Crohn’s disease and ulcerative colitis are long-term, and can be kept quiet.
In inflammatory bowel disease (IBD) the body’s own defences attack the lining of the gut, which becomes red, swollen and ulcerated. It comes in flares and calm spells, usually for life. It is not the same as IBS: in IBD the bowel is truly inflamed, and tests show it. With steady treatment most people lead full lives.
In plain words.
Ulcerative colitis affects only the large bowel. It always starts at the back passage and spreads upwards in one unbroken stretch, and it harms only the inner lining. The main sign is loose motions with blood and mucus, and an urgent need to go.
Crohn’s disease can affect any part of the gut from mouth to back passage, most often the end of the small bowel. It comes in patches with healthy gut in between, and it goes through the whole thickness of the wall. That is why it can narrow the bowel, or make tunnels (fistulas) and boils near the back passage. Tummy pain, loose motions and weight loss are common; blood is less common than in colitis.
Both can also bring tiredness, fever, anaemia, mouth ulcers, painful joints, red eyes and skin problems. Children may grow slowly.
In India, tuberculosis of the gut can look exactly like Crohn’s disease. It must be ruled out before treatment, because steroids and some other IBD medicines can make TB much worse.
Treatment has two aims: to calm a flare, and then to keep the bowel quiet with daily medicine even when you feel well. Medicines include mesalamine, short courses of steroids, azathioprine and newer injections or drips. Some people need surgery. Stopping smoking is one of the most helpful things for Crohn’s disease.
Healthy, colitis or Crohn’s?
The bowel lining is smooth and pink. Under it lie a soft layer and a muscle wall that squeezes food along.
Starting at the back passage and spreading upwards in one unbroken stretch, the inner lining turns red and raw with shallow ulcers. It bleeds, so motions carry blood and mucus. The deeper layers are spared.
Patches of inflammation appear anywhere, most often at the end of the small bowel, with healthy gut in between. Each patch goes through the whole wall, which can thicken and narrow the bowel.
Go to hospital now if
- Six or more bloody motions a day with fever, a fast heartbeat or feeling very unwell: go to hospital now. A severe flare of colitis needs treatment in hospital.
- Severe tummy pain with a swollen, hard or very tender tummy: go to hospital now.
- Vomiting with a swollen tummy and not passing stool or wind: go to hospital now. The bowel may be blocked.
- Heavy bleeding, or feeling dizzy, faint or breathless: call 112.
- Signs of losing too much water: very little urine, a dry mouth, or dizziness on standing: go to hospital now.
- Any fever (38°C or more), shivering, or feeling very unwell, while taking azathioprine, steroids, or an injection or drip for IBD: go to hospital now.
Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).
See a doctor within a day or two if
- A flare is not settling after a few days of your usual plan
- You take azathioprine, steroids or an injection for IBD and have a fever, sore throat or feel unwell: see a doctor the same day
- A painful lump or discharge near the back passage
Tests that help.
Not everyone needs every test. He decides which ones are worth doing for you.
| Test | What it tells |
|---|---|
| Stool tests | Look for germs that cause loose motions, and calprotectin, which rises when the bowel is inflamed and helps tell IBD from IBS. |
| Blood count, CRP and ESR | Show anaemia and how active the inflammation is. |
| Colonoscopy with biopsies | A camera through the back passage to see the lining and take small samples. The key test for both. |
| CT or MR enterography | A scan of the small bowel, where Crohn’s disease often hides. |
| TB tests | Samples from colonoscopy, a chest X-ray and blood or skin tests, to rule out TB before treatment. |
| Liver, kidney and vitamin tests | Before and during some medicines, and to check iron, vitamin B12 and vitamin D. |
Have it ready.
Tick them off as you gather them. The ticks stay on this phone only.
Online, or in person?
Painkillers such as diclofenac, ibuprofen and nimesulide can set off a flare; ask your doctor before taking any. Do not stop steroids suddenly after more than a few weeks: they must be tapered. Plan pregnancy with your doctor: most IBD medicines are continued, but some, such as methotrexate, must be stopped months before.
A video call can
- Review your reports and explain what the disease and its extent mean for you
- Keep maintenance medicine on track and watch blood tests, alongside your gastroenterologist
- Make a plan for what to do early in a flare
- Look after anaemia, bones, vaccines and other health needs
Needs a visit in person
- A severe flare, heavy bleeding or a blocked bowel: that is for hospital
- Colonoscopy with biopsies, and scans
- Drips or injections of biologic medicines, and surgery
Talk it through with Dr. Arya.
Bring your reports and medicines to a video consultation. He goes through them with you, in plain words, and says clearly if you need to be seen in person.
Book a video consultationDr. Prabhat Arya · MBBS, MD (Internal Medicine) · Delhi Medical Council Reg. No. DMC-83759