BSG From Top to Bottom

Recorded at the BSG annual meeting in Liverpool, this episode features Professor Florian Rieder of the Cleveland Clinic, who joins the BSG IBD committee Chair and Co-chair, Dr Shahida Din and Dr Gareth Parkes, to discuss the arrival of the first randomised trials of anti-fibrotic therapies in Crohn’s disease. Rieder, a founder of the STAR Consortium, explains how trials recruit through radiology rather than endoscopy, why stricture morphology is the endpoint of choice, and why fibrosis has lagged so far behind inflammation in drug development. The conversation also covers safety questions, whether strictures and fistulas are distinct phenotypes, practical design issues such as background therapy and placebo arms, and the potential for locally delivered drugs in IBD-associated PSC. Essential listening for anyone interested in where fibrosis research is heading. Chapters (00:00:00) - Introduction and Fibrosis Trial Landscape(00:01:16) - Imaging-Based Trial Design and Eligibility(00:02:59) - Incorporating Bowel Motility into Endpoints(00:04:16) - Why Fibrosis Therapies Have Lagged Behind(00:06:28) - Safety Concerns and Local Drug Delivery(00:07:48) - Strictures vs Fistulizing Disease Progression(00:10:41) - Balancing Anti-Fibrotic and Anti-Inflammatory Therapy(00:13:19) - Placebo Arms and Ethical Trial Design(00:15:51) - Potential Applications in PSC and Closing Remarks

Dr. Noor Jawad, consultant gastroenterologist and the new BSG mentoring lead, discusses the value of mentoring in healthcare careers with Dr Francesca Moroni, consultant at NHS Grampian, Aberdeen. They describes how the free BSG mentoring platform matches mentors and mentees, how the relationship can be structured around the mentee’s goals, and the benefits mentoring brings to mentors as well as mentees. They also addresses the importance of clear boundaries and signposting to specialist support, and makes the case for mentoring as a means of supporting and retaining the workforce. To watch the interview, click here:  https://www.bsg.org.uk/web-education/how-to-be-a-good-mentor  Chapters (00:00:00) - Introduction and Importance of Mentoring(00:00:41) - What Makes a Good Mentor(00:02:12) - Reverse Mentoring and Inclusivity(00:03:02) - How the BSG Mentoring Platform Works(00:04:28) - Benefits for Mentors(00:05:19) - Setting Up the Mentor-Mentee Relationship(00:06:49) - Mentee-Driven Goals and Preparation(00:07:40) - Boundaries and Limits of Mentoring(00:09:17) - Raising Awareness and Closing Thoughts

Consultant gastroenterologists Dr Hugo Penny, Sheffield Teaching Hospitals NHS Foundation Trust and Dr. Michael Fitzpatrick, Oxford University Hospitals NHS Foundation Trust, discuss why new Coeliac Disease treatments are needed and what is on the horizon. They review the drug pipeline, which targets the known antigen and immune response: cytokine inhibitors (e.g. IL-15), gluten-degrading enzymes, tissue transglutaminase 2 (TG2) inhibitors, and tolerogenic therapies. JAK inhibitors show promise in refractory coeliac disease.With no licensed therapies and no regulatory roadmap, several agents are in phase 2 trials, with anti-TG2 therapy furthest advanced. Trials currently focus on adults with ongoing disease despite at least 12 months on a GFD, with paediatric patients a likely future focus. To watch the interview, click here: https://www.bsg.org.uk/web-education/immunological-and-therapeutic-coeliac-disease 

In this episode, Dr. Asma Fikree, Consultant Neurogastroenterologist at UCLH and Chair of the BSG Neurogastroenterology & Motility Section and Dr Maria Eugenicos, Senior Lecturer/Neurogastroenterologist, Western General Hospital, Edinburgh discuss the effects of anti-obesity medications on gastric motility, dyspepsia, and gastroparesis-like symptoms. The discussion covers the management of nausea, vomiting and delayed gastric emptying, considerations before endoscopy and surgery, the phenomenon of tachyphylaxis, and practical approaches to dose titration. Dr. Fikree also examines the emerging evidence for GLP-1 therapies in patients with IBS and chronic gastrointestinal symptoms, highlighting both the benefits and limitations of these increasingly prescribed treatments.

