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A large-scale study, presented at UEG Week 2026, has identified distinct antibody patterns up to 10 years before the diagnosis of inflammatory bowel disease (IBD), potentially opening new avenues for earlier risk detection and providing insights into future disease course.

IBD is a group of chronic conditions, including Crohn's disease (CD) and ulcerative colitis (UC), in which abnormal immune responses contribute to ongoing inflammation and damage in the digestive system. Although IBD is increasingly recognized to develop over a prolonged period before diagnosis, relatively little is known about the immune changes that occur during this time.

To investigate these changes, researchers analyzed 2,000 serum samples from 500 individuals, including 200 who developed CD, 200 who developed UC and 100 age- and sex-matched healthy controls. Samples were collected at diagnosis and approximately two, four and 10 years beforehand.

The researchers profiled antibody responses against around 357,000 microbial-, viral-, food- and immune-associated antigens, allowing them to examine antibody patterns in the years leading up to diagnosis.

Across the 2,000 samples, researchers identified 123,980 unique antibodies. Compared with healthy controls, antibody diversity was significantly lower in people who later developed CD or UC, with distinct antibody responses evident in both conditions up to 10 years before diagnosis.

In CD, elevated responses against herpesviruses and anti-flagellin antibodies were observed, particularly in people who later developed complicated or ileal disease, while responses to encapsulated bacteria progressively declined toward diagnosis.

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