Gut Microbiome and Paediatric Inflammatory Bowel Disease: Emerging Mechanistic and Therapeutic Insights Into Pathogenesis and Microbiota-Based Approaches

Abstract

The gut microbiome is crucial for paediatric intestinal development and holds therapeutic potential for inflammatory bowel disease (IBD). This review explores the link between gut microbiome dysbiosis and paediatric IBD pathogenesis. Microbial colonisation during early developmental windows establishes immune tolerance, reinforces epithelial barrier integrity and regulates metabolic functions. Dysbiosis contributes to disease through reduced beneficial microbial metabolites, impaired mucosal barriers and aberrant immune activation. Distinct dysbiosis signatures in paediatric patients correlate with clinical phenotypes and treatment responses, suggesting potential biomarkers. Emerging therapies include targeted nutritional therapies, designed microbial consortia, microbiota transplantation and tailored diets. By correcting underlying microbial imbalances, these approaches may offer more sustainable disease control with fewer side effects than conventional anti-inflammatory treatments. However, challenges persist, such as limited paediatric cohort sizes, a lack of causal mechanistic data and variability in microbiome profiles due to diet, geography and developmental stage. Future research requires larger longitudinal studies to develop paediatric-specific interventions that restore microbial equilibrium, ultimately transforming IBD management in children.