Dr. Amy Lightner has spent her career moving between the operating room and the research lab, treating ulcerative colitis (UC) and other inflammatory bowel disease (IBD) patients as a surgeon while also searching for better treatments as a scientist.

“I sit in clinic with patients and hear their stories about how IBD affects every aspect of their lives—professional, personal, emotional, physical. It is chronic and it can be devastating. These stories motivate me to find better treatments,” she says. “These patients, in some of their most vulnerable times, go through life-altering surgeries. Honestly, I’d love to give up surgery if that meant we had found a cure.”

Lightner, who is the chief medical officer at Calibr-Skaggs, a professor at Scripps Research and a colorectal surgeon at Scripps Clinic, recently published updated clinical practice guidelines for the surgical management of ulcerative colitis. In the following Q&A, she walks through what’s changed, from why some patients may now need fewer colonoscopies, to how surgery rates have dropped by half in the last decade. She also shares what her own research is turning up on the lab side, and what she thinks patients and providers should be watching for.

What are the key updates from the prior guidelines?

The main thing that’s changed is how we approach cancer risk in patients with UC, specifically colon cancer risk. Patients with UC and other types of IBD have been told to undergo a surveillance colonoscopy every year if they have inflammation in the colon.

But recently, visibility during an endoscopy has improved dramatically, thanks to advanced imaging technology. We’re now able to see lesions that could otherwise become precancerous. That’s a real shift from before, when limited visibility meant relying on random biopsies and sometimes taking a patient’s entire colon out. Today, we can visualize these lesions and remove them at the time of the colonoscopy, continuing surveillance from there.

The recommendation is nuanced—it still depends on the size of the lesion and biopsies from the surrounding area—but the big picture is that because the technology has advanced so far, we can often remove a lesion completely and keep watching, rather than jumping straight to removing the entire colon.

How does this affect how UC patients receive care on a day-to-day basis?

There’s a lot more focus now on multidisciplinary care and clinics. Rather than a patient being managed solely by a GI physician with a long list of medications, surgeons get involved early on. That way, we begin to form a relationship, and we’re not seeing them for the first time in an emergency setting. That multidisciplinary team also includes a radiologist, pathologist, psychologist, nutritionist and even an OB-GYN in certain cases, if a patient is thinking about the impact of medications on fertility and pregnancy.

It really takes a team of providers around a patient to deliver optimal care. Many of these patients also deal with other extraintestinal manifestations, like eye, skin or joint issues, so this model allows them to be cared for comprehensively. We’re moving away from the old, siloed approach.

As an experienced colorectal surgeon, how have you seen the UC field evolve?  

IBD incidence is clearly increasing, which now affects 1 in 100 people in the U.S. The good news is that with access to so many more advanced therapies beyond the traditional anti-inflammatory medicines—like JAK inhibitors and IL-23 inhibitors—many UC patients no longer need their colon removed. It used to be that 25–30% of patients required a surgical procedure; now it’s closer to 10–15%.

Something worth knowing: If you’re having diarrhea, urgency or blood in your stool, these can all be signs or symptoms of UC. If they persist for a week or two, you should be evaluated, and UC should be on the list of things to rule out.

At Scripps Research and Calibr-Skaggs, we continue to think about different ways to approach disease management. In IBD, for example, we have focused on tissue regeneration and repair to complement the currently approved anti-inflammatories. One therapy that’s come out of that work is CLF065, a long-acting GLP-2 receptor agonist we’re advancing into two phase 2 studies in chronic pouchitis and Crohn’s disease. CLF065 is the first phase 2 asset being investigated in IBD that is designed to actively regenerate and repair the damaged gut lining.

How does your work as a surgeon inform your work as CMO of Calibr-Skaggs?

It really helps me identify areas of unmet need: Where are the gaps in patient care? What could we be doing better? There may be published literature on how well a drug works, but patients may not want to be on those drugs, may not be compliant or may be dealing with side effects. We hear directly from patients, in real time, about why a drug isn’t working for them. This real-world data doesn’t always match the published reports.

As a surgeon, one thing I’m really grateful for is that patients have been generous enough to let us study colon tissue that’s had to be surgically removed. At Calibr-Skaggs, we run a high-throughput screen using our ReFRAME library to compare healthy volunteer tissue against diseased tissue. That gives us a shot at identifying new treatments and continuing to push things forward for patients.