Dr Hanauer gives an overview of some of the key themes that were discussed in sessions on inflammatory bowel diseases at Digestive Diseases Week 2026, including prevention, early treatment, and combination therapy.

Stephen Hanauer, MD, is the Clifford Joseph Barborka Professor of Medicine at the Feinberg School of Medicine and medical director of the Digestive Health Center at Northwestern University in Chicago, Illinois.

DDW 2026 to AIBD 2026: IBD Clinical Translation Highlights

• Pre-diagnosis/interception in IBD: Emerging strategies aim to diagnose IBD before symptoms and “intercept” disease in high-risk populations (eg, children or families with multiple affected members). Approaches under consideration include diet, probiotics, and lifestyle modification to prevent disease onset, though no specific trial outcomes or approvals were reported.
• Early treatment in Crohn’s disease: Crohn’s disease presents as luminal disease in ~80% of patients but progresses to transmural complications in ~80% over 10–20 years. Early intervention within 2 weeks of diagnosis using anti-TNF therapy achieved ~80% clinical remission in the PROFILE study—substantially higher than outcomes reported in later-stage populations (mean disease duration ~10 years). Preventing fibrosis remains an unmet need; antifibrotic agents are under investigation without confirmed results.
• Therapeutic evolution: Oral therapies (S1P modulators, JAK inhibitors) are established in ulcerative colitis and expanding into Crohn’s disease (microRNA-targeting agents; oral IL-23 inhibitor—approved for psoriasis, higher doses under evaluation in Crohn’s). Combination biologics (eg, anti-TNF + anti–IL-23; golimumab + guselkumab) showed improved outcomes vs monotherapy in VEGA (phase 2) and DUET studies, including refractory populations, with phase 3 programs ongoing.

Hi, I'm Steve Hanauer from Northwestern University, and I'm here at DDW 2026 looking at a perspective towards what's going to be happening at AIBD 2026.

And I think that there are several themes here that are going to be important for us to begin to look at how are we going to be putting these into the clinical perspective. And that's what AIBD is going to do. It's going to take the data from DDW and put it into a clinical perspective that we can all use down the line. 

And I think the first theme is actually prediagnosis of IBD. We're developing the opportunities and the potential to diagnose the disease even before symptoms. And that may allow us to, quote, intercept, as one of the trials is looking at, to prevent the occurrence of disease in highly susceptible children or family members where there are multiple affected members. And there are a number of ways to consider this, including diet, potential probiotics, lifestyle changes, in order to help prevent the disease. 

Secondly, early disease treatment, particularly in Crohn's disease, is very relevant. We know that Crohn's presents as a luminal disease in about 80% of patients, but over 10 to 20 years, that proportion reverses, and 80% of patients develop transmural complications. We have not yet learned how to medically treat the fibrosis in transmural disease. Although there are several topics of potential antifibrotic agents, we haven't seen the results as far as fibrosis is concerned. 

So how do we prevent it? By treating early with early effective therapy. As several years ago, the PROFILE study that looked at patients within 2 weeks of diagnosis of Crohn's disease and were put on an anti-TNF regimen early, 80% achieved clinical remission. That's a proportion far higher than any of our newer advanced therapies, which are primarily looking at later stage disease with an average disease duration of about 10 years. So early disease management and Crohn's disease and control is very important.

I guess another evolving theme is the evolution to oral therapies. We've already seen that in ulcerative colitis with sphingosine 1-phosphate agents and the JAK inhibitors that have made significant inroads into the treatment of refractory ulcerative colitis. And now moving towards Crohn's disease, we have 2 potential oral therapies: one that is targeting the microRNA that leads to inflammatory changes, and the other is an oral inhibitor of IL-23. And interestingly, the oral inhibitor of IL-23 has already been approved for psoriasis, and as anticipated, higher doses are being evaluated in Crohn's disease, probably as an early management strategy. 

And then on the other end of the spectrum are combination therapies. And we've seen data here presented at DDW that expand what was known as the VEGA trial that looked at combining an anti-TNF and an anti-IL-23 agent into a single syringe therapy, which in phase 2 demonstrated good results in both bio-naive and bio-exposed patients.

And here the DUET-Ulcerative colitis and the DUET-Crohn's disease studies have demonstrated that in a more refractory population, we can achieve better results with combining therapies than with either therapy alone. And of course, that's been a point of discussion, and we're looking at combining other mechanisms of action in much earlier phases. But it looks like the combination of golimumab and guselkumab is actually entering into phase 3 results, and hopefully will translate into approval in the relatively near future.

So I think that's kind of the concept that we're going from soup to nuts, from early disease or early prevention, to treating early disease and the prevention of progression, to optimizing our current therapies, and eventually looking at combinations to actually raise that therapeutic ceiling.

So with these concepts being presented here at DDW 2026, we look forward to many more discussions and how we are actually going to apply these into our current clinical practices.