Gastroenterology Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped gastroenterology practice.

IBD Biologic Selection

The expanding therapeutic arsenal

5-ASA/steroids → infliximab (ACT/ACCENT) → vedolizumab (GEMINI) → ustekinumab (UNITI) → JAK (tofacitinib/upadacitinib)

Overcoming resistance

Triple therapy → resistance rise → bismuth quadruple → vonoprazan (PHALANX)

First approved therapies at last

No approved drugs → vitamin E (PIVENS) → semaglutide (STEP-NASH) → resmetirom (MAESTRO-NASH)

Earlier, smarter, AI-assisted

Sigmoidoscopy → colonoscopy → FIT → age 45 start → AI-assisted colonoscopy

The end of aggressive hydration

NPO + aggressive IV → WATERFALL moderate fluids (2022) → early feeding → paradigm reversal