Hyderabad’s AIG study in Lancet claims ‘urban’ IBD now affecting rural population too

Hyderabad: A scientific paper on the world’s largest population-based study on Inflammatory Bowel Disease (IBD) involving 30,000 symptomatic patients from India, was published in the prestigious Lancet medical journal.

This was a significant achievement of the Hyderabad-based Asian Institute of Gastroenterology (AIG) which pioneered the study, which showed that IBD is equally prevalent among rural and urban Indian populations.

What is IBD?

IBD is a chronic illness characterised by symptoms varying from diarrhoea with blood, 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.

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.

Around 15 lakh Indians suffer from IBD

“It is estimated that more than 15 lakh people in India are suffering from IBD but we don’t have a large-scale, population-based epidemiological study to understand the exact incidence rate. In 2020, we started the Rural Outreach Programme 2.0 (the first one was in 2006) in Telangana with the intent to discover the true prevalence of IBD not only in rural areas but also make IBD diagnosis and treatment accessible for people in these areas,” said Dr D Nageshwar Reddy, chairman of AIG Hospitals. He added, “In three years, we covered more than 150 villages across Telangana touching approximately 1.75 lakh people. Data till 2022 has been published in the Lancet. The project is still ongoing.”

“The study published in the prestigious Lancet journal is a testament to the quality of data that we have been able to produce to prove that IBD is no longer an urban disease, but it is slowly spreading to rural households as well. From our initial survey in 2006, the incidence of IBD in rural areas was just 0.1% and now it stands at 5.1%, which is alarming,” Dr Reddy added.

IBD affects active, working populations more

Dr Rupa Banerjee, director of IBD Centre, AIG Hospitals and principal author of the study said, “The most problematic thing about the incidence of IBD especially in India is the age group that is getting affected. It is the active, working population between 20 and 40 years who are getting diagnosed more frequently.”

Elaborating on the AIG Rural Outreach Programme, 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 across villages in Telangana and setting up temporary medical camps either at a village school or at the panchayat office. Our epidemiology team visits every house as part of the door-to-door survey and collects data about gastrointestinal problems. People who are symptomatic 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, for free treatment as well.”

IBD fast spreading to rural areas

“We are constantly deliberating on the probable cause of this increased incidence and can say that a multitude of factors are involved. First, with increased urbanisation even in rural areas, dietary habits have changed. We can now easily find processed food items in villages. Second, the adoption of western toilet seats replacing the conventional Indian-style seats is also a cause, as the latter are more favourable for our anatomy. Thirdly, C-section deliveries coupled with a lack of breastfeeding for the first six months after childbirth caused a lack of essential gut microflora in the child. Fourthly, excessive use of antibiotics during the neonatal stage kills the gut bacteria. All these factors are responsible for not just increased incidences of IBD but also for other lifestyle diseases like diabetes, fatty liver, cardiovascular diseases etc,” Dr Reddy explained.

Ways to curb the disease in rural areas

Dr 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 before they spread like an epidemic. The suggestions include an increase in awareness about lifestyle diseases in rural areas in regional languages and at Primary Health Centres (PHC) levels, bringing regulation on ultra-processed food, focussing on diet and exercise for the rural population and constant monitoring of the rural population.

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