Treatable traits in inflammatory bowel disease: a conceptual framework for personalized care

Inflammatory bowel disease (IBD) is a complex, immune-mediated, and heterogeneous condition requiring individualized, mechanism-based care. Despite advances in therapies and treat-to-target strategies, achieving and maintaining sustained remission, as well as restoring health-related quality of life (HRQoL), remains challenging. The concept of treatable traits provides a framework for precision medicine grounded on identifying specific, measurable, and actionable mechanisms whose modification can improve outcomes meaningful to both patients and healthcare systems. This manuscript proposes a conceptual structure for applying the treatable-traits paradigm to IBD. It describes three primary domains: gastrointestinal and intrinsic, extraintestinal and comorbidity, and psychological and behavioral, integrating immunological mechanisms, systemic complications, and psychosocial determinants. The model emphasizes the bidirectional gut-brain axis and shared immune-inflammatory pathways linking intestinal inflammation with mental health. It also highlights how the STRIDE-II initiative and modern clinical trials have shifted therapeutic targets toward deep and sustained remission, explicitly including quality-of-life endpoints such as the IBD Quality of Life Questionnaire (IBDQ). Operationalizing treatable traits in clinical reasoning may bridge biological and "experiential remission", helping clinicians prioritize actionable mechanisms, optimize therapy, and achieve the ultimate goals of IBD care: inflammation control, organ preservation, and restored wellbeing.

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