Who said you couldn’t travel to Thailand with ulcerative colitis

There are those who dream of traveling to tropical paradises, but out of caution stay on the Spanish coast, close to home. Patients with inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease, are reluctant to travel to countries where the diet is very different, healthcare works differently, and where they visit areas with difficulties in keeping medication refrigerated.

Read more Shakira’s lawyer, after the sentence: «The tax authorities have acted recklessly»

But there are also those who show courage. Dr. Lucía Expósito, a sexual health expert and patient, 32 years old, was encouraged to go to Thailand. “Who would have thought it when I was diagnosed with ulcerative colitis at 17 years old. But we have to fight not to give up a quality life,” says this woman from Granada living in Tenerife. IBD causes incontinence, abdominal pain, fatigue. It prevents them from getting live virus vaccines, such as yellow fever, necessary for certain destinations; they have to travel with translated reports of their disease, purchase insurance, justify with documentation the needles they carry in their luggage to administer treatment… “When you receive the diagnosis, life stops. But you have to be able to resume your projects at some point,” she states.

“When you receive the diagnosis, life stops. But you have to be able to resume your projects at some point”

Lucía Expósito, president of ACCU Spain, the confederation of associations of patients with Crohn’s disease and ulcerative colitis

The ulcerative colitis that Expósito suffers from and Crohn’s disease are immune-mediated inflammatory diseases (IMID), like psoriasis and psoriatic arthritis. The immune system mistakenly attacks a part or the entire digestive tract, which extends from the mouth to the anus. IBD usually appears in an age range between 15-20 years and 40 years. The most obvious symptoms include unexpected weight loss, diarrhea for more than four weeks with up to 20 bowel movements a day (with blood in the case of ulcerative colitis), abdominal pain.

More invisibly, IBD affects psychologically, can cause anxiety or depression. Like any IMID, these are chronic, incurable diseases, but there is the possibility of silencing them, of entering remission. The patient will instinctively continue locating the nearest bathroom when going to an unfamiliar place, but may not have to use it.

Most frequent emotions reported by patients with inflammatory bowel disease (IBD)

Stress

63%

Irritability

55%

Anxiety

53%

Apathy

50%

Misunderstanding

46%

Isolation

40%

Source: ACCU Spain. Barometer of inflammatory bowel disease (BAREII): social and emotional experience of people with IBD, 2026

The key for this, summarizes Yamile Zabana, gastroenterologist, the specialty that treats IBD patients, lies in early diagnosis: “It is proven that the response to treatment is much better. And when the disease starts, there has not yet been time for complications to occur”: sometimes surgery may be required, the removal of part of the intestine if it is permanently very inflamed.

“When there was less awareness and diagnosis took longer, seven out of 10 people with Crohn’s disease had to undergo surgery,” Zabana recalls. It is not about raising alarm messages, the doctor clarifies, diarrhea or bleeding can be due to multiple causes. But if there are suspicions, one must see a doctor immediately. After diagnosis, it is essential to promptly apply the most appropriate innovative treatment according to the patient’s characteristics. “IBD is a progressive disease. We know that if we do not control inflammation early, intestinal damage progresses and becomes irreversible,” explains the gastroenterologist.

“Between 60 and 70% of patients recall a stressful event as a trigger of the disease: a separation, the death of a loved one…”

Read more A man dies after receiving a high-voltage electric shock in Torrejón de Ardoz

Yamile Zabana, gastroenterologist and president of GETECCU, the Spanish working group on Crohn’s disease and ulcerative colitis

Expósito, who shortly after learning the diagnosis entered the associative world, is also the president of ACCU Spain, the confederation of associations of patients with Crohn’s disease and ulcerative colitis. They estimate that 300,000 people live with IBD in Spain (living is a kind way associations use to say suffering from the disease), and that by 2030 the figure will have reached 1% of the population. The disease affects you repeatedly. It is not contagious, nor is it associated with a specific lifestyle. It is usually triggered by a period of stress. “Between 60 and 70% recall a stressful event as a trigger: a separation, the death of a loved one…,” Zabana says.

