Epidemiology of Inflammatory Bowel Disease in India: The Great Shift East

Kedia, Saurabh; Ahuja, Vineet

doi:10.1159/000465522

Cited by 165Inflammatory Bowel DiseaseOcular Diseases and Behçet’s SyndromeGut microbiota and health

Epidemiology of Inflammatory Bowel Disease in India: The Great Shift East

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Kedia, Saurabh, Ahuja, Vineet·2017·Inflammatory Intestinal Diseases

DOI 10.1159/000465522PMC PMC5988149

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Abstract

Background: Inflammatory bowel disease (IBD), once considered to be a Western disease, is increasingly being reported from India and other Asian countries. The present review summarizes epidemiology and disease characteristics of IBD in India with reference to other Asian countries and the West. Summary: India is projected to have one of the highest disease burden of IBD across the globe. The overall genetic risk and microbial signature in Indian IBD patients are similar to those of patients in the West as demonstrated by the similar incidence of IBD in second-generation Indian immigrants and matching perturbations in the structural and functional component of gut microbiota in Indian studies. The concept of the hygiene hypothesis continues to remain controversial with Indian studies demonstrating contradictory findings. The disease characteristics, long-term outcomes including the risk of colorectal cancer, and the effect of pregnancy on IBD and vice versa in Indian patients with IBD are in general similar with few differences. Unlike patients in the West, very few Indian patients have a positive family history. Key Message: The Indian disease pattern is going through a phase of epidemiological transition with a surge in the incidence of IBD. The epidemiology and disease characteristics of IBD mirror the patterns observed in the West.

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Published incidence figures from some areas of Brazil, China and India are near the Western-world Coalescing Incidence Range, such as 6-11 per 100,000 for ulcerative colitis.
“For example, some regions in Brazil, China and India already have published incidence values that are close to the Coalescing Incidence Range (for example, 6–11 per 100,000 for ulcerative colitis) in the Western world4,49,53,57.”
From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [57]
If IBD prevalence follows a similar trend in India and China, Asia alone might surpass the Western world in IBD cases before 2050.
“If the prevalence of IBD follows a similar trend in regions such as India and China with populations of more than one billion people57,89, Asia alone might have more cases of IBD than the Western world before 2050 (ref.1).”
From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [57]