Professor Vikram Mitra (Chair, Pancreas Clinical Section, British Society of Gastroenterology) speaks with Professor Pramod Garg, President of the Indian Society of Gastroenterology, about the link between gut microbiome and acute pancreatitis. Topics include whether admission microbiome can predict disease severity, which bacterial classes (notably Proteobacteria) are tied to worse outcomes, and what's known about how gut bacteria may drive pancreatic inflammation. They also discuss the case against prophylactic antibiotics, why early enteral nutrition beats bowel rest, mixed results on interventions like rifaximin, and key confounders in microbiome research (diet, ethnicity, drug use, disease etiology). To watch the interview, click here: https://www.bsg.org.uk/web-education/gut-microbiome-in-acute-pancreatitis 

In this BSG Podcast episode, Consultant Pharmacist, Fiona Rees is joined by Gastroenterology Registrar, Dr Krishna Shah and Consultant Obstetrician & Gynaecologist, Dr Mandeep Kaler to discuss pregnancy and inflammatory bowel disease (IBD). They explore the importance of preconception counselling and achieving disease remission before pregnancy. The conversation covers how IBD can affect pregnancy and how risks can be reduced with good disease control. They discuss practical approaches to managing flares and medication safety, reassuring that many treatments are low risk. The episode also highlights the role of multidisciplinary care between IBD and obstetric teams. Key topics include delivery planning, breastfeeding, and postpartum care. The speakers emphasise empowering patients with accurate information throughout their journey.

In this episode of the BSG Top to Bottom podcast, Prof James East and Prof Pradeep Bhandari dive into the endoscopic aspects of the new BSG IBD Surveillance Guidelines. Building on part one’s focus on cancer risk and surveillance rationale, this discussion explores practical essentials, from bowel preparation and patient comfort to chromoendoscopy, lesion detection, and the nuances of managing dysplasia in IBD. The conversation also highlights training, service delivery, MDT decision‑making, and the evolving roles of advanced endoscopic techniques and surgery.  Chapters (00:00:00) - Top to Bottom: Endoscopic Surveillance(00:01:03) - The BSG Guidelines on IBD(00:02:04) - IBD bowel prep(00:06:01) - Colonoscopy: Comfort and Safety(00:09:26) - BSG 5, Virtual Chromo Endoscopy(00:18:24) - Invisible dysplasia(00:21:09) - Who should be doing IBD endoscopy?(00:25:06) - Diabetes and colitis 6, Neoplasia management(00:34:11) - Segmental resection in IBD(00:38:51) - Intensive surveillance for colonoscopy patients with dysplasia(00:41:55) - Endoscopy and cancer: concordance

Join Dr. Shahida Din, consultant gastroenterologist and Chair of the BSG IBD Section, for an in‑depth conversation with Professor James East, leading gastroenterologist, endoscopist, and co‑author of the new BSG IBD Surveillance Guidelines. They explore how cancer risk in IBD has evolved, when to start or stop surveillance, and the shift toward personalised risk assessment. The episode covers key updates on bowel prep, biopsy strategies, patient experience, and what clinicians should know to deliver high quality, patient centred surveillance. Stay tuned for Part 2 on endoscopic techniques and dysplasia management with Professor Pradeep Bhandari 

Part seven of seven: Dr Alexandra Kent, Consultant Gastroenterologist at King’s College Hospital, is joined by Professor Jimmy Limdi, Head of the IBD section at the Northern Care Alliance NHS Foundation Trust, to explore how Crohn's Disease recurrence is defined, predicted, monitored, and managed after surgery as recommended in the BSG IBD Guidelines. Together, they discuss the continuum of post-operative recurrence from histological and endoscopic changes to clinical and surgical relapse. They highlight key patient, disease, and surgical risk factors, including smoking and aggressive disease phenotypes. The episode covers best practice for post-operative monitoring, including the role of ileocolonoscopy, Rutgeerts scoring, faecal calprotectin, intestinal ultrasound, and cross-sectional imaging.

Part six of seven: Polychronis Pavlides, Consultant Gastroenterologist at King's College Hospital in London and Fraser Cummings, Consultant Gastroenterologist in Southampton and adult IBD service lead, discuss the first line treatment of Luminal Crohn’s Disease outlined in the newly updated BSG IBD Guidelines. They explore the importance of shared decision making and patient centred care along with practical guidance on choosing therapies, monitoring response, and aligning with STRIDE targets. This podcast also includes the challenges in comparative effectiveness and why sequencing remains complex.