Crohn’s Disease in Dhaka: Symptoms, Treatment & Surgery in Bangladesh

✍️  Written by: Md. Salauddin Biswas

MA in Medical Anthropology, University of Heidelberg, Germany | Former Senior Research Associate, James P Grant School of Public Health, BRAC University | Health Content Writer & SEO Specialist | Published: BMC Human Resources for Health | EEAT-Optimized Medical Content

🩺  Medically reviewed and approved by: Dr. Muhammad Nazrul Islam

FCPS (Surgery)  ·  MS (Colorectal Surgery)  ·  FACS (Fellow, American College of Surgeons) Assistant Professor (Colorectal Surgery), Shaheed Suhrawardy Medical College & Hospital, Dhaka.

📅 Last reviewed: March 2026

✅ Quick Summary / সংক্ষেপে

• Crohn’s disease = পেটের প্রদাহ — a chronic autoimmune inflammatory disease of the gut; NOT an infection
• Can affect any part of the gut — mouth to anus — but most commonly the terminal ileum (small bowel) and colon
• Unlike ulcerative colitis, Crohn’s causes full-thickness inflammation and skip lesions (patchy, non-continuous disease)
• Crohn’s disease is NOT caused by eating spicy food, stress or poor hygiene — it is an autoimmune condition
• In Bangladesh: most commonly misdiagnosed as abdominal tuberculosis — a potentially fatal error if immunosuppressants are given to a TB patient
• Surgery in Crohn’s is NOT curative — unlike ulcerative colitis, disease recurs after bowel resection
• IBD Bangladesh: both Crohn’s disease and ulcerative colitis are managed by Dr. Nazrul Islam in Dhaka — call +88019 7684 2234

Feature	Crohn’s Disease / পেটের প্রদাহ	Ulcerative Colitis / রক্ত আমাশয় →
Location	Any part of gut — mouth to anus. Most common: terminal ileum + colon. Skip lesions (patchy).	Colon and rectum ONLY. Always starts at rectum. Continuous inflammation — no skip lesions.
Depth of inflammation	Full-thickness (transmural) — through entire bowel wall. Causes fistulas, strictures, abscesses.	Mucosal only — inner lining only. Does not cause fistulas or strictures typically.
Rectal involvement	Rectum often spared — distinguishing feature on colonoscopy	Rectum ALWAYS involved — essential for diagnosis
Fistula	Very common — perianal fistula in 30% of Crohn’s patients. Enterocutaneous, enteroenteric fistulas.	Rare
Strictures	Common — bowel narrowing causing obstruction	Rare
Granulomas on biopsy	Present in ~50% — pathognomonic when found	Absent — crypt distortion instead
Mesalazine response	Poor — mesalazine less effective in Crohn’s than UC	Good — mesalazine is cornerstone of UC treatment
Surgery outcome	NOT curative — disease recurs at anastomosis after resection. Surgery for complications only.	Curative — colectomy removes all diseased bowel permanently
Cancer risk	Slightly increased for colonic Crohn’s — less than UC	Significantly increased in extensive UC — surveillance essential. See colon cancer →
Smoking	Worsens Crohn’s disease	Paradoxically protects against UC — not a reason to smoke

Location / স্থান	Frequency & Features
Terminal ileum + right colon (Ileocolonic)	Most common — 40–50% of patients. Right lower abdominal pain mimicking appendicitis. Classic ‘string sign’ on barium studies.
Small bowel only (Ileal)	30% of patients. Abdominal pain, diarrhoea, malabsorption, weight loss. Risk of stricture and obstruction.
Colon only (Colonic Crohn’s)	~20%. Bloody diarrhoea similar to UC — hardest to distinguish clinically. Rectal sparing on colonoscopy is the key diagnostic clue. See rectal bleeding →
Perianal disease পায়ুপথের ভগন্দর	30% — fistula-in-ano, perianal abscess, skin tags, deep fissures. Often the first presentation in Bangladesh.
Upper GI (stomach, duodenum)	<5%. Nausea, vomiting, epigastric pain. Often missed because endoscopy focuses on colon.
Mouth (aphthous ulcers)	10–20% — oral ulcers as extraintestinal manifestation. Patients often treated by dentists without bowel assessment.

