IBD

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.

Introduction Patients with disorders of gut–brain interaction (DGBI) and gastrointestinal dysmotility (GID) frequently experience severe nutritional compromise requiring enteral support. Jejunal feeding is often considered in patients unable to maintain adequate oral intake, particularly when gastric feeding intolerance or severe dysmotility exists. However, clinical practice in this area remains highly variable and evidence guiding management is limited.

Problem Statement The experiences, confidence levels and perceptions of healthcare professionals managing jejunal feeding in DGBI and GID are poorly understood. Limited specialist neurogastroenterology access and uncertainty regarding feeding tolerance may contribute to inconsistent care pathways and suboptimal nutritional management.

Summary This survey-based study evaluated healthcare professionals’ perceptions regarding jejunal feeding in patients with DGBI and gastrointestinal dysmotility. Most respondents were dietitians and physicians actively involved in nutritional support, although a striking majority reported limited access to specialist neurogastroenterology services. Clinicians perceived jejunal feeding to be more commonly required in severe gastrointestinal dysmotility disorders than in DGBI, reflecting the greater burden of objective motility impairment in GID. Interestingly, despite DGBI generally being considered less structurally severe conditions, respondents reported lower confidence managing these patients compared with those with GID. This likely reflects the complex overlap of visceral hypersensitivity, symptom amplification, psychosocial comorbidity and uncertainty surrounding pathophysiology in DGBI populations. Tolerance to jejunal feeding was also perceived to be poorer in DGBI compared with GID, with most clinicians reporting inability of patients to tolerate infusion rates above 50 mL/hour. Another important finding was the extremely high prevalence of opioid exposure across both groups, highlighting the growing concern regarding opioid-associated gut dysfunction and worsening dysmotility in these patients. The study emphasizes substantial gaps in specialist service provision and underscores the need for multidisciplinary neurogastroenterology-led nutritional pathways. It also highlights the importance of individualized feeding strategies, cautious opioid stewardship and further prospective research to optimize jejunal feeding protocols in complex DGBI and dysmotility populations.