All research presented at ACG 2025 is strictly embargoed until 12:00 pm local Arizona Time, which aligns with Pacific Daylight Time (PDT)/3:00 pm ET on Sunday, October 26, 2025.
Oral 24 – Does Mild Endoscopic Disease Drive Persistent Symptoms in Crohn’s Disease? A Repeated Measures Analysis
Tuesday, October 28, 2025 | 9:20 AM – 9:30 AM PDT | North Ballroom 120D
Author Insight from Carl Samaha, MD
What’s new here and important for clinicians?
The Treat-to-Target (T2T) approach in Crohn’s disease has improved outcomes by focusing on measurable inflammation control. Achieving endoscopic, biochemical, and histologic remission remains essential, as these targets predict fewer complications and better long-term results. However, T2T also emphasizes shared, realistic goals with patients, including symptom relief and quality of life. Our study shows that once patients reach mild endoscopic disease (SES-CD 3–6), inflammation no longer explains most ongoing gastrointestinal symptoms, which instead appear to reflect functional, sex-specific changes. At this stage, management should expand from immunosuppression alone to include symptom-directed care through dietary optimization, neuromodulators, antispasmodics, behavioral therapy, and targeted physiologic testing. Once inflammatory targets are achieved, treatment should again center on the person behind the disease.
What do patients need to know?
In Crohn’s disease, inflammation and symptoms do not always move in the same direction. Even when a colonoscopy shows healing, it’s common to still have abdominal pain, urgency, or stool changes. This does not mean the disease is active again. Over time, inflammation or prior surgery can make the gut more sensitive, change how it moves, and disrupt the balance of helpful bacteria. These changes can lead to ongoing symptoms even when inflammation is mild or resolved. While inflammation should always be treated to a clear target, symptomatic care often needs to continue alongside it. This may include dietary adjustments, medication, behavioral therapy, or testing for motility and pelvic floor issues. Recognizing this helps patients and doctors focus on both controlling inflammation and restoring comfort, confidence, and quality of life.
Author Contact
Carl Samaha, MD
University of Pittsburgh
Pittsburgh, PA
cas692 [at] pitt.edu
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