Practical guidelines on medical management of adults with moderate-to-severe inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic, relapsing inflammatory disorder that predominantly includes Crohn's disease (CD) and ulcerative colitis (UC). IBD has emerged as a significant healthcare challenge in Saudi Arabia, with a more than fivefold increase in annual incidence over the past 2 decades. These guidelines promote high-quality, evidence-based care for adult patients with moderate-to-severe CD and UC in Saudi Arabia. These guidelines were developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. A multidisciplinary panel of 16 experts created 41 PICO questions addressing CD and UC separately. Evidence was synthesized through major databases (PubMed, EMBASE, Cochrane Library), prioritizing high-quality studies published between 2015 and 2025. Evidence certainty was categorized as high, moderate, low, or very low. Recommendations were formulated based on evidence quality, risk-benefit analyses, and clinical expertise, requiring a minimum consensus threshold of 70% for approval. A total of 38 recommendations and two good practical statements address induction and maintenance of remission with advanced therapies, combination treatment sequences, treatment optimization strategies, and management of special clinical scenarios. These Saudi national guidelines provide an evidence-based approach for managing adult patients with moderate-to-severe IBD and establish a comprehensive framework for optimizing management and treatment with advanced therapies. However, further research on local/regional real-world evidence is necessary to refine and improve the efficacy of these guidelines.