Inflammatory Bowel Disease: Crohn's Disease and Ulcerative Colitis

What IBD is

Inflammatory bowel disease (IBD) is a group of chronic conditions in which abnormal immune reactions cause inflammation in the digestive tract. The two most common types are Crohn's disease and ulcerative colitis; microscopic colitis is another. [1]

• Crohn's disease can affect any part of the digestive tract, from mouth to anus, most commonly the small intestine and start of the large intestine. [1]
• Ulcerative colitis causes inflammation and ulcers on the inner lining of the large intestine. [2]

Symptoms come and go: periods with symptoms are called flares, and periods without are remission, which can last weeks or years. The goal of treatment is to keep people in remission long term. [1] About 1 million people in the US have Crohn's disease, and about 600,000 to 900,000 have ulcerative colitis. [1][2]

IBD, IBS and other look-alikes

IBD is a different condition from irritable bowel syndrome (IBS). In IBS there is no visible damage to the digestive tract, while IBD involves inflammation. [3][1] Doctors may use stool and blood tests, colonoscopy or other tests to rule out conditions such as IBD in people with IBS-type symptoms. [4] The American College of Gastroenterology suggests a fecal calprotectin test in people with suspected IBS and diarrhea to rule out IBD. [5] See irritable bowel syndrome, celiac disease and lactose intolerance, which can have overlapping symptoms.

Symptoms and complications (overview)

• Crohn's disease: the most common symptoms are diarrhea, cramping and belly pain, and weight loss. Others include anemia, tiredness, fever, joint pain, nausea, and eye or skin changes. [6]
• Ulcerative colitis: common symptoms include diarrhea, blood in the stool or rectal bleeding, cramping and pain, mucus or pus in the stool, and an urgent need to go. [7]
• Complications over time can include anemia, bone problems such as low bone mass, and problems with growth in children. [1][2] See osteoporosis and bone health.
• Long-standing ulcerative colitis affecting a third or more of the colon raises colorectal cancer risk and needs closer screening. [2]

This list is not a way to diagnose yourself. Symptoms overlap with many other conditions, and diagnosis takes a clinician.

Established care

Treatment aims to lower inflammation, prevent flares and maintain remission. [8] Medicines do not cure Crohn's disease but can reduce inflammation and bring on and maintain remission. [8] Medicines used include corticosteroids (short-term only), immunosuppressants, biologics and small-molecule medicines. [8] Many people also need surgery: between 30% and 55% of people with Crohn's disease need surgery within 10 years of diagnosis. [8] People with ulcerative colitis typically need lifelong medicine unless the colon and rectum are removed. [9] Doctors typically do not prescribe corticosteroids for long-term use because of serious side effects. [9]

Never stop or change a prescribed IBD medicine because of something you read online. Talk to your care team first.

Where complementary approaches fit

This is a limited and cautious role. Evidence labels: established recommendation = guideline or agency recommends; mixed = studies disagree; insufficient evidence = not enough human research.

Because some supplements and herbs can interact with IBD medicines, read how interactions work and existing conditions, and tell your care team what you take. See also probiotics and prebiotics for gut health.

When to get help

Seek medical care for ongoing diarrhea with abdominal pain or weight loss, blood in the stool, black and tarry stools, or fever. [6][7][13] Severe flares of ulcerative colitis, such as more than 10 bloody bowel movements a day often with fever and rapid heart rate, are medical emergencies treated in hospital. [2][9] If you have IBD and develop severe pain, heavy bleeding, or signs of dehydration, call your care team or, in the US, call 911 if it is an emergency. See digestive symptoms: red flags.