Rising tide of Inflammatory Bowel Disease in India

 Once called disease of the West, cases of Inflammatory Bowel Disease (IBD) are rising at a rapid rate in the country, driven by factors including lifestyle changes and early antibiotic use.  Experts highlight challenges in distinguishing the condition, significance of awareness and early diagnosis to arrest its spread.

In recent years, India has witnessed a worrying surge in cases of Inflammatory Bowel Disease (IBD), a chronic inflammatory condition of the gastrointestinal tract that includes ulcerative colitis and Crohn’s disease. Previously considered uncommon in the country, IBD is increasingly being diagnosed in urban and semi-urban populations, signaling a shift in the disease’s epidemiology.

A 2023 study conducted by the IBD Center of the Asian Institute of Gastroenterology (AIG) in Hyderabad revealed that the prevalence of IBD in the region has risen from 0.1% in 2006 to over 5% in 2022, a significant increase from previous years. The study also highlighted that the prevalence of IBD is consistent across both urban and rural populations, suggesting that factors beyond urbanization may be contributing to the rise.

According to projections from recent epidemiological studies, India could see its IBD patient population quadruple within the next decade, reaching over two million cases by 2035. Experts attribute this rise to changes in lifestyle, diet, and environment.

Highlighting the impact of rapid urbanization on disease prevalence, Dr. Sharad Malhotra, Senior Consultant & Director, Gastroenterology, Hepatology & Therapeutic Endoscopy, Aakash Healthcare explained, "India is witnessing a rapid increase in IBD cases, especially in urban centers due to a transition from traditional Indian diets rich in fiber and natural foods to a more Westernized intake of processed foods, saturated fats, and sugars. This dietary shift has altered gut microbiota weakening intestinal barriers and potentially triggering the inflammation."

The frequent use of antibiotics in early life has also been substantially linked to development of IBD.

Dr. Sunil Rana, Associate Director and Head- Internal Medicine (Unit III), Asian Hospital "Antibiotic exposure during early childhood can disrupt the developing gut microbiota, leading to long-term alterations in microbial composition and function. This dysbiosis has been linked to an increased risk of inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis, later in life,"

Historically, IBD was often misdiagnosed as infectious or other inflammatory conditions. According to Dr Suhas Udgirkar, Consultant - Gastroenterology from Jupiter Hospital, diagnosing IBD in India is particularly challenging due to its symptomatic overlap with intestinal tuberculosis (TB), a condition more prevalent in the region.

Dr Suhas Udgirkar said “The histopathological distinction between IBD/ Crohns and intestinal tuberculosis remains a critical challenge in India. Accurate biopsy analysis is essential because misdiagnosis can lead to inappropriate therapy and serious complications. Such patients may be subjected to ineffective treatments, delaying appropriate management and increasing morbidity."

Clinically, patients of IBD often present with vague symptoms such as abdominal pain, diarrhea, and weight loss, which complicates timely diagnosis, said Dr. Sunil Rana “Many patients present with nonspecific symptoms, making early detection difficult. A multidisciplinary approach is necessary, integrating clinical evaluation with detailed investigations to manage IBD effectively," he/she explained.

Experts point out that several other conditions can mimic the symptoms of IBD, making accurate diagnosis challenging. A thorough and often lengthy evaluation is required that depends on advanced diagnostic facilities, which are still lacking in many regions.

"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. However, there is no single diagnostic test for Ulcerative Colitis or Crohn’s Disease. It is a combination of physical, laboratory, and endoscopy tests. However, access to such diagnostics remains limited in many regions. Their availability is often restricted to tertiary care centers in metropolitan areas," said Dr. Aakaar Kapoor, CEO and Lead Medical Advisor at City XRay and Scan Clinic.

Beyond the clinical challenges, social factors compound the problem. The  cultural stigma surrounding chronic illness and a lack of awareness may cause patients to hide symptoms or delay seeking care, further complicating disease management.

Emphasizing the need for increased awareness, Dr. Sharad Malhotra said "Many people still do not get the right help on time because they do not know enough about the disease or feel afraid to talk about it. Awareness campaigns can help people seek early diagnosis and proper treatment that can drastically improve their quality of life."