Evolving concepts in IBD therapy: What should be studied in the future?

New knowledge regarding the etiopathophysiology of inflammatory bowel diseases (IBD) may provide new approaches for treatment. The most convincing concept at the moment is a defective mucosal barrier due to inappropriate recognition of the luminal flora or to a defective defense against those bacteria. These concepts indicate that the paradigm of immune suppression may not be the optimal concept. Therefore variable approaches to improve the barrier function or to modulate luminal components have to be studied in the future. This includes probiotics, bile acid receptor agonists, Toll-like receptor agonists and many other as yet hypothetical ideas. We still have much to learn about the concepts mentioned in order to achieve the goals of treatment, i.e. avoiding structural damage and complications.