বাংলাদেশ প্রসঙ্গ: In Bangladesh, perianal Crohn’s disease is frequently the first — and sometimes only — presentation that brings a patient to a colorectal surgeon. A patient with a recurrent complex perianal fistula that has failed multiple operations should always be assessed for underlying Crohn’s disease. Simple fistulotomy fails repeatedly in Crohn’s fistula if the underlying bowel disease is not treated.

Symptom / লক্ষণ	Details
পেটে ব্যথা Abdominal pain	Most common symptom — typically right lower quadrant (terminal ileum involvement), crampy, worse after eating. Can mimic appendicitis.
ডায়রিয়া Diarrhoea	Chronic loose stools — may or may not contain blood depending on location. Blood more common in colonic Crohn’s.
ওজন কমা Weight loss	Significant — due to malabsorption, reduced appetite, nutritional deficiency. A defining feature of small bowel Crohn’s. Vitamin B12, iron and folate deficiency are common.
জ্বর Fever	Low-grade fever during flares; high fever if abscess or perforation — surgical emergency requiring urgent assessment.
ক্লান্তি Fatigue	Profound tiredness — from anaemia, malnutrition, chronic inflammation and poor sleep.
পায়ুপথে সমস্যা Perianal disease	Perianal fistula, abscess, skin tags, deep fissures — often the first presentation in Bangladesh. Repeated failed fistula surgery is a red flag for undiagnosed Crohn’s.
অন্ত্রের বাইরে লক্ষণ Extraintestinal manifestations	Arthritis (most common), eye inflammation (uveitis), skin lesions (erythema nodosum), liver disease (PSC) — same spectrum as UC but more common in Crohn’s.
অন্ত্রের বাধা Bowel obstruction	Chronic inflammation → strictures → obstruction. Colicky pain, distension, vomiting, constipation — surgical emergency if complete. See constipation page →

⚠️ Critical Safety Warning for Bangladesh

• Giving immunosuppressants (steroids, azathioprine, biologics) to a patient with UNDIAGNOSED active TB can cause disseminated TB, meningitis and death
• Treating Crohn’s disease as TB means years of unnecessary anti-TB drugs, progressive bowel damage, malnutrition and delayed effective treatment
• Both conditions affect the terminal ileum and ileocaecal region most commonly — identical location
• Both show granulomas on biopsy in many cases — Crohn’s granulomas are non-caseating; TB granulomas are caseating in only ~50%
• TB MUST be excluded before starting immunosuppression for suspected Crohn’s — this is non-negotiable

Feature	Crohn’s Disease পেটের প্রদাহ	Abdominal Tuberculosis পেটের যক্ষ্মা	How to Differentiate
Most affected site	Terminal ileum, ileocaecal region, colon — skip lesions	Ileocaecal region (90%) — usually single site	Skip lesions in multiple sites favour Crohn’s
Perianal disease	Very common (30%) — complex fistulas	Rare	Perianal fistula strongly favours Crohn’s
Chest X-ray / sputum	Usually normal	Active pulmonary TB in ~30%; old TB changes in many	CXR + sputum AFB essential — positive = TB
Mantoux / TST / IGRA	May be weakly positive (background exposure)	Strongly positive in most cases	Strong positivity + symptoms favours TB; IGRA more specific
Colonoscopy appearance	Longitudinal ulcers, cobblestone mucosa, skip lesions, rectal sparing	Transverse ulcers, ileocaecal valve deformity, caecal scarring, ‘gaping’ valve	Longitudinal ulcers + skip = Crohn’s; transverse ulcers + caecal scarring = TB
Biopsy — granulomas	Non-caseating granulomas (~50%)	Caseating granulomas (50–60%) — pathognomonic if found; AFB stain +ve rarely	Caseating granuloma = TB; non-caseating + no AFB = likely Crohn’s
CT / MRI enterography	‘Comb sign’ — increased mesenteric vascularity; mural stratification; skip lesions	Lymph node calcification; peritoneal thickening; ascites; necrotic lymph nodes	Calcified lymph nodes = TB; comb sign + skip lesions = Crohn’s
Response to anti-TB trial	No improvement after 2–3 months of ATT	Significant improvement within 6–8 weeks	If no response to ATT after 2–3 months → reconsider Crohn’s
Treatment	Mesalazine, steroids, azathioprine, biologics — ONLY after TB excluded	ATT: rifampicin + isoniazid + pyrazinamide + ethambutol for 6–9 months	NEVER start biologics / immunosuppressants without TB exclusion

