Inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, involves chronic inflammation of the gastrointestinal tract. Current immune-modulating therapies are insufficient for 30–50% of patients or cause significant side effects, emphasizing the need for new treatments. Targeting the innate immune system and enhancing drug delivery to inflamed gut regions are promising strategies. Neutrophils play a central role in IBD by releasing reactive oxygen species (ROS) and neutrophil extracellular traps (NETs) —DNA-based structures with cytotoxic proteins—that contribute to mucosal damage and inflammation. Recent studies linking ROS production, DNA repair, and NET formation have identified NETs as potential therapeutic targets, with preclinical models showing positive outcomes from NET inhibition. Innovative oral drug delivery systems designed to target gut inflammation directly—without systemic absorption—could improve treatment precision and reduce side effects. Advanced formulations utilize properties such as particle size, surface modifications, and ROS-triggered release to selectively target the distal ileum and colon. A dual strategy that combines a deeper understanding of IBD pathophysiology to identify inflammation-related therapeutic targets with advanced drug delivery systems may offer significant promise. For instance, pairing NET inhibition with ROS-responsive nanocarriers could enhance treatment efficacy, though further research is needed. This synergistic approach has the potential to greatly improve outcomes for IBD patients.

Chronic inflammatory diseases (CIDs) pose a growing healthcare challenge, with a substantial proportion of patients showing inadequate response to biological treatment. There is renewed interest in dietary changes to optimize treatment regimens, with a growing body of evidence suggesting beneficial effects with adherence to a gluten‐free diet. This study compared the likelihood of achieving clinical response to biological treatment after 14–16 weeks in patients with CID with high versus low‐to‐medium gluten intake. Secondary outcomes of interest included changes in disease activity, health‐related quality of life and C‐reactive protein. The study was a multicentre prospective cohort of 193 participants with a CID diagnosis (i.e. Crohn's Disease, Ulcerative Colitis, Rheumatoid Arthritis, Axial Spondyloarthritis, Psoriatic Arthritis or Psoriasis) who initiated biological treatment between 2017 and 2020. Participants were stratified based on their habitual gluten intake: the upper 33.3% (high gluten intake) and the remaining 66.6% (low‐to‐medium gluten intake). The proportion of patients achieving clinical response to biological treatment after 14–16 weeks was compared using logistic regression models. The median gluten intake differed significantly between groups (12.5 g/day vs. 5.9 g/day, standardized mean difference = 1.399). In total, 108 (56%) achieved clinical response to treatment, with no difference between 35 (55%) in the high gluten group and 73 (57%) in the medium‐to‐low gluten group (OR = 0.96 [0.51–1.79], p = 0.897). No differences were found with secondary outcomes. In conclusion, this study found no association between gluten intake and response to biological treatment in patients with CID.

Background: Diet significantly impacts the onset and progression of inflammatory bowel disease (IBD), and diet offers unique opportunities for treatment and preventative purposes. However, despite growing interest, no diet has been conclusively associated with improved long-term clinical and endoscopic outcomes in IBD, and evidence-based dietary guidelines for IBD remain scarce. This narrative review critically examines dietary assessment methods tailored to the unique needs of IBD, highlighting opportunities for precision and inclusivity. Methods: We conducted a comprehensive literature review using search terms related to diet, diet assessment, nutrition, food, sex, gender, equity, and IBD. Results: The identified dietary assessment tools evaluated nutritional quality, dietary patterns, food processing, lifestyle interactions, inflammatory potential, and effects of specific nutrients. Advanced methods, including biomarkers, multi-omics approaches, and digital tools, were highlighted as being complementary to traditional approaches, offering enhanced precision and real-time monitoring. Women remain under-represented in dietary research but face unique nutritional needs due to hormonal cycles, pregnancy, and higher malnutrition risks in IBD. Discussion: Traditional diet assessment methods remain valuable but are often limited by misreporting biases. Advanced approaches may provide greater precision, enabling real-time monitoring and personalised dietary tracking. Incorporating considerations of sex, gender, age, ethnicity, socioeconomic, and sustainability enhances the relevance and applicability of these methods. Addressing these multifaceted aspects of dietary assessment in IBD can facilitate robust interventional trials. Conclusions: Diet assessment tools are essential for developing personalised dietary interventions in IBD, informing evidence-based guidelines, and improving health outcomes and quality of life in IBD.

