Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory conditions of the gastrointestinal tract associated with impaired quality of life. The Communicating Needs and Features of IBD Experiences (CONFIDE) study aimed to assess the impact of CD/UC symptoms on the lives of people with IBD and elucidate any communication gaps between healthcare professionals (HCPs) and people with IBD. The current Canadian study replicates the CONFIDE study previously conducted in the United States, Europe, and Japan. Online cross-sectional surveys were conducted between February and April 2023 among people with moderate-to-severe CD/UC and prescribing HCPs. Disease severity was defined using criteria based on previous treatment, steroid use, and/or hospitalization. Data were presented using descriptive analyses. Surveys were completed by 107 individuals with CD, 82 individuals with UC, and 53 HCPs. Bowel urgency was the second most common symptom reported by individuals, following diarrhoea, and it was the most frequently reported symptom leading to declining participation in work/school, social events, and physical exercise. HCP-perceived symptoms with the greatest impact on people with IBD and their treatment decisions were diarrhoea and blood in stool. While most HCPs reported proactive discussion of bowel urgency with their patients, more than a third of those experiencing this symptom reported discussing it infrequently during HCP appointments. The results indicate that CD/UC symptoms have a substantial impact on the daily lives of people with IBD, even among those receiving advanced therapies. Although both HCPs and individuals with IBD reported a substantial symptom burden, their perceptions regarding the most impactful symptoms differed. Bowel urgency was identified as a common yet overlooked symptom and should be incorporated into regular IBD assessments.
Small bowel bleeding accounts for about 5%-8% of all cases of gastrointestinal bleeding. Suspected small bowel bleeding (SSBB) can be classified into occult, inactive overt, and overt. Most patients with SSBB will undergo balloon-assisted enteroscopy (BAE) for diagnosis and treatment. There are currently no recommendations from practice guidelines on what is the best approach and limited information about diagnostic and therapeutic yields for each subtype of SSBB. We aimed to investigate the diagnostic and therapeutic yields of BAE in the 3 subtypes of patients with SSBB by performing a retrospective analysis of all patients that underwent BAE for this diagnosis at the University of Alberta Hospital in a 5-year period. We also aimed to identify other factors that could influence diagnostic and therapeutic yields. The overall diagnostic and therapeutic yields of BAE for SSBB were 66% and 51%, respectively. When stratified by subtypes of SSBB, the diagnostic yield for occult, inactive overt, and active overt SSBB were reported to be 61%, 67%, and 95% (P < .05), respectively. BAE performed within 72 hours of presentation and patients requiring transfusion within the past 12 months had a significantly higher diagnostic yield. Our data showed the clinical differences between the 3 subtypes of patients with SSBB and the usefulness of an appropriate and timely approach to maximize the diagnostic and therapeutic yields.
The contemporary epidemiology of hepatocellular carcinoma (HCC) shows a shift in the main etiological risk factors from less common but highly virulent (eg, hepatitis C and B) to more common but weak risk factors (eg, alcohol and metabolic syndrome). Therefore, we are in a seemingly paradoxical state of declining overall incidence rates of HCC-related to improved prevention and treatment of viral hepatitis but burgeoning number of people at an elevated risk of HCC. Several geographic regions have reported an increase in HCC attributable to alcoholic liver disease and metabolic dysfunction associated with steatotic liver disease (MASLD). The importance of risk stratification is increasing to allow for targeted prevention and early detection of HCC. Most risk factors predispose HCC through the formation of cirrhosis, which has served as the main risk stratifying factor. However, this scheme is showing cracks at both ends of the spectrum. On one hand, the risk of developing HCC varies widely among patients with contemporary advanced fibrosis or cirrhosis, and on the other hand up to one-third of MASLD-related HCC occurs among patients with no clear evidence of cirrhosis. The use of multidimensional (eg, clinical, epidemiological, and biochemical) predictive algorithms may improve risk stratification efforts. The shift in HCC risk factors also further heightened the importance and limitations of current surveillance practices (eg, reduced performance of ultrasound in MASLD). Therefore, exploring advanced imaging methods, new biomarkers but also existing combinations of biomarkers augmented by clinical factors for HCC early detection is crucial.
