Optimizing evidence based primary care framework for inflammatory bowel disease

Inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, is a chronic, relapsing immune-mediated condition with rising global prevalence. While traditionally defined by gastrointestinal inflammation, IBD is increasingly recognized as a systemic disease with extraintestinal manifestations that significantly impact quality of life, including anxiety, depression, fatigue, chronic pain, sexual dysfunction, and nutritional deficiencies. These comorbidities often persist despite remission of intestinal disease and contribute to significant morbidity, higher healthcare utilization, and increased mortality risk. Mechanistic insights highlight the role of gut barrier disruption, microbiota-derived metabolites, immune dysregulation, and gut–brain axis interactions in shaping both intestinal and extraintestinal disease burden. Synthesis of peer reviewed guidelines, consensus statements, and key observational studies on the recognition and management of common extraintestinal challenges—with principle focus on anxiety and depression, fatigue, chronic abdominal pain, sexual health, pregnancy, lactation and preventive health including cancer screening—within primary care practice. Systematic review of peer reviewed national and international guidelines, consensus statements, key observational studies, and expert opinions using clinical vignettes. The authors in this review have multi-disciplinary expertise ranging from Internal Medicine, Family Practice, Nutrition and Gastro-enterology (GI). Primary care physicians (PCPs) are uniquely positioned to address holistic needs of IBD patients; however, evidence demonstrates substantial gaps in guideline familiarity, preventive care practices, and confidence in managing IBD-related comorbidities. Integrated care models, including patient-centered medical homes, demonstrate reductions in unplanned care and improvements in disease activity and well-being, yet implementation remains inconsistent. It emphasizes the use of validated screening instruments, behavioral and pharmacologic treatment strategies, and lifestyle interventions to address these domains that require streamlined clinical tools, multidisciplinary collaboration, and PCP-directed educational initiatives.