From infectious diarrhoea to IBD dominance: India's health landscape shifts with Western lifestyle uptick: Lancet study

IBD now afflicts over 5 percent of patients, outpacing the prevalence of infectious diarrhoea in India.

Adoption of Western lifestyles has led to the surge in Inflammatory Bowel Disease (IBD) among patients in India, according to a study published in The Lancet. This research brings to light an important finding: IBD now afflicts over 5 percent of patients, outpacing the prevalence of infectious diarrhoea in India.

This marks a notable shift since infectious diarrhoea traditionally accounted for the primary cause of lower gastrointestinal symptoms in developing regions. The origins of infectious diarrhoea could be attributed to viral, parasitic, or bacterial infections, with common culprits like Salmonella and E. coli often transmitted through contaminated food and water.

In contrast, IBD, which includes Crohn's disease and ulcerative colitis, was commonly associated with Western societies. IBD includes disorders involving chronic inflammation of tissues in the digestive tract.  Lifestyle patterns similar to the Western way of life might significantly contribute to the increasing prevalence of IBD, as previously indicated in studies. Studies also suggest that westernised diets are associated with a reduced gut microbial diversity, which may result in increased susceptibility to diseases like IBD.

Examining over 30,000 participants across various districts of Telangana, the study featured in Lancet Regional: Southeast Asia unveiled that IBD's prevalence was 5.4 percent, surpassing infectious colitis at 4.6 percent. These findings also suggest a decline in infectious diarrhoea cases alongside a rise in IBD cases over recent decades. Notably, the distribution of IBD cases exhibited no significant variation between rural and urban populations.

Despite its historical dominance, prevalence of infectious diarrhoea has declined in developing nations. Interestingly, escalating urbanisation seems to correlate with the surge in IBD cases.

In India, there is an ongoing acceleration of IBD incidence, although its overall prevalence remains modest. The potential repercussions are immense, especially when considering countries like India and China, each housing over a billion people, undergoing a surge in chronic inflammatory gut diseases. This suggests that in the next decade, the affected population in these regions might surpass that of Western countries, prompting significant shifts in healthcare policies and expenditures, according to the study.

If a chronic inflammatory gut disease such as IBD is a feature of industrialisation, then living in an urban environment is likely to increase the risk of developing Crohn's Disease, the study noted. There has been speculation that migration of the population from rural areas to cities is responsible for the increasing incidence of IBD in Asia.

Additionally, the study emphasised the importance of early diagnosis through colonoscopy for conditions like IBD, Crohn's Disease, and other colonic ailments. Unfortunately, access to such diagnostics remains inadequate in rural areas. A prior investigation highlighted the scarcity of gastroenterologists in India, with only one per 5 million individuals.

The study was funded by Leona M. and Harry B. Helmsley Charitable Trust.