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Low hygiene and exposure to infections may be associated with increased risk for ulcerative colitis in a North Indian population.
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Role of Tumor Necrosis Factor-Alpha (C-863A) Polymorphism in Pathogenesis of Inflammatory Bowel Disease in Northern India
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Short- and Long-Term Outcomes of Acute Severe Ulcerative Colitis in Korea
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Long‐term follow‐up reveals high incidence of colorectal cancer in Indian patients with inflammatory bowel disease
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Familial aggregation of inflammatory bowel disease in patients with ulcerative colitis
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Cigarette smoking adversely affects disease activity and disease-specific quality of life in patients with Crohn’s disease at a tertiary referral center
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Short-Term Clinical Response to Corticosteroids Can Predict Long-Term Natural History of Ulcerative Colitis: Prospective Study Experience
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Detection of single‐nucleotide polymorphisms in the intron 9 region of the nucleotide oligomerization domain‐1 gene in ulcerative colitis patients of North India
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Ulcerative colitis
Kobayashi, T., Siegmund, B., Berre, C. L., Wei, S. C., Ferrante, M., Shen, B., Bernstein, C. N., Danese, S., Peyrin‐Biroulet, L., & Hibi∥, T. (2020) · Nature Reviews Disease Primers · doi:10.1038/s41572-020-0205-x · Cited by 1,744 · see citing works
The four epidemiological stages in the global evolution of inflammatory bowel disease
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Incidence and Prevalence of Inflammatory Bowel Disease across Asia
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Anti-inflammatory Bifidobacterium strains prevent dextran sodium sulfate induced colitis and associated gut microbial dysbiosis in mice
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Early management of acute severe UC in the biologics era: development and international validation of a prognostic clinical index to predict steroid response
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The global, regional, and national burden of inflammatory bowel diseases, 1990–2019: A systematic analysis for the global burden of disease study 2019
Park, J., Jeong, G. H., Song, M., Yon, D. K., Lee, S. W., Koyanagi, A., Jacob, L., Kostev, K., Dragioti, E., Raduà, J., et al. (2023) · Digestive and Liver Disease · doi:10.1016/j.dld.2023.04.003 · Cited by 76 · see citing works
Mechanism-Based Treatment Strategies for IBD: Cytokines, Cell Adhesion Molecules, JAK Inhibitors, Gut Flora, and More
Schreiner, P., Neurath, M. F., Ng, S. C., El-Omar, E. M., Sharara, A. I., Kobayashi, T., Hisamatsu, T., Hibi∥, T., & Rogler, G. (2019) · Inflammatory Intestinal Diseases · doi:10.1159/000500721 · Cited by 75 · see citing works
Controlled release of sulfasalazine loaded amidated pectin microparticles through Eudragit S 100 coated capsule for management of inflammatory bowel disease
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Diagnostic yield and therapeutic impact of novel motorized spiral enteroscopy in small-bowel disorders: a single-center, real-world experience from a tertiary care hospital (with video)
Ramchandani, M. J., Rughwani, H., Inavolu, P., Singh, A. P., Tevethia, H. V., Jagtap, N., Sekaran, A., Kanakagiri, H., Darishetty, S., & Reddy, D. N. (2020) · Gastrointestinal Endoscopy · doi:10.1016/j.gie.2020.07.001 · Cited by 67 · see citing works
Stevioside, a diterpenoid glycoside, shows anti-inflammatory property against Dextran Sulphate Sodium-induced ulcerative colitis in mice
Alavala, S., Sangaraju, R., Nalban, N., Sahu, B. D., Jerald, M. K., Kilari, E. K., & Sistla, R. (2019) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2019.05.015 · Cited by 60 · see citing works
A synbiotic combination of Bifidobacterium longum Bif10 and Bifidobacterium breve Bif11, isomaltooligosaccharides and finger millet arabinoxylan prevents dextran sodium sulphate induced ulcerative colitis in mice
Sharma, S., Bhatia, R., Devi, K., Rawat, A., Singh, S., Bhadada, S. K., Bishnoi, M., Sharma, S. S., & Kondepudi, K. K. (2023) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2023.123326 · Cited by 57 · see citing works
Disease burden of inflammatory bowel disease in China from 1990 to 2017: Findings from the global burden of diseases 2017
Qiu, Y., Ren, W., Liu, Y., Chen, W.-E., Pan, X., & Ren, J. (2020) · EClinicalMedicine · doi:10.1016/j.eclinm.2020.100544 · Cited by 54 · see citing works
Role of a probiotic strain in the modulation of gut microbiota and cytokines in inflammatory bowel disease
Bamola, V. D., Dubey, D., Samanta, P., Kedia, S., Ahuja, V., Madempudi, R. S., Neelamraju, J., & Chaudhry, R. (2022) · Anaerobe · doi:10.1016/j.anaerobe.2022.102652 · Cited by 53 · see citing works