Diagnostic Approach in Bangladesh: (1) Full TB workup FIRST — chest X-ray, Mantoux/IGRA, sputum AFB × 3; (2) Colonoscopy with multiple biopsies — H&E, AFB stain, TB PCR and culture; (3) CT enterography if available; (4) If TB strongly suspected — trial of anti-TB treatment (ATT) for 2–3 months and reassess; (5) If no response to ATT AND clinical/endoscopic features favour Crohn’s — multidisciplinary decision to start Crohn’s therapy, ideally with gastroenterology input.

The practical reality: Many patients in Bangladesh have had BOTH conditions at different times — past TB followed by new-onset Crohn’s, or active TB superimposed on Crohn’s. This is a genuinely complex clinical situation requiring experienced specialist assessment. Dr. Nazrul works alongside gastroenterology colleagues for these patients.

Investigation	Role in Crohn’s Diagnosis
TB exclusion (FIRST) Chest X-ray, Mantoux/IGRA, sputum AFB	Must come first in Bangladesh before any immunosuppressive therapy is considered. See TB section above.
Colonoscopy with ileoscopy + biopsy ⭐ কোলোনোস্কপি	Essential — shows skip lesions, cobblestone mucosa, longitudinal ulcers, rectal sparing, ileocaecal disease. Biopsies for H&E, AFB, TB PCR. Multiple biopsies from affected and apparently normal areas.
CT or MRI enterography CT/MRI এন্টেরোগ্রাফি ⭐	Best investigation for small bowel Crohn’s — shows extent of disease, strictures, fistulas, abscesses, mesenteric changes. MRI preferred (no radiation) for young patients and follow-up. Available in Dhaka.
Blood tests CBC, CRP, ESR, albumin, B12, iron, folate	Assess anaemia (type — iron vs B12 vs folate deficiency indicates site of malabsorption), inflammatory markers, nutritional status. All typically deranged in active Crohn’s.
Stool calprotectin	Elevated in active IBD — useful to distinguish IBD from IBS and to monitor treatment response. Available at some Dhaka labs.
Capsule endoscopy	Small camera swallowed as a pill — images entire small bowel; used when CT/MRI is inconclusive. NOT used if stricture suspected — capsule may get stuck.
Upper GI endoscopy	If upper GI symptoms — shows gastric or duodenal Crohn’s (uncommon but important to document for staging).

Drug / চিকিৎসা	Role in Crohn’s Disease
Prednisolone (oral steroids)	First-line for inducing remission in moderate-severe Crohn’s flares. Effective but NOT for maintenance — significant side effects with long-term use. Budesonide (locally acting) preferred for ileocaecal disease.
Exclusive enteral nutrition (EEN)	Liquid formula diet exclusively for 6–8 weeks — as effective as steroids for inducing remission. Particularly important for malnourished Bangladeshi patients who cannot tolerate steroids or have severe weight loss.
Antibiotics (metronidazole + ciprofloxacin)	For perianal Crohn’s disease (fistulas, abscesses) — adjunct to surgical drainage and seton placement. Reduces perianal sepsis; cannot close fistula tract alone.
Mesalazine / 5-ASA	Limited role in Crohn’s (unlike UC where it is the cornerstone). May help colonic Crohn’s mildly. Not recommended as primary treatment in international guidelines — but used in Bangladesh due to cost.

