Dr Ahmed Shuqer

GI Fellow, Al-Azhar University hospitals ,Cairo , Egypt

[Dr Ahmed Shuqer @Ashoqueer2]

@DouglasAdlerMD

[Dr Ahmed Shuqer @Ashoqueer2]

@papascopy

[Dr Ahmed Shuqer @Ashoqueer2]

@a_fisiolog57853 https://t.co/amUQu7Daak

[Dr Ahmed Shuqer @Ashoqueer2]

@drkeithsiau https://t.co/T9DhKRYm4P

[Dr Ahmed Shuqer @Ashoqueer2]

@japariciot2 https://t.co/guRG5D1HJh

[Dr Ahmed Shuqer @Ashoqueer2]

@papascopy https://t.co/guRG5D2fyP

[Dr Ahmed Shuqer @Ashoqueer2]

Endosonography: Evidence based practice and review of endoscopic ultrasound https://t.co/S8XxWpK7LN

[Dr Ahmed Shuqer @Ashoqueer2]

@DouglasAdlerMD @Stentingwoman @EUSandEndoscopy @NEndoscopy Endosonography: Evidence based practice and review of endoscopic ultrasound https://t.co/S8XxWpK7LN

[Dr Ahmed Shuqer @Ashoqueer2]

@DharJahnvi @MDPIOpenAccess @CrinoStefano @DrAnuraagJ @Taalamri @Rajan___Singh @pankaj_jo @_JJ_stent @japariciot2 @JoanB_Gornals @Belenmm271 @doctorboletoh Endosonography: Evidence based practice and review of endoscopic ultrasound https://t.co/S8XxWpK7LN

[Dr Ahmed Shuqer @Ashoqueer2]

@DharJahnvi @Jayanta_sam @DrLakhtakia @neilRsharmaMD @Taalamri @AntonioFaccior6 @paris_golfakis @DeMadaria @DrRajeshPuri1 @DrAnuraagJ Endosonography: Evidence based practice and review of endoscopic ultrasound https://t.co/S8XxWpK7LN

[Dr Ahmed Shuqer @Ashoqueer2]

@DharJahnvi @Baishideng @ShubhraMishra91 @CrinoStefano @Samanta_JayPGI @Rajan___Singh @Taalamri @Endoscopist4 @DrLakhtakia @japariciot2 @roshmat15 @SChandanMD @gastroendonews @ManikGIMD @sayan006GI Endosonography: Evidence based practice and review of endoscopic ultrasound https://t.co/S8XxWpK7LN

[Dr Ahmed Shuqer @Ashoqueer2]

@papascopy Endosonography: Evidence based practice and review of endoscopic ultrasound https://t.co/S8XxWpK7LN

[Dr Ahmed Shuqer @Ashoqueer2]

@yannickneuder Endosonography: Evidence based practice and review of endoscopic ultrasound https://t.co/S8XxWpK7LN

[Dr Ahmed Shuqer @Ashoqueer2]

@rkalyes1 So totally agree that when there is acock's crow sure there has been alight

[Dr Ahmed Shuqer @Ashoqueer2]

@rkalyes1 Surely angels are light
The Messenger of Allah (ﷺ) said, "Angels were created from light, jinns were created from a smokeless flame of fire, and 'Adam was created from that which you have been told (i.e., sounding clay like the clay of pottery

[Dr Ahmed Shuqer @Ashoqueer2]

@rkalyes1 Actually we have an explanation done specifically for roosters in our religious
Our prophet Muhammad said "When you hear the cock's crow, ask Allah for His favor upon you for surely it has seen an angel.

