BSG From Top to Bottom

Consultant gastroenterologists Dr Hugo Penny, Sheffield Teaching Hospitals NHS Foundation Trust and Dr. Michael Fitzpatrick, Oxford University Hospitals NHS Foundation Trust, discuss why new Coeliac Disease treatments are needed and what is on the horizon. They review the drug pipeline, which targets the known antigen and immune response: cytokine inhibitors (e.g. IL-15), gluten-degrading enzymes, tissue transglutaminase 2 (TG2) inhibitors, and tolerogenic therapies. JAK inhibitors show promise in refractory coeliac disease.With no licensed therapies and no regulatory roadmap, several agents are in phase 2 trials, with anti-TG2 therapy furthest advanced. Trials currently focus on adults with ongoing disease despite at least 12 months on a GFD, with paediatric patients a likely future focus.

In this episode, Dr. Asma Fikree, Consultant Neurogastroenterologist at UCLH and Chair of the BSG Neurogastroenterology & Motility Section and Dr Maria Eugenicos, Senior Lecturer/Neurogastroenterologist, Western General Hospital, Edinburgh discuss the effects of anti-obesity medications on gastric motility, dyspepsia, and gastroparesis-like symptoms.

The discussion covers the management of nausea, vomiting and delayed gastric emptying, considerations before endoscopy and surgery, the phenomenon of tachyphylaxis, and practical approaches to dose titration. Dr. Fikree also examines the emerging evidence for GLP-1 therapies in patients with IBS and chronic gastrointestinal symptoms, highlighting both the benefits and limitations of these increasingly prescribed treatments.

Professor Vikram Mitra (Chair, Pancreas Clinical Section, British Society of Gastroenterology) speaks with Professor Pramod Garg, President of the Indian Society of Gastroenterology, about the link between gut microbiome and acute pancreatitis.

Topics include whether admission microbiome can predict disease severity, which bacterial classes (notably Proteobacteria) are tied to worse outcomes, and what's known about how gut bacteria may drive pancreatic inflammation. They also discuss the case against prophylactic antibiotics, why early enteral nutrition beats bowel rest, mixed results on interventions like rifaximin, and key confounders in microbiome research (diet, ethnicity, drug use, disease etiology).

To watch the interview, click here: https://www.bsg.org.uk/web-education/gut-microbiome-in-acute-pancreatitis 

In this BSG Podcast episode, Consultant Pharmacist, Fiona Rees is joined by Gastroenterology Registrar, Dr Krishna Shah and Consultant Obstetrician & Gynaecologist, Dr Mandeep Kaler to discuss pregnancy and inflammatory bowel disease (IBD). They explore the importance of preconception counselling and achieving disease remission before pregnancy.

The conversation covers how IBD can affect pregnancy and how risks can be reduced with good disease control.
They discuss practical approaches to managing flares and medication safety, reassuring that many treatments are low risk. The episode also highlights the role of multidisciplinary care between IBD and obstetric teams. Key topics include delivery planning, breastfeeding, and postpartum care. The speakers emphasise empowering patients with accurate information throughout their journey.

In this episode of the BSG Top to Bottom podcast, Prof James East and Prof Pradeep Bhandari dive into the endoscopic aspects of the new BSG IBD Surveillance Guidelines. Building on part one’s focus on cancer risk and surveillance rationale, this discussion explores practical essentials, from bowel preparation and patient comfort to chromoendoscopy, lesion detection, and the nuances of managing dysplasia in IBD. The conversation also highlights training, service delivery, MDT decision‑making, and the evolving roles of advanced endoscopic techniques and surgery. 

Join Dr. Shahida Din, consultant gastroenterologist and Chair of the BSG IBD Section, for an in‑depth conversation with Professor James East, leading gastroenterologist, endoscopist, and co‑author of the new BSG IBD Surveillance Guidelines. They explore how cancer risk in IBD has evolved, when to start or stop surveillance, and the shift toward personalised risk assessment. The episode covers key updates on bowel prep, biopsy strategies, patient experience, and what clinicians should know to deliver high quality, patient centred surveillance.
Stay tuned for Part 2 on endoscopic techniques and dysplasia management with Professor Pradeep Bhandari 

Part seven of seven: Dr Alexandra Kent, Consultant Gastroenterologist at King’s College Hospital, is joined by Professor Jimmy Limdi, Head of the IBD section at the Northern Care Alliance NHS Foundation Trust, to explore how Crohn's Disease recurrence is defined, predicted, monitored, and managed after surgery as recommended in the BSG IBD Guidelines.

Together, they discuss the continuum of post-operative recurrence from histological and endoscopic changes to clinical and surgical relapse. They highlight key patient, disease, and surgical risk factors, including smoking and aggressive disease phenotypes. The episode covers best practice for post-operative monitoring, including the role of ileocolonoscopy, Rutgeerts scoring, faecal calprotectin, intestinal ultrasound, and cross-sectional imaging.

Part six of seven: Polychronis Pavlides, Consultant Gastroenterologist at King's College Hospital in London and Fraser Cummings, Consultant Gastroenterologist in Southampton and adult IBD service lead, discuss the first line treatment of Luminal Crohn’s Disease outlined in the newly updated BSG IBD Guidelines.

They explore the importance of shared decision making and patient centred care along with practical guidance on choosing therapies, monitoring response, and aligning with STRIDE targets. This podcast also includes the challenges in comparative effectiveness and why sequencing remains complex.

Part five of seven: Krishna Shah, Gastroenterology Registrar and IBD Research Fellow at the Royal London Hospital and Dr. Kamal Patel, Consultant Gastroenterologist at St George's Hospital discuss the Advanced Therapies in Ulcerative Colitis section of the new BSG guidelines beginning with mesalazine, prednisolone and azathioprine through to thiopurines and anti-TNFs. They discuss the cost-benefit outcomes of the drug pathways advised in the BSG Guidelines including some of the potential adverse side-effects.

Part four of seven: Professor Naila Arebi, Consultant Gastroenterologist and colleague, Consultant Colorectal Surgeon, Janindra Warusavitarne, both at St Mark's National Bowel Hospital, discuss the application of the BSG IBD Guidelines to provide optimal treatment using a holistic approach and deliver the best quality of care for patients.

They talk about the important relationship between surgeons and gastroenterologists in the diagnosis and treatment of Perianal Crohn’s disease, supporting this with systematic clinical research.