Like any IMID, ulcerative colitis and Crohn’s disease manifest in flare-ups. They can be in a remission phase thanks to treatments and symptoms can suddenly flare up overnight. “With the therapeutic arsenal of recent years, the goal is for the silent periods of the disease to be long and the flare-ups mild, not requiring hospitalization or surgery,” says Expósito, who urges patients to consult reference professionals and associations to get information about nutrition.

There is little evidence on this and it is very tempting to think that diet greatly affects the disease because it involves the digestive tract, but it is not so. It is the immune system attacking the body. “The Mediterranean diet, which is anti-inflammatory, exercising, and quitting smoking are recommended,” says Zabana, guidelines that apply to the entire population. “It is not advisable to restrict or limit foods because we could end up malnourished. And to face a flare-up it is important to be well nourished,” adds Expósito.

The patient speaks, the doctor listens

The way of approaching the disease in consultation has changed. Zabana, who is also president of Geteccu, the Spanish working group on Crohn’s disease and ulcerative colitis, sums it up in one phrase: “Making the patient co-responsible in decisions.” And in another expression, embraced by all associations and increasingly by doctors: “Putting the patient at the center.” This implies that the specialist’s relationship ceases to be paternalistic, before the doctor’s word or judgment was never questioned, Zabana recalls; and the doctor remains the doctor, but now the treatment is agreed upon with the patient, who must come informed and prepared to the consultation, “you have 15 golden minutes, you have to go with symptoms noted: I went to the cinema and had to get up five times to go to the bathroom; I was invited to a birthday and couldn’t eat anything,” Expósito illustrates. “The patient also has to take responsibility for treatment adherence, it is not enough just to prescribe it,” says the gastroenterologist referring to that co-responsibility.

That list of symptoms Expósito refers to, with 15 years of experience with the disease, is useful to address less visible consequences of IBD, such as anxious or depressive states, or fatigue, that chronic tiredness “misunderstood, not well treated, lacking research and knowledge.” It does not appear in blood tests or colonoscopies. “You have to listen to the patient,” insists Expósito. “The blood test may be fine but the patient is not, or vice versa,” she adds.

How inflammatory bowel disease affects the workplace

39.5% have needed medical leave

The average duration of leave is 1 month

In 8-hour workdays, 3 hours are affected by low productivity

30% have lost their job at some point due to low productivity

Source: ACCU Spain. Barometer of inflammatory bowel disease (BAREII): social and emotional experience of people with IBD, 2026

Living without symptoms, aging healthily

The goal, recalls Zabana, who works at the Universitari Mútua Terrassa hospital (Barcelona), was previously focused on the disappearance of symptoms. It was a way for the patient to return to the life they had before the disease diagnosis. Now a new goal arises, mucosal healing, the internal tissue lining the intestine. And healing cannot be understood as eradicating the disease, because it is chronic, but rather reducing inflammation in that part of the body. A patient can feel well and have inflamed mucosa, which increases the risk of colorectal cancer. “We must not only aspire to live without symptoms, but look to the future, age healthily. Bet on treatments that ensure mucosal healing,” requests the patient and president of ACCU Spain.

Expósito traveled to Thailand in 2024. She went with another person who also had ulcerative colitis. “We carried an arsenal of medications,” she recalls. It included serum to prevent sudden diarrhea from dehydrating them. The treatment was refrigerated at all times. They printed reports of their disease in case their luggage was inspected and for a possible hospital admission, these diseases, Expósito says, are not well known in Asia. Once there, they avoided street food stalls and tap water, which no one would consider. “Without doing crazy things that could harm your health, but I am in favor of not giving up your life,” Expósito summarizes. This summer they repeat, going to Vietnam and Cambodia.

Read more Begoña Gómez appeals the acquittal of the agitator who called her “Begoño” and linked her to “drug trafficking in Morocco”