In short
- Two very different conditions with similar names
- Red flags that point to IBD
- How the diagnosis is made
- Why the distinction changes everything
- The bottom line
Two very different conditions with similar names
IBS — irritable bowel syndrome — is a disorder of how the gut functions: nerves are oversensitive and movement is irregular, but the lining is normal. IBD — inflammatory bowel disease, meaning ulcerative colitis and Crohn's — is immune-driven inflammation that visibly damages the lining and can cause bleeding, strictures and, over decades, cancer.
Red flags that point to IBD
Blood in stool, diarrhoea that wakes you at night, fever, weight loss, anaemia, mouth ulcers, joint pains, and symptoms starting before 40 with a family history. IBS never causes bleeding, fever or weight loss.
How the diagnosis is made
Blood tests (CRP, haemoglobin), stool calprotectin, celiac serology — and colonoscopy with biopsies when any marker is abnormal. In India, intestinal tuberculosis must also be excluded before treating Crohn's.
Why the distinction changes everything
IBS is treated with diet, antispasmodics, neuromodulators and gut-brain approaches. IBD needs anti-inflammatory and immune therapy, sometimes biologics, and lifelong follow-up. Treating one as the other is the commonest error Dr Paliwal sees in referred patients.
The bottom line
Long-standing bowel symptoms deserve a proper diagnosis once — not years of trial and error. A gastroenterologist with a colonoscopy and a calprotectin test settles the question quickly.
Dr Maneesh Paliwal
MBBS, MD, DM Gastroenterology & Hepatology (SGPGI), SCE (UK). Senior Consultant, PSRI Hospital; founder, Gut Liver Obesity Clinic, Chittaranjan Park. 22+ years; founded Delhi's first luminal GI lab.