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  • Perspective
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The global burden of inflammatory bowel disease: from 2025 to 2045

Nature Reviews Gastroenterology & Hepatology volume 22, pages 708–720 (2025)Cite this article

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Abstract

Inflammatory bowel disease (IBD) is a global condition that progresses through four epidemiologic stages: emergence, acceleration in incidence, compounding prevalence and prevalence equilibrium. Early industrialized countries are currently in the compounding prevalence stage before transitioning to the prevalence equilibrium stage, with >1% of their populations expected to live with IBD within the next decade. Prevalence equilibrium can be modelled using a health–illness–death compartment framework and partial differential equations to predict prevalence to 2045. Meanwhile, newly industrialized countries are projected to shift from accelerated incidence with low prevalence to compounding prevalence over the next two decades. This Perspective explores the global evolution of IBD through these epidemiologic stages, presenting a framework for disease prevention and innovative health-care strategies to address the critical challenges the global IBD community will face over the next 20 years.

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Fig. 1: Understanding the four epidemiologic stages of IBD evolution.
Fig. 2: Epidemiologic stages of IBD across global regions.
Fig. 3: Spatiotemporal transitions across the four epidemiologic stages in four example countries: the USA, Japan, Malaysia and Zambia.
Fig. 4: An example of a compartment model framework for IBD.
Fig. 5: A road map to address the rising burden of IBD from 2025 to 2045.

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Data availability

Global IBD epidemiologic data depicted in the figures are provided in an open-access, downloadable, online interactive source, the ShinyApp: https://kaplan-gi.shinyapps.io/GIVES21.

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Acknowledgements

The author acknowledges S. Coward, M. Cummings, L. Hracs and J. Windsor for their expertise, contextual insights and editorial contributions to the article. In particular, the author thanks J. Gorospe for her assistance in drafting the figures and J. Windsor for developing the visual representation and guitar-string analogy in Fig. 1. The author’s research is funded by operating grants from the Canadian Institutes of Health Research and the Leona M. and Harry B. Helmsley Charitable Trust.

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    Gilaad G. Kaplan

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Correspondence to Gilaad G. Kaplan.

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G.G.K. has received honoraria for speaking or consultancy from AbbVie, Amgen, Janssen, Pfizer and Takeda; and has received grants for research from Ferring and for educational activities from AbbVie, Bristol Myers Squibb, Ferring, Fresenius-Kabi, Janssen, Pfizer and Takeda. He shares ownership of a patent: Use of mirtazapine in the treatment of inflammatory disorders, autoimmune disease and PBC (patent WO/2019/046959A1, PCT/CA2018/051098).

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Kaplan, G.G. The global burden of inflammatory bowel disease: from 2025 to 2045. Nat Rev Gastroenterol Hepatol 22, 708–720 (2025). https://doi.org/10.1038/s41575-025-01097-1

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