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Crohn’s disease and ulcerative colitis already feel complicated, but when IBD shows up in a baby or a preschooler, the rules can change fast. We’re joined by Dr. Scott B. Snapper, a leader in pediatric and adult IBD research from Boston Children's Hospital, to unpack very early onset IBD (VEO-IBD) and why some of these cases are driven by single-gene immune disorders rather than the “usual” mix of risks we talk about in inflammatory bowel disease.

We get into how Dr. Snapper's work with immune deficiency and mouse models helped reveal clear cause-and-effect pathways, and why that matters for real treatment choices. If a child has IL-10 receptor deficiency, standard IBD medications like anti-TNF therapy may not work, and bone marrow transplant can be curative. We also talk about what happens when transplant isn’t possible right away, including the promise of targeted options like IL-1 blockade, and why certain immune defects respond to very specific therapies. Along the way, we zoom out to the big goal in IBD care: fewer rounds of trial and error, more precision medicine guided by biomarkers from blood, stool, and biopsies.

We also dig into whole exome sequencing, insurance realities, and the ethics of genetic information, including the very real fear of future discrimination. Finally, Scott shares how the VEO-IBD Consortium grew into a global resource for clinicians and families through veoibd.org, and why he’s genuinely optimistic about the future of IBD therapy, including better tools for pain and gut-brain symptoms.

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• VEO-IBD Consortium
• Dr. Snapper won the Sherman Prize last year
• VEO-IBD Information from Boston Children's Hospital
• VEO-IBD Information from the Crohn's & Colitis Foundation- USA

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