Inflammatory bowel disease (IBD) is the name for two related but distinct conditions — Crohn's disease and ulcerative colitis — where your immune system mistakenly attacks the lining of your digestive tract, causing inflammation. IBD is not the same as irritable bowel syndrome (IBS); it involves real, measurable changes in the bowel that can cause serious complications if not well managed. Both conditions tend to flare up and settle down in cycles, and treatment aims to keep them quiet for as long as possible.
Crohn's disease is unusual in that it can affect any part of the digestive tract — from the mouth all the way to the bottom — though it most commonly involves the last section of the small bowel (the terminal ileum) and the colon. One of the challenging features of Crohn's is that the inflammation goes all the way through the bowel wall (called transmural inflammation), which means it can lead to narrowings (strictures), abnormal connections between loops of bowel or skin (fistulas), and collections of pus (abscesses). Some people also get Crohn's-related problems around the back passage, such as fistulas or skin tags. Crohn's is primarily managed by a gastroenterologist using medications; your surgeon becomes involved when complications arise or an operation is needed to remove a badly affected segment of bowel.
Ulcerative colitis (UC) affects only the large bowel (colon) and rectum. The inflammation stays on the inner lining of the bowel — it does not go all the way through the wall like Crohn's does. Typical symptoms include bloody diarrhoea, urgency (the sudden desperate need to go to the toilet), cramping pain, and fatigue. Most people with UC can keep their symptoms under control with medication — including anti-inflammatory tablets, immunosuppressants, or newer biologic injections. If medication stops working, or if there is a risk of bowel cancer developing, surgery to remove the entire large bowel (a total colectomy) is curative — meaning it can completely eliminate ulcerative colitis.
If you have had widespread inflammation of the large bowel (pancolitis) for 8–10 years or more, your risk of developing bowel cancer is higher than average. Regular colonoscopy check-ups (surveillance) allow any early changes to be caught and dealt with before they become a problem. Your gastroenterologist will advise you on the right surveillance schedule for your situation.
Surgery for IBD covers a range of situations — from removing a section of bowel affected by Crohn's disease, to emergency surgery during a severe flare of colitis, to a planned operation for ulcerative colitis that may ultimately involve creating a J-pouch (ileal pouch-anal anastomosis, or IPAA) — an internal reservoir made from your small bowel that allows you to pass stools normally without a permanent stoma (bag). Perianal Crohn's disease — fistulas and abscesses around the back passage — is managed with a procedure called a seton insertion, in close coordination with your gastroenterologist.
Mr Nguyen works closely alongside the gastroenterologists who manage your IBD day-to-day, stepping in when a surgical opinion is needed — whether that is for an urgent complication, a decision point about surgery, or a planned elective operation. Every surgical decision is made together with your gastroenterologist, with your preferences at the centre. The goal is always to do the least possible surgery that achieves a good, durable result. Wherever feasible, bowel-preserving and stoma-avoiding approaches are chosen — and if a temporary or permanent stoma is ever on the table, Mr Nguyen will talk through what that means in detail, honestly and without rushing you.
If you have IBD and notice your symptoms getting worse — more diarrhoea, blood in your stools, increasing abdominal pain, unintended weight loss, or new or worsening symptoms around your back passage — seek review promptly. Do not wait for your next scheduled appointment if things have changed significantly.
Day-to-day medical management of IBD is led by your gastroenterologist, and Mr Nguyen's role is to step in when a surgical opinion is needed. Your GP or gastroenterologist will send a referral when surgical input becomes appropriate — most commonly for a complication such as a stricture, fistula, perianal abscess, or disease that is no longer responding to medical treatment. Routine surgical referrals are usually seen within one to two weeks, and urgent cases are prioritised.
At the consultation, Mr Nguyen will review your imaging, endoscopy reports, and current treatment, and have an honest conversation about whether surgery is the right next step. Every plan is made jointly with your gastroenterologist, with the aim of doing the least surgery needed to achieve a durable result. Follow-up after any operation is shared between Mr Nguyen and your gastroenterologist so your ongoing IBD care is seamless.
No — and this confusion is very common. IBD causes real, measurable inflammation inside your bowel and can lead to serious complications if left untreated. IBS is a different condition where the bowel is structurally normal but does not work as smoothly as it should — it causes real symptoms, but it does not carry the same risks as IBD. The two need to be distinguished, which is why proper investigation matters.
Not necessarily — many people with IBD never need surgery. That said, over their lifetime, approximately 70–80% of people with Crohn's disease and 20–30% of those with ulcerative colitis will have an operation at some point. For Crohn's, surgery manages complications but does not cure the disease. For ulcerative colitis, removing the large bowel is the only cure — though it is a major decision that is considered carefully.
Yes — most people with well-controlled IBD have healthy pregnancies and good outcomes. Some IBD medications do need to be reviewed before you try to conceive, so it is worth discussing your plans with your gastroenterologist and obstetrician in advance. Your team will work together to keep you and your baby safe.
Mr Ba Nguyen consults at his rooms in Heidelberg and operates at Warringal Private Hospital, Heidelberg, and Epworth Eastern, Box Hill. A GP or specialist referral is required.