This episode explores inflammatory bowel disease as the pharmacology of misdirected defence. In ulcerative colitis and Crohn’s disease, immune mechanisms designed to protect the intestinal barrier instead sustain injury over time. We examine cytokine signalling, epithelial integrity, microbiome interaction, and immune tolerance to understand why IBD is not simply “over-inflammation,” but a failure of regulation and resolution. Pharmacological strategies are framed as attempts to restore immune proportion-quieting harmful pathways while preserving essential defence.

Key takeaways to anchor the episode:

* Barrier breakdown: why epithelial integrity matters as much as immunity.

* Immune misalignment: TNF-α, integrins, interleukins, and cellular trafficking.

* Step-up logic: aminosalicylates, corticosteroids, immunomodulators, biologics.

* Targeted therapy: choosing drugs by disease location, severity, and trajectory.

* Long-term thinking: remission maintenance, safety monitoring, and shared decision-making.

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