Inflammatory Bowel Disease (Crohn’s & Ulcerative Colitis) — Diagnosis, Treatment and Surveillance

TL;DR — Inflammatory bowel disease (IBD) is the umbrella term for two chronic relapsing-remitting inflammatory conditions of the gut: Crohn’s disease and ulcerative colitis. They are lifelong conditions but, with modern therapy, most patients are able to live full lives with infrequent flares. IBD is diagnosed with a combination of colonoscopy + biopsy, blood tests, faecal calprotectin, and imaging (MRI / CT for small-bowel Crohn’s). Treatment ranges from 5-ASA medications through immunomodulators to biologic therapy. Surveillance colonoscopy is essential because long-standing colitis increases bowel cancer risk. Dr Goutham diagnoses IBD, performs surveillance colonoscopy, and co-manages with an IBD physician where biologic therapy is needed.

What is inflammatory bowel disease?

• Crohn’s disease — can affect any part of the GI tract from mouth to anus, in patches (“skip lesions”), with inflammation that goes through the full thickness of the bowel wall (transmural). Strictures, fistulas and perianal disease are characteristic complications.
• Ulcerative colitis — affects only the large bowel, in a continuous pattern starting at the rectum, with inflammation limited to the mucosa. Severe attacks can require hospitalisation; colectomy is curative when medical therapy fails.
• Indeterminate colitis / IBD-unclassified — the term used when the pattern doesn’t clearly fit either

Symptoms

• Chronic or recurrent diarrhoea (often bloody in ulcerative colitis)
• Abdominal pain — cramping; often right-lower-quadrant in Crohn’s ileal disease
• Urgency and tenesmus (a constant sense of needing to defaecate)
• Unintentional weight loss
• Fatigue, low-grade fever
• Iron-deficiency anaemia
• Mouth ulcers (Crohn’s)
• Joint pain, eye inflammation (uveitis), skin rashes (pyoderma gangrenosum, erythema nodosum) — extraintestinal manifestations
• Perianal abscess, fistula, fissure (especially Crohn’s)

How is IBD diagnosed?

• Blood tests — FBC (anaemia, leukocytosis), CRP, ferritin, albumin (low in active disease), LFTs (associated primary sclerosing cholangitis)
• Faecal calprotectin — a stool marker of bowel inflammation; elevated in IBD, normal in IBS. The single most useful non-invasive test in distinguishing IBD from functional gut symptoms
• Colonoscopy with multiple biopsies — the gold standard for diagnosis, assessment of extent and severity, and surveillance
• Gastroscopy with biopsy — if upper GI Crohn’s is suspected
• MR enterography or CT enterography — for assessing the small bowel in Crohn’s disease
• Capsule endoscopy (PillCam) — small-bowel imaging in selected cases; not used if a stricture is suspected (capsule retention risk)

How is IBD treated?

IBD management has been transformed by biologic and small-molecule therapy over the past two decades. Treatment is personalised based on disease type, location, severity and patient preference. A typical stepwise approach:

• 5-ASA medications (mesalazine, sulfasalazine) — first-line for mild-to-moderate ulcerative colitis
• Corticosteroids (prednisolone, budesonide) — for inducing remission in flares; not for long-term maintenance
• Immunomodulators (thiopurines — azathioprine, mercaptopurine; methotrexate) — for steroid-sparing maintenance
• Biologic therapy — anti-TNF (infliximab, adalimumab), anti-integrin (vedolizumab), anti-IL-12/23 (ustekinumab), anti-IL-23 (risankizumab) — for moderate-to-severe disease; usually managed by an IBD physician
• JAK inhibitors (tofacitinib, upadacitinib) — oral small molecules for moderate-to-severe ulcerative colitis
• Surgery — resection for Crohn’s strictures / fistulas; colectomy for refractory ulcerative colitis
• Nutritional therapy — exclusive enteral nutrition is highly effective in paediatric Crohn’s and used in adults in selected cases

Surveillance for bowel cancer

Long-standing colitis increases the risk of bowel cancer — particularly when:

• Disease has been present for ≥ 8–10 years
• The whole colon is affected
• There is concurrent primary sclerosing cholangitis
• There is a family history of bowel cancer
• Past dysplasia has been found at colonoscopy

Surveillance colonoscopy starts 8–10 years after diagnosis and is repeated every 1–5 years depending on risk. Chromoendoscopy (dye-spray) or virtual chromoendoscopy is recommended to detect subtle dysplasia. The exact schedule is documented on the surveillance intervals page and discussed individually.

When to see a specialist

• Chronic (> 4 weeks) bloody diarrhoea
• Recurrent diarrhoea with weight loss, fatigue, or anaemia
• Elevated faecal calprotectin (typically > 250 µg/g)
• Family history of IBD with new GI symptoms
• Known IBD — for surveillance, flare management, or step-up therapy
• Perianal abscess or fistula (especially in a young adult)

What to expect at your appointment with Dr Goutham

Dr Goutham’s role with IBD is usually diagnostic and surveillance: confirming the diagnosis at colonoscopy with biopsy, assessing extent and severity, and performing the ongoing surveillance colonoscopies that prevent cancer over the long term. For patients who need biologic therapy or have complex disease, ongoing medical management is co-managed with an IBD physician; for those with surgical complications, referral to a colorectal surgeon is arranged. Dr Goutham continues to provide endoscopic surveillance throughout.

Frequently asked questions

Is IBD curable?

Crohn’s disease is not curable but can usually be controlled to a state where patients feel well for long periods. Ulcerative colitis can be cured by removing the colon (proctocolectomy), but most patients are managed medically and surgery is reserved for refractory or complicated disease.

Can diet cause or cure IBD?

Diet alone does not cause IBD — the cause is a complex interaction of genetics, immune function, gut microbiome and environment. Diet does influence symptoms and disease behaviour, particularly during flares; specific exclusive enteral nutrition is highly effective in paediatric Crohn’s. There is no single “IBD diet” that fits all patients; work with an IBD-experienced dietitian.

Will I need a colostomy?

The vast majority of IBD patients do not need a stoma. In ulcerative colitis, colectomy is performed only when medical therapy fails or in severe acute attacks; an ileal pouch reconstruction often avoids a permanent stoma. In Crohn’s, resection of strictured or fistulating segments is sometimes needed but a stoma is the exception rather than the rule.

Book a consultation

Phone 07 3733 1551 or send a referral via the contact form. See about Dr Goutham or the cost page.

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