Experts at the 2026 Crohn’s & Colitis Congress argued that so-called “treatment-refractory” IBD is often not true drug failure, but rather the result of factors such as bowel fibrosis, structural damage, immunogenicity, poor drug delivery, delayed therapy changes, or psychosocial barriers. They emphasized that persistent symptoms should prompt clinicians to identify the underlying cause rather than simply cycling through additional therapies.
The discussion highlighted growing evidence that fibrotic bowel damage can begin early in Crohn’s disease, with the pediatric RISK study identifying fibrosis-associated gene signatures at diagnosis in children who later developed stricturing disease. The findings reinforce the importance of early reassessment and intervention, as anti-inflammatory therapies cannot reverse established scar tissue. As Dr. Peter Higgins noted, “Time is bowel,” underscoring the need to distinguish active inflammation from irreversible structural damage.