🌀 Men's Health

Crohn's Disease & Inflammatory Bowel Disease

Understanding Crohn's disease and ulcerative colitis in Nigeria

Inflammatory bowel disease (IBD) — which includes Crohn's disease and ulcerative colitis — was once considered rare in Africa. However, its incidence is rising in urban Nigeria as lifestyles and diets change. IBD is a chronic autoimmune condition causing inflammation of the digestive tract. While it cannot be cured, it can be managed effectively with modern treatments available in Nigeria. Accurate diagnosis is critical to distinguish IBD from infectious colitis and tuberculosis of the bowel, which are far more common in Nigeria.

Signs and Symptoms

✓ Crohn's disease: abdominal pain, chronic diarrhoea, weight loss, fatigue; can affect anywhere from mouth to anus; skip lesions (patchy involvement)

✓ Ulcerative colitis: bloody diarrhoea (blood and mucus mixed with stool), urgent need to defecate, cramping, tenesmus (feeling of incomplete emptying)

✓ Both: anaemia, fever, mouth ulcers, joint pain, eye inflammation

✓ Complications: fistulae (Crohn's), strictures, toxic megacolon, bowel perforation (emergencies)

Risk Factors

Family history: 10–15× increased risk in first-degree relatives
Urbanisation and westernised diet (low fibre, high processed food)
Smoking: increases risk of Crohn's disease; paradoxically reduces UC risk
Antibiotic overuse altering gut microbiome
Previous gastrointestinal infections
Stress (worsens existing IBD but does not cause it)

When to Seek Help

EmergencySevere bloody diarrhoea (more than 6 bloody stools/day), high fever, severe abdominal pain, abdominal rigidity — risk of toxic megacolon or perforation

Urgent referralAny Nigerian with chronic diarrhoea >4 weeks, bloody stool, or weight loss should be referred to gastroenterology — TB of the bowel and amoebic colitis must be excluded before treating as IBD

Regular monitoringAll IBD patients need regular follow-up: colonoscopy every 1–3 years for cancer surveillance; blood tests to monitor inflammation and drug side effects

Tests & Diagnosis

🧪 Colonoscopy with biopsy

Essential for diagnosis — shows continuous inflammation (UC) or skip lesions with granulomata (Crohn's); biopsy distinguishes IBD from infectious colitis and bowel TB

🧪 Stool microscopy, culture and TB PCR

Must exclude Mycobacterium tuberculosis, Clostridium difficile, amoeba, and other infections before IBD treatment

🧪 CRP and ESR

Raised inflammatory markers during active disease; monitor treatment response

🧪 Faecal calprotectin

Protein released by inflamed intestinal cells — elevated in IBD; useful non-invasive marker; not yet widely available in Nigeria

🧪 Imaging (MRI enterography)

Best for assessing small bowel involvement in Crohn's disease — available at some Nigerian tertiary centres

Treatment Options

5-ASA (mesalazine/sulphasalazine)

First-line for mild-moderate ulcerative colitis — oral or rectal suppositories; used for maintenance of remission

Corticosteroids (prednisolone/budesonide)

For acute flares — induce remission; not for long-term maintenance due to side effects

Immunomodulators (azathioprine, 6-mercaptopurine)

Long-term maintenance therapy — prevent relapse; slow to act (3–6 months); require regular blood monitoring (FBC, LFTs)

Biologics (infliximab, adalimumab)

For moderate-severe IBD not responding to standard therapy; highly effective; available at some Nigerian teaching hospitals; very expensive without insurance

Surgery

Colectomy (removal of colon) for severe UC not responding to medical treatment; in Crohn's, surgery is for complications (stricture, fistula, abscess) — not curative

Diet and lifestyle

High-fibre diet during remission; low-residue during flares; food diary to identify personal triggers; probiotics may help some patients; avoid NSAIDs

Frequently Asked Questions

Is IBD the same as IBS?

No — IBS (irritable bowel syndrome) is a functional disorder without inflammation; IBD is an organic disease with actual intestinal inflammation, tissue damage, and potential for serious complications. They require completely different investigations and treatments.

Can IBD be confused with intestinal TB in Nigeria?

Yes — bowel TB can look almost identical to Crohn's disease on colonoscopy. TB is far more common in Nigeria and must be excluded with TB tests and biopsy before starting immunosuppressant IBD treatment.

Is IBD curable?

IBD is not curable — it is a lifelong condition, but it is manageable. Most people achieve long periods of remission with appropriate treatment and live full lives.

Are biologics (infliximab) available in Nigeria?

Yes — at federal teaching hospitals and some major private hospitals. The cost is high but NHIS or pharmaceutical patient support programmes may assist.

Does diet cause IBD?

No specific diet causes IBD, but diet affects symptoms. High-fibre diets help maintain gut health generally. During flares, liquid or low-residue diets reduce bowel irritation. Food triggers vary between individuals.