A Pragmatic Prevention Framework for IBD in the Global South : Gut | 2026

Introduction

Inflammatory bowel disease is rapidly emerging as a global disease, with rising incidence across low-income and middle-income countries. Although biologics and small-molecule therapies have transformed disease outcomes, long-term treatment remains costly, infrastructure-intensive and difficult to sustain in resource-constrained healthcare systems.

Problem Statement

Conventional IBD prevention and interception models—including biomarker screening, precision medicine and large-scale prevention trials—may be impractical in much of the Global South because of economic limitations, inadequate healthcare infrastructure and shortages of trained specialists. A scalable and economically feasible preventive strategy is urgently needed.

Summary

This conceptual review proposes a pragmatic prevention framework for IBD modeled on successful public health approaches used in non-communicable diseases such as metabolic syndrome and cardiovascular disease. The authors argue that rather than relying exclusively on expensive precision medicine strategies, IBD prevention in resource-limited regions should focus on modifiable environmental and lifestyle risk factors already linked to broader NCD prevention initiatives. The proposed “sieving strategy” prioritizes interventions that satisfy three key criteria: evidence supporting IBD prevention, overlap with established NCD prevention measures and economic feasibility for widespread implementation. Potential preventive targets include dietary modification, smoking reduction, physical activity promotion, obesity prevention, antibiotic stewardship and improvement in early-life environmental exposures. By integrating IBD prevention into existing NCD public health infrastructure, the framework aims to maximize scalability and cost-effectiveness while avoiding creation of parallel healthcare systems. The review also highlights major barriers to conventional prevention models, including limited access to advanced diagnostics, biologic therapies and population-level risk stratification tools in developing countries. Importantly, the authors emphasize that prevention-focused strategies may ultimately provide greater long-term population benefit than relying solely on escalating therapeutic complexity after disease onset. Overall, the article presents a highly relevant public health-oriented roadmap for addressing the growing burden of IBD in the Global South and advocates for prevention strategies grounded in equity, feasibility and population-level impact rather than resource-intensive precision approaches alone.