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.

Part five of seven: Krishna Shah, Gastroenterology Registrar and IBD Research Fellow at the Royal London Hospital and Dr. Kamal Patel, Consultant Gastroenterologist at St George's Hospital discuss the Advanced Therapies in Ulcerative Colitis section of the new BSG guidelines beginning with mesalazine, prednisolone and azathioprine through to thiopurines and anti-TNFs. They discuss the cost-benefit outcomes of the drug pathways advised in the BSG Guidelines including some of the potential adverse side-effects.

Part four of seven: Professor Naila Arebi, Consultant Gastroenterologist and colleague, Consultant Colorectal Surgeon, Janindra Warusavitarne, both at St Mark's National Bowel Hospital, discuss the application of the BSG IBD Guidelines to provide optimal treatment using a holistic approach and deliver the best quality of care for patients.

They talk about the important relationship between surgeons and gastroenterologists in the diagnosis and treatment of Perianal Crohn’s disease, supporting this with systematic clinical research.

Part three of seven: Trainee Gastroenterologist, Jennifer Tham, interviews, Dr. Bel Kok, Consultant Gastroenterologist at the Royal London Hospital and Honorary Senior Lecturer at Queen Mary University of London, to discuss the practical application of the latest ASUC guidelines. They explore the presenting symptoms and diagnosis of acute severe ulcerative colitis, including the use of statistical algorithms summarised in the IBD guidelines.

Given the severity and high risk profile of ASUC, rapid access to up-to-date guidance is essential to prevent delays in treatment. Jennifer and Dr. Kok also examine the updated therapies and management strategies outlined in the new guidelines.

Part two of seven: Dr. Shahida Din, Chair of our IBD Committee, and Dr. Jonathan Blackwell—both Consultant Gastroenterologists at the Edinburgh IBD Unit—are joined by Mrs. Fiona Rees, Consultant Pharmacist at University Hospitals Sussex, to explore the BSG IBD Guidelines with a focus on therapy de-escalation. Together, they discuss how best to manage patient expectations around treatment and outcomes.

They also take a detailed look at the role of Mesalazine, routes of administration, Thiopurines, anti-TNF therapies, Pulse Therapy, and the importance of continually reassessing treatment plans.

Part one of a seven part series discussing different elements of the BSG IBD in Adults Guideline published in June 2025.

Prof. Gordon Moran from the University of Nottingham and Prof. Morris Gordon from the University of Central Lancashire (UCLan) discuss the new BSG IBD Guidelines published in GUT, June 2025. In particular, they discuss insight on methodology used to produce the guideline, the difference in previous guidelines (e.g. ECCO Guideline) and the use of network meta-anaysis.

Dr. Jabed Ahmed and Dr. Ravi Ranjan discuss colorectal polyps in patients with limited life expectancy. The bowel cancer screening strategies rely on the long time a polyp takes before progressing to cancer by early detection and removal of polyps. Although polypectomy comes with risks of some significant complications the risk is deemed small compared to the benefit of cancer prevention. This risk benefit equation changes in patients with advanced age or multiple co-morbidities

This new BSG ACP guidance developed by a multidisciplinary guidance development group aims to provide a structural framework to support clinicians and the patients in decision making in such situations.

Dr. Ranjan is a Consultant physician and gastroenterologist at University Hospital of North Tees and completeing his MD at Newcastle University. He also coordinated the a BSG/ACPGBI guidance.

Video Interview with Dr. Ahmed and Dr. Ranjan: Colorectal polyps in patients with limited life expectancy

• (00:00:09) - BSG Guidelines on management of colorectal polyps
• (00:01:50) - Polypectomy Guidance for elderly patients
• (00:07:58) - Colorectal cancer: non-invasive investigations and outcomes
• (00:10:55) - Charleston Comorbidity Index
• (00:14:19) - How did you calculate the average annual cancer transition rate for polyp
• (00:18:52) - Polypectomy 14, Risk of cancer and complication
• (00:22:05) - Role specific recommendations for polyp MDT 1
• (00:23:56) - Polypectomy 14, Risk of cancer and adverse events
• (00:26:44) - Clinical guidance on polyp and management
• (00:30:02) - Colonoscopy: New Guidance for polyps