Abstract
BACKGROUND: Inflammatory bowel disease (IBD) is a chronic, relapsing condition associated with diagnostic delays, disease misclassification, and variable treatment response. Conventional diagnostic and monitoring tools remain limited in capturing the biological complexity of IBD, prompting growing interest in metabolomics as a complementary approach. OBJECTIVES: This systematic review aimed to examine the role of metabolomics in enhancing the diagnosis and management of IBD across adult and pediatric populations. DESIGN: Systematic review. DATA SOURCES AND METHODS: The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. PubMed, Web of Science Core Collection, ScienceDirect, Cochrane Library, and Google Scholar were searched from inception to identify eligible studies. Observational studies and clinical trials assessing metabolomics in IBD diagnosis or management were included. Methodological quality was appraised using the Newcastle-Ottawa Scale, RoB 2, and ROBINS-I. Due to substantial heterogeneity, a narrative synthesis was performed. RESULTS: Fourteen studies involving approximately 3700 participants met the inclusion criteria. Metabolomic analyses of serum, feces, urine, and plasma consistently identified disease-associated metabolic perturbations, particularly in amino acids, bile acids, lipids, and short-chain fatty acids. Only two studies reported formal diagnostic performance, with sensitivity and specificity exceeding 80% for distinguishing IBD subtypes. Several studies demonstrated metabolomic changes associated with treatment response and remission; however, outcome definitions varied widely across studies. CONCLUSION: Metabolomics shows significant potential to enhance IBD diagnosis and management, particularly for disease differentiation and treatment monitoring. Nonetheless, clinical translation is constrained by methodological heterogeneity and limited diagnostic validation. Future research should prioritize standardized protocols and robust diagnostic accuracy studies.