Rural Indian population at par with urban in inflammatory bowel disease: AIG Study 

The historic paper is world’s largest population-based study on IBD with 30,000 symptomatic patients Inflammatory Bowel Disease (IBD) is a chronic illness characterised by symptoms varying from bloody diarrhoea, weight loss, fever, fatigue and abdominal pain to anaemia, joint pain and skin problems among others. The incidence of IBD in India has been on an exponential increase over the past couple of decades, but it was mainly considered an urban disease like in the Western countries where the disease has been on an upward trend since the 1960s. It is worth noting that People with longstanding inflammatory bowel disease (IBD), particularly those with ulcerative colitis and Crohn's disease involving the colon, have an increased risk of developing colorectal cancer (CRC) compared to the general population.  “It is estimated that more than 15 lakh people in India are suffering from IBD but the true picture is not clear as we don’t have a large-scale, population-based epidemiological study to understand the exact incidence rate. In 2020, we started the Rural Outreach Program 2.0 (First in 2006) in Telangana with the intent to discover the true prevalence of IBD not just in rural places but also making IBD diagnosis/treatment accessible for people in these areas,” Dr D Nageshwar Reddy, Chairman, AIG Hospitals said.  Dr Reddy further added, “In three years, we covered more than 150 villages across Telangana touching approx. 1.75 lakh people. Data till 2022 has been published in the Lancet. The project is still ongoing.” “With the advent of globalisation, IBD made its entry into the developing world and today we are in a similar situation where the West was two decades back. The most problematic thing about the incidence of IBD especially in India is the age group that is getting affected and it is the active, working population between 20 – 40 years who are getting diagnosed more frequently,” Dr Rupa Banerjee, Director, IBD Center, AIG Hospitals and Principal Author of the study said.  Elaborating on the AIG Rural Outreach Program which has been instrumental in collecting the data for this mammoth study comprising more than 30,000 patients, Dr Banerjee further added, “With the help of the Hemsley Trust and Asian Healthcare Foundation, we are going from village to village across Telangana and setting up temporary medical camps either at a village school or panchayat office. Our epidemiology team visits every house as part of the door-to-door survey and collects data about gastrointestinal problems. Symptomatic people are then called to the camp for further evaluation including blood investigations, ultrasound, endoscopy or colonoscopy as required. All this is done for free and those who are diagnosed with IBD are called to the AIG Hospitals, Gachibowli, Hyderabad for free treatment as well.”  “The study published in the prestigious Lancet journal is a testament to the quality of data that we have been able to produce and prove that IBD is no longer an urban disease rather it is slowly cementing its place in the rural household as well. From our initial survey in 2006, the incidence of IBD in rural areas was just 0.1 per cent and now it stands at 5.1 per cent, which is alarming,” Dr Reddy added.  “We are constantly deliberating on the probable cause of this increased incidence and can say with a fair amount of certainty that a multitude of factors are involved. First, with increased urbanisation even in rural areas, dietary habits changed. We can now easily find processed food items in villages. Secondly, the adoption of the Western lifestyle too has contributed to a trivial Western toilet seat replacing the conventional Indian-style seats which were more favourable to our human anatomy. Third, C-section deliveries coupled with a lack of breastfeeding for the first six months after childbirth devoid the child of the essential gut microflora. Fourth, excessive use of antibiotics during neonatal stage which again kills the gut bacteria. All these factors in culmination are responsible for not just increased incidence of IBD but we are seeing the same for another lifestyle disease like Diabetes, Fatty Liver, Cardiovascular Diseases as well,” Dr Reddy said.  Dr D Nageshwar Reddy made a four-point appeal to the government as an immediate measure to curb the menace of such diseases, especially in the rural areas where we have an opportunity to halt the incidence before it takes up the shape of an epidemic.  The suggestions are as below:  Increase awareness about lifestyle diseases in rural areas in regional languages and at PHC levels

1. Bring regulation on ultra-processed food
2. Focus on diet and exercise for the rural population too
3. Constant monitoring of the rural population is required

AIG Hospitals’ study on GI diseases affecting the rural population is ongoing and plans to include public awareness into the program collaborating with village PHCs and schools.