Inflammatory Bowel Disease (IBD): Crohn's Disease and Ulcerative Colitis Symptoms and Treatment

Inflammatory bowel disease (IBD) is a chronic condition in which the immune system causes ongoing inflammation in the digestive tract. It is different from irritable bowel syndrome (IBS), which causes symptoms without visible inflammation or damage. IBD is becoming more common in India, and early diagnosis makes a real difference to long-term health.

Crohn's disease vs ulcerative colitis

Symptoms of IBD

• Diarrhoea for more than 4 weeks, often at night
• Blood or mucus in the stool, and urgency to pass stool
• Abdominal pain or cramps, often in the lower right abdomen in Crohn's disease
• Weight loss, poor appetite, tiredness and anaemia
• Fever during flares
• Painful fissures, fistulas or abscesses around the anus (Crohn's disease)
• Problems outside the gut: joint pain, red eyes, skin rashes, mouth ulcers

What causes IBD?

The exact cause is not known. IBD develops when the immune system reacts abnormally to gut bacteria in people with a genetic tendency, triggered by environmental factors. Smoking increases the risk and severity of Crohn's disease. IBD is not caused by stress or spicy food, although these can worsen symptoms in some people.

Crohn's disease or intestinal tuberculosis?

Abdominal tuberculosis is common in India and can affect the same part of the bowel as Crohn's disease, with similar symptoms and colonoscopy findings. Treating TB as Crohn's (with steroids or biologics) can make TB worse, and treating Crohn's as TB delays the right treatment. Indian guidelines therefore recommend careful evaluation, including colonoscopy with biopsies, TB tests, CT or MR enterography and sometimes a trial of anti-TB treatment, before confirming Crohn's disease.

How is IBD diagnosed?

• Blood tests: blood count, CRP, iron, vitamin B12, liver and kidney function
• Stool tests: to rule out infection, and faecal calprotectin to look for gut inflammation
• Colonoscopy with biopsies: the key test to see the inflammation and confirm the diagnosis
• CT or MR enterography, capsule endoscopy or upper endoscopy for small bowel Crohn's disease

Treatment of IBD

The aim is to settle the flare, then keep the gut healed (remission) and prevent complications.

• Aminosalicylates (5-ASA, such as mesalamine): the main treatment for mild to moderate ulcerative colitis, as tablets, enemas or suppositories.
• Steroids: for short periods to control flares only; they are not used for long-term maintenance.
• Immunomodulators (azathioprine, methotrexate): to keep the disease quiet and reduce steroid use, with regular blood tests.
• Biologics and small molecules (such as infliximab, adalimumab, vedolizumab, ustekinumab and tofacitinib) for moderate to severe disease or when other treatments fail. TB and hepatitis B screening is done before starting them.
• Surgery: for complications such as strictures, fistulas or severe colitis that does not respond to medicines.

Diet and lifestyle with IBD

• There is no single IBD diet. Eat a balanced diet and keep a food diary to find personal triggers.
• During flares, soft, low-fibre food may be easier; see our guide to easy-to-digest Indian foods.
• If you have a stricture, avoid hard, fibrous foods your doctor advises against.
• Stop smoking, especially with Crohn's disease.
• Avoid regular painkillers such as ibuprofen or diclofenac without advice; they can trigger flares.
• Keep up with vaccinations, bone health checks and colonoscopy surveillance as advised.

When to see a gastroenterologist

• Diarrhoea for more than 4 weeks, or blood in the stool
• Weight loss, anaemia or night-time diarrhoea
• Severe abdominal pain, fever or more than 6 bloody stools a day, which needs urgent care

Frequently Asked Questions

Conclusion:

Crohn's disease and ulcerative colitis are lifelong conditions, but they are very treatable. Early diagnosis, ruling out tuberculosis, the right medicines and regular follow-up help most people stay well. If you have persistent diarrhoea or blood in the stool, see a gastroenterologist.