IBD Journal Scan
Key articles from high impact journals in last month
Editorial Recommendations
DEC-2025
Inflammatory bowel disease (IBD) is entering a new era shaped by the “3 Ps” - prevention, pre-diagnosis and participation. Globally, IBD continues to rise, progressing through defined epidemiologic stages as newly industrialized regions experience rapid increases in incidence. Diet is a major modifiable driver: studies show ultra-processed grains and high inflammatory dietary patterns increase IBD and Crohn’s disease risk, while whole and minimally processed foods appear protective. Parallel breakthroughs reveal a pre-clinical phase where immune and microbial biomarkers emerge up to a decade before diagnosis, opening opportunities for prediction, risk modelling and early intervention. Together, these insights signal a shift from reactive treatment to a proactive, population-level prevention strategy - encouraging healthier diets, earlier detection tools and stronger multisectoral participation to reduce the global burden of IBD.
The 3 Ps of IBD today - prevention, pre-diagnosis and participation
In 2025, inflammatory bowel disease (IBD) research shifted from treatment to proactive prevention. The emerging “3 Ps” - prevention, pre-diagnosis and participation - are reshaping how we understand and manage IBD. Studies now highlight the importance of reducing dietary risks, identifying biomarkers years before symptoms appear, and encouraging broad collaboration across healthcare and society. Key advances The PURE study showed that higher consumption of ultra-processed grains (≥19 g per day) was significantly associated with increased risk of developing inflammatory bowel disease; fresh bread and rice had lower risk1. The EPIC cohort found that pro-inflammatory diets are linked to a higher likelihood of developing Crohn’s disease. Meanwhile, new research identified microbial antibody patterns appearing four years before diagnosis, including Crohn’s-specific responses to bacterial flagellins. Together, these insights mark a major step toward earlier detection, targeted prevention and more engaged participation in IBD care.
The evolution of IBD
Over the past century, inflammatory bowel disease (IBD) has transformed from a condition limited to early industrialized regions to a worldwide health challenge. Initially common in North America, Europe and Oceania, IBD rates surged in newly industrialized regions across Asia, Africa and Latin America in the twenty-first century. This global spread reflects four proposed epidemiologic stages: emergence (low incidence and prevalence), acceleration (rapid rise in incidence), compounding prevalence (slowing or stabilizing incidence with increasing prevalence) and a predicted prevalence equilibrium, in which prevalence plateaus as populations age. Until now, these stages lacked real-world indicators. Using data from 522 population-based studies spanning 82 regions from 1920 to 2024, researchers have mapped how countries transition through stages 1–3 and model the progression toward stage 4. Understanding these patterns helps health systems anticipate future demands and prepare for the growing global burden of IBD.
Risk of IBD with Ultra Processed Grains
Ultraprocessed grains - highly refined products common in Western diets - may meaningfully increase the risk of inflammatory bowel disease (IBD). Using data from 124,590 participants across 21 countries in the PURE study, researchers explored how varying levels of ultraprocessed grain intake influence IBD development. Dietary patterns were assessed through validated questionnaires, and outcomes were tracked using multivariate hazard models. The results were clear: individuals consuming ≥19 g/day of ultraprocessed grains had a significantly higher risk of developing IBD compared with those consuming <9 g/day (HR 1.86). A broader look at ultraprocessed foods showed even stronger associations, with ≥5 servings/day nearly quadrupling IBD risk. In contrast, foods like fresh bread and rice were linked to lower risk. These findings highlight the growing importance of dietary quality in IBD prevention and underscore ultraprocessed grain reduction as a potential public health priority.
High inflammatory score of the diet is associated with higher risk of CD
The EPIC study examined how pro-inflammatory dietary patterns contribute to the development of inflammatory bowel disease. Using data from 394,255 participants across Europe, researchers calculated an inflammatory score of the diet (ISD) based on baseline food frequency questionnaires. After 13.6 years of follow-up, they assessed Crohn’s disease (CD) and ulcerative colitis (UC) risk using adjusted Cox models. Findings showed that individuals with high ISD scores had a significantly higher risk of developing Crohn’s disease—an 88% increase between the highest and lowest quartiles. The association was strongest in women. No meaningful link was found between ISD and ulcerative colitis. Subgroup analyses indicated that low intake of fibre, monounsaturated fats, vitamin C, magnesium, onions and alcohol largely contributed to the higher ISD.
The pre-clinical phase of IBD and potential prevention strategies
Despite major therapeutic advances, remission remains inconsistent in inflammatory bowel disease (IBD), and a significant treatment gap persists - especially in low-resource regions. Once symptoms appear, IBD becomes irreversible, and relapse is common after treatment withdrawal. Increasing evidence now shows that IBD begins with a pre-clinical phase, similar to other immune-mediated diseases. Research using pre-disease cohorts has identified biomarkers detectable up to 10 years before diagnosis, revealing pathways that drive early disease development. These discoveries are enabling risk prediction models and opening the door to targeted prevention strategies. As scientists integrate biomarker, environmental and immune data, a new paradigm is emerging: shifting from reactive treatment to early prediction and prevention. This evolving understanding may ultimately allow interventions that halt or reverse early disease processes before IBD fully manifests.