Equity gaps are now a frontline issue in IBD care

Inflammatory bowel disease is no longer a predominantly Western diagnosis — and the authors of a new review in the Journal of Crohn’s and Colitis say the field needs to treat equitable access as a core quality metric, not an aspirational add-on.

Drs. Johan Burisch, Rupa Banerjee, and Gillian Watermeyer frame the challenge bluntly: “The global burden of inflammatory bowel disease (IBD) is rising rapidly… [but] access to high-quality care remains uneven.”

A central theme of the review is the study’s distinction between equality and equity. “Equal access means offering the same resources to all patients,” the authors write, “but this often fails when individuals start from unequal positions.” Their bottom line: “Equity instead acknowledges diverse needs and barriers, directing additional support to those who need it most.”

Geography still dictates care

The authors highlight the compounding effect of workforce shortages and diagnostic limitations, particularly outside major urban centers. In the United States, they note, “nearly 70 percent of rural counties have no practicing gastroenterologist,” with downstream effects that include fewer routine specialist visits and greater reliance on emergency departments and hospitalizations. Limited access to endoscopy, cross-sectional imaging, histopathology, and even routine monitoring tests such as fecal calprotectin and CRP can further delay diagnosis and undermine treat-to-target care.

Cost and reimbursement shape real-world therapy decisions

The review points to biologics and small molecules as a major equity flashpoint. “Reimbursement policies are one of the strongest determinants of equity in IBD care,” the authors write, describing how payer structure and national reimbursement design shape access to advanced therapies — even as prices have “escalated dramatically during the past two decades.” They also underscore that inequity isn’t only an LMIC problem; fragmented systems can create barriers unrelated to clinical need.

Race, ethnicity, stigma, and caregiver strain are not side issues

Burisch and colleagues describe how demographic disparities can manifest as delayed diagnosis and lower utilization of biologics among minority groups, while also calling out a persistent evidence gap: minority populations and patients in LMICs remain underrepresented in trials and registries, limiting generalizability.

They also elevate the “hidden” burdens that GI clinicians often see but systems rarely measure — food insecurity, caregiver strain, and stigma. In a practical callout for multidisciplinary care, the authors state that, “embedding routine screening of care-giver burden and providing psychological counselling is today a necessity.”

What strategies rise to the top?

The review emphasizes multi-level solutions: policy reforms that incorporate social determinants of health, strengthened referral pathways, and expanding diagnostic capacity. For day-to-day practice, two scalable approaches get particular attention: telehealth and point-of-care intestinal ultrasound — while warning that the push toward digital care must avoid “digital exclusion.”

The authors’ broader message is that equity work is shared work. Quoting World IBD Day’s theme, they write, “IBD has no borders,” and argue patients should be included “as the core members of the IBD care team” in both healthcare delivery and policy-making.