The rising incidence of Inflammatory Bowel Disease (IBD) across the globe has become a concern for doctors. While early diagnosis is lacking, diagnosis in itself is challenging considering that other conditions could mimic IBD.
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“IBD is a significant problem. It comprises Ulcerative Colitis and Crohn’s Disease and is characterised by inflammation. It is different from Irritable Bowel Syndrome which is predominantly non-inflammatory,” said Jonathan Leighton, president at the American College of Gastroenterology, U.S.
“Both Ulcerative Colitis and Crohn’s Disease are complex immune-mediated diseases; there is a dysregulated immune response. We do believe there are genetic markers that contribute to the disease but not in isolation. There is a synergy between the external environment and gut bacteria,” he added.
There is an increasing incidence of IBD across the globe. including in North America and western Europe. “The prevalence is also rising… From 0.5% right now, the prevalence will increase to 0.6% in America,” he said.
Early onset
There is also a rise in early onset cases among those under 18. For the Indian perspective, Vineet Ahuja, Professor of Gastroenterology, All India Institute of Medical Sciences, New Delhi, has pinpointed a challenge in diagnosing Crohn’s disease. “We have peculiar issues such as intestinal tuberculosis, which is common in India and resembles Crohn’s disease. The phenotype is very similar, and so is the clinical presentation. As a result, the challenge is greater,” he said.
“What was an uncommon condition three decades ago has become much more common.”Vineet Ahuja, Professor of Gastroenterology, All India Institute of Medical Sciences, New Delhi
On incidence in India, Dr. Ahuja observed that lifestyle changes have contributed. “What was an uncommon condition three decades ago has become much more common. Changes in lifestyle, a Westernised diet with high fat and high sugar, processed and packaged food cause an insult to the gut epithelium, precipitating inflammation.”
T. S. Chandrasekar, founder and chief gastroenterologist, MedIndia Hospitals and Academy, and the Governor of American College of Gastroenterology, India region, said the incidence of IBD has almost doubled in India from 1990 to 2019, with a rise in the death rate as well.
A study in Tamil Nadu showed that there were more cases of Crohn’s Disease than Ulcerative Colitis. Nearly 50% of IBD were Crohn’s Disease and 40% were Ulcerative Colitis. It is important to catch patients early so treatment is better, he said.
Dr. Leighton noted that in terms of diagnosis there is still a delay in diagnosis, particularly among the young. “The symptoms of IBD overlap with Irritable Bowel Syndrome. This does delay diagnosis. Individuals with alarming symptoms such as bleeding and severe abdominal pain need a complete evaluation,” he said.
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Delay in diagnosis
There are other diseases that mimic IBD, and there is a need to rule out infections as well. “There is no single diagnostic test for Ulcerative Colitis or Crohn’s Disease. It is a combination of a physical, laboratory, and endoscopy tests. We have come a long way in the treatment of IBD. Over the last 25 years, biological therapy has emerged that uses monoclonal antibodies specifically directed at inflammatory pathways. Several biologics have been developed to target different parts of the inflammatory pathways to control the disease thereby decreasing hospital stays and surgeries. In addition, we have developed small molecules that can be given orally that have had a significant impact.”
Both stressed that the cost was a challenge. “There is no cure. It is a lifelong disease. So, in India, we are looking at low cost therapy such as faecal microbiota transplantation along with regular medication,” Dr. Ahuja added.
Environmental factors play a big role in IBD, Dr. Leighton said, adding: “This includes smoking and antibiotics. There are no human studies that have proved the role of diet, but we do think some foods such as super processed foods have the potential to be pro-inflammatory. A healthy diet avoiding highly processed food, and consuming wholesome food — for instance a Mediterranean diet — is recommended.”
Dr. Ahuja said patients are advised to avoid being restrictive about their diet as they could become malnourished. “Packaged and processed foods should be avoided. We have an anti-inflammatory diet containing curd and buttermilk, and less milk, more rice and millets, fresh fruits, and vegetables. Avoid red meat and consume fish. This seems to be helpful,” he said.
