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.

In the accompanying video, Benjamin McDonald, MD, PhD, a gastroenterologist specializing in inflammatory bowel diseases at UChicago Medicine, 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.