Recent research has identified an association between proximal sessile serrated lesions (SSLs) and an increased risk of advanced metachronous neoplasia (TMAN), with no significant impact from distal SSL. This study aimed to assess the risk of TMAN at follow-up colonoscopy after detecting proximal hyperplastic polyps (HP), adenomas, or their combination at the initial colonoscopy. Medical records from patients who underwent colonoscopies in 2014 and 2015 were reviewed. The primary outcome was the presence of TMAN (advanced adenomas or high-risk SSL) at follow-up, based on the presence of proximal HP, adenomas, or their combination during the index colonoscopy. Out of 2014 patients screened, 764 were included in the final analysis (44.1% male; mean age 63 years; median follow-up of 3.46 years). Patients with both proximal HPs and adenomas during the initial colonoscopy had a significantly higher risk of developing TMAN compared with patients with adenomas and distal HP or adenomas alone (30.5% vs 19%; HR = 1.87; 95% CI, 1.3-2.7). Additionally, a combination of proximal HPs and adenomas posed a higher risk of TMAN than proximal HP alone (30.5% vs 13.9%; HR = 3.6; 95% CI, 1.4-9.5). No significant difference in TMAN risk was observed between patients with adenomas alone versus proximal HP (19.1% vs 13.9%; HR = 1.8; 95% CI, 0.73-4.4). The presence of both proximal HPs and adenomas significantly increases the risk of TMAN compared with adenomas or HPs alone, highlighting the need for further studies to evaluate the effect of these variables on postcolonoscopy CRC.
Over the past several years, there has been increasing interaction between Hepatology and Endoscopy, mainly facilitated by EUS-guided modalities. There are 4 main areas that have led to the emergence of what has been called "Endohepatology". The first is EUS-guided parenchymal liver biopsy (EUS-LB). An optimal technique EUS-LB has been developed using a 19G EUS fine needle biopsy needle with "wet suction." There are several advantages to EUS-LB. Another component of Endohepatology is the ability to directly measuring portal pressure gradient (PPG) under EUS guidance. A 25G needle can be inserted directly into branches of the hepatic vein and portal vein to measure PPG. Although this technique requires a sedated endoscopic procedure, it is technically easier and better tolerated than the traditional transjugular approach and is very safe. Newer techniques of endoscopic management of gastric varices using EUS-guided injection of glues and coils is another driver of Endohepatology. EUS-guided glue injection is safer than direct endoscopic injection, and the use of coils decreases the incidence of glue embolization. The fourth pillar is expanded use of EUS-guided gallbladder drainage (EUS-GB) with lumen apposing metal stents. This is beginning to revolutionize management of gallbladder disease in cirrhotic patients who are poor candidates for cholecystectomy. Endohepatology will grow as these 4 main applications become more widespread and Hepatologists become more comfortable with the role of Endohepatology in patient management.
Acute severe ulcerative colitis (ASUC) is associated with significant morbidity. In patients with ulcerative colitis (UC), the estimated lifetime risk of developing severe colitis is 25%. Several gastrointestinal societies have provided recommendations on pathways of care for managing ASUC. The degree to which they are adhered to in different care settings remains unclear. We conducted a retrospective review using data from 7 acute-care hospitals collected through the general medicine inpatient initiative (GEMINI), a hospital research collaborative that collects administrative and clinical data from hospital information systems. We identified all patients with the most responsible inpatient discharge diagnosis of ulcerative colitis between April 2015 and December 2019. The primary outcome was the difference in hospital length of stay of patients admitted with ASUC based on hospital-type; community, academic, or inflammatory bowel disease (IBD)-focussed sites. 765 eligible patients were identified between April 2015 and December 2019. The mean hospital length of stay was 9.21 days for the academic sites, 6.94 days for the community sites, and 8.03 for the IBD specialty centre (P = .094). Adverse events were uncommon overall. In our multiple logistic regression analysis, we identified that admission to an IBD-focussed centre compared to an academic centre, carried an odds ratio of 2.07 (95% CI, 1.16-3.78) for the outcome of inpatient-colectomy. The processes of care for patients with ASUC varied on the basis of the type of hospital they were admitted to, with the IBD specialty centre providing the most guideline adherent care. Low-cost interventions should be utilized to promote adherence to clinical practice recommendations.
Environmental change is underway and has the potential to adversely affect digestive health. Professional medical organizations have an important role to play in addressing the challenge. An important initial response is the development of a sustainability plan for the medical organization. There are no standardized criteria as to what should be included in such a plan. We have proposed 12 key components that should be contained in sustainability plans for medical organizations. We describe how these were developed for the Canadian Association of Gastroenterology (CAG) and plans for future implementation. We hope that the CAG plan may serve as a template to assist peer medical organizations optimize their response to the climate crisis.
