Inflammatory Bowel Disease: Current Concepts, Therapeutic Advances and Challenges in Resource-Limited Settings

Background: Inflammatory bowel disease (IBD), comprising mainly ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic, relapsing inflammatory disorder of the gastrointestinal tract that requires long-term multidisciplinary management. IBD is increasingly recognized as an important global health problem, with its incidence and prevalence rising in many newly industrialized and developing regions. South Asia, including Bangladesh, has experienced a growing burden of IBD, reflecting changing environmental exposures, dietary patterns, urbanization, lifestyle factors, improved diagnostic capacity, and greater disease recognition. The increasing prevalence of IBD and its intestinal and extraintestinal complications highlights the need for updated approaches to diagnosis, monitoring, treatment, and prevention. Objectives: To review current concepts and recent advances in the epidemiology, pathogenesis, risk factors, clinical manifestations, biomarkers, therapeutic strategies, treat-to-target approaches, and emerging management options for IBD, with particular relevance to the growing burden in South Asia. Methods: A narrative review of relevant peer-reviewed literature was undertaken, focusing on major studies, systematic reviews, international guidelines, and clinical trials addressing the epidemiology, pathogenesis, diagnosis, monitoring, complications, and management of IBD. Particular attention was given to recent advances in biologic and small-molecule therapies, therapeutic drug monitoring, biomarkers, microbiome-directed interventions, dietary factors, and treat-to-target strategies. Results: IBD results from a complex interaction between genetic susceptibility, dysregulated immune responses, intestinal microbiota, and environmental factors. Its global epidemiological transition has been accompanied by increasing incidence and prevalence in regions where IBD was previously considered uncommon. South Asian populations are increasingly affected, although epidemiological data remain comparatively limited, particularly from Bangladesh. Advances in biomarkers, including fecal calprotectin and other inflammatory markers, have improved non-invasive disease assessment and monitoring. Contemporary management has shifted from symptom control toward objective disease modification using treat-to-target strategies. Conventional immunomodulators remain relevant, while biologic therapies targeting tumor necrosis factor, integrins, and interleukin pathways, as well as newer oral small molecules, have expanded therapeutic options. Emerging evidence also supports the potential roles of dietary modification, microbiome-directed therapies, and personalized treatment approaches. Early intervention and tight disease control may reduce inflammatory burden and the risk of long-term complications. Conclusion: IBD represents an expanding global health challenge with increasing importance in South Asia. Improved epidemiological surveillance, earlier recognition, objective monitoring, and access to evidence-based therapies are essential to address the growing disease burden. Future research in South Asian populations, particularly Bangladesh, should focus on population-based epidemiology, environmental and genetic determinants, cost-effective diagnostic strategies, and locally applicable treatment approaches. A personalized, treat-to-target model integrating clinical, biochemical, endoscopic, and patient-centered outcomes may improve long-term disease control and quality of life J Com Med Col Teachers’ Asso July 2026; 30(2): 134-141