Inflammatory bowel disease: more than just a stomach ache

Some symptoms are frequently overlooked or downplayed. Repeated diarrhoea, recurring abdominal pain, severe fatigue or unexplained weight loss are often attributed to stress, nerves or simply to a difficult time. However, if these symptoms persist or keep returning, they may be a sign of inflammatory bowel disease.

This is the topic of the Hablemos de Salud episode dedicated to this condition. In this video podcast, Dr Ingrid Ordás, a gastroenterologist at the Hospital Clínic Barcelona, speaks with patient Tanit Tubau, helping to shed light on a chronic disease that is often under-recognised.

A little-known condition

Inflammatory bowel disease (IBD) mainly includes two conditions: ulcerative colitis and Crohn’s disease. Both cause chronic inflammation of the digestive tract, but they affect different areas and have different symptoms:

• Ulcerative colitis: affects only the colon and always begins in the rectum, from where it spreads continuously. This often results in an urgent need to go to the toilet with blood visible in the stool—symptoms that usually prompt an earlier medical consultation.
• Crohn’s disease: this, on the other hand, can affect any part of the digestive tract, from the mouth to the anus, although it most commonly involves the end of the small intestine and the colon. It tends to appear in patches, with inflamed areas alternating with healthy sections, which can make diagnosis more difficult.

The cause is not “just stress”

While it is true that stress or anxiety can make digestive symptoms worse, they have not been shown to be the cause of the disease.

As Dr Ordás explains, the origin is complex and involves many factors. There may be genetic predisposition, but this does not mean the disease is directly inherited; environmental factors also play a role; along with changes in the gut microbiota. When these factors come together, they can trigger a sustained inflammatory response that gradually damages the intestine.

When should you see a healthcare professional?

You should consult a healthcare professional if symptoms continue and start to affect your daily life. The main warning signs are persistent diarrhoea, recurring abdominal pain, blood in the stool, unintentional weight loss and severe fatigue. You need not see a specialist straight away, but you should discuss these symptoms with your family doctor, who can begin an assessment, even if the cause is not immediately apparent.

In the episode, Tanit explains that she was diagnosed with Crohn’s disease at the age of 9 after experiencing significant weight loss, abdominal pain, diarrhoea and vomiting, as well as an increasing link between eating and pain. The diagnosis was made following a hospital admission and a colonoscopy.

Dr Ordás also reminds us that, although IBD is often diagnosed between the ages of 20 and 40, it can also occur in children and older adults.

Diet, gluten and other myths

The episode also addresses some common myths. One of the most widespread is the belief that Crohn’s disease or ulcerative colitis can be cured with a gluten-free diet. The answer is clear: no—unless the person also has coeliac disease.

What is recommended is a balanced diet, with less ultra-processed food and moderate sugar intake. Diet can help improve overall wellbeing, but it does not replace medical treatment.

There is, however, one well-established risk factor: smoking, particularly in Crohn’s disease. Smoking makes the disease worse, increases the need for immunosuppressive treatment and increases the risk of surgery.

A condition that also affects social and emotional life

IBD can also cause problems outside the gut (extraintestinal symptoms), such as joint, eye or skin conditions, as well as having a significant emotional and social impact.

As Tanit explains, living with a chronic condition from childhood can affect many areas of life, including education, friendships, relationships, work and how a person relates to their own body. It also brings up less visible challenges, such as the fear of not having a toilet nearby, worry about sudden symptom onset or the need to explain an ostomy or the use of an accessible bathroom.

Increasingly personalised treatments

IBD is a chronic condition that currently has no definitive cure, but there are effective treatments to keep it under control. Dr Ordás sums it up well when saying that treatment needs to be “tailored” to each patient.

Depending on the individual case, treatment may include mesalazine, corticosteroids, immunosuppressants or biologic therapies. The latter represent a major breakthrough and have significantly improved disease control and quality of life for many people.

Surgery may be necessary in some cases, but not for everyone, as the course of the disease can vary greatly from one person to another.

Living with a chronic condition does not mean you are always ill

With the right diagnosis, follow-up, treatment and support, many people can study, work, travel, have relationships and maintain a good quality of life. The story shared by Tanit Tubau—honest, sometimes difficult, but also full of humour and resilience—helps to show the complexity of the condition. That’s why this episode of Hablemos de Salud is well worth watching. It combines the medical expertise of Dr Ordás with Tanit’s first-hand experience; while challenging common myths and giving visibility to a condition that is often under-recognised and poorly understood.

Information documented by:

Dr Ingrid Ordás, Inflammatory Bowel Disease Unit, Gastroenterology Department, Hospital Clínic Barcelona.