Historically, registrational trials have captured the minority of patients with IBD seen in clinical care: in a study from 2011, Ha et al. examined the eligibility of 81 UC patients who required escalation or adjustment of their medical treatment, demonstrating that only 1 in 4 patients would have been eligible to participate in the ACT 1 or ACT 2 trials of infliximab for UC.9 Common reasons for exclusion were use of topical rescue therapy and requirement for colectomy (due to age, comorbidities, or dysplasia), and 1 in 3 patients were excluded due to TNF antagonist exposure. Here, TNF is linked to irritable bowel syndrome.