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Crohn disease treatment in Ahmedabad · Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Crohn’s disease is a lifelong inflammation of the bowel. Medicines, given with a gastroenterologist, control it in most people; an operation treats the complications it leaves — a narrowing, an abscess, a fistula — and removes as little bowel as possible. In India one step comes before everything else: intestinal tuberculosis can look exactly like Crohn’s disease, and steroids or biologic injections given to undiagnosed TB can be dangerous. At Dr. Jivraj Mehta Hospital, TB is excluded first, treatment aims at a healed lining rather than only fewer symptoms, and surgery, when it is right, is offered as part of treatment rather than as a last resort.
Crohn’s disease needs a gastroenterologist and a surgeon who plan together, because the timing of an operation depends on the medicines and the choice of medicines depends on what an operation would achieve. Both sit in one service here, with radiology and pathology at the same table.
Dr. Jivraj Mehta Hospital. Trained in super-specialty surgical gastroenterology programmes, qualified twice over in the specialty, with 18 years of experience in surgery of the intestine. Colonoscopy, enterography, the IBD discussion, keyhole bowel surgery, nutrition support and long-term follow-up sit within one practice.
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Intestinal and Small Bowel Surgeon · Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Google rating 4.94 from 18 reviews at Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad.
Crohn’s disease is suspected in a young adult with long-standing diarrhoea, abdominal pain, weight loss and tiredness; in repeated pain or a lump in the right lower abdomen; in an abscess, fistula or unusual fissure near the back passage, which is often the first sign; in bowel obstruction that comes and goes; and in joint pain, skin nodules, eye inflammation or anaemia that travel with gut symptoms. Blood tests often show low iron, raised inflammation markers and low protein, and a stool test called faecal calprotectin is raised.
The cornerstone is a colonoscopy that enters the last part of the small bowel and takes biopsies from each segment. MR or CT enterography then maps the small bowel for narrowings, fistulae and abscesses; faecal calprotectin and blood tests measure activity; stool tests exclude infection; and before any medicine that lowers immunity, TB and other infections are screened for.
| Step | Test | What it decides |
|---|---|---|
| First | Ileocolonoscopy with entry into the small bowel and biopsies from each segment | Whether this is Crohn’s disease, and how far it extends in the large bowel and the end of the small bowel |
| Second | MR enterography (preferred in the young, as it needs no radiation) or CT enterography | Small bowel extent, narrowings, fistulae and abscesses — which shape whether medicines or surgery come next |
| Alongside | Faecal calprotectin; blood count, CRP, ESR, albumin, iron, vitamin B12, folate, vitamin D | How active the disease is, and the nutritional deficits to correct |
| Alongside | Stool culture and C. difficile test | Infection that can mimic or worsen a flare |
| Before any immunity-lowering medicine | Chest X-ray with IGRA or Mantoux for TB; hepatitis B and C, HIV and chickenpox status; vaccination review | Whether steroids, immunosuppressants or biologic injections can be started safely |
Each patient’s disease is then described on three axes — age at diagnosis, where it sits (small bowel, large bowel or both, sometimes the upper gut) and how it behaves (inflammation only, narrowing, or penetrating with fistulae, with or without disease around the back passage). Behaviour tends to move from inflammation towards narrowing or penetration over the years, which is why effective treatment early matters in people at higher risk.
The differential that dominates Indian practice is intestinal tuberculosis. At the junction of the small and large bowel, TB and Crohn’s disease often cannot be told apart at the first assessment. Steroids, immunosuppressants and biologics are not started until TB has been excluded, or until a trial course of anti-TB treatment has failed to heal the lining.
Giving immunity-lowering drugs to undiagnosed tuberculosis can be fatal, so this rule is never bent to save time. Other conditions are also separated by biopsy and the overall picture: infections of the small bowel, damage from painkillers such as NSAIDs, Behçet’s disease, and, rarely, a lymphoma or a cancer at the start of the large bowel that can look similar on a scan. Crohn’s disease itself is benign, but long-standing Crohn’s of the large bowel needs surveillance colonoscopy for precancerous change, which is part of follow-up.
