Attaining sustainability in inflammatory bowel disease

The global burden of inflammatory bowel disease (IBD) is expanding into newly industrialized and lower- and lower-middle-income countries and is projected to place increasing pressure on healthcare systems. Advances in treat-to-target strategies have extended care trajectories and intensified monitoring demands, raising urgent questions about how to deliver durable benefits within fiscal, system, and environmental constraints. Stringent targets may come at the cost of higher expenses, increased treatment burden, and adverse effects. In addition, there is potential adverse environmental impact of intensive management and monitoring strategies which may involve increased waste and use of single-use materials. Attaining sustainability in IBD care requires a patient-centered approach that balances clinical effectiveness with feasibility, affordability, sustainability, and environmental responsibility. In this narrative review, we examine the environmental footprint of IBD care and explore the broader concept of sustainability, including clinical, financial, equity, and environmental dimensions. We further highlight strategies to reduce harm while preserving-and potentially enhancing-patient outcomes. A clear understanding of sustainable IBD care is what enables the transition from fragmented efforts to coordinated, evidence-based strategies that can support both patient care and planetary health.