Current Therapeutic Strategies for Inflammatory Bowel Disease: A Narrative Review

Abstract

Background: Inflammatory bowel disease (IBD) is a chronic, relapsing disorder resulting from genetic, immune, microbial, and environmental factors. Therapeutic options have expanded from conventional drugs to biologic agents and targeted small molecules, enabling individualized management. Aim: This narrative review aimed to summarize current treatment strategies for IBD, focusing on conventional therapies, biologics, targeted small molecules, antibiotics, and surgery. Materials and Methods: A narrative literature review was conducted using PubMed, MEDLINE, Google Scholar, and the Journal of Education, Health and Sport (JEHS). Current clinical guidelines, European Medicines Agency (EMA) product information, clinical studies, systematic reviews, and meta-analyses were reviewed, with attention to indications, efficacy, and safety. Results: Biologic agents and targeted small molecules have broadened therapeutic options for moderate-to-severe IBD. Anti-TNF agents, vedolizumab, ustekinumab, selective IL-23 inhibitors, Janus kinase (JAK) inhibitors, and ozanimod act through different pathways and allow treatment to be adapted to disease phenotype, severity, and previous treatment exposure. Conventional therapies, including aminosalicylates, corticosteroids, thiopurines, and methotrexate, remain important in selected situations. Antibiotics retain a role in specific complications, while surgery remains essential in refractory disease and structural complications. Conclusions: Contemporary IBD management follows an individualized, treat-to-target approach aimed at symptom control, objective inflammatory control, mucosal healing, and prevention of long-term complications. Despite therapeutic advances, uncertainties remain regarding treatment sequencing, predictors of response, long-term safety, and access to advanced therapies. Further research is needed to optimize personalized strategies and improve long-term outcomes.