Severe abdominal pain with a distended abdomen and fever, or heavy bleeding, needs emergency care now. Toxic megacolon and bowel perforation are emergencies. Also seek urgent care for more than six bloody stools a day with fever.
Chronic inflammation of the digestive tract driven by the immune system. It runs a relapsing course over decades, and modern treatment aims to heal the bowel lining rather than merely settle symptoms.
One point matters more for our patients than any other on this page: intestinal tuberculosis looks almost identical to Crohn's disease, and treating one as the other causes serious harm.
Two main conditions sit under this heading. Ulcerative colitis affects the large bowel only, in a continuous pattern extending back from the rectum, and involves the surface lining. Crohn's disease can affect any part of the digestive tract from mouth to anus, in patches with normal bowel between, and inflammation extends through the full thickness of the wall — which is why it causes strictures, fistulas and abscesses.
Both run a relapsing and remitting course over decades. The aim of modern treatment has shifted from simply relieving symptoms to healing the bowel lining, because mucosal healing predicts fewer complications, fewer hospital admissions and less surgery over the long term.
For patients from South Asia, the Middle East and Africa there is a critical diagnostic problem. Intestinal tuberculosis affects the same part of the bowel as Crohn's disease, produces very similar appearances at colonoscopy, and can look identical on imaging and even on biopsy. Distinguishing them is genuinely difficult and it is one of the recognised diagnostic challenges in gastroenterology.
The consequences of getting it wrong are severe. Immunosuppressive drugs and steroids given for presumed Crohn's disease in a patient who actually has tuberculosis allow the infection to disseminate, sometimes catastrophically. Indian gastroenterologists deal with this distinction routinely, which is a genuine reason to seek an opinion here.
This is the most important thing on the page for patients from our markets. Intestinal tuberculosis affects the same region of the bowel as Crohn's disease and produces almost identical findings at colonoscopy, on imaging and sometimes on biopsy. If a patient with tuberculosis is given steroids or immunosuppressive drugs for presumed Crohn's disease, the infection can disseminate with serious and occasionally fatal consequences. Before starting immunosuppression, testing should include tuberculin or interferon-gamma testing, chest imaging, and biopsies sent for tuberculosis culture and molecular testing as well as histology. Where doubt remains, a trial of anti-tuberculous therapy with reassessment is a recognised and sensible approach. Ask specifically whether tuberculosis has been excluded.
Colonoscopy with biopsies, plus deliberate exclusion of tuberculosis.
Send the colonoscopy report and, importantly, the histology report in full — the pathologist's description often contains the features that separate tuberculosis from Crohn's disease. Include any tuberculosis testing, chest imaging, and whether biopsies were sent for TB culture and PCR rather than histology alone. If you are from a region where tuberculosis is endemic and immunosuppressive treatment has been proposed without that testing, tell us.
Treatment is stepped, and the modern aim is healing the lining rather than masking symptoms.
Mesalazine controls mild to moderate ulcerative colitis well and is used long term to maintain remission. Steroids settle acute flares effectively but are not a maintenance treatment — repeated or prolonged courses cause serious side effects and indicate that better maintenance therapy is needed.
Azathioprine, mercaptopurine or methotrexate maintain remission and reduce dependence on steroids. They take weeks to months to work and require regular blood monitoring for effects on the liver and blood counts. Tuberculosis must be excluded before starting.
Anti-TNF drugs, anti-integrin and anti-interleukin agents, and small molecule inhibitors have transformed outcomes in moderate to severe disease, achieving mucosal healing in a substantial proportion. Biosimilars in India cost a fraction of Western prices, which makes these accessible to patients who could not otherwise afford them.
In ulcerative colitis, removing the colon cures the intestinal disease and is a genuine option in severe or refractory cases. In Crohn's disease surgery treats complications — strictures, fistulas, abscesses — but does not cure, and disease recurs, so bowel is conserved carefully.
Exclude it before immunosuppression. This is the single most important question for patients from endemic regions.
They differ in distribution, depth and complications, and the treatments and surgical options differ accordingly.
This determines whether conventional drugs suffice or biologic therapy is needed, and biosimilars here make that affordable.
Biologic biosimilars in India cost a fraction of Western prices, and for a patient with moderate to severe disease that is frequently the single most valuable thing we can arrange.
Severe colitis and toxic megacolon are emergencies requiring hospital admission. Both are treated where you are, immediately.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
This is the right question to ask, and it is genuinely difficult to answer. Tuberculosis affects the same part of the bowel and produces very similar findings. Proper exclusion needs tuberculin or interferon-gamma testing, chest imaging, and biopsies sent for tuberculosis culture and molecular testing, not just histology. Where doubt remains, a trial of anti-tuberculous therapy with reassessment is a recognised approach.
Because the treatments are opposite. Immunosuppressive drugs and steroids given for presumed Crohn's disease in someone who actually has tuberculosis allow the infection to spread, sometimes with severe or fatal consequences. Getting the diagnosis right before immunosuppression is one of the most consequential decisions in this area.
Yes, and this is one of the strongest reasons to consider treatment here. Biosimilar versions of anti-TNF and other biologic agents are available at a fraction of Western prices, making treatment accessible to patients who could not otherwise afford it. Screening for tuberculosis and hepatitis B is required before starting.
It depends on the condition. In ulcerative colitis, removing the colon cures the intestinal disease and is a genuine option for severe or refractory cases. In Crohn's disease surgery treats complications rather than curing, and disease tends to recur, so surgeons conserve bowel carefully and repeated resections are avoided where possible.
Largely, yes, and that is usually the sensible arrangement. Once the diagnosis is secure and treatment is established, medication and monitoring blood tests can be managed near your home. We write out the regimen and monitoring schedule clearly enough for your local doctor to follow, and stay available to them.
Diet does not cause inflammatory bowel disease and no diet cures it, despite a great deal of material claiming otherwise. Specific dietary approaches help some patients with symptoms, and exclusive enteral nutrition has a genuine role in children with Crohn's disease. Nutritional support matters, but diet is not a substitute for treatment.
Send the colonoscopy and full histology reports, and tell us whether tuberculosis has been formally excluded. That question matters more than any other for patients from our markets.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
WhatsApp +91 83035 86344 · Phone +91 83035 86344 · Email tibhind@gmail.com
Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.