Drug / চিকিৎসা	Role
Azathioprine / Mercaptopurine ⭐	Cornerstone maintenance therapy for Crohn’s. Prevents relapse after steroid-induced remission. Takes 3–6 months for full effect. Regular blood monitoring required (FBC, LFTs). Available in Bangladesh.
Methotrexate	Alternative immunosuppressant for azathioprine-intolerant patients. Weekly injection or oral. Requires folic acid supplementation.
Infliximab (anti-TNF biologic) ⭐	Most important biologic in Bangladesh for Crohn’s — IV infusion every 6–8 weeks. Highly effective for luminal AND perianal Crohn’s; can close fistulas. Used when azathioprine is insufficient or perianal disease is severe. Expensive — cost is a significant barrier.
Adalimumab (anti-TNF biologic)	Self-injectable alternative to infliximab — fortnightly subcutaneous injection. Increasingly available in Bangladesh.
Vedolizumab / Ustekinumab	Newer biologics — gut-selective (vedolizumab) or IL-12/23 blocker (ustekinumab). Used for anti-TNF failure. Limited availability in Bangladesh currently.

Indication / কারণ	Surgical Procedure
Stricture causing obstruction	Strictureplasty (widening the stricture without removing bowel — preserves bowel length) or short segment resection. Strictureplasty preferred to avoid short bowel syndrome in patients with extensive small bowel disease.
Fistula (enterocutaneous, enteroenteric, rectovaginal)	Resection of diseased bowel segment causing fistula + fistula repair. Perianal fistula: seton placement + infliximab — surgery only after medical optimisation.
Intra-abdominal abscess	CT-guided drainage first; resection of diseased segment causing abscess after inflammation settles.
Refractory disease (failed all medical therapy)	Resection of worst-affected segment — provides 12–24 months of remission. Disease-modifying therapy must be restarted postoperatively to delay recurrence.
Perforation (rare)	Emergency resection + stoma (Hartmann’s procedure). High mortality if delayed.
Colonic Crohn’s refractory to all therapy	Subtotal colectomy — unlike UC, does not cure as small bowel disease may persist.

অস্ত্রোপচারের পর কি রোগ ফিরে আসে? / Does Crohn’s come back after surgery? Yes — endoscopic recurrence at the anastomosis occurs in ~70% of patients within one year of surgery if no maintenance therapy is given. Clinical recurrence (symptoms) in ~30% within one year without treatment. This is why maintenance therapy (azathioprine, biologics) MUST be restarted after surgery. Surgery in Crohn’s buys time and treats complications — it does not cure the underlying disease.

Crohn’s Disease Fistula — When Standard Surgery Fails

• Crohn’s perianal fistula is caused by full-thickness inflammation of the rectal wall extending through to the perianal skin — creating complex, branching, high-level fistula tracts that do not heal with standard surgery
• Simple fistulotomy (the standard operation for cryptoglandular fistula) FAILS in Crohn’s fistula — it causes large non-healing wounds and worsens incontinence
• Correct approach: seton placement (draining non-cutting seton) to control sepsis FIRST + infliximab biologic therapy to induce fistula closure + careful staged surgery only after bowel disease is controlled
• If you have had multiple failed fistula operations — especially if you also have diarrhoea, abdominal pain or weight loss — Crohn’s disease must be excluded by colonoscopy and biopsy before any further surgery

Food / খাবার	During Flare / ফ্লেয়ারে	Remission / রেমিশনে
সাদা ভাত (white rice)	✅ Safe — easy to digest, low residue	✅ Freely
ডাল (lentils, split)	⚠️ Small amounts well-cooked red lentil only	✅ Most dals tolerated
মাছ (white fish, steamed)	✅ Excellent — anti-inflammatory omega-3; rui, catla, tilapia steamed	✅ All fish
মুরগি (boiled chicken)	✅ Good protein — skinless boiled/steamed	✅ All preparations
দই (plain yoghurt)	✅ Probiotic benefit; well tolerated	✅ Recommended
সবজি (vegetables)	⚠️ Well-cooked, peeled only — potato, carrot, কুমড়া, লাউ	✅ Most vegetables; introduce leafy greens slowly
আঁশযুক্ত খাবার (high-fibre)	❌ Avoid — increases gut transit and cramps; risk of obstruction in stricture	⚠️ Assess individually — some Crohn’s patients tolerate
তেলে ভাজা / মসলাদার	❌ Avoid completely during flare	⚠️ Occasional, minimal spice
পানি ও তরল (fluids)	✅ 2–3 litres/day — oral saline, coconut water, rice water. Dehydration is dangerous.	✅ Continue

