Abstract: Inflammatory Bowel Diseases (IBD) are a group of immune-mediated disorders characterized by chronic intestinal inflammation. Their incidence and prevalence have been increasing worldwide, posing a significant public health challenge. Diagnostic delay remains a prominent issue in the clinical management of IBD. The preclinical stage, serving as a critical window period from the initiation of pathogenic mechanisms to the manifestation of symptoms, has become a focal point for diagnostic delay in IBD. Research into its pathophysiological features and early identification is paramount. This review summarizes the definition and scope of the preclinical stage of IBD, and illustrates its pathophysiological evolution and major driving mechanisms, including genetic susceptibility, environmental exposures, immune dysregulation, and gut microbiota imbalance. In addition, recent advances in emerging technologies for early identification are discussed. Furthermore, based on the Traditional Chinese Medicine concept of preventive treatment of disease, it explores potential intervention strategies for the preclinical stage of IBD. This review aims to provide theoretical references and practical insights for the early prevention, early diagnosis, and early treatment of IBD.