[Charlie Lees @charlie_lees]

IBD Treatment Paradigms: past, present and future

by @IBDMD #DDW2025

What is a treatment paradigm?
Established approaches and strategies used in medical care for specific diseases or conditions
Involves a combination of therapies (surgery, medications and other interventions like diet) to achieve optimal patient outcomes

Traditional strategies that define treatment paradigms
• Sequential monotherapy
• Step up and combo therapy
• Targeted therapy
• Precision medicine
• Combination therapies
• Immunotherapies

OPTIMAL PATIENT OUTCOMES IN IBD
1. Unrestricted high QoL
2. Sustained control of bowel inflammation
3. Unencumbered personal and professional functioning
4. Healthcare that is affordable

General forces and factors in the development of treatments for IBD
· We do not know the cause and do not have medical cures
· Recognition of the chronic nature of IBD and phases of managements
· Development of outcomes of interest: short-term and long-term
· Evidence-based medicine
· Development of regulatory pathways for drug approval
· Advancements in technology
· Market forces and competition

Treatment paradigms in IBD
Desperation
Sequential monotherapy
Step-up
Top-down
Treat to target
Combination therapies
Biomarker driven
Cellular immunotherapy

The era of desperation in IBD marked by a multitude of evidence-free therapies: including horse serum, artificial fever therapy, hot water enemas, tincture of iodine and intracolonic insufflation of oxygen

Early surgical approaches in IBD: presumed “parasympathetic overactivity” or central nervous system causation; thymectomy in UC and bypassed loops of bowel in CD

Early approaches to diet in IBD: including elimination of raw fruits and vegetables, hyperalimentation with protein hydrolysates, bowel rest, fish oil

SEQUENTIAL MONOTHERAPY, STEP UP
Fail first, complications, delayed treatments

Treatment breakthroughs
Prontosil rubrum (1935, the source of sulfanilamide)
Antibiotics
Sulfasalazine (Professor Nanna Svartz, Karolinska)
Steroids
Mesalamine
Infliximab – taught us a lot about disease biology

Early step-up strategies –
Pyramids – staircases and lots of failures

Top-down – early effective therapy
This is the superior strategy for patients with Crohn’s disease

Proliferation of new therapies

Head-to-head studies in CD and UC – more are needed; the only trials that really change treatment practice / sequencing

Despite options and data, uptake by clinicians is not happening (Siegel CA Clin Trans Gastro 2020)

TREAT TO TARGET
Adjusting therapies until goal achieved

Challenges with treat to target
Crohn’s only –
Optimisation of one therapy, not sequencing to other MoA
Timing : how long to wait btwn assessments
How far to go
Need pragmatic research – verdict in UC, perianal, post-op

COMBINATIONS THERAPIES –
Breaking the therapeutic ceiling

Practical considerations
• Due to inadequate response
• Treatment of multiple diseases

Mechanistic considerations
• Additive efficacy
• Synergy
8 Durability

Safety considerations
Cost considerations

On-going combo studies
• DUET UC and CD
• EXPLORER 2.0
• ExiGEM
• Various diet studies

BIOMARKER DRIVEN elusive but promising
? will finally come of age with the biomarker in the TL1A studies

Consider clinical clues – cytokine-based strategies
The presence of other IMIDS gives clues to dominant biological process and therefore clues to treatment target

FUTURE CONSIDERATIONS

Emerging endpoints of interest
• Transmural healing
• Disease clearance
• Collateral remission (rheumatology) 0or functional remission

In progress STRIDE III (end 2025 / 26)

New(er) and novel treatments
- Improving existing MoAs
- New MoAs – novel small molecules, mucosal healing agents, cellular immunotherapy
- Pulse and de-escalation strategies
- Biome-based strategies
- Dietary strategies – elimination; modification

[Dr Ahmed Shuqer @Ashoqueer2]

@AdvaniRashmiMD NSBB

[Dr Ahmed Shuqer @Ashoqueer2]

@bakhsh_reda الاتنين يكملوا بعض يادكتور الصيام المتقطع يكمل نظام السعرات والاخلال بكليهما او احدهما يسبب زيادة بالوزن

[Dr Ahmed Shuqer @Ashoqueer2]

@KapuriaMD @BilalMohammadMD @AhmadBazarbashi @MN_GIMD @GIDrDon @ginorthshore @yuvalpatelMD @AasmaShaukatMD @SahajRathi Healed TB ulcer