Inflammatory bowel disease, or IBD, is long-term inflammation of the gut caused by a misdirected immune response. It has two main forms. Ulcerative colitis affects the inner lining of the large bowel, always starting at the rectum. Crohn's disease can affect any part of the gut from mouth to anus, in patches and through the full thickness of the wall.
IBD is different from irritable bowel syndrome, which does not inflame or damage the bowel. It follows a course of flares and remissions over many years. Modern drugs bring most people into lasting remission, and surgery helps when they do not, but there is at present no medical cure.
Symptoms
- Diarrhoea lasting more than 4 weeks, often waking you at night
- Blood or mucus in the stool, particularly in ulcerative colitis
- Urgency and a feeling of incomplete emptying
- Cramping abdominal pain, often lower right in Crohn's disease
- Weight loss, tiredness and anaemia
- Abscesses, fistulas or skin tags around the anus in Crohn's disease
- Joint pain, red sore eyes, mouth ulcers or tender red skin lumps
- Delayed growth or puberty in children
Causes and risk factors
The cause is an interplay of inherited susceptibility, the gut bacteria and environmental triggers, leading to an immune attack on the bowel that does not switch off. Having a close relative with IBD raises the risk. Smoking roughly doubles the risk of Crohn's disease and worsens its course, while ulcerative colitis sometimes first appears after stopping smoking. Anti-inflammatory painkillers, gut infections and antibiotics can provoke flares. Stress and diet do not cause IBD, though they influence symptoms. Onset is most often between the ages of 15 and 35.
How it is diagnosed
- Blood and stool tests: Blood count, CRP, albumin, iron and B12, with stool cultures to exclude infection. Faecal calprotectin is a sensitive marker of gut inflammation and helps separate IBD from irritable bowel.
- Colonoscopy with biopsies: The definitive test. It shows the pattern and extent of inflammation, reaches the end of the small bowel, and biopsies confirm the diagnosis.
- MRI enterography: Images the small bowel without radiation, showing inflamed segments, narrowing and fistulas in Crohn's disease.
- Pelvic MRI: Maps fistulas and abscesses around the anus before treatment.
- Capsule endoscopy and intestinal ultrasound: Used selectively for small bowel disease and for monitoring.
Treatment options
- Aminosalicylates (mesalazine): Tablets, suppositories or enemas. First-line for mild to moderate ulcerative colitis and for maintaining remission. Of little value in Crohn's disease.
- Corticosteroids: Prednisolone or budesonide to settle a flare over 6 to 8 weeks. Not suitable for maintenance because of side effects.
- Immunomodulators: Azathioprine, mercaptopurine or methotrexate to keep remission, with regular blood monitoring.
- Biologics and small molecules: Anti-TNF drugs, vedolizumab, ustekinumab, IL-23 blockers and JAK inhibitors for moderate to severe disease. Given by infusion, injection or tablet on a continuing basis.
- Exclusive enteral nutrition: A liquid diet for 6 to 8 weeks, used mainly in children with Crohn's disease in place of steroids.
- Surgery: Colectomy, with or without an internal pouch, removes ulcerative colitis. In Crohn's disease, limited resection, stricture widening and fistula surgery treat complications but disease can recur.
- Cancer surveillance: Colonoscopy at intervals starting about 8 years after onset of colitis.
When it is urgent
Go to an emergency department locally if you pass bloody stools more than six times a day with fever or a fast pulse, have severe constant abdominal pain or a swollen tense abdomen, vomit repeatedly and cannot pass wind or stool, develop a hot painful swelling near the anus, or become dizzy and dehydrated. Do not board a flight during a severe flare.
Travelling to Türkiye for treatment
IBD needs a regular team for infusions, blood monitoring and quick help in flares, so ongoing care belongs near home. A visit can offer a full reassessment with colonoscopy and MRI, a second opinion on diagnosis or on the next drug, or a planned operation such as resection or perianal fistula surgery with 10 to 14 days in the city. Carry a medical summary, keep biologics in a cool bag in hand luggage, and check your vaccines if you take immune-suppressing drugs.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Is IBD the same as IBS?
No. Irritable bowel syndrome causes pain and altered bowel habit without inflammation or damage. IBD shows inflammation on stool tests, colonoscopy and biopsies.
Is there a diet that treats IBD?
No single diet has been proven to control inflammation in adults. A balanced diet, correcting deficiencies and, in narrowing of the bowel, a lower-fibre diet are standard advice. Liquid nutrition therapy works in children with Crohn's.
Will I need a stoma?
Most people do not. When one is needed it is often temporary. Surgery is kept for disease that does not respond to drugs or for complications.
Can I have children?
Yes. Fertility is near normal when disease is in remission. Most IBD medicines are continued in pregnancy, except methotrexate and some newer tablets, so plan with your specialist beforehand.