Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis, is becoming more common in the UAE, says Dr. Mohammed Nabil Quraishi Consultant Gastroenterologist (PhD, MBChB, MSc, FRCP, FRCPE, FEBGH), who adds that earlier diagnosis, advanced therapies and emerging tools such as AI are improving patient care.
1. For readers who are not specialists, what is inflammatory bowel disease, how do Crohn’s disease and ulcerative colitis differ, and which early symptoms should prompt someone to seek medical advice?
Inflammatory bowel disease is a lifelong condition in which the immune system keeps the gut inflamed when there is nothing there to fight. Ulcerative colitis affects only the large bowel, starting at the rectum and spreading upwards in one continuous stretch. Crohn’s disease can affect any part of the gut, often in patches, and goes through the full thickness of the bowel wall, which is why it can cause narrowing, fistulas and abscesses. We are seeing more of both in the UAE every year.
Diarrhoea lasting more than a few weeks, blood in the stool, waking at night to open your bowels, weight loss or ongoing abdominal pain all need a doctor. In a young person I would not wait.
2. What role does the gut microbiome play in digestive health and inflammation, and why has it become such an important focus of research into IBD?
Most of the time we live peacefully with the trillions of bacteria in our gut; they help digest fibre, feed the lining of the bowel and train the immune system. In IBD that relationship breaks down, with fewer protective species and an immune system that reacts to bacteria it should tolerate. What we still don’t know is which comes first. That question has pushed the field towards the years before diagnosis, and it is why our UAE Epi-IBD study is now building a workstream in unaffected first-degree relatives of our patients, looking for the earliest changes before disease appears.
3. How does faecal microbiota transplantation work, what does the evidence currently show about its benefits and limits, and how close are microbiome-based therapies to routine clinical use?
FMT transfers stool from a carefully screened donor into a patient’s bowel to restore a damaged microbial community. For recurrent C. difficile infection, it works very well, and the UK guidelines I co-authored recommend it there. In ulcerative colitis, randomised trials show it can induce remission in some patients. Our STOP-Colitis work in Birmingham looked at why some people respond and others don’t, and the answer depends heavily on both donor and recipient. The evidence in Crohn’s disease is thinner. Routine use in IBD is still some years off, and I suspect defined bacterial products will get there before whole stool does.
4. IBD is often diagnosed late. What are the main barriers to early diagnosis and timely access to treatment, and how can primary care and patients help shorten that journey?
In many Western countries that is true. Patients there usually go through a GP first, and the wait for a specialist referral and a colonoscopy can add many months, particularly in Crohn‘s disease. The UAE is different because there is no gatekeeper; patients can see a gastroenterologist directly, and we have published on the effect of that from the UAE Epi-IBD study. In 243 patients, the median time from first symptom to diagnosis was 4 months for Crohn’s disease and 3 months for ulcerative colitis, shorter than pooled figures from high-income countries. For colitis it has fallen to around 2 months since 2021.
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Primary care can still help by checking faecal calprotectin early in anyone with persistent bowel symptoms. Patients can help by not putting blood in the stool down to piles.
5. How are treatment approaches evolving, from biologic therapies to diet, lifestyle and personalised care, and what should patients understand about long-term management?
Ten years ago, we had a handful of options. Now there are several biologic and oral drug classes, and newer targets such as TL1A are in phase 3 trials. Over two thirds of our IBD patients require an advanced therapy, and when we measured them against the international STRIDE-II targets, 62% of those fully assessed were in deep remission. Diet, stopping smoking and mental health still matter. The goal is a healed bowel, which is a higher bar than feeling well, and that takes a long-term partnership with the team.
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6. How can artificial intelligence, digital tools and stronger clinical research help improve IBD care over the next five years, and what should health systems prioritise now?
AI can already score inflammation on colonoscopy images with a consistency close to expert readers, and it is starting to predict from biopsies which patients are in true healing. The bigger shift will be monitoring at home. Studies with smartwatches have shown that heart rate variability and sleep change in the weeks before a flare, before the patient notices anything, and paired with home calprotectin tests that could let us act on the signal rather than wait for symptoms.
The research matters as much as the technology. At SSMC we are running trials of newer drug classes, the UAE Epi-IBD study and a genomic testing programme with the Department of Health. Health systems should fund specialist IBD nurses and bring more trials to the region so our patients are represented in the evidence. The Middle East quality indicators we are developing across 8 countries will let us measure whether any of it is working.
