This Week in Gastroenterology — Jul 23, 2026

Welcome to This Week in Gastroenterology. This week we're covering 9 notable papers spanning inflammatory bowel disease diagnostics and advanced therapeutics, functional gastrointestinal disorders and motility, and hepatology. Let's dive in.

In the realm of inflammatory bowel disease, establishing consensus on acute severe ulcerative colitis is critical for modern management. A modified Delphi consensus by the REFINED-ASUC working group published in Clinical Gastroenterology and Hepatology established new diagnostic criteria for acute severe ulcerative colitis in patients already receiving outpatient corticosteroids or advanced therapies [2]. Recognizing that the historical Truelove and Witts criteria do not account for modern treatments, the international panel agreed that diagnosis can be based on three major criteria including C-reactive protein at least two times the upper limit of normal, at least six bowel movements per 24 hours, and at least 50% of bowel movements with visible blood, plus at least two minor criteria such as hypoalbuminemia, tachycardia, nocturnal bowel movements, anemia, pyrexia, or leukocytosis. For patients on high-dose corticosteroids, lower thresholds of C-reactive protein at least one times the upper limit of normal and at least 33% bloody bowel movements apply [2]. When medical rescue is required for acute severe ulcerative colitis refractory to both intravenous corticosteroids and infliximab, upadacitinib serves as a viable option. In a multicenter cohort study of 50 patients published in Inflammatory Bowel Diseases, upadacitinib rescue therapy resulted in a 52% overall drug continuation rate at week 48, with rapid improvements in stool frequency, rectal bleeding, partial Mayo score, and C-reactive protein by week 1 that persisted through one year [4]. Colectomy occurred in 22% of patients, mostly within the first week, and adverse events occurred in 24% of patients and were almost entirely non-severe [4]. Higher baseline C-reactive protein predicted colectomy, confirming that third-line upadacitinib is associated with a low colectomy rate and a manageable safety profile in refractory acute severe ulcerative colitis [4].

Turning to functional gastrointestinal disorders and novel therapeutics, managing supragastric belching often relies on diaphragmatic breathing, though patient adherence can be challenged by its monotony. A multicenter randomized controlled trial published in Clinical Gastroenterology and Hepatology compared structured singing therapy to diaphragmatic breathing in 72 patients diagnosed with supragastric belching according to Rome criteria [6]. Singing therapy demonstrated a significantly higher treatment response rate, defined as at least a 50% reduction in belching visual analog scale scores, both immediately post-intervention at 72.2% compared to 38.9% for diaphragmatic breathing, and at the one-month follow-up at 50% compared to 30.6% [6]. Singing produced greater relief in belching symptoms and larger improvements in quality of life, particularly in older patients with more severe baseline symptoms [6]. For patients with medically refractory fecal incontinence, options remain limited. A clinical trial published in Alimentary Pharmacology & Therapeutics evaluated the safety and effectiveness of the StaySure anal insert device in patients with moderate to severe fecal incontinence refractory to conservative therapies [3]. Following a fitting and run-in period, 59 participants in the intent-to-treat cohort experienced a 69% reduction in weekly fecal incontinence episodes, declining from 5.4 to 2.1 episodes per week [3]. The primary endpoint of achieving at least a 50% reduction in incontinence frequency was met by 76.3% of participants, and over half achieved at least a 75% reduction alongside significant improvements in fecal incontinence quality of life scores and no treatment-related serious adverse events [3]. In another study examining gut function, a randomized controlled trial published in Alimentary Pharmacology & Therapeutics investigated the De Simone formulation 8-strain probiotic in 22 patients with a history of bile acid malabsorption [8]. Three weeks of probiotic supplementation led to a significant decrease in the percentage of faecal primary bile acids, including chenodeoxycholic acid and cholic acid, with a median change from baseline of -5.7% compared to an increase of 9.8% in the placebo group, alongside significant alterations in the faecal microbiome and metabolome, though symptoms and intestinal permeability showed no statistically significant differences [8].

In hepatology, primary sclerosing cholangitis remains a challenging cholestatic liver disease lacking approved medical therapies. A phase 3, 18-month, double-blind, placebo-controlled trial published in The American Journal of Gastroenterology examined oral vancomycin in adults with primary sclerosing cholangitis and a serum alkaline phosphatase greater than 1.5 times the upper limit of normal [1]. Rates of the primary endpoint of serum alkaline phosphatase normalization were similar at 5% for placebo and 6.7% for oral vancomycin [1]. While oral vancomycin recipients achieved a greater reduction in serum alkaline phosphatase of -21.9% compared to +1.2% with placebo, there were no significant differences in Mayo primary sclerosing cholangitis risk scores or liver stiffness values, with tooth and tongue discoloration being the most common side effect [1]. When managing complications of cirrhosis, patient stratification is equally vital. A systematic review and individual participant data meta-analysis published in Clinical Gastroenterology and Hepatology evaluated 1,659 patients with Child-Pugh class A or B cirrhosis who received non-selective beta-blockers plus endoscopic variceal ligation to prevent recurrent variceal hemorrhage [5]. Two-year mortality was significantly higher in patients with prior decompensation at 25.1% compared to 13.5% without prior decompensation, yielding a pooled adjusted hazard ratio for death of 1.4, indicating that prior decompensation identifies a high-risk subgroup requiring further investigation for potential pre-emptive transjugular intrahepatic portosystemic shunt placement [5]. Broader oncologic horizons in hepatology were reviewed in the Journal of Hepatology, which highlighted how advances in surgical planning, functional liver remnant evaluation, integrative systemic and locoregional therapies, and molecular biology are expanding resectability boundaries for hepatocellular carcinoma and intrahepatic cholangiocarcinoma [9]. Finally, a comprehensive primer in Nature Reviews Disease Primers detailed the pathogenesis, increasing global incidence, diagnostic criteria via histology after secondary cause exclusion, and emerging biologic treatments for eosinophilic gastrointestinal diseases [7].

If you only have time for one paper this week, make it the multicenter cohort study on upadacitinib rescue therapy for steroid- and infliximab-refractory acute severe ulcerative colitis published in Inflammatory Bowel Diseases [4]. It provides crucial real-world data showing that third-party advanced small-molecule rescue can achieve sustained clinical remission and prevent colectomy in over three-quarters of patients with otherwise intractable disease.

Here are the key takeaways from this week in Gastroenterology: - New Delphi criteria for acute severe ulcerative colitis incorporate modern outpatient treatments and biologic failure into expanded major and minor diagnostic thresholds [2]. - Third-line upadacitinib rescue for steroid- and infliximab-refractory acute severe ulcerative colitis demonstrated a 52% drug retention rate at 48 weeks and a low colectomy rate of 22% [4]. - Structured singing therapy outperformed diaphragmatic breathing in reducing supragastric belching frequency and improving quality of life, especially in older patients with severe symptoms [6]. - The StaySure anal insert device significantly reduced weekly fecal incontinence episodes by 69% in patients with refractory symptoms without serious treatment-related adverse events [3]. - Oral vancomycin did not improve liver-related endpoints such as alkaline phosphatase normalization or Mayo risk scores in patients with primary sclerosing cholangitis over 18 months [1].

That's your roundup for This Week in Gastroenterology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.