IBD Clinic: Crohn's Disease & Ulcerative Colitis

Inflammatory bowel disease covers two related but distinct chronic conditions — Crohn's disease and ulcerative colitis — both causing ongoing inflammation of the digestive tract, though in different patterns and locations. IBD in India is going through what researchers have called an epidemiological transition: incidence is rising quickly, in a population where the disease was historically considered far less common than in the West. At KAGE's IBD Clinic, that context shapes how care is delivered — diagnosis that properly rules out mimicking conditions common in this region, and a treatment and surveillance approach informed by Indian-specific data, not simply imported Western protocols.

IBD incidence in India has been rising steadily for decades, and current data suggests India's rate of increase now exceeds that of other Southeast Asian countries — a genuine shift after IBD was historically considered uncommon in the region. One notable difference from Western patient populations: very few Indian IBD patients report a family history of the condition, and the specific genetic variants strongly implicated in Western IBD research haven't been shown to be equally causal in Indian patients. This points toward environmental and lifestyle factors playing a larger relative role in driving IBD in India, an area still being actively researched.

• Chronic or recurrent diarrhea, often with urgency
• Abdominal pain and cramping
• Rectal bleeding, more typical of ulcerative colitis
• Unintended weight loss
• Fatigue
• Fever during flares
• Symptoms outside the digestive tract — joint pain, skin changes, or eye inflammation — occur in a meaningful subset of patients

As covered in detail on the Diarrhoea page, Crohn's disease in particular can closely resemble intestinal tuberculosis both clinically and on endoscopy — a distinction that matters enormously in India given how common TB remains here. A substantial proportion of Indian patients with suspected Crohn's disease receive a trial of anti-tuberculosis treatment as part of a thorough diagnostic workup before an IBD diagnosis is confirmed. See the Diarrhoea page for the full clinical picture on telling the two apart.

• Blood and stool tests, including inflammatory markers such as fecal calprotectin — though Indian data has noted these biomarkers have real limitations in sensitivity and specificity here, meaning they support but don't replace direct evaluation
• Colonoscopy and, where relevant, upper GI endoscopy with biopsy — the definitive diagnostic step
• Imaging (CT or MRI enterography) — particularly useful for assessing Crohn's disease involving the small intestine
• TB-specific testing, given the diagnostic overlap discussed above

• Aminosalicylates (5-ASA medications) — first-line for milder ulcerative colitis
• Corticosteroids — used for inducing remission during flares, generally not for long-term maintenance
• Immunomodulators — for maintaining remission in moderate to more persistent disease
• Biologic therapy — for moderate to severe disease, or when other treatments haven't achieved adequate control
• Surgery — reserved for complications (strictures, fistulas, or bleeding not controlled medically) or disease not responding to medical therapy; a meaningful proportion of patients with long-standing disease eventually need it

Long-standing ulcerative colitis carries an increased colorectal cancer risk compared to the general population — this is well established internationally, and drives standard surveillance colonoscopy recommendations. What's genuinely useful to know is that a South Indian tertiary hospital study, following patients over 25 years, found the actual risk in Indian UC patients to be lower than commonly cited Western figures: around 2.3% at 10–20 years of disease duration (rising to 4.4% for extensive colitis specifically), and 5.8% beyond 20 years (10.2% for extensive colitis). Disease duration beyond 10 years and the extent of colitis were the strongest risk factors identified. The study's own conclusion was direct: surveillance strategies developed from Western data may need to be tailored specifically for Indian patients rather than applied unchanged — which is exactly the kind of nuance a generic, Western-sourced patient information page would miss.

IBD is a chronic condition managed over the long term, with the goal of sustained remission rather than a one-time cure. Regular follow-up, even during quiet periods, matters — for monitoring disease activity, medication effects, and, for long-standing ulcerative colitis, surveillance colonoscopy on a schedule matched to your specific duration and extent of disease rather than a generic interval.

The most consequential decision in Indian IBD practice is intestinal TB vs. Crohn's disease, because the two look alike endoscopically and their treatments are opposites. The clinic, led by Dr. Venkatesh Pabbisetti, settles that question before any immunosuppression is started. Our gastroenterologists then track disease activity objectively, with calprotectin and interval endoscopy, rather than by how the patient feels on the day. To be assessed, book a consultation.