Gut microbial healing in IBD: visionary approach or evidence-based reality?

Introduction: Gut microbiota plays a crucial role in the treatment outcomes of inflammatory bowel disease (IBD). Evidence suggested a bidirectional interaction between gut microbiota and medical treatments, in which drugs modulate microbial composition, while microbiota, in turn, impact drug metabolism. This influences the effectiveness of therapy and leads to individual variations in treatment responses, opening the door to personalized medicine in IBD management. Area covered: This review summarizes how various therapeutic agents–including aminosalicylates, corticosteroids, immunomodulators, and newer drug classes such as biologics and small molecules–modulate gut microbiota and how gut microbiota conversely impact their pharmacological effects. The clinical outcome of microbiota to medical treatment is also discussed. PubMed/Medline databases were used in the search for the pre- and post-therapeutic results of microbiota-IBD drug interactions, covering publications from January 2000 to March 2025. Expert opinion: Drug-microbiota interactions are crucial in personalized medicine. Nevertheless, therapeutic strategies for modulating the interaction of microbiota and the drugs remain largely unexplored. In addition, clinical applications of microbiota profiling are restricted by technical challenges and inter-individual variability. Future integration of microbiome sequencing in clinical practice combined with advanced analytics is fundamental for a more thorough identification of diagnostic markers and optimizing therapeutic strategies for IBD patients.