Takeuchi I.Arai K.Tanpowpong P.Lai M.W.Day A.S.Lee W.S.Huang J.G.Calixto-Mercado K.S.Wong R.M.S.Alvi M.A.Grover Z.Shim J.O.Poddar U.Mahidol University2025-11-022025-11-022025-10-01Intestinal Research Vol.23 No.4 (2025) , 405-42915989100https://repository.li.mahidol.ac.th/handle/123456789/112889Children diagnosed with inflammatory bowel disease (IBD) before the age of 6 years are considered to have “very early-onset IBD (VEO-IBD),” which is challenging to diagnose and treat. Notably, many children with VEO-IBD have monogenic forms of the disease, meaning that early genetic testing is useful. However, because the prevalence of genetic variants causing VEO-IBD differs globally, the diagnosis and treatment of this disease should be tailored to each region. In the present review paper, the IBD Subcommittee of the Scientific Committee of the Asia-Pacific Society of Pediatric Gastroenterology, Hepatology and Nutrition (APSPGHAN) has summarized the epidemiology, presenting features, diagnosis, and treatment of VEO-IBD in the Asia–Pacific region, with an aim to guide clinicians and researchers who work with VEO-IBD in this area. Our 3 main messages are as follows: endoscopy is essential for VEO-IBD diagnosis; all children diagnosed with VEO-IBD should be suspected of having a monogenic form; and children with suspected monogenic IBD should undergo early genetic testing. Our messages aim to improve the early diagnosis and treatment of VEO-IBD in the Asia–Pacific region, including the early detection of monogenic IBD in this area.MedicineReviewSCOPUS10.5217/ir.2025.000822-s2.0-10501997009122881956