Every year, around 600,000 Americans are diagnosed with inflammatory bowel disease (IBD), a group of chronic, inflammatory disorders that vary in root cause and degree of inflammation. Crohn’s disease and ulcerative colitis are two of the most common inflammatory disorders that affect the lining of the gastrointestinal tract. Both disorders trigger symptoms such as persistent diarrhea, severe pain, fatigue, loss of appetite, abdominal pain, gastrointestinal bleeding, and weight loss.
For quite a while now, IBD has been characterized as a disease of Caucasians with European descent, living in industrialized countries. Yet, recent studies have shown that IBD is not a matter of ethnicity, but rather individuals of all ethnic groups living in the western world.
In 1/3 of the countries around the globe, especially in underdeveloped countries, IBD practically does not exist. A few researchers figure that this is because the inhabitants may be protected against IBD by being abundant in parasitic helminths, which are various types of parasitic worms that live within the intestines of humans and animals. “It turns out that countries where IBD is common are those industrialized, developed nations like the U.S., where there are no intestinal helminths. Conversely, where helminths are prevalent, the incidence of IBD is very low. In fact, Crohn’s and ulcerative colitis really emerged in the U.S. during the 1920s and 1930s, when we began to shift to improved plumbing and sanitation and we no longer fertilized soil with both human and animal waste. Until then, these parasites were very common. And we didn't have much IBD,” said Robert W. Summers, gastroenterologist of the University of Iowa College of Medicine.
An interesting study
In a recent study, conducted by Summers and his fellow colleagues, 7 patients with IBD were administered with a solution that contained thousands of eggs of Trichuris suis, also known as “whipworm”. They found that all 7 of the patients experienced signs of improvement in regards to their symptoms and overall quality of life. “All had active IBD when the study began and weren't doing well on medications. On the initial dose, we noticed an improvement, but their symptoms recurred. So, we continued with additional doses every two weeks. Some patients have continued getting the doses for years now and are doing well. And we have yet to detect any side effects in any patient,” said Summers.
The rate of IBD is rising in newly industrialized countries
Another recent study showed that the rates of IBD have been rising as high as 15% a year in newly industrialized countries such as Asia, Africa, the Middle East and South America - especially since the beginning of the 21st century. The study, known as ‘Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies’, was published in the journal The Lancet. To date, it is the most wide-ranging study to cover epidemiology of inflammatory bowel disease on a global level.
For a fairly long time, researchers believed that IBD was a disease that was mostly seen among Western industrialized nations. However, nowadays, it has become a health concern all around the globe. In North America, over 1.5 million individuals have IBD and in Europe, this figure reaches as high as 2.5-3 million affected individuals. In the Western nations, the rate is still high, affecting 0.3% of the population.
“While our study demonstrates a paradigm shift whereby the incidence of inflammatory bowel disease in most Western countries has begun to stabilize and in some regions decrease, it is important to note that the prevalence of the disease is now 0.3% of the population in North America, Australia, and most countries in Europe. The high prevalence of this disease in the Western world will challenge clinicians and health policy makers to provide quality and cost-efficient care to patients with this condition,” said Dr. Gilaad Kaplan, an associate professor at the Cumming School of Medicine.
Researchers from the Chinese University of Hong Kong (China), the University of Calgary (Canada), and the University of Birmingham (Great Britain) decided to conduct studies of IBD rates seen across the globe from the years 1990 to 2016. “Over the past 100 years, the incidence of IBD in western countries has climbed and then plateaued. Our research shows that countries outside the western world now appear to be in the first stage of this sequence,” said Dr. Kaplan.
Rates are climbing in newly industrialized countries
The researchers uncovered that the IBD rates in North America and in Europe were either stable or declining; however, in newly industrialized countries, rates were seen to be rising. A particular emphasis was put on countries in South America, Africa, and Asia. “IBD is a modern disease, growing in prevalence in North America, Europe and Australia since the 1950s.
As countries in Asia, South America and the Middle East have become industrialized, IBD has emerged and its incidence is rising dramatically. At the turn of the 21st century, it became a global disease” said Dr. Kaplan. In Brazil, IBD cases involving Crohn’s disease had risen by 11% annually and cases involving ulcerative colitis had risen by 15% annually.
In Taiwan, IBD cases involving Crohn’s disease had risen by 4% annually and cases involving ulcerative colitis had risen by 5%. “This rise in incidence over time creates a very important question for us to answer: ‘Will the incidence of IBD in newly industrialized countries mirror the progression of IBD in the Western world during the 20th century?’ If so, the implications for countries like China and India that have populations that exceed over a billion people, will be profound,” said Dr. Kaplan.
History repeats itself
“Our study shows that at the turn of the 21st Century, inflammatory bowel disease has become a global disease with accelerating incidence in newly industrialized countries whose societies have become more Westernized. We have shown an accelerating incidence in countries in Africa, Asia, the Middle East and South America that mirrors inflammatory bowel disease incidence in the Western world during the latter half of the 20th Century,” said Professor Subrata Ghosh, director of the United Kingdom's Institute of Translational Medicine.
“As newly industrialized countries become more westernized, we can clearly see that the incidence of IBD is also rapidly rising,” said professor Siew Ng from the Chinese University of Hong Kong. Professor Ng also believes the increased IBD rates outside the West suggest a “strong environmental influence within a genetically susceptible population.” That is, particular types of bowel disease are hereditary.
The researchers stated that they believe the IBD rates in newly industrialized countries have yet to reach their peak, as projections predict a global increase of IBD within the next decade. As IBD continues to remain a global concern, researchers are hopeful that an effective solution can be introduced to help develop new therapies to both prevent and treat the disease.
“Future research should focus on identifying environmental risk factors observed during the early stages of industrialization,” said Ng. Dr. Kaplan agreed with this statement, stating “research into environmental intervention that helps to prevent IBD should be prioritized.”
Newly industrialized countries must be prepared
“The peak in the incidence of this disease has likely not transpired in newly industrialized countries. Consequently, these countries will need to prepare their clinical infrastructure and personnel to manage what is a complex and costly disease to treat,” concluded Dr. Kaplan.