Once considered rare in India, inflammatory bowel disease is rising steadily among younger people, with doctors pointing to delayed diagnosis, stress, urban lifestyles and changing food habits as possible triggers.
For years, stomach pain, bloating, diarrhoea and fatigue were dismissed as routine digestive troubles in many Indian households. But for a growing number of young Indians, these recurring symptoms are turning out to be something far more serious, like inflammatory bowel disease (IBD), a chronic condition that attacks the digestive tract and can significantly impact quality of life.
On World Inflammatory Bowel Disease Day, observed every year on May 19, doctors and patient advocates are highlighting the increasing burden of IBD in India, especially among urban populations and younger adults. While the condition was once considered more prevalent in Western countries, gastroenterologists say India is now witnessing a steady rise in cases, fuelled by a mix of genetic susceptibility, changing lifestyles, environmental factors and growing awareness.
What is IBD?
IBD is an umbrella term mainly used for two chronic disorders, Crohn’s disease and ulcerative colitis. Both involve inflammation of the gastrointestinal tract, but they affect the body differently. Ulcerative colitis impacts the large intestine and rectum, while Crohn’s disease can affect any part of the digestive tract, from the mouth to the anus.
Unlike temporary stomach infections, IBD is lifelong and often unpredictable. Patients may go through periods of remission followed by severe flare-ups that can interfere with work, education, relationships and mental health.
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Dr Harshad Khairnar, consultant, gastroenterology, Fortis Hiranandani Hospital, Navi Mumbai, says lifestyle changes such as poor sleep, stress, pollution, high intake of processed foods and increased use of antibiotics are all believed to have a negative impact on gut health and contribute to an imbalance in overall immune system function.
"An alarming statistic is that many young adults will develop the first symptoms of IBD between the ages of 13-29. Developing the first IBD symptoms in such a crucial time in one's life can negatively impact one's ability to lead an overall high quality of life. However, if diagnosed early enough and given the proper treatment, most patients with IBD can achieve good management of the disease and live healthy, productive lives," he said.
One of the biggest challenges with IBD, doctors say, is delayed diagnosis. Since symptoms overlap with common gastrointestinal conditions like irritable bowel syndrome, acidity or food poisoning, many patients spend years seeking treatment before receiving the correct diagnosis.
Common symptoms include persistent diarrhoea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite and frequent urgency to use the toilet. In children and adolescents, it can also lead to delayed growth and nutritional deficiencies.
For many patients, the disease extends beyond the gut. IBD has also been associated with joint pain, skin conditions, eye inflammation and liver complications.
Experts say stigma around bowel-related symptoms also prevents people from seeking timely medical attention. Conversations around digestion and bowel movements remain uncomfortable in many families, leading people to normalise symptoms or self-medicate for long period of time.
India does not yet have a comprehensive nationwide registry for IBD, but several hospital-based studies suggest that cases have increased significantly over the past two decades.
Doctors point to rapid urbanisation, processed food consumption, sedentary lifestyles, antibiotic overuse, pollution and stress as possible contributors. Researchers are also studying the role of the gut microbiome, the ecosystem of bacteria living inside the intestines and how modern lifestyles may be disrupting it.
The exact cause of IBD remains unknown. However, experts believe it is linked to an abnormal immune response in genetically susceptible individuals.
Many doctors note that patients are now being diagnosed at a younger age, often in their teens, twenties and thirties. Since IBD is chronic, managing the condition can become emotionally and financially exhausting.
Unlike common digestive disorders, IBD does not have a permanent cure. Treatment focuses on controlling inflammation, preventing flare-ups and improving quality of life.
Depending on the severity, treatment may involve anti-inflammatory drugs, steroids, immunosuppressants, biologics and dietary modifications. Some patients also require surgery.
But beyond medication, patients often have to redesign their daily lives around the disease.
Many struggle with fatigue, anxiety around public spaces, dietary restrictions and the unpredictability of symptoms. Flare-ups can disrupt careers, social lives and travel plans. Young patients especially speak about the emotional toll of constantly planning life around access to toilets or fear of sudden symptoms.
Mental health experts say chronic illnesses like IBD are closely linked to anxiety and depression, particularly because symptoms can be invisible to others.
“As psychiatrists, we recognise the ‘gut-brain axis’ where stress, anxiety, depression and trauma can both result from and sometimes worsen gastrointestinal illnesses through complex neurobiological pathways," Dr Ruksheda Syeda tells THE WEEK. Chronic gut diseases, she says, burden the mind, relationships, education, work life and self-esteem, impacting daily decisions and functioning.
"Holistic care must therefore integrate gastroenterology with psychiatric care and mental health support, rather than treating them as separate worlds.”
While awareness around IBD has improved in metropolitan cities, access to specialised treatment remains uneven.
Advanced therapies such as biologics, which can significantly improve outcomes for moderate to severe IBD, are often expensive and inaccessible for many patients without insurance coverage.
Doctors also warn against unverified dietary advice circulating online. Social media is flooded with claims around miracle cures, elimination diets and supplements, many of which lack scientific evidence.
Globally, World IBD Day is marked to increase awareness about inflammatory bowel disease and reduce stigma surrounding invisible illnesses.
In India, awareness remains limited outside major cities. Many people continue to associate chronic digestive symptoms with food poisoning, stress or temporary infections.
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Doctors stress that early diagnosis is critical because untreated inflammation can lead to complications such as intestinal damage, strictures, fistulas and increased risk of colorectal cancer.
They also emphasise that people should not ignore symptoms like blood in stool, unexplained weight loss or persistent diarrhoea lasting several weeks.
As conversations around gut health become more mainstream, doctors hope greater awareness will encourage patients to seek medical help earlier rather than suffer silently. For many living with IBD, recognition itself can be life-changing because behind what may seem like an ordinary stomach problem is often a chronic condition that reshapes everyday life.