Family physicians often hold reactive, case-by-case mental models for cirrhosis care due to systemic gaps in coordination, continuity, and transitions of care. Confusion may also exist between palliative and end-of-life care, with uncertainty around the timing of conversations with patients. Examining how family physicians approach symptom management with patients living with cirrhosis may provide insights into how they incorporate palliative principles of care. This study aims to elicit and explore family physicians' mental models of symptom management in cirrhosis care to reveal if palliative principles are integrated into primary care practice. A cross-sectional formal elicitation of mental models was conducted using Cognitive Task Analysis. We used purposive sampling of family physicians (n = 6) who saw small numbers, typical for unspecialized practice, of cirrhosis patients in Alberta, Canada. Lack of continuity in cirrhosis care obliges physicians to hold reactive mental models of symptom management. This, with the confusion between palliative and end-of-life care, causes uncertainty around when and how to have conversations about advanced care planning and end-of-life care. Physicians expressed a desire for tools, processes, and education to fit palliative principles into their care. Without formal processes and structures in place, family physicians will continue to hold reactive mental models of cirrhosis management, often lacking fully integrated palliative principles. Family physicians and care teams require support to guide when and how to have conversations about advanced care planning with patients, family, and caregivers at the time of diagnosis, and throughout the trajectory of the illness.
The therapeutic landscape of ulcerative colitis (UC) has undergone significant change over the last 2 decades. While there are multiple new therapies for the management of UC, long-term remission rates remain low, and this may be in part due to the difficulty of navigating a successful treatment strategy. In this review, we propose a rational framework for treatment selection, sequencing, and optimization in patients with UC. We outline treatment goals and targets for UC, followed by a discussion of the challenges in treatment selection and considerations to help guide a sequencing strategy. These include an assessment of a therapy's efficacy and safety, the convenience in the delivery of the therapy, ease of access, and patient-related factors. We then provide an overview of the currently approved therapies for UC, with an in-depth analysis of their advantages and disadvantages. Finally, we conclude with future directions in the management of UC, which include the use of naturopathic therapies, faecal microbiota therapy, the use of precision medicine, and other strategies such as combination therapy.
Among Crohn's disease patients with loss of response or non-response to ustekinumab (UST), there remains no clear strategy for dose escalation. Moreover, clinical associations and the role of therapeutic drug monitoring (TDM) are poorly understood. This study assessed response to escalation of UST therapy via increased dosing frequency or re-induction, as well as assessed associations of response. A single-centre retrospective cohort study was performed. Adults who underwent dose escalation to every 4 weeks or reinduction of UST were included. The primary outcome was clinical and biochemical remission which was defined as a Harvey Bradshaw Index (HBI) of <5 and a C-reactive protein (CRP) level within the normal limit or a Fecal Calprotectin (FCP) level <250 ug/g. Partial response to treatment was defined as a 50% decrease from baseline HBI, CRP, or FCP. Thirty-nine patients were included. Clinical outcomes were assessed at a median of 17 weeks (IQR 12-21). Clinical and biochemical remission was achieved in 30.8% of patients (n = 12). Remission was found to be more likely among patients with lower baseline HBI (5.2 vs 9.0 P = .044) and younger patients (29.8 years vs 37.7 P = .046). No association was observed between baseline TDM values in the remission vs the non-remission group (3.32 ug/mL vs 2.91 ug/mL p=0.77). No severe adverse events were recorded. UST dose escalation, in the form of reinduction or increased frequency to every 4 weeks may be effective among patients with loss of response or partial response, though predictors of response and strategy of escalation remain unclear.
