Article information
Authors: Jian Wan, Jiaming Zhou, Zhuo Wang, Dan Liu, Hao Zhang, Shengmao Xie, Kaichun Wu
Journal: Chinese Medical Journal
Year: 2025
Volume: 138
Issue: 7
Pages: 763-776
DOI: 10.1097/CM9.0000000000003542
Study at a glance
- Study type: Narrative review
- Population studied: Patients with inflammatory bowel disease (ulcerative colitis and Crohn’s disease)
- Topics covered: Epidemiology, pathogenesis, diagnosis, telemedicine, and treatment
- Time period: Primarily literature from the past two years (2023-2024)
- Key focus areas: Novel biomarkers, remote monitoring technologies, new therapeutic agents, and precision medicine approaches
Why was this study done?
Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is a long-term inflammatory condition of the gut that develops when the immune system becomes overactive and starts causing inflammation. It can occur in people whose genes leave them more susceptible, but may also be influenced by the gut microbiome and environmental factors.
Wan and colleagues conducted this review to summarise key IBD advances over the past two years. Whilst the diagnosis of new cases of IBD has stabilised in Western countries, it is rapidly increasing in newly industrialised countries, particularly China, making IBD a global disease. Despite treatment progress, approximately one third of patients do not respond to initial treatment, and half eventually lose response over time. The authors set out to give an up-to-date overview of how common IBD is becoming, what causes it, and how it is diagnosed, monitored, and treated.
How was the study performed?
The authors conducted a review focusing primarily on research published within the past two years. They examined population-wide studies, genetic and molecular research, clinical trials, diagnostic and monitoring technologies, and new emerging approaches. The review organised the research into key themes: population-wide trends, underlying disease mechanisms, methods for diagnosis, the application of remote consultations, new emerging therapies, precision medicine, and complementary or adjunctive treatments.
What did the researchers find?
Western countries are experiencing stable or decreasing rates of new IBD diagnoses, but the overall prevalence continues to increase. In Canada, IBD prevalence was 843 per 100,000 in 2023, projected to reach 1098 per 100,000 by 2035 (exceeding 1.1% of the population). The rates of new diagnoses in China is rapidly accelerating, with the first nationwide study recording about 10 new cases each year for every 100,000 people.
51 protein biomarkers predicted CD development within five years. Significant changes in multiple blood and bodily biomarkers were observed up to eight years before CD diagnosis and three years before UC diagnosis.
The largest genome-wide association study in East Asian populations identified 80 regions of DNA linked to IBD, 16 of which were newly discovered. Environmental risk factors included smoking (increased risk for both CD and UC), ultra-processed foods (71% increased CD risk), and microplastics (higher concentrations in IBD patients, correlated with disease severity).
Home testing kits for faecal calprotectin was consistent with laboratory testing. Wearable devices measuring inflammatory markers in sweat, including C-reactive protein, interleukin-6, and calprotectin, showed promise for continuous monitoring. Heart rate variability measured by wearable devices showed significant changes before clinical or biochemical evidence of flare-ups.
Several new medications have been tested and showed promise in phase 3 trials. For UC: mirikizumab achieved clinical remission in 24.2% of patients at 12 weeks, risankizumab achieved remission in 20.3% of patients, and etrasimod achieved remission in 27%. For CD: upadacitinib achieved remission in 49.5% of patients at 12 weeks. Upadacitinib belongs to the JAK inhibitor drug class, which carries a boxed warning from regulators (the FDA and MHRA) for increased risk of major cardiovascular events, blood clots, cancer, and death, based on long-term surveillance data; the decision to use it is made on an individual basis, weighing these risks against expected benefit. A machine learning model combining clinical, genetic, and biological data was proven to be accurate in 96.3% of cases at predicting a person’s treatment response to vedolizumab.
Management strategies for psychological wellbeing showed beneficial short-term effects on anxiety, depression, stress, and quality of life.
What did the authors conclude?
The authors concluded IBD has evolved into a global disease, however advancements in diagnosis and detection provide opportunities for earlier treatment. Remote monitoring tools, including home testing kits and wearable devices, enable real-time disease activity assessment and timely treatment adjustments.
Precision medicine integrating multiple datapoints, advanced combination therapy, and complementary approaches including stem cell transplantation, psychological therapies, nerve stimulation, and gut microbiome treatments may help improve current treatment limitations. Further research is needed to continue this research, including developing artificial intelligence models, evaluating early treatment strategies, and investigate combination and complementary approaches.
Key takeaways
- The rate of new diagnoses of IBD is stabilising in Western countries but rapidly increasing in newly industrialised countries, with Canada projected to have over 1.1% of its population affected by 2035 and China reporting about 10 new cases each year for every 100,000 people.
- Significant changes in blood biomarkers occur up to eight years before Crohn’s disease diagnosis and three years before ulcerative colitis diagnosis, offering opportunities for earlier intervention.
- New remote monitoring technologies, including home testing kits, wearable devices measuring sweat biomarkers, and heart rate variability monitoring, enable real-time disease activity assessment without invasive procedures.
- Several new medications have demonstrated positive results in phase 3 clinical trials, with clinical remission rates ranging from approximately 20% to 50% depending on the drug and disease type.
- Precision medicine approaches integrating multiple types of biological data, advanced combination therapies, and complementary treatments including psychological therapies, nerve stimulation, and microbiome modulation may help overcome current limitations where one third of patients do not respond to initial treatment and half lose response over time.
This Scientific Publication Summary is an objective summary of the published study for personal and educational use. It does not constitute medical advice, endorsement of the intervention, or a recommendation to alter clinical practice.