Mild disease at the end of the small bowel is treated with budesonide; moderate to severe flares with a short course of steroids, never as long-term treatment; high-risk disease with early advanced therapy; and remission is maintained with immunosuppressants or biologic medicines. Surgery is used for complications and, in limited disease at the junction of the bowel, as a genuine alternative to long-term injections.
| Rung | Who it suits | What it involves |
|---|---|---|
| Budesonide | Mild disease at the end of the small bowel | A steroid that acts mainly in the gut, with fewer effects on the rest of the body |
| Systemic steroids | A moderate to severe flare | To bring the flare under control only — never to keep the disease quiet in the long term |
| Early advanced therapy | Young age at diagnosis, extensive small bowel disease, deep ulcers, disease around the back passage, narrowing or fistula at presentation, smoking, steroids needed at diagnosis | Starting a biologic or targeted medicine early, rather than climbing slowly |
| Maintenance | Everyone in remission | Azathioprine, mercaptopurine or methotrexate; anti-TNF injections (infliximab, adalimumab); vedolizumab; ustekinumab, risankizumab or mirikizumab; upadacitinib — chosen with the gastroenterologist, with blood monitoring |
| Surgery as treatment | Limited inflammatory disease at the junction of the small and large bowel that has not settled on standard medicines | Keyhole ileocaecal resection, a reasonable first choice alongside biologic injections |
| Surgery for complications | A scarred narrowing with blockage, an abscess, a fistula, perforation, bleeding, or failure of medicines | The least resection that solves the problem, or a stricturoplasty that widens the bowel without removing it |
Mesalazine, often prescribed for colitis, does not work in Crohn’s disease and is not used to keep it in remission. Treatment aims at targets in order: first relief of symptoms, then normal CRP and calprotectin, and finally a healed lining on colonoscopy with a normal quality of life. Calprotectin is the practical check between colonoscopies.
Most people with Crohn’s disease are treated with medicines and never need an operation for long stretches of their lives. Inflammation responds to medicines; a narrowing made of scar does not, and that is the point at which surgery becomes the better tool.
The decision is made at the IBD discussion, with imaging that separates an inflamed, swollen segment from a scarred one. A short narrowing can sometimes be stretched with a balloon through the colonoscope instead of being operated on. Equally, delaying a necessary operation in a thin patient on increasing steroid doses produces the worst results, so “not yet” is reviewed at every visit rather than repeated by habit.
The supportive measures change outcomes as much as the medicines: stopping smoking, which is the single most effective thing a patient controls; correcting iron, vitamin B12, vitamin D and calcium; protecting bone after steroids; vaccinations before immunosuppression; and a liquid nutrition programme that can itself calm a flare.
Crohn’s surgery follows one principle: this is a lifelong disease, and every length of bowel is precious. Only the grossly diseased segment is removed, with a short margin of normal-looking bowel; short scarred narrowings are widened by stricturoplasty instead of being removed; and the length of bowel removed and remaining is recorded every time.
Microscopically clear margins are not chased, because wider removal does not reduce the chance of the disease coming back and only costs bowel. Stricturoplasty — Heineke-Mikulicz for a short narrowing, Finney for a longer one, and a side-to-side technique for long segments — keeps bowel where earlier operations have already used some. For the join after an ileocaecal resection, a Kono-S anastomosis is preferred, as it is associated with less recurrence at the join. The operation is done by keyhole surgery wherever possible, because fewer adhesions matter in a disease that may need another operation one day.
Disease around the back passage is handled differently. An abscess there is drained, with a soft seton thread if needed, and the patient is referred to a colorectal and IBD service for definitive management alongside medicines; this practice does not treat perianal fistula disease definitively.
The preparation decides the outcome. An abscess is drained through the skin first and the operation done weeks later on a patient without sepsis; steroids are reduced as far as possible; nutrition is built up, often with a liquid diet for some weeks; smoking stops; and a stoma nurse marks a stoma site in every case.
When infection, high-dose steroids and malnutrition are all present together, a temporary stoma is safer than joining the bowel, and that is recognised and discussed before the operation rather than decided during it. Biologic injections do not have to be stopped before surgery as a rule; their timing is agreed at the IBD discussion so that a needed operation is not delayed.
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“Dr. Harsh shah is really great doctor and he is very kind and calm . he gives enough time to patent and explain deeply so patent is very clear about his illness. he is not providing unnecessary medicine also. thanks DR.Harsh shah — Ankit Patel, Google review”
★★★★★
“Excellent service, very polite, very well explained the treatment plan and follow up after surgery. I am truly grateful to him for the treatment. — Amar Singh, Google review”
Real Google reviews from Dr Harsh Shah’s two listings, reproduced exactly as written.