Quick answer: Crohn’s disease is a chronic autoimmune inflammatory disease that can affect any part of the gut from mouth to anus — most commonly the small bowel and colon. It causes abdominal pain, diarrhoea, weight loss and fistulas. It is NOT an infection.

ক্রোন ডিজিজ (পেটের প্রদাহ) হলো একটি দীর্ঘমেয়াদী অটোইমিউন রোগ যা পাকস্থলী থেকে মলদ্বার পর্যন্ত পাচনতন্ত্রের যেকোনো অংশকে আক্রান্ত করতে পারে। এটি কোনো সংক্রমণ নয় — শরীরের নিজস্ব প্রতিরক্ষাব্যবস্থা নিজের অন্ত্রকে আক্রমণ করে। পেটে ব্যথা, ডায়রিয়া, ওজন কমে যাওয়া এবং ভগন্দর (fistula) এর প্রধান লক্ষণ।

Quick answer: IBD (inflammatory bowel disease) is the umbrella term covering both Crohn’s disease and ulcerative colitis — two chronic autoimmune conditions causing gut inflammation. Both are distinct from IBS (irritable bowel syndrome), which does not cause inflammation or bowel damage.

IBD (ইনফ্ল্যামেটরি বাওয়েল ডিজিজ) হলো দুটি রোগের সমষ্টি: (১) ক্রোন ডিজিজ এবং (২) আলসারেটিভ কোলাইটিস। উভয়ই অটোইমিউন প্রদাহজনিত রোগ — কিন্তু সংক্রমণ নয়। IBS (ইরিটেবল বাওয়েল সিনড্রোম) সম্পূর্ণ আলাদা — এতে কোনো প্রদাহ বা অন্ত্রের ক্ষতি নেই। IBD Bangladesh: ঢাকায় ডা. নজরুল ইসলাম IBD-এর সম্পূর্ণ চিকিৎসা দেন।

Quick answer: Both affect the same part of the bowel (terminal ileum), look similar on colonoscopy and biopsy, and both occur in Bangladesh. Key tests: chest X-ray, Mantoux/IGRA, biopsy for caseating granulomas and AFB stain. TB must be excluded before starting immunosuppressants for Crohn’s — failure to do so can be fatal.

বাংলাদেশে ক্রোন ডিজিজ এবং পেটের যক্ষ্মার পার্থক্য করা সবচেয়ে কঠিন। উভয়ই টার্মিনাল ইলিয়ামে হয়। পার্থক্যের পরীক্ষা: বুকের এক্স-রে, ম্যান্টু/IGRA, বায়োপসিতে AFB দাগ ও TB PCR। ক্রোনের সন্দেহ হলে TB নিশ্চিতভাবে বাদ দিতে হবে — নইলে স্টেরয়েড বা বায়োলজিক্স দিলে TB ছড়িয়ে যেতে পারে এবং মৃত্যু হতে পারে।

Quick answer: No — Crohn’s disease cannot be cured by medicine or surgery. Surgery removes diseased bowel but disease recurs at the anastomosis. The goal is long-term remission and preventing complications. Most patients with good medical management live a full, normal life.

ক্রোন ডিজিজ সম্পূর্ণ সারানো যায় না — না ওষুধে, না অস্ত্রোপচারে। অস্ত্রোপচারের পরেও রোগ ফিরে আসে। তবে সঠিক চিকিৎসায় (আজাথিওপ্রিন, বায়োলজিক্স) বেশিরভাগ রোগী দীর্ঘমেয়াদী রেমিশনে থাকতে পারেন। আলসারেটিভ কোলাইটিসে কোলেকটমি = স্থায়ী চিকিৎসা — কিন্তু ক্রোন ডিজিজে নয়।

Quick answer: Crohn’s fistulas recur because the underlying bowel inflammation — not just the fistula tract — drives the disease. Standard fistula surgery fails in Crohn’s. Correct treatment requires infliximab biologic to control bowel inflammation FIRST, then carefully staged surgery with seton placement.

