Inflammatory bowel disease

Inflammatory bowel disease (IBD) is a long-term condition in which the digestive tract becomes inflamed. The two main types are ulcerative colitis and Crohn's disease. IBD is different from irritable bowel syndrome (IBS) — IBS is a functional condition without inflammation.

IBD was once considered rare in India, but incidence has risen sharply in recent decades — particularly in urban areas and among young adults. This trend is seen across Asia.

The two types

• Ulcerative colitis (UC) — inflammation affects only the colon (large intestine) and rectum, in a continuous pattern. Causes bloody diarrhoea, urgency, abdominal cramping.
• Crohn's disease — can affect any part of the digestive tract from mouth to anus, often in patches. Can cause abdominal pain, non-bloody diarrhoea, weight loss, fatigue, and sometimes fistulas or strictures.

Symptoms

• Persistent diarrhoea, sometimes with blood
• Abdominal pain and cramping
• Urgency to pass stools
• Fatigue
• Unintentional weight loss
• Fever during flare-ups
• Joint pain, eye inflammation, or skin rashes (extra-intestinal features)

Diagnosis

IBD is diagnosed through:

• Medical history and examination
• Blood tests — for inflammation markers, anaemia
• Stool tests — to look for infection and inflammation (faecal calprotectin)
• Colonoscopy with biopsies — the definitive test
• Imaging (CT or MRI) for Crohn's disease to assess deeper involvement
• In India, distinguishing Crohn's from intestinal tuberculosis is an important challenge — symptoms and appearance can overlap, and treatment differs entirely. Experienced gastroenterologists use a combination of clinical picture, biopsy findings, imaging, and sometimes TB testing to tell them apart.

Treatment

IBD is long-term and managed rather than cured. The aim is to reduce inflammation, manage flare-ups, and maintain remission:

• Anti-inflammatory medicines — for mild-to-moderate ulcerative colitis
• Steroids — for flare-ups, not long-term use
• Immunosuppressant medicines — for moderate disease or when other treatments don't work
• Biologic therapies — for moderate-to-severe disease
• Surgery — for complications (severe flares not responding to medicines, strictures, fistulas, cancer). In ulcerative colitis, removal of the colon can be curative.
• Diet and lifestyle — no single IBD diet works for everyone, but a dietitian can help you identify foods that trigger flares. Smoking worsens Crohn's disease — not smoking is important.