Equitable access to inflammatory bowel disease care: challenges, strategies, and future directions

The global burden of inflammatory bowel disease (IBD) is rising rapidly, not only in high-income countries but also in low- and middle-income countries (LMICs). At the same time, access to high-quality care remains uneven. Patients in LMICs and rural regions often face shortages of gastroenterologists, limited diagnostic capacity, and poor access to advanced therapies. In high-income countries, disadvantaged groups encounter financial barriers, food insecurity, and caregiver strain. Ethnic and racial minorities are more often diagnosed late, less likely to receive biologics, and remain underrepresented in clinical trials, reducing the generalizability of evidence. Structural factors add further challenges. Shortages of IBD nurses and allied specialists, fragmented care pathways, and lack of multidisciplinary teams widen disparities. Strategies to improve equity must address several levels: policy reforms that include social determinants of health and secure reimbursement; expansion of diagnostic and therapeutic capacity; use of cost-effective innovations such as telemedicine and intestinal ultrasound; and greater involvement of patients and communities. Training, awareness, and cultural competence are also important to reduce stigma and shorten diagnostic delay. Future efforts should embed equity into value-based care models, scale digital health while preventing digital exclusion, and apply artificial intelligence in ways that support fair allocation of resources. Global partnerships are needed to build capacity where it is lacking. Achieving equitable access to IBD care will require coordinated action between clinicians, policy-makers, patients, and industry to ensure sustainable, patient-centered, and inclusive care worldwide.