Publications
Dr. Squirell's research looks at the long-term realities of living with IBD, with a focus on pregnancy, preventive care and population-level outcomes. Open-access papers can be downloaded free: click the first page.
All publications
2025
PDFPregnant Pause? Not for IBD Care: A Single Tertiary Care Center Prospective Cohort Study Affirming IBD Management in Pregnancy
Squirell E, Rosenfeld G, Bressler B, Meade S, Klemm N, Chen V, Joa E, Leung Y
Crohn's & Colitis 360 2025;7(2):otaf029 · Original research
We followed 287 women with IBD through 291 pregnancies between 2017 and 2023, before conception, in each trimester and after birth. Most had healthy pregnancies while continuing their IBD medicines.
Key findings
- 92.7% of pregnancies ended in a live birth.
- Preterm birth (6.7%) and small-for-gestational-age babies (7%) were in line with the general population.
- Disease activity rose during pregnancy in ulcerative colitis, peaking at 37% in the second trimester, but stayed stable in Crohn’s disease.
- Biologic use did not change outcomes; steroid use was linked to more preterm births.
Open access under CC BY-NC 4.0. Shared here as permitted by the licence.
PDFDeprescribing Advanced Therapies in Inflammatory Bowel Disease
Squirell E, Hearn J, MacMillan M
Canadian IBD Today 2025;3(2):6–12 · Review
A practical framework for stopping or lowering advanced IBD therapy in carefully chosen patients: who to consider, how to assess the risks, shared decision-making, close monitoring, and a rescue plan agreed in advance in case of relapse.
Open access under CC BY-NC-ND 4.0. Shared here as permitted by the licence.
2024
PDFThe Fundamentals of Inflammatory Bowel Disease Management in Pregnancy: A Practical Review for the Gastroenterologist
Squirell E, Meade S, Leung Y
Journal of the Canadian Association of Gastroenterology 2024;7(1):121–131 · Review
Seven practical principles for caring for people with IBD before, during and after pregnancy in Canada, from preconception counselling to breastfeeding and infant vaccines.
Key findings
- Aim for steroid-free remission, confirmed by objective tests, before conception.
- Methotrexate and small molecules are contraindicated in pregnancy; most 5-ASA, biologics and thiopurines can continue through pregnancy and breastfeeding.
- Check blood markers and fecal calprotectin each trimester; ultrasound and unenhanced MRI are safe if imaging is needed.
- Caesarean section is advised after ileal pouch surgery or with active perianal disease; otherwise follow obstetric indications.
Open access under CC BY-NC 4.0. Shared here as permitted by the licence.
PDFAn Update on Anti-TNF Biosimilar Switching: Real-World Clinical Effectiveness and Safety
Meade S, Squirell E, Hoang TT, Chow J, Rosenfeld G
Journal of the Canadian Association of Gastroenterology 2024;7(1):30–45 · Systematic review
A systematic review of 43 real-world studies (7,462 people with IBD) who switched from an originator anti-TNF to a biosimilar, as Canadian provinces moved to mandatory switching.
Key findings
- Infliximab: 75% maintained remission beyond 12 months after switching, versus 78% who stayed on the originator.
- Adalimumab: 82% maintained remission at 6 months.
- Loss of response, stopping treatment and serious adverse events were similar to staying on the originator; injection-site pain was more common with citrate-containing adalimumab biosimilars.
Open access under CC BY-NC-ND 4.0. Shared here as permitted by the licence.
2023
PDFGut microbiome-associated predictors as biomarkers of response to advanced therapies in inflammatory bowel disease: a systematic review
Meade S, Liu Chen Kiow J, Massaro C, Kaur G, Squirell E, Bressler B, Lunken G
Gut Microbes 2023;15(2):2287073 · Systematic review
Which gut microbes and microbial products, measured before treatment, predict who will respond to advanced IBD therapy? Promising signals include short-chain-fatty-acid–producing bacteria, butyrate pathways, bile acids and other metabolites, and the fungal microbiome.
Open access under CC BY 4.0. Shared here as permitted by the licence.
A True Residual Bias: Did the Exacerbation Truly Precede NSAID Exposure?
Squirell E, Bressler B
American Journal of Gastroenterology 2023;118(8):1462 · Letter
A letter to the editor about a study linking NSAIDs to IBD flares, asking whether the flares truly began after NSAID exposure.
2021
Preparation, Timing, Prokinetics, and Surface Agents in Video Capsule Endoscopy
Squirell E, Ricci M, Hookey L
Gastrointestinal Endoscopy Clinics of North America 2021;31(2):251–265 · Review
A review of how to prepare patients for capsule endoscopy. The evidence leans towards active bowel preparation, with split dosing possibly best; adjuncts such as prokinetics and surface agents have not been shown to improve results.
Cystic fibrosis liver disease in Newfoundland and Labrador: a prevalence study
Squirell E, Lockyer J
Canadian Liver Journal 2021;4(1):33–37 · Original research
A chart review of adults with cystic fibrosis in Newfoundland and Labrador found cystic fibrosis liver disease in 14 of 57 people (24.6%), and in 30% of those who had complete imaging.