Inflammatory bowel diseases: pathological mechanisms and therapeutic perspectives

Inflammatory bowel disease (IBD) is a heterogeneous group of disorders characterized primarily by chronic relapsing intestinal inflammation, encompassing Crohn's disease (CD) and ulcerative colitis (UC), affecting individuals across age groups with variable clinical manifestations. With the advancement of global industrialization, its incidence continues to rise, particularly in newly industrialized regions, which not only severely impairs patients' quality of life but also emerges as a major public health concern threatening digestive system health, accompanied by a substantial healthcare burden, thus necessitating the development of more effective and safer individualized treatment strategies. This review summarizes the pathogenesis of IBD, including intestinal mucosal immune dysregulation, intestinal barrier damage, gut microbiota dysbiosis, reactive oxygen species (ROS) homeostasis imbalance, and the complex crosstalk between genetic and environmental factors; however, clinical treatment still faces numerous challenges: 30%-40% of patients exhibit primary or secondary non-response to existing therapeutic regimens such as biologics and small-molecule drugs, and prolonged administration tends to induce significant side effects. Further integrated herein are emerging strategies such as ROS modulators, novel immune-targeted modulation, intestinal barrier repair agents, microbiota-directed interventions, multi-omics-based precision medicine, and artificial intelligence (AI)-assisted therapy, which represent key directions to address the limitations of traditional treatments. This article begins with an overview of basic pathological mechanisms and offers a comprehensive overview of relevant therapeutic approaches and future development directions, aiming to facilitate the transition of the field from traditional generalized therapies to personalized precision medicine and to bridge the long-standing gap between basic research and clinical practice.