Russell Cohen, MD

Therapeutic innovation in gastroenterology has accelerated over the past decade, reshaping how clinicians evaluate treatment response, define success, and identify unmet needs across inflammatory and metabolic diseases. As the armamentarium expands, so too does the complexity of decision-making in both inflammatory bowel disease (IBD) and broader digestive disorders. The question is no longer whether options exist, but how to deploy them effectively—and when to pivot.

Advancing Gastroenterology from the Frontlines of Patient Care

, a gastroenterologist specializing in inflammatory bowel diseases at 

, explains that early identification of suboptimal response remains grounded in careful clinical reassessment. In the absence of predictive biomarkers that reliably match individual patients to specific agents, clinicians must synthesize disease severity, distribution, comorbidities, and patient preferences. Clinical trial data provide practical benchmarks—particularly regarding expected timelines for response. Some therapies demonstrate benefit within weeks, whereas others may require months, informing when optimization or switching should be considered.

, noted that 2025 marked a banner year for guideline development across ulcerative colitis, metabolic liver disease, and gastrointestinal bleeding. Institutional leadership in translational research continues to bridge laboratory discovery and bedside application, reinforcing the importance of evidence-based adaptation as new mechanisms of action emerge.

McDonald anticipates that emerging therapies—including anti-fibrotic strategies in Crohn disease—may necessitate new monitoring paradigms. While core goals remain unchanged—symptom control, mucosal healing, and durable remission—success metrics may expand as clinicians begin treating disease phenotypes previously managed surgically.

Cohen highlighted additional clinical lessons from 2025, including the growing use of combination biologic strategies to overcome therapeutic ceilings and the expanding investigation of glucagon-like peptide-1–based agents beyond metabolic indications. Looking ahead, both physicians identified precision medicine and microbiome-directed interventions as critical areas for trial development. Cohen emphasized prevention as a particularly underexplored frontier, including efforts to identify microbiome alterations preceding overt disease.

Together, their perspectives underscore a shared priority: refining therapeutic sequencing, improving patient-specific targeting, and designing clinical trials that better anticipate real-world complexity while advancing measurable, durable outcomes in digestive disease care.

Videos

Discover how new IBD therapies, combo drugs, and microbiome research aim to predict response, prevent Crohn’s complications, and expand trial options.

Advancing Gastroenterology from the Frontlines of Patient Care 

Keeping Pace with Advances in Gastroenterology, With Benjamin McDonald, MD, at UChicago Medicine

Inflammatory bowel disease (IBD) management increasingly requires clinicians to reconcile patient-reported symptoms with objective markers of inflammation, a dynamic that continues to evolve as diagnostic tools and therapeutic targets advance. Although symptom control remains central to patient care, contemporary practice recognizes that clinical remission does not always equate to mucosal healing. This distinction has meaningfully shifted how disease activity is monitored and how response to therapy is defined.

, describes a multimodal approach to monitoring that integrates symptoms, biomarkers, imaging, and endoscopy. “How patients feel is the most important thing—it’s paramount,” McDonald said. “But we also know that many patients who feel well will continue to have ongoing inflammation, and it’s important to treat that too.” Rather than relying on a single metric, he advocates for longitudinal assessment using complementary tools, including biomarkers and imaging modalities alongside periodic endoscopic evaluation.

The treat-to-target paradigm, long embedded in IBD care, has further refined how clinicians assess therapeutic response. While the overarching goals—clinical remission and mucosal healing—remain consistent, McDonald noted that the field has shifted away from heavy reliance on endoscopy alone. Greater emphasis is now placed on noninvasive strategies, including stool-based testing and imaging, which may offer more patient-friendly monitoring while still aligning with guideline-directed targets. However, gaps remain between controlled trial environments and real-world populations, particularly given differences in disease severity and comorbid conditions.

Noninvasive biomarkers such as fecal calprotectin and C-reactive protein (CRP) are widely used, yet discordance between laboratory findings, symptoms, and endoscopic results is common. “There isn’t a perfect test,” McDonald said. In cases of discrepancy, he often seeks additional clarification through more targeted evaluation—frequently endoscopy or ultrasound—to better define inflammatory burden before adjusting therapy.

Endoscopic healing continues to serve as a central trial endpoint, but McDonald emphasized that translating trial-defined outcomes into meaningful, sustained benefit for patients requires individualized interpretation. As monitoring strategies become more nuanced, integrating objective inflammation control with patient-centered outcomes remains the cornerstone of effective IBD care.

Discover how intestinal ultrasound and biomarkers help spot hidden IBD inflammation, guiding faster treat-to-target decisions beyond endoscopy.

Clinical trial innovation in inflammatory bowel disease (IBD) increasingly reflects a dual mandate: advancing novel therapeutics while ensuring research populations reflect the patients seen in everyday practice. Academic centers play a critical role in bridging this gap, particularly through translational science and inclusive recruitment strategies that expand both scientific discovery and clinical relevance.

UChicago Advances IBD Trials With Focus on Microbiome and Access

, professor of medicine and clinical director of the Inflammatory Bowel Disease Center at the University of Chicago, highlighted several ongoing investigations within the Digestive Diseases Center that may shape the next generation of IBD care. Among the most promising are therapies targeting TL1A, a cytokine within the tumor necrosis factor superfamily believed to act upstream in the inflammatory cascade. By interrupting earlier immune signaling, these agents may offer more durable disease control.