ক্রোন ডিজিজে ভগন্দর বারবার ফিরে আসে কারণ মূল কারণ — অন্ত্রের প্রদাহ — চিকিৎসা না হওয়া পর্যন্ত ফিস্টুলা ভালো হয় না। সাধারণ ফিস্টুলোটমি ক্রোনের ভগন্দরে কাজ করে না। সঠিক চিকিৎসা: প্রথমে ইনফ্লিক্সিমাব দিয়ে অন্ত্রের প্রদাহ নিয়ন্ত্রণ, তারপর সিটন অপারেশন।

Quick answer: UC affects only the colon, always starts at the rectum, causes mucosal inflammation only, and surgery (colectomy) cures it. Crohn’s affects the entire gut, skips areas, causes full-thickness inflammation with fistulas and strictures, and surgery does NOT cure it.

UC: শুধু বৃহৎ অন্ত্র; মলদ্বার থেকে শুরু; শুধু আবরণী প্রদাহ; কোলেকটমি = স্থায়ী চিকিৎসা। ক্রোন: মুখ থেকে মলদ্বার; এলোমেলো skip lesions; পুরো অন্ত্রপ্রাচীর; ভগন্দর ও সংকীর্ণতা; অস্ত্রোপচার চিকিৎসা নয়। আলসারেটিভ কোলাইটিস সম্পর্কে জানুন →

Quick answer: Yes — azathioprine is available in Bangladesh. Infliximab (biologic) is available at major Dhaka hospitals. Colonoscopy, MRI enterography and CT are available. Dr. Nazrul Islam provides medical and surgical management of Crohn’s disease in Dhaka.

হ্যাঁ — বাংলাদেশে ক্রোন ডিজিজের চিকিৎসা সম্ভব। আজাথিওপ্রিন ও স্টেরয়েড পাওয়া যায়। ইনফ্লিক্সিমাব ঢাকার প্রধান হাসপাতালে পাওয়া যায়। কোলোনোস্কপি, MRI এন্টেরোগ্রাফি ও CT ঢাকায় উপলব্ধ। ডা. নজরুল ইসলাম IBD-এর সম্পূর্ণ ব্যবস্থাপনা দেন। কল করুন: +88019 7684 2234।

Quick answer: Crohn’s disease prognosis has improved dramatically with biologics. Most patients achieve good quality of life with modern treatment. 70–80% avoid surgery within the first 10 years with good medical management. Life expectancy is near-normal.

আধুনিক বায়োলজিক্স চিকিৎসায় ক্রোন ডিজিজের পূর্বাভাস অনেক উন্নত হয়েছে। সঠিক চিকিৎসায় ৭০–৮০% রোগী প্রথম ১০ বছরে অস্ত্রোপচার ছাড়াই ভালো থাকতে পারেন। বেশিরভাগ রোগী স্বাভাবিক কর্মজীবন, পরিবার ও সমাজজীবন পরিচালনা করতে পারেন।

Crohn’s Disease / পেটের প্রদাহ — Expert Assessment in Dhaka

Crohn’s disease is complex — especially in Bangladesh where it is frequently misdiagnosed as abdominal tuberculosis or treated as infectious colitis for years. Accurate diagnosis requires colonoscopy with biopsy, TB exclusion tests and often CT or MRI enterography. Dr. Muhammad Nazrul Islam provides complete assessment and management of Crohn’s disease and inflammatory bowel disease (IBD) in Dhaka — from initial diagnosis through medical therapy and, where needed, bowel surgery.

If you have had recurrent abdominal pain, diarrhoea, weight loss or fistula that has not fully responded to treatment — proper IBD assessment may give you answers that years of prior treatment has not.

📞 Call or WhatsApp: +88019 7684 2234

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