Inflammatory Bowel Disease: A Growing Global Problem

Progress in treatment is being made, but more awareness is needed

For many years, inflammatory bowel disease (IBD) was a disease of the Western world—most diagnoses occurred in Europe, North America and Australia. Today, however, IBD incidence is on the rise on nearly every continent.

Some 5 million people around the world have IBD, and in the United States alone, the disease is estimated to cost the healthcare system more than $6 billion a year. In the fast-growing populations of China and India, rates of the two main subtypes of IBD—ulcerative colitis and Crohn’s disease—are beginning to rise.

“In countries where these diseases have been ignored in the past, we’re now seeing them appear for the first time,” Dr. Jean-Frederic Colombel, director of the Susan and Leonard Feinstein IBD Clinical Center at Icahn School of Medicine at Mount Sinai, said. “It’s becoming a worldwide epidemic.”

Inflammatory Bowel Disease: A Growing Global Problem

IBD is characterized by inflammation of the digestive system that can cause chronic nausea, diarrhea, cramping and weight loss. The disease often surfaces when patients are in their teens, twenties or thirties, leading to many years of pain and disability as well as costly monitoring.

First described in the 1930s,IBD has recently become much more common. Most studies suggest a significant rise in the number of cases of Crohn’s disease and ulcerative colitis worldwide since 1960. Between 2000 and 2009, the number of children hospitalized with IBD in the United States jumped by 64 percent.

The current hypothesis is that changes in lifestyle are making people more susceptible to IBD. These changes could include diet, cleanliness, and pollution exposure.

Scientists don’t fully understand what causes IBD, although studies suggest that genetics and bacteria that live in the human gut may be involved. “The current hypothesis is that changes in lifestyle are making people more susceptible to IBD,” explained Colombel. “These changes could include diet, cleanliness and pollution exposure.” These factors can cause changes in the gut bacteria, increasing the risk for IBD.

While the causes remain unclear, a cure has been even more elusive. Although surgery is an option, colectomy for ulcerative colitis is associated with significant morbidity, and Crohn’s disease may recur even after surgical resection of the small bowel or colon. As a result, most patients turn toward medicines to manage their disease, and new treatment options are being explored in clinical trials.

Gastroenterologist Dr. Jean-Frederic Colombel has witnessed the global rise of inflammatory bowel disease first hand at Mount Sinai in New York City.

Gastroenterologist Dr. Jean-Frederic Colombel has witnessed the global rise of inflammatory bowel disease first hand at Mount Sinai in New York City.

“We have made a lot of progress with the treatments we have now,” Colombel said. “We can heal some patients and block the progression of the disease towards bowel damage and disability.”

But Colombel stresses that early detection is critical to improving outcomes in IBD.

“There is a window of opportunity for treatment; when you miss this window, it becomes much more difficult to manage,” Colombel said. “Unfortunately, there is often a long delay between the onset of symptoms and when a patient is actually diagnosed.”

In fact, it usually takes more than a year—and sometimes a few years—for people to be diagnosed after their symptoms appear. In countries where IBD is a more recent phenomenon, this delay may be even longer.

Patients and primary care physicians need to be aware of the signs of IBD, so a proper diagnosis can be made. Gastroenterologists around the world must also be more aware and better equipped to treat the growing and complex burden of IBD.