One of the main drawbacks of upflow anaerobic sludge blanket (UASB) reactors that treat low-strength sewage at room temperature is related to the low quality of their effluents in terms of dissolved methane, organic matter, and nitrogen content. The present study aims to evaluate the feasibility of using an integrated fixed-film activated sludge (IFAS) system as an alternative post-treatment technology to mitigate the environmental impact of such effluents. For this purpose, a pilot plant composed of a UASB (120 L) followed by an IFAS (66 L) system was operated for 407 days. Special attention was paid to the suspended biomass retention capacity and the dissolved methane and nitrogen removal potential of the IFAS post-treatment system. Furthermore, the role of carriers on denitrification and nitrification processes and the microbial communities present in the biofilm were also analyzed. Average total chemical oxygen demand (CODT) and ammonium removal efficiencies of 92 ± 3% and around 57 ± 16% were attained throughout the entire operation, respectively. During a first period in which biomass was maintained in both biofilms and suspension, and nitrite was the main electron acceptor, maximum nitrogen removal and methane removal efficiencies of 32.5 mg TN L-1 and 93% were observed in the IFAS system, respectively. However, throughout the second period, in which suspended biomass was completely washed out from the IFAS system, and nitrate became the main electron acceptor, these values decreased to 18 ± 4 mg TN Lfeed-1 and 77 ± 12%, respectively. Surprisingly, throughout the entire operation, it was observed that around 50 and 41% of the total nitrogen and methane removals observed in the IFAS system, respectively, were carried out in the aerobic compartment. Aerobic methane oxidizers and anammox were detected with significant relative abundances in the biofilm carriers used in the anoxic and aerobic compartments using 16S rRNA gene amplicon sequencing analysis. Therefore, the use of an IFAS system could be suited to diminish greenhouse gas emissions and nutrients concentration for those sewage treatment plants that used UASB systems, especially in countries with temperate and warm climates.