Recovery after a planned keyhole resection follows a short daily plan: sitting out of bed and sipping fluids on the day of surgery, eating and walking from the next day, and home within a few days. Before discharge, the medicine to prevent the disease returning at the join is chosen and prescribed, and the colonoscopy within the first year is booked.
That colonoscopy is the step most often missed and the one that decides whether the operation lasts: it looks at the new join, and visible return of the disease there leads to stronger medicines even if the patient feels well. Stopping smoking makes a return of the disease and a second operation much less likely. After the end of the small bowel is removed, vitamin B12 may need lifelong replacement, and loose stools from bile acids are common and easily treated.
The operation treats the complication; it does not make Crohn’s disease go away. Its risks are higher with steroids, malnutrition and infection, and Dr Harsh Shah names each one at the consent discussion with figures adjusted to your situation, including the small risk of death that every abdominal operation carries.
After surgery: a leak from the join, an abscess inside the abdomen, a temporary or permanent stoma, a fistula to the skin, slow return of bowel function, bleeding, wound infection, clots, conversion from keyhole to open surgery, and, later, adhesions causing blockage or a hernia in the scar. Over a lifetime: the disease returning near the join, the possibility of another operation, and, after repeated resections, short bowel — the reason every operation removes as little as possible.
Follow-up combines the surgeon and the gastroenterologist: the pathology and the preventive medicine at the first visit after surgery, the colonoscopy at the join within the first year, calprotectin and blood tests at regular intervals, and an annual review of nutrition, bone health, vitamins, vaccinations and skin and cervical screening for those on immunosuppression.
Smoking status is recorded at every visit, because it is the factor the patient controls that most affects the outcome. Where Crohn’s affects the large bowel, surveillance colonoscopy for precancerous change starts some years after diagnosis and continues at intervals set by risk. The total length of remaining bowel is carried forward in the notes, and pregnancy is planned with the team, since active disease is more of a risk to a pregnancy than most of the medicines.
The cost of Crohn’s care depends on the medicines — biologic injections carry their own, often substantial, cost — and, for surgery, on the operation, the room category and the length of stay. Cost and access are discussed early and openly rather than at the point of prescription, and a written estimate is given before any operation.
Because cost and access, not evidence, often decide which medicine a patient can actually take, a keyhole resection for limited disease at the junction of the bowel is a legitimate, cost-effective first choice — not a fallback for those who cannot afford injections. Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad, works with the major insurers and cashless schemes, and the office handles pre-authorisation directly.
Bring: colonoscopy and biopsy reports, enterography images on a disc or drive, blood and calprotectin results, TB test results, previous discharge summaries, a list of every medicine tried with dates, the insurance card and identification, and one family member as the point of contact.
Often they cannot be separated at the first visit. Biopsies, imaging and TB tests are read together, and if doubt remains a trial course of anti-TB treatment is completed before any immunity-lowering medicine is started.
Many patients are managed with medicines for long periods. Surgery is needed for a scarred narrowing, an abscess, a fistula or failure of medicines, and for limited disease at the junction of the bowel it is a reasonable first choice.
No. It treats the complication, and the disease can return near the join. That is why preventive medicine is started after surgery and a colonoscopy is done within the first year.
Because Crohn's disease can need more than one operation in a lifetime. Removing only the damaged part, or widening a narrowing without removing it, protects against short bowel later.
Yes. Smoking makes the disease more likely to return and a second operation more likely. Stopping is the most effective thing in your own hands.
No. Mesalazine does not work in Crohn's disease. Maintenance uses immunosuppressants or biologic medicines, chosen with the gastroenterologist.
Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Dr. Jivraj Mehta Hospital, Dr Jivraj Mehta Marg, Vasna, Ahmedabad 380007.
Google: Dr Harsh Shah · 4.94 from 17 reviews
Directions to Dr. Jivraj Mehta Hospital, Vasna · WhatsApp +91-63555-64601
Patients come to Ahmedabad for Crohn’s disease care from across Gujarat — Gandhinagar, Mehsana, Banaskantha, Nadiad, Anand, Bhavnagar, Rajkot, Jamnagar and Kutch — and from southern Rajasthan and western Madhya Pradesh.
Already told it could be Crohn's — or TB? Colonoscopy and biopsy reports, CT or MR enterography images, blood and calprotectin results and a list of the medicines tried so far can be sent ahead of the appointment, so the consultation starts with them already read. Treatment is decided at the consultation, after examination. Call +91-63555-64601 · Send the reports ahead on WhatsApp
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