic ducts or common bile duct.

✳️ Clostridioides difficile is a Gram-positive bacillus causing pseudomembranous colitis, typically after recent broad-spectrum antibiotic use.

▶️ Transmission occurs via the faecal-oral route through ingestion of spores.

▶️ Toxins A and B produced by C. difficile cause intestinal epithelial damage and inflammation leading to colitis.

▶️ Clindamycin is historically associated with a high risk of causing C. difficile infection, though cephalosporins are now more common triggers.

▶️ Oral vancomycin is the first-line antibiotic treatment for initial episodes of C. difficile infection.

▶️ The severity of infection is assessed using criteria such as white cell count, creatinine rise, temperature, and clinical features, guiding management.

▶️ Recurrent infection occurs in approximately 20% after first episode; fidaxomicin or vancomycin are used depending on timing of recurrence.

▶️ Infection control measures: isolation until diarrhoea resolves for 48 hours, use of gloves and aprons, and hand washing (not alcohol gel) to prevent spread.

2026 ADA standard of care “ slide deck “

Primary Biliary Cholangitis in 2025: A New Frontier

AJG December 2025