Inflammatory bowel disease management could be revolutionized by eliminating the harsh systemic side effects that plague current treatments. Traditional IBD therapies—corticosteroids, immunosuppressants, and aminosalicylates—often cause joint pain, diabetes, and osteoporosis because they circulate throughout the body rather than concentrating where inflammation occurs. This comprehensive review in Biomaterials examines how engineered delivery systems could transform treatment by precisely targeting inflamed intestinal tissues. The analysis highlights biomaterial carriers designed to navigate the digestive tract and release therapeutics specifically at sites of epithelial barrier disruption and immune dysregulation. These systems address IBD's complex pathophysiology, which involves genetic predisposition, environmental triggers, and microbial imbalances that collectively drive chronic inflammation. Beyond conventional drug delivery, emerging biomaterial approaches focus on neutralizing reactive oxygen species, modulating local inflammatory cascades, and restoring healthy gut microbiota composition—addressing root causes rather than just symptoms. The clinical potential extends beyond symptom management to genuine tissue repair and microbiome restoration. However, translating these sophisticated delivery systems from laboratory to clinic faces significant hurdles. The variable nature of IBD presentation, individual differences in intestinal transit times, and the challenge of achieving consistent drug release in the dynamic gut environment complicate development. Additionally, regulatory pathways for combination biomaterial-drug products remain complex. While this represents incremental progress in targeted therapeutics rather than a fundamental breakthrough, the convergence of materials science with IBD pathophysiology understanding offers genuine hope for reducing treatment burden while improving outcomes for millions affected by this debilitating condition.