Additional areas of active investigation include microRNA-based therapies designed to suppress inflammatory protein production at the cellular level and stem cell approaches for fistulizing Crohn disease, a complication that remains difficult to manage with existing treatments. Cohen also emphasized the center’s leadership in advanced diagnostic and monitoring technologies, including capsule endoscopy and device-based drug delivery platforms. “There is a lot of interest in what is going to be potentially the next big medicine,” Cohen said, noting the breadth of ongoing therapeutic exploration.

Equally important is ensuring equitable access to clinical trials. Cohen described a multidisciplinary model that integrates dietitians, specialty pharmacists, and gastrointestinal psychologists to support patients throughout the research and treatment process. This infrastructure helps address common barriers to participation, including financial concerns, treatment complexity, and logistical challenges.

Institutional outreach efforts have also focused on historically underserved communities, particularly on Chicago’s South Side and surrounding regions. Partnerships with community health systems, patient education initiatives, and geographically expanded clinical services have helped broaden engagement while preserving rigorous study protocols.

Explore emerging IBD treatments—TL1A blockers, microRNA, stem cells—and new small-bowel imaging, plus team-based care improving access.

Expanding specialty care beyond traditional academic campuses has become a critical strategy for improving access to advanced therapies for complex digestive diseases such as inflammatory bowel disease (IBD). However, geographic growth alone is insufficient without maintaining the clinical rigor, continuity, and innovation that define tertiary referral centers. Ensuring patients receive the same level of expertise regardless of location has become a defining priority for leading gastroenterology programs. In the accompanying video, Russell Cohen, MD, professor of medicine and clinical director of the Inflammatory Bowel Disease Center at the University of Chicago, described how UChicago Medicine’s expansion throughout the Chicagoland region has fundamentally improved access to subspecialty care. Historically, patients seeking advanced IBD management were required to travel to the Hyde Park campus. Today, University of Chicago faculty deliver care across a network spanning northern suburbs, western communities, and northwest Indiana. “We’re doing the driving to you,” Cohen said, emphasizing that patients seen at satellite locations receive care directly from University of Chicago specialists rather than affiliated providers without academic appointments. Maintaining consistency across sites has been central to the expansion strategy. Cohen noted that care delivery extends beyond outpatient visits to include procedures, inpatient management, infusion therapies, and clinical trial access—all coordinated through the same academic teams. This integrated model allows patients to transition seamlessly between community-based care and the university’s tertiary services while preserving continuity and expertise. “You’re getting the full monty with the University of Chicago,” he said, underscoring the program’s commitment to delivering comprehensive, academically grounded care throughout its network. At the same time, rapid therapeutic innovation has transformed clinical practice. Cohen reflected on the institution’s longstanding role in advancing biologic and targeted therapies, dating back to early breakthroughs in Crohn disease research and continuing through participation in modern clinical trials. These advances have expanded treatment options and improved outcomes, while ongoing translational research continues to connect laboratory discoveries with clinical application.

Expanding Access, Advancing Science- How the University of Chicago Is Redefining IBD Care Across Chicagoland

Expanding specialty care beyond traditional academic campuses has become a critical strategy for improving access to advanced therapies for complex digestive diseases such as inflammatory bowel disease (IBD). However, geographic growth alone is insufficient without maintaining the clinical rigor, continuity, and innovation that define tertiary referral centers. Ensuring patients receive the same level of expertise regardless of location has become a defining priority for leading gastroenterology programs.

, professor of medicine and clinical director of the Inflammatory Bowel Disease Center at the 

, described how UChicago Medicine’s expansion throughout the Chicagoland region has fundamentally improved access to subspecialty care. Historically, patients seeking advanced IBD management were required to travel to the Hyde Park campus. Today, University of Chicago faculty deliver care across a network spanning northern suburbs, western communities, and northwest Indiana. “We’re doing the driving to you,” Cohen said, emphasizing that patients seen at satellite locations receive care directly from University of Chicago specialists rather than affiliated providers without academic appointments.

Maintaining consistency across sites has been central to the expansion strategy. Cohen noted that care delivery extends beyond outpatient visits to include procedures, inpatient management, infusion therapies, and clinical trial access—all coordinated through the same academic teams. This integrated model allows patients to transition seamlessly between community-based care and the university’s tertiary services while preserving continuity and expertise. “You’re getting the full monty with the University of Chicago,” he said, underscoring the program’s commitment to delivering comprehensive, academically grounded care throughout its network.

At the same time, rapid therapeutic innovation has transformed clinical practice. Cohen reflected on the institution’s longstanding role in advancing biologic and targeted therapies, dating back to early breakthroughs in Crohn disease research and continuing through participation in modern clinical trials. These advances have expanded treatment options and improved outcomes, while ongoing translational research continues to connect laboratory discoveries with clinical application.

UChicago GI faculty bring expert endoscopy and IBD care closer to you, with seamless hospital follow-up and cutting-edge clinical trials.

Russell Cohen, MD

Articles