Inflammatory Bowel Disease: Why we need to talk about it openly and sensitively in India

IBD primarily includes two major conditions: Crohn’s disease and Ulcerative colitis
| Photo Credit: Getty Images/iStockphoto

Inflammatory Bowel Disease (IBD) is a term used for a group of chronic conditions that cause inflammation of the digestive tract. While IBD has long been considered a Western disease, India is now witnessing a steady rise in its incidence. Despite its growing burden, awareness remains low, and many patients suffer for years without the right diagnosis or treatment.

IBD primarily includes two major conditions: Crohn’s disease and Ulcerative colitis. While both involve long-standing inflammation of the bowel, they differ in how and where they affect the digestive system. Ulcerative colitis affects only the colon (large intestine) and rectum, while Crohn’s disease can affect any part of the gastrointestinal tract, from the mouth to the anus, often in patches.

Why does IBD occur?

The exact cause behind IBD is not known, but several factors may contribute to it. These include: genetics, as people with a family history of it are more likely to get IBD; immune system abnormalities: the body’s immune system attacks the gut lining, causing chronic inflammation; environmental factors: changes in diet, pollution, use of antibiotics, and urban living have been linked to rising IBD rates and the gut microbiome: the balance of good and bad bacteria in the gut appears to play a key role

Importantly, IBD is not caused by stress or spicy food, although these may aggravate symptoms.

How does IBD present?

Symptoms of IBD can vary depending on the type and severity of the disease, but commonly include: chronic diarrhea (often blood or with mucus), abdominal pain or cramping, urgent need to pass stool, weight loss and lack of hunger, fatigue and weakness and a low-grade fever during flare-ups.

IBD can also cause symptoms outside the gut, such as: joint pain, skin rashes, red or painful eyes and mouth ulcers. These symptoms may come and go, with periods of worsening (called flare-ups) followed by improvement or remission.

The importance of early diagnosis

One of the challenges in India is delays in diagnosis. Many patients are misdiagnosed with infections or with irritable bowel syndrome. Tests needed for accurate diagnosis include: blood and stool tests to check for inflammation or infection; a colonoscopy with a biopsy to view the colon and obtain tissue samples and imaging tests like MRIs or CT scans to assess deeper parts of the bowel. Early diagnosis is critical to prevent complications like intestinal strictures, fistulas, or malnutrition.

Is there a cure?

There is no complete cure for IBD, but it can be managed well. The goal of treatment is to control inflammation, relieve symptoms, and improve quality of life. Most patients can lead normal lives with the right treatment plan. Available treatments include: medications such as aminosalicylates (e.g., mesalamine) for mild to moderate disease; corticosteroids for flare-ups; immunomodulators like azathioprine to maintain remission; biologic therapies (e.g., anti-TNF agents) for moderate to severe cases. Surgery may be needed in Crohn’s disease to remove structured segments or in ulcerative colitis when medicines fail.

Diet, nutrition and lifestyle modifications

A balanced diet is essential. Though there is no one-size-fits-all diet, patients are encouraged to avoid processed foods, high-fat items, and foods containing lactose, if intolerant. Nutritional supplements may be needed for those with vitamin deficiencies or weight loss. Smoking cessation is advised, and is especially important in Crohn’s disease). Managing stress through yoga, exercise, and counselling is important. Adequate sleep and hydration are also crucial.

Living with IBD

IBD can affect one’s quality of life, especially during flare-ups. Patients may face emotional challenges due to frequent bathroom visits, fatigue, or fear of social embarrassment. Support from family, friends, schools, and workplaces is vital. Mental health support should be an integral part of IBD care.

In India, stigma, lack of awareness, and limited access to specialist care are major hurdles. There is a growing need for public education, improved diagnostics, and affordable treatment.

When to see a doctor

If you have blood in your stool, weight loss, or prolonged diarrhoea, consult a gastroenterologist at the earliest. Early intervention can prevent complications and improve long-term outcomes.

Inflammatory Bowel Disease is no longer rare in India. Symptoms can disrupt daily life but with timely attention, people can live well. Increased awareness, access to treatment, and empathy from society can improve the lives of those with IBD.

Let us talk about gut health—openly, sensitively, and scientifically.

(Dr. Jacob Raja A.S. is a medical gastroenterologist with Naruvi Hospitals, Vellore. Email: [email protected])