Expanding Clinical Reach in GI and Hepatology While Preserving Standards of Care

Digestive health is entering a period of rapid transformation, with scientific discovery, biologic therapies, precision diagnostics, and multidisciplinary care models redefining how clinicians manage complex gastrointestinal disease.

Conditions once associated with frequent hospitalizations and surgery are increasingly controlled with targeted medications and earlier intervention. At the same time, rising prevalence of inflammatory bowel disease (IBD), colorectal cancer, and other chronic GI disorders has heightened the need for coordinated specialty care.

According to David Rubin, MD, Joseph B. Kirsner Professor of Medicine, chief of Gastroenterology, Hepatology and Nutrition, and director of the Inflammatory Bowel Disease Center at University of Chicago Medicine, meeting this demand requires both clinical depth and a deliberate strategy to expand access without diluting expertise.

Rubin explains that the Inflammatory Bowel Disease Center at UChicago Medicine has long been recognized as a national leader in complex IBD care, treating patients with ulcerative colitis and Crohn’s disease across the full disease spectrum, including individuals referred for refractory symptoms or complications. He emphasizes that the growth of advanced biologics and small-molecule therapies has dramatically improved patient outcomes, allowing many to avoid surgery and maintain durable remission.

Recent regulatory developments of note in GI include the US Food and Drug Administration approval of mirikizumab-mrkz (Omvoh) as a single-injection once-monthly maintenance regimen for adult patients with ulcerative colitis, an updated indication statement allowing the use of upadacitinib (Rinvoq) for patients with moderately to severely active IBD after they have received ≥ 1 approved systemic therapy in the event TNF blockers are clinically inadvisable, and a subcutaneous induction regimen of guselkumab (Tremfya) for the treatment of adults with moderately to severely active ulcerative colitis.

However, Rubin notes that this therapeutic expansion has also introduced greater complexity. With multiple mechanisms of action now available, selecting the right therapy requires careful phenotyping, understanding prior treatment response, and monitoring for side effects.

“In addition to [the rising prevalence of IBD], there are multiple new therapies that are available, and for clinicians taking care of patients with IBD and patients who have these conditions, it is very confusing which treatments to use and how to know what's the best approach to management,” Rubin said, describing UChicago Medicine’s longstanding excellence in providing comprehensive IBD care.

Beyond medication, Rubin highlights the value of integrated, multidisciplinary care, describing how UChicago Medicine gastroenterologists work closely with colorectal surgeons, radiologists, pathologists, dietitians, and mental health professionals to address both intestinal and extraintestinal manifestations of disease. For patients facing surgery, he says, seamless coordination between medical and surgical teams improves both short- and long-term outcomes.

“Good medicine is a team sport. We have to work together, and we recognize that it takes a lot of people who understand the different aspects of what we're trying to provide to do it the right way,” he said.

Rubin additionally describes how research remains central to the program’s mission, citing active participation in clinical trials evaluating next-generation biologics, novel immune targets, and emerging therapeutic pathways. Access to investigational therapies, he notes, offers patients options beyond standard-of-care treatment and reinforces the institution’s role in shaping national practice guidelines.

As demand grows, Rubin also points to the importance of thoughtful geographic expansion. Extending subspecialty expertise into community settings increases access while maintaining centralized oversight for the most complex cases. He stresses that preserving program identity and clinical standards during expansion is essential to sustaining outcomes and reputation.

He describes education and patient engagement as being equally critical, emphasizing that empowering patients to understand their disease, adhere to therapy, and recognize early signs of flare can reduce hospitalizations and improve quality of life. Structured follow-up and long-term monitoring, he adds, are key components of chronic disease management.

Looking ahead, Rubin believes the future of GI care will center on precision medicine using biomarkers, genomics, and predictive modeling to match patients with the most effective therapy earlier in their disease course. Even as science advances, he maintains that success depends on maintaining a cohesive, multidisciplinary framework capable of delivering highly specialized care at scale.

Editors’ Note: Rubin reports relevant disclosures with AbbVie, Abivax, Bristol Myers Squibb, Celltrion, Eli Lilly, Genentech/Roche, Janssen Pharmaceuticals, Johnson & Johnson, Merck & Co., Pfizer, Sanofi, Spyre Therapeutics, Takeda, and others.

References

1. Livingston R. FDA Approves Single-Dose Formulation of Mirikizumab-mrkz for Ulcerative Colitis. HCPLive. October 27, 2025. Accessed February 17, 2026. https://www.hcplive.com/view/fda-approves-single-dose-formulation-of-mirikizumab-mrkz-for-ulcerative-colitis

2. Brooks A. FDA Approves Updated Indication for Upadacitinib (Rinvoq) in IBD. HCPLive. October 13, 2025. Accessed February 17, 2026. https://www.hcplive.com/view/fda-approves-updated-indication-for-upadacitinib-rinvoq-in-ibd

3. Brooks A. FDA Approves Guselkumab (Tremfya) Subcutaneous Induction Regimen for Ulcerative Colitis. HCPLive. September 19, 2025. Accessed February 17, 2026. https://www.hcplive.com/view/fda-approves-guselkumab-tremfya-subcutaneous-induction-regimen-for-ulcerative-colitis