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Daily Medical Update
Gastroenteritis
Sunday, May 31, 2026
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🔬 Practice-Changing Findings
Evidence from RCTs and meta-analyses published in the
last 12 months.
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Gastroenterology (2025) - Evidence synthesis/network meta-analysis
Key Findings
- In biologic-naive Crohn's disease, infliximab, adalimumab, vedolizumab, ustekinumab, risankizumab, mirikizumab, and guselkumab increased induction remission vs no treatment, while certolizumab pegol and upadacitinib were supported by lower-certainty evidence.
- In biologic-exposed Crohn's disease, risankizumab and guselkumab improved induction remission vs vedolizumab and ustekinumab, and adalimumab, ustekinumab, risankizumab, guselkumab, and upadacitinib all improved remission vs no treatment.
📋 Practice Implication: Use prior biologic exposure to position advanced Crohn's therapies, with IL-23 pathway agents and ustekinumab favored when higher-certainty comparative remission data are needed.
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Medicine (Baltimore) - Meta-analysis of randomized trials
Key Findings
- JAK inhibitors increased clinical remission vs placebo (RR 2.48, 95% CI 1.64-3.73) and clinical response (RR 2.53, 95% CI 1.73-3.70) in moderate-to-severe ulcerative colitis.
- Endoscopic remission improved vs placebo (RR 3.52, 95% CI 2.55-4.86), mucosal healing increased across models, and overall adverse event rates did not increase in short-term trials.
📋 Practice Implication: JAK inhibitors are a credible oral option when rapid symptom and endoscopic control are priorities, but clinicians should still pair this with long-term safety surveillance.
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JAMA Network Open (2025) - Systematic review and meta-analysis
Key Findings
- Across 42 studies and 813881 patients, JAK inhibitors vs TNF antagonists showed no significant increase in serious infections (pooled HR 1.05, 95% CI 0.97-1.13), malignant neoplasms (HR 1.02, 95% CI 0.90-1.16), or major cardiovascular events (HR 0.91, 95% CI 0.80-1.04).
- Venous thromboembolism risk was higher with JAK inhibitors vs TNF antagonists (pooled HR 1.26, 95% CI 1.03-1.54), although absolute incidence remained low at 0.57 vs 0.52 per 100 person-years.
📋 Practice Implication: When choosing between JAK inhibitors and TNF antagonists, the main additional counseling point is thromboembolism risk rather than a broad excess of infection, cancer, or cardiovascular toxicity.
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The American Journal of Gastroenterology (2025) - Practice guideline
Key Findings
- More than 70% of patients with inflammatory bowel disease will at some point receive immune-modifying therapy, increasing infection risk that can be reduced with timely vaccination.
- The guideline recommends coordinated screening for osteoporosis, cervical cancer, melanoma, non-melanoma skin cancer, depression, anxiety, and smoking cessation to improve long-term preventive outcomes.
📋 Practice Implication: IBD follow-up should include a structured prevention checklist, with vaccination review and nonintestinal screening treated as core disease-management tasks rather than deferred primary care issues.
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JAMA Surgery (2026) - Practice guideline
Key Findings
- Clinical risk scores and imaging improve diagnostic accuracy and reduce negative appendectomy rates, and appendectomy for uncomplicated appendicitis may be delayed up to 24 hours without increased adverse outcomes.
- In selected uncomplicated cases, antibiotics are safe and effective vs immediate surgery, and postoperative antibiotic courses of 2-3 days reduce excess exposure in complicated appendicitis without worsening outcomes.
📋 Practice Implication: For suspected appendicitis, clinicians can use imaging-guided risk stratification to avoid unnecessary operations and reserve longer antibiotic exposure for cases that truly need it.
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Summary
Recent gastrointestinal evidence in this run emphasizes therapeutic selection and safety in inflammatory bowel disease, plus updated management strategies for acute appendicitis. Comparative data support several advanced agents for Crohn's disease remission and show that JAK inhibitors improve both clinical and endoscopic ulcerative colitis outcomes, while head-to-head safety data mainly raise concern for venous thromboembolism rather than broad excess toxicity. Updated guideline evidence also reinforces vaccination-centered preventive care in IBD and selective antibiotic-first or short-course strategies in appendicitis to reduce avoidable harm.
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