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Global burden of inflammatory bowel disease 1990-2019: A systematic examination of the disease burden and twenty-year forecast
Li, C., Wang, Y., Zhang, S.-M., Ren, M., & He, S. (2023) · World Journal of Gastroenterology · doi:10.3748/wjg.v29.i42.5751 · Cited by 51 · see citing works
Antitubercular Therapy Given to Differentiate Crohn’s Disease From Intestinal Tuberculosis Predisposes to Stricture Formation
Gupta, A., Mouli, V. P., Mohta, S., Kante, B., Kalaivani, M., Madhu, D., Sahu, P., Kumar, S., Sharma, R., ‎Sahni, P., et al. (2020) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjaa091 · Cited by 45 · see citing works
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The role of dietary polyphenols in inflammatory bowel disease: A possible clue on the molecular mechanisms involved in the prevention of immune and inflammatory reactions
Arya, V. S., Kanthlal, S. K., & Linda, G. (2020) · Journal of Food Biochemistry · doi:10.1111/jfbc.13369 · Cited by 42 · see citing works
Alginate-based drug carrier systems to target inflammatory bowel disease: A review
Swastha, D., Varsha, N., Aravind, S., Samyuktha, K. B., Yokesh, M. M., Balde, A., Ayilya, B. L., Benjakul, S., Kim, S., & Nazeer, R. A. (2023) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2023.125472 · Cited by 41 · see citing works
Impact of dietary beliefs and practices on patients with inflammatory bowel disease: An observational study from India
Tomar, S. K., Kedia, S., Upadhyay, A. D., Bopanna, S., Yadav, D. P., Goyal, S., Jain, S., Makharia, G. K., Ahuja, V., & Singh, N. (2017) · JGH Open · doi:10.1002/jgh3.12002 · Cited by 41 · see citing works
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Colitis and Crohn’s Foundation (India): a first nationwide inflammatory bowel disease registry
Sood, A., Kaur, K., Mahajan, R., Midha, V., Singh, A., Sharma, S., Puri, A. S., Goswami, B., Desai, D., Pai, C. G., et al. (2020) · Intestinal Research · doi:10.5217/ir.2019.09169 · Cited by 42 · see citing works
Gut microbiome dysbiosis in inflammatory bowel disease
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Emerging inflammatory bowel disease demographics, phenotype, and treatment in South Asia, South‐East Asia, and Middle East: Preliminary findings from the Inflammatory Bowel Disease‐Emerging Nations' Consortium
Banerjee, R., Pal, P., Hilmi, I. N., Ghoshal, U. C., Desai, D., Rahman, M. M., Dutta, U., Mohiuddin, S., Mohanadi, M. A., Philip, M., et al. (2022) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.15801 · Cited by 39 · see citing works
Effectiveness and safety of adalimumab biosimilar in inflammatory bowel disease: A multicenter study
Kamat, N., Kedia, S., Ghoshal, U. C., Nehra, A., Makharia, G. K., Sood, A., Midha, V., Gupta, V., Choudhuri, G., & Ahuja, V. (2019) · Indian Journal of Gastroenterology · doi:10.1007/s12664-018-0922-1 · Cited by 36 · see citing works
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Anti‐inflammatory effects of eriocitrin against the dextran sulfate sodium–induced experimental colitis in murine model
Guo, G., Shi, W., Shi, F., Gong, W., Li, F., Zhou, G., & She, J. (2019) · Journal of Biochemical and Molecular Toxicology · doi:10.1002/jbt.22400 · Cited by 36 · see citing works
Endocrine disruption in Crohn’s disease: Bisphenol A enhances systemic inflammatory response in patients with gut barrier translocation of dysbiotic microbiota products
Linares, R., Fernández, M. F., Gutiérrez, A., Garcı́a-Villalba, R., Suárez, B., Zapater, P., Martínez-Blázquez, J. A., Caparrós, E., Tomás-Barberán, F. A., & Francés, R. (2021) · The FASEB Journal · doi:10.1096/fj.202100481r · Cited by 37 · see citing works
Colon-Adhering Delivery System with Inflammation Responsiveness for Localized Therapy of Experimental Colitis
Kumar, A., Kanika, Kumar, V., Ahmad, A., Mishra, R. K., Nadeem, A., Siddiqui, N. M., Ansari, M. M., Raza, S. S., Kondepudi, K. K., et al. (2023) · ACS Biomaterials Science & Engineering · doi:10.1021/acsbiomaterials.3c00480 · Cited by 33 · see citing works
Exploring Links Between Industrialization, Urbanization, and Chinese Inflammatory Bowel Disease
Cui, G., Liu, H., Xu, G., Laugsand, J.-B., & Pang, Z. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.757025 · Cited by 34 · see citing works
Development of modified apple polysaccharide capped silver nanoparticles loaded with mesalamine for effective treatment of ulcerative colitis
Kaur, G., Singh, S. K., Kumar, R., Kumar, B., Kumari, Y., Gulati, M., Pandey, N. K., Gowthamarajan, K., Ghosh, D., Clarisse, A., et al. (2020) · Journal of Drug Delivery Science and Technology · doi:10.1016/j.jddst.2020.101980 · Cited by 32 · see citing works
From west to east: dissecting the global shift in inflammatory bowel disease burden and projecting future scenarios
Yang, K., Zhang, C., Gong, R., Jiang, W. B., Ding, Y., Yu, Y., Chen, J., Zhu, M., Zuo, J., Huang, X., et al. (2025) · BMC Public Health · doi:10.1186/s12889-025-24009-z · Cited by 31 · see citing works
