Persistent Symptoms, Equity Gaps, Pushing For Whole-Person IBD Care, With Victor Chedid, MD, MS

Reaching mucosal remission in inflammatory bowel disease (IBD) is increasingly viewed as a necessary milestone, but may not be sufficient. Even after inflammation has been controlled, a meaningful number of patients continue to experience symptoms. Meanwhile, a separate but related challenge is disproportionate access to the therapies needed to reach remission in the first place across patient populations.

Victor Chedid, MD, MS, an assistant professor of medicine and director of the IBD Pride Clinic at Mayo Clinic, spoke with HCPLive at Digestive Disease Week (DDW) 2026 about how he approaches these problems, along with his belief that expanding the definition of personalized medicine beyond molecular targets is the future of IBD care.

When Symptoms Persist After Remission

A patient with confirmed mucosal remission who continues to report diarrhea, pain, or fatigue is a common experience in IBD care. The clinical instinct to escalate or switch biologic therapy can be counterproductive in this setting. According to Chedid, this is not because it is unreasonable, but because it may not address the driving symptoms.

"Whenever a hurricane hits a town, the hurricane is actively damaging the town during the active storm, and as it passes, it goes away, but then we are left with the damage that that hurricane left behind, and the city or the town would be working on rebuilding over time," Chedid said. "Inflammation in inflammatory bowel disease, in Crohn's disease, ulcerative colitis, is like the hurricane that just hit. As the inflammation subsides and we are able to get the inflammation under control, we are left with the damage that that inflammation has caused that will take time to be rebuilt."

The underlying mechanisms can be varied, such as residual intestinal barrier dysfunction, gut microbiome disruption during recovery, bile acid malabsorption, pelvic floor dysfunction, and neuro-visceral hypersensitivity. Thesea re among the functional contributors that may explain ongoing symptoms in a patient who is, by objective measures, in remission. Each of these has a distinct, and potentially targetable mechanism.

A Practical Framework for Workup

Chedid's approach to IBD care management begins with confirming remission, using objective biomarkers rather than symptom report alone. Once that is established, the workup pivots toward identifying specific functional drivers.

Bile acid testing may reveal malabsorption as a cause of chronic diarrhea, which can be addressed pharmacologically. Anorectal manometry and pelvic floor evaluation may uncover dysfunction amenable to biofeedback. Neuro-visceral hypersensitivity is increasingly recognized as a distinct entity within disorders of gut-brain interaction, and may respond to neuromodulatory agents.

Clinicians should be wary of defaulting to an irritable bowel syndrome (IBS) and IBD overlap, explains Chedid.

"No patient should be dismissed with their symptoms," he said. "Many times when a patient presents with persistent symptoms, their doctors end up cycling through the different IBD biologics, although there is no active inflammation. Doing that quick transition from one IBD drug to another will reduce the toolbox of actual IBD therapies we have for that patient, and will not be addressing the root cause."

Access Disparities Remain a Real Clinical Problem

The IBD field has moved toward earlier initiation of high-efficacy biologics as a standard of care, but that recommendation is dependent on patient characteristics. Patients from racial and ethnic minority groups, as well as those from other marginalized communities, often face structural barriers to subspecialty care and to the advanced therapies that guidelines now recommend up front.

"People from minoritized backgrounds might have less insurance coverage or less access to such advanced therapies," he said, "so they might be at a disadvantage and end up with poor outcomes just because of lack of access."

Contributing to this gap are insurance hurdles, geographic barriers to IBD subspecialists, and cultural factors that shape care-seeking and patient-provider communication. For Chedid, addressing equity is a major piece in the precision medicine agenda.

That also means rethinking how clinicians approach the patient encounter itself. Chedid described a move away from cultural competence as a framework and toward cultural humility. For example, clinicians can have genuine curiosity about the individual patient, their intersectional identities, their values, and their experience of care.

Digital Tools and AI: Useful, With Caveats

Remote monitoring technologies, including telemedicine, symptom-tracking applications, and wearable biosensors, are beginning to provide more continuous data on treatment response, with the possibility of earlier detection of disease flares. AI-based decision support tools are being developed to help synthesize complex datasets, from lab trends to endoscopic reports, to assist with diagnosis, disease activity scoring, and therapeutic sequencing.

"We got to make sure that as we're developing them, we're always inclusive of all populations," he said, "so that we are not missing a certain group and furthering the disparities we've been talking about."

He also emphasized the importance of robust data privacy protections, particularly given existing mistrust among some communities regarding how health information is used.

Putting It Together: Personalization Beyond the Prescription

The personalized medicine framework in IBD has tended to center on biomarkers, genomics, and therapeutic targets. Chedid's view is that the framework needs to extend further towards the patient's goals, preferences, lifestyle, and identity.

"Personalization is not only about the drugs that you choose," he said. "We engage the patients as partners in their own care. We have to make sure that we're aligning their treatment choices with their lifestyles, their life goals, their preference."

A clinician’s treatment goal might be a fecal calprotectin below a certain threshold, while the patient's goal might be running a marathon. Chedid emphasizes that both are important in modern IBD care, especially finding a treatment approach and communicating clearly about what each goal requires.

Managing IBD comprehensively also means not treating it in isolation. Chedid described a model of care that includes IBD-trained dietitians, GI psychologists, pelvic floor specialists, mental health providers, colorectal surgeons, IBD pharmacists, and advanced practice nurses, describing IBD care as taking a village.

References

1. Mak JWY, Mak TN, Ng SC, et al. Inequalities in healthcare access, experience and outcomes in adults with inflammatory bowel disease: a scoping review. J Crohns Colitis. 2024;18(12):1989-2004. doi:10.1093/ecco-jcc/jjae113

2. Saleh M, et al. Racial disparities in utilization of medications and disease outcomes in inflammatory bowel disease patients. BMC Gastroenterol. Published 2024. doi:10.1186/s12876-024-03196-8

3. Sinagra E, Rossi F, Raimondo D, et al. Irritable bowel syndrome in inflammatory bowel disease: an evidence-based practical review. J Clin Med. 2025;15(1):116. doi:10.3390/jcm15010116