Access to inflammatory bowel diseases (IBD) specialist care is a predictor of health outcomes. We sought to characterize the impact of the pandemic on patterns of IBD healthcare delivery and whether it compromised overall access to care. We identified adults with an IBD diagnosis residing in Ontario between 2016 and 2021 using administrative data at ICES. We determined quarterly rates of in-person and virtual IBD specialist visits and stratified that by regions with high and low access to IBD specialists. We stratified our analyses into 3 periods: pre-COVID, immediate COVID, and maintenance COVID. We performed interrupted time series analysis to assess for time trends. During the immediate COVID phase, there was a 69% relative quarterly decline in in-person IBD specialist visits with a concurrent 591% relative quarterly rise in rates of virtual visits. Entering the COVID maintenance phase, there was a 7% quarterly relative decline in the rate of in-person visits, and a 7% and 4% quarterly relative increases in the rates of virtual and total IBD specialist visits, respectively. Pre-pandemic, IBD patients residing in regions with high specialist access had a 16% higher rate of visits than those in low-access regions. During the COVID maintenance phase, the disparity was reduced to 12%. During the COVID-19 pandemic, the rapid transition from in-person to virtual IBD specialist care led to a slight increase in overall IBD visits. There was also a small decrease in the gap in rates of IBD specialist visits between high- and low-access regions.
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus that effects both pediatrics and adult patients in Canada and is increasing in prevalence. No Canadian focused best practice recommendations currently exist to guide clinical practice. The study used a modified Delphi technique to develop evidence and expert opinion-based recommendations for providing care for patients with EoE. The Delphi process consisted of 3 rounds of quantitative surveys and qualitative consensus meetings. Experts were included in the Delphi if they had experience caring for EoE patients in Canada within one of the following professional groups: allergist, adult gastroenterologists, pathologists, pediatric gastroenterologists, and dieticians. Delphi rounds were completed between May 1, 2024, and June 30, 2024. A total of 31 experts in EoE care from across Canada were recruited to participate in the Delphi consensus process. All participants completed all 3 rounds of Delphi surveys. The final statement includes 38 recommendations for the care of patients with EoE organized into 3 sections: definition, diagnosis, and management. A table of research gaps is provided to stimulate further knowledge development on this topic. This consensus statement includes actionable recommendations to support quality care of patients with EoE at any age across Canada. We encourage EoE centres in Canada to come together in a multidisciplinary form to not only provide clinical care but also do much needed research on Canadian specific topics and gaps in EoE care.
Individuals with ulcerative colitis (UC) are frequently re-hospitalized for persistent or recurrent severe disease flares. Accurate prediction of the risk of early re-hospitalization at the time of discharge could promote targeted outpatient interventions to reduce this risk. We conducted a retrospective study in adults with UC admitted to The Ottawa Hospital between 2009 and 2016 for an acute UC-related indication. We ascertained candidate demographic, clinical, and health services predictors through medical records and administrative health databases. We derived and bootstrap validated a multivariable logistic regression model of 90-day UC-related re-hospitalization risk. We chose a probability cut point that maximized Youden's index to differentiate high-risk from low-risk individuals and assessed model performance. Among 248 UC-related hospitalizations, there were 27 (10.9%) re-hospitalizations within 90 days of discharge. Our multivariable model identified gastroenterologist consultation within the prior year (adjusted odds ratio [aOR] 0.11, 95% confidence interval [CI], 0.04-0.39), male sex (aOR 3.27, 95% CI, 1.33-8.05), length of stay (OR 0.94, 95% CI, 0.88-1.01), and narcotic prescription at discharge (OR 1.96, 95% CI, 0.73-5.27) as significant predictors of 90-day re-hospitalization. The optimism-corrected c-statistic value was 0.78, and the goodness-of-fit test P-value was .09. The chosen probability cut point produced a sensitivity of 77.8%, specificity of 80.9%, positive predictive value (PPV) of 33.0%, and negative predictive value (NPV) of 96.7% in the derivation cohort. A limited set of variables accessible at the point of hospital discharge can reasonably discriminate re-hospitalization risk among individuals with UC. Future studies are required to validate our findings.
Foreign body ingestions (FBI) are a common reason for emergency department (ED) visits in children. We hypothesized that increased time spent at home by children due to COVID-19 restrictions could contribute to a rise in FBI ingestion rate and severity. Our primary objective was to evaluate the number of FBI cases at a Canadian tertiary paediatric hospital in Montreal during the pandemic as compared to the two previous years. Children assessed at CHU Sainte-Justine ED for FBI between March 2018-February 2020 (pre-pandemic) and March 2020-February 2021 (pandemic) were included. FBI ratio was calculated by dividing the number of FBI cases by the total number of ED visits. Differences between the two groups were analyzed by Student's t-test or Chi-square test. A total of 614 cases of FBI (median age, 3.5 years; 54% male) were included. The ratio of FBI doubled during the pandemic: 51.7 cases/10,000 ED visits vs 24.0 cases/10 000 visits in the pre-pandemic group (P = 0.0002). The overall number of cases increased significantly during the pandemic period from an average 15.5 cases per month to 20.2. Almost one-fourth of the cohort was hospitalized at similar rates during both observation periods. The ratio of FBI cases increased significantly during the pandemic in comparison with the two previous years. The high hospitalization rates, although stable during the pandemic, underline the significant morbidity associated with paediatric FBI.
