Inflammatory Bowel Disease Is on the Rise

September 19, 2025

A conceptual illustration of the gut microbiome

Digestive problems are something most people deal with at one point or another. But when severe abdominal pain, diarrhea and fatigue don’t go away, those symptoms may amount to more than a sensitive stomach. Inflammatory bowel disease (IBD) – which includes Crohn’s disease and ulcerative colitis – affects about three million Americans, and doctors are seeing more cases each year.

Carine Bou-Abboud Matta, MD, a gastroenterologist at University Hospitals, explains what sets Crohn’s and ulcerative colitis apart, why these conditions are on the rise and how people impacted can manage their symptoms.

IBD or IBS? Understanding the Difference

People often confuse IBD with IBS, or irritable bowel syndrome. While both affect the digestive system, they are very different. IBS has a spectrum of symptoms— including pain, bloating and altered bowel habits—but when doctors run tests, everything looks normal.

IBD, on the other hand, is an autoimmune disease. “Your immune system is attacking your gut,” says Dr. Matta. “That causes inflammation and damage that we can see on a colonoscopy.” Unlike IBS, IBD requires treatment with medication to control the inflammation and prevent long-term damage.

The two main types of IBD are Crohn’s disease and ulcerative colitis. The difference comes down to where inflammation appears. Crohn’s can affect any part of the digestive tract, from the mouth to the anus, and it doesn’t always spread continuously. Inflammation may appear in one area, skip a healthy stretch of intestine and then flare again somewhere else. Ulcerative colitis is limited to the colon, starting in the rectum and moving upward in the large intestine.

Both conditions can cause abdominal pain, diarrhea, fatigue and sometimes blood in the stool. Crohn’s may also lead to mouth sores or narrowing of the small intestine, while ulcerative colitis more often presents with rectal bleeding. Because symptoms overlap among IBS and IBD, Crohn’s and ulcerative colitis, if these symptoms appear it’s important to see a doctor who can use colonoscopy, biopsies and lab tests to tell the difference and to rule out other possibilities like infection.

What’s Driving More IBD Diagnoses?

Researchers and doctors have noticed a rise in IBD cases, particularly in Western industrialized countries. Genetics play a role, but the reason behind the rising cases likely involves a combination of factors.

“We think diet and environment are big contributors,” says Dr. Matta. Diets high in saturated fat and processed foods and low in fiber are likely driving some of the inflammation behind IBD. Antibiotic use, which can alter the ecosystem of microbes that live in your gut, is also linked to IBD. Together, these factors may be driving the increase in diagnoses worldwide.

Targeting IBD with the Right Treatment

For those diagnosed with Crohn’s or colitis, doctors now have more treatment options to choose from than ever before — including infusions, self-injected biologics and oral medications that target the immune system. Choosing the right one depends on factors such as how severe someone’s disease is, whether a patient has tried other medications before and personal preference. “Some people prefer an infusion every two months, while others like the convenience of a pill,” explains Dr. Matta.

In most cases, patients who take their medications regularly and keep inflammation under control can expect to live a normal lifespan and enjoy a good quality of life. True remission means a patient not only feels better but also has no signs of inflammation on a colonoscopy or biopsy. Because patients with IBD may be at higher risk of colon cancer, experts also recommend regular screening colonoscopies beginning eight years after an IBD diagnosis, whether or not symptoms are present.

Identifying Triggers and Preventing Flare-Ups

Once IBD is well managed with medication, the key is to try to prevent flare-ups, a return of inflammation and symptoms that can interrupt remission. Several things can trigger a flare, including high stress, stomach infections, and even common pain relievers such as ibuprofen or naproxen. “Another big one is missing doses of medication,” says Dr. Matta. That’s especially common in younger patients.

While there is no one “IBD diet,” Dr. Matta recommends a Mediterranean-style approach that emphasizes fruits, vegetables, lean proteins and healthy fats while limiting processed foods and excess sugar. Regular exercise and maintaining a healthy weight also help lower the risk of flare-ups. Because stress can worsen symptoms, behavioral health support, mindfulness or relaxation strategies can be just as important as diet and medication.

When to See a Doctor

With growing awareness of IBD, more people are bringing concerns about their gut health to a gastroenterologist. “That’s a good thing,” says Dr. Matta. “If you’re worried about symptoms or wondering if you might have Crohn’s or colitis, it’s better to get checked. If we catch it early and start treatment, patients usually do very well.”