Dietary intervention trials in inflammatory bowel disease (IBD) are difficult to implement due to poor adherence, despite their increasing importance for disease management. We conducted a systematic review to evaluate completion rates of dietary intervention trials recruiting patients with IBD and assess completion rate associations with trial design features. We systematically searched MEDLINE (Ovid), Embase (Ovid) and CINAHL (EBSCO) databases on 13. May 2024 for randomised controlled trials examining dietary or macronutrient supplementary intake effects in patients with IBD, excluding enteral and parenteral nutrition trials. The flow of participants and pre-specified trial design features were extracted. Completion rates by study arm were estimated using a multilevel mixed-effects model. Covariates were assessed via meta-regression and presented as a forest plot. For each study, the risk of bias was assessed using the Cochrane Collaboration appraisal tool (RoB2) for randomised trials and randomised cross-over trials. Three main risk of bias domains (selection and detection biases) were associated with completion rate. These were included to explore potential biases in the reported information. In total, 62 trials comprising 122 study arms and 3,523 participants were included. The overall pooled completion rate was 0.84 (95%CI: 0.80; 0.87) with lower rates of completion in trials published within the last 10 years. Low completion rates were associated with fecal sampling (0.75, 95%CI: 0.50; 1.00), study duration of 4-8 weeks (0.79, 95%CI: 0.40; 1.00), and having a low risk of bias in the management of missing data (0.74, 95%CI: 0.34; 1.00). Overall, the completion rates of patients with IBD participating in controlled dietary intervention trials was high, and there was less than 15% variation in completion rates in relation to trial design. No linear correlation with trial duration was found. The most pronounced association with low completion was a comprehensive intervention content, i.e., fecal sampling. STUDY REGISTRATION: PROSPERO CRD42022327783.

Background Inflammatory bowel diseases (IBDs) are often associated with high healthcare utilisation. This systematic review aimed to summarize what is known about the impact of sex, income, and education on the risk of bowel surgery, hospitalization and use of corticosteroids and biologics among patients with IBD. Methods We used EMBASE, MEDLINE, CINAHL, and Web of Science to perform a systematic literature search. Pooled hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random effects meta-analysis for the impact of sex on risk of surgery and hospitalization. In addition, we performed subgroup analyses of the effect of IBD type (Crohn’s disease or ulcerative colitis), children or adults, and country. Finally, meta-regression was undertaken for the year of publication. Results In total, 59 studies were included. In the meta-analysis, male sex was associated with an increased risk of bowel surgery in UC patients (HR: 1.78, 95% CI: 1.16;2.72) and an increased risk of hospitalization in CD patients (OR: 1.42, 95% CI: 1.28;1.58). In 6 of 6 studies, female patients had lower adherence to biologics, whereas 9 of 10 studies reported no significant sex-based difference in use of corticosteroids. The evidence of the impact of income and education on all four outcomes was sparse and pointed in different directions. The substantial heterogeneity between studies was explained, in part, by differences in IBD type, age and country. Conclusions Population-based observational studies have revealed that sex influence the surgery rate and risk of hospitalization among IBD patients with more men having surgeries and hospitalizations than women, whereas female patients appear to have statistically significantly lower adherence to biologics compared to male patients. Thus, clinicians should not underestimate the impact of sex on patient outcomes. Evidence for income- and education based differences remains sparse. Systematic review registration: PROSPERO Registration ID: CRD42022315788.