Telemedicine offers a promising approach to reduce the carbon footprint of healthcare delivery by minimizing travel-related greenhouse gas emissions. In this study, we quantified the carbon emissions savings from shifting gastroenterology clinic visits from in-person to telemedicine in a single gastroenterologist's clinic in a major urban Canadian centre that serves a mixed urban and rural Canadian population. A cross-sectional analysis was conducted on 5690 telemedicine encounters from March 2020 to March 2022 at a tertiary-care gastroenterology clinic in Winnipeg, Manitoba, for a single gastroenterologist. Carbon emissions related to travel from home to clinic were estimated. The values are presented as CO2e, a standardized measure used to compare and aggregate the impact of different greenhouse gases on global warming. Travel distances were estimated using driving routes or flights for non-drivable locations. Clinic operational emissions were also estimated to assess total potential savings. The total potential travel distance avoided was 880 336 km. Rural patients accounted for 92.7% of this distance. The average CO2e emissions saved per encounter was 42.9 kg, with rural encounters averaging 106.7 kg and urban encounters 4.6 kg. Clinic operational emissions were minimal at 0.06 kg of CO2e per encounter, compared to travel-related emissions. Over the 2 years, telemedicine visits saved approximately 244 079 kg of CO2e, underscoring the significant environmental benefit of virtual care. Telemedicine reduces the carbon footprint of gastroenterology outpatient care by minimizing patient travel, especially for rural populations. Incorporating telemedicine into routine practice can promote environmental sustainability within healthcare systems.
The incorporation of artificial intelligence (AI) into gastrointestinal (GI) endoscopy represents a promising advancement in gastroenterology. With over 40 published randomized controlled trials and numerous ongoing clinical trials, gastroenterology leads other medical disciplines in AI research. Computer-aided detection algorithms for identifying colorectal polyps have achieved regulatory approval and are in routine clinical use, while other AI applications for GI endoscopy are in advanced development stages. Near-term opportunities include the potential for computer-aided diagnosis to replace conventional histopathology for diagnosing small colon polyps and increased AI automation in capsule endoscopy. Despite significant development in research settings, the generalizability and robustness of AI models in real clinical practice remain inconsistent. The GI field lags behind other medical disciplines in the breadth of novel AI algorithms, with only 13 out of 882 Food and Drug Administration (FDA)-approved AI models focussed on GI endoscopy as of June 2024. Additionally, existing GI endoscopy image databases are disproportionately focussed on colon polyps, lacking representation of the diversity of other endoscopic findings. High-quality datasets, encompassing a wide range of patient demographics, endoscopic equipment types, and disease states, are crucial for developing effective AI models for GI endoscopy. This article reviews the current state of GI endoscopy datasets, barriers to progress, including dataset size, data diversity, annotation quality, and ethical issues in data collection and usage, and future needs for advancing AI in GI endoscopy.
Women with inflammatory bowel disease (IBD) experience greater delays and misdiagnosis than men. Data from other conditions suggest that sex and/or gender bias in the process of referral to speciality care may contribute. We undertook a mixed methods analysis of 120 referral letters to gastroenterology for people ultimately diagnosed with IBD in Calgary, Alberta. Letters were masked for patient sex and gender prior to analysis. Gastroenterologists who were masked to the objective of the study rated the quality of referral letters and triaged letters for urgency. Two study team members performed a Framework analysis to identify agentic (masculine) and commensal (feminine) adjectives, mentions of caregiving and work roles, and psychosocial history. After analysis, letters were unmasked and findings were compared by patient sex. There were 116 referral letters included in the analysis (n = 59, 50.9% for male patients). There were no differences in letter quality or triage urgency between male and female patients (median quality 4 [IQR 4-7] and 5 out of 10 [IQR 4-6], respectively, higher scores represent better quality; P = .37, and P = .44 for triage category). There was no difference in the use of adjectives and mention of caregiving or work roles, psychiatric history, or social history between letters for female and male patients. This mixed methods analysis identified no difference in referral letter language, contents, or quality for female and male patients with IBD. Masked letters were triaged similarly to unmasked letters, suggesting an absence of sex and/or gender bias in the gastroenterology triaging process in our setting.
