ECCO 2026: New Insights Into IBD Risk & Care

Work Environment as a Possible Risk Modifier

One large multicohort study examined whether occupations and the exposures embedded within them influence IBD risk. Researchers analyzed 120,290 participants in the UK Biobank and confirmed key findings in an independent Chinese medical insurance database. They identified higher IBD risk in certain skilled trades and occupations with higher levels of pollutant exposure.

High exposure to diesel exhaust was associated with a 56% increased risk of IBD, and exposure to mists and aerosols was associated with a 31% increased risk (1).

Lifelong high levels of work-related physical activity were also associated with elevated risk, whereas occupations associated with greater socioeconomic advantage were linked to lower IBD risk.

Severe Infection as a Long-Term Immune Stressor

A second large prospective study examined whether serious infections requiring hospital treatment were linked to later development of inflammatory bowel disease. Researchers followed more than 359,000 UK Biobank participants for an average of 12 years after their first hospital-treated infection (2).

People who experienced a hospital-treated infection had a little more than three times the risk of developing IBD compared with those who did not.

The increased risk was seen across different types of infections – including bacterial, viral, fungal, and parasitic – and across multiple organ systems.

The researchers also found that genetics influenced how strongly infection was associated with IBD risk. Variants in immune-related genes modified susceptibility, and the team developed an “Infection IBD Score” to help identify individuals who may be more vulnerable following severe infection.

The findings support a multi-hit model in which severe infection may act as an immune stressor in people who are already genetically susceptible.

Early Treatment Strategy and Long-Term Crohn’s Outcomes

Follow-up data from the PROFILE randomized trial examined whether starting combination biologic therapy at diagnosis changes the long-term course of Crohn’s disease (3).

Over a median follow-up of about 4.5 years from diagnosis, patients initially treated with the step-up strategy were significantly more likely to experience serious disease complications.

From diagnosis onward, 27 abdominal surgeries occurred in the step-up group compared with 6 in the top-down group. Overall, patients who began with step-up treatment had about five times the odds of requiring Crohn’s-related abdominal surgery. Progression to more severe forms of disease (stricturing or penetrating Crohn’s) was also more common in the step-up group.

Hospital admissions related to Crohn’s disease were nearly four times higher among patients who started with step-up treatment.

Because this analysis reflects longer-term follow-up after the initial trial period, treatment decisions beyond the first year varied. However, the findings suggest that early and effective control of inflammation may reduce long-term complications rather than simply managing short-term symptoms.