Music therapy is a low-cost and low-risk intervention that has been shown to improve patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in various areas of medicine including gastrointestinal (GI) endoscopy. A scoping review was performed to answer the following research question: What is known from the existing literature about the effect of music therapy used in adult GI endoscopy on PROMs (eg pain, anxiety) and PREMs (eg satisfaction, willingness to repeat procedure)? Guided by the methodologic framework proposed by Arksey and O'Malley, 3 medical databases were queried for articles pertinent to the research question and published between January 2005 and December 2024. Studies were selected for inclusion based on established criteria and summarized in a comprehensive data table as well as accompanying figures. A total of 30 original research articles were selected for inclusion. The most reported outcomes were pain (N = 21), anxiety (N = 21), and satisfaction (N = 14). Significant improvements following music therapy were described most commonly for anxiety (N = 15, 71% of 21) and satisfaction (N = 10, 71% of 14) and less commonly for pain (N = 11, 52% of 21). Reductions in pain and anxiety were more consistent for music interventions performed in the pre-endoscopy period. Music therapy appears to be an effective means of improving anxiety and satisfaction in patients undergoing GI endoscopy. Endoscopists should consider music therapy as a non-pharmacologic adjunct to improve the patient experience in endoscopy.
As inflammatory bowel disease (IBD) becomes increasingly common worldwide, optimizing service delivery is critical to ensuring timely access to high-quality IBD care. We conducted a scoping review to understand the extent and type of evidence related to models of outpatient IBD care. We searched MEDLINE, EMBASE, CINAHL, and PsycINFO from inception to April 29, 2025 to identify English-language studies describing or evaluating models of care delivery for individuals with IBD in outpatient settings. Eligible peer-reviewed articles included publications of any type (primary studies, reviews, perspectives) focusing on any age group, timepoints in care (eg, transition from pediatric to adult care), and context (eg, remote delivery). Of the 14,202 records searched, 243 met the inclusion criteria, including 89 studies evaluating models of care, 141 studies describing models of care without formal evaluation, and 13 consensus statements/guidelines. Models discussed included value-based multidisciplinary teams (with either biomedical or biopsychosocial approaches), care provided by nurses and other allied healthcare professionals (HCPs), remote monitoring and healthcare delivery, and rapid access clinics. Models increased patient satisfaction, enhanced collaboration between patients and HCPs, reduced health services utilization (eg, emergency department visits, hospitalizations), and improved patient outcomes (ie, disease activity, mental health, quality of life). Gastroenterologists, IBD nurses, and allied HCPs were consistently identified as key team members. Innovative outpatient models of IBD care have been proposed and evaluated. These models of care can guide modifications to IBD care globally to help address the rising demand of IBD on healthcare systems, increasing the efficiency of care.
The primary objectives of the management of patients with inflammatory bowel disease (IBD) are to prevent IBD flares, prevent/delay disease progression and improve patients' quality of life. To this end, one needs to identify risk factor(s) associated with flare-ups and disease progression. We posit that disruption of circadian rhythms is one of the key factors that is associated with risk of flare-up and disease progression. This hypothesis is based on published studies that show: (1) The circadian rhythm regulates many biological processes including multiple IBD-relevant biological processes that are critical in inflammatory/immune processes such as environment/microbe interaction, microbe/host interaction, intestinal barrier integrity and mucosal immunity-all central in the pathogenesis of IBD, and (2) Circadian machinery is the primary tool for the host to interact with the environment. Circadian misalignment results in a loss of preparedness of the host to respond and adjust to the environmental changes that could make the host more vulnerable to IBD flare-ups. In this review, we first provide an overview of circadian rhythms and its role in healthy and disease states. Then we present data to support our hypothesis that: (1) IBD patients have disrupted circadian rhythms ("social jet lag") and (2) circadian misalignment and associated disrupted sleep decreases the resiliency of IBD patients resulting in microbiota dysbiosis, more disrupted intestinal barrier integrity and a more aggressive disease phenotype. We also show that circadian-directed interventions have a potential to mitigate the deleterious impact of disrupted circadian and improve IBD disease course.