Paediatric inflammatory bowel disease in India: a prospective multicentre study
Srivastava, A., Sathiasekharan, M., Jagadisan, B., Bolia, R. K., Peethambaran, M., Mammayil, G., Acharya, B., Malik, R., Sankaranarayanan, S., Biradar, V., et al. (2020) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000001859 · Cited by 29 · see citing works
Zn-dipicolylamine-based reactive oxygen species-responsive lipids for siRNA delivery and in vivo colitis treatment
Guo, Y. C., He, X., Zhao, R.-M., Yang, H., Huang, Z., Zhang, J., & Yu, X. (2022) · Acta Biomaterialia · doi:10.1016/j.actbio.2022.04.033 · Cited by 28 · see citing works
Unravelling of nitric oxide signalling: A potential biomarker with multifaceted complex mechanism associated with canine inflammatory bowel disease (IBD)
Rana, T. (2020) · Anaerobe · doi:10.1016/j.anaerobe.2020.102288 · Cited by 27 · see citing works
What Are the Different Phenotypes of Inflammatory Bowel Disease in Asia?
Park, S. B., Yoon, J. Y., & Cha, J. M. (2022) · Gut and Liver · doi:10.5009/gnl210385 · Cited by 28 · see citing works
Familial aggregation of inflammatory bowel disease in India: prevalence, risks and impact on disease behavior
Banerjee, R., Pal, P., Hutfless, S. M., Ganesh, B. G., & Reddy, D. N. (2019) · Intestinal Research · doi:10.5217/ir.2018.00174 · Cited by 25 · see citing works
Application of chitosan as nano carrier in the treatment of inflammatory bowel disease
Liu, X., Dong, Y., Wang, C., & Guo, Z. (2024) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2024.134899 · Cited by 24 · see citing works
IBD in India
Banerjee, R., Pal, P., Nugent, Z. J., Ganesh, G., Adigopula, B., Pendyala, S., & Bernstein, C. N. (2019) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000001282 · Cited by 23 · see citing works
Inflammatory bowel disease (IBD) in rural and urban India: results from community colonoscopic evaluation of more than 30,000 symptomatic patients
Banerjee, R., Pal, P., Patel, R., Godbole, S., Komawar, A., Mudigonda, S., Akki, Y., Gaddam, A., Pasula, N. P., Joseph, S., et al. (2023) · The Lancet Regional Health - Southeast Asia · doi:10.1016/j.lansea.2023.100259 · Cited by 23 · see citing works
Combination of increased visceral fat and long segment involvement: Development and validation of an updated imaging marker for differentiating Crohn's disease from intestinal tuberculosis
Kedia, S., Madhusudhan, K. S., Sharma, R., Bopanna, S., Yadav, D. P., Goyal, S., Jain, S., Das, P., DATTAGUPTA, S., Makharia, G. K., et al. (2017) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.14065 · Cited by 23 · see citing works
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Inflammatory bowel disease
Jain, M., & Venkataraman, J. (2021) · The Indian Journal of Medical Research · doi:10.4103/ijmr.ijmr_936_18 · Cited by 23 · see citing works
Antibacterial potential of ellagic acid and gallic acid against IBD bacterial isolates and cytotoxicity against colorectal cancer
Cota, D. L., & Patil, D. (2022) · Natural Product Research · doi:10.1080/14786419.2022.2111560 · Cited by 22 · see citing works
Crohn’s Disease Among the Poorest Billion: Burden of Crohn’s Disease in Low- and Lower-Middle-Income Countries
Rajbhandari, R., Blakemore, S., Gupta, N., Mannan, S. M., Nikolli, K., Yih, A., Drown, L., & Bukhman, G. (2022) · Digestive Diseases and Sciences · doi:10.1007/s10620-022-07675-6 · Cited by 22 · see citing works
Is the emergence of inflammatory bowel disease a prime example of “the third epidemiological transition”?
Kedia, S., & Ahuja, V. (2018) · Indian Journal of Gastroenterology · doi:10.1007/s12664-018-0852-y · Cited by 22 · see citing works
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Addressing unmet needs from a new frontier of IBD: the South Asian IBD Alliance
Aswani-Omprakash, T., Sharma, V., Bishu, S., Balasubramaniam, M., Bhatia, S., Nandi, N., Shah, N. D., Deepak, P., & Sebastian, S. (2021) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(21)00336-8 · Cited by 21 · see citing works
The relationship between inflammatory bowel disease and Helicobacter pylori across East Asian, European and Mediterranean countries: a meta-analysis
Imawana, R. A. (2020) · Annals of Gastroenterology · doi:10.20524/aog.2020.0507 · Cited by 20 · see citing works
Rapidly changing epidemiology of inflammatory bowel disease: Time to gear up for the challenge before it is too late
Desai, D., & Dhoble, P. (2023) · Indian Journal of Gastroenterology · doi:10.1007/s12664-023-01453-6 · Cited by 20 · see citing works
Inflammatory bowel disease in south Asia: a scoping review
Shenoy, S., Jena, A., Levinson, C., Sharma, V., Deepak, P., Aswani-Omprakash, T., Sebastian, S., Colombel, J., & Agrawal, M. (2025) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(24)00341-8 · Cited by 19 · see citing works
Trends of inflammatory bowel disease at a tertiary care center in northern India
Sood, A., Kaur, K., Singh, A., Midha, V., Mahajan, R., Bansal, N., Mehta, V., & Singh, D. (2020) · Intestinal Research · doi:10.5217/ir.2020.00010 · Cited by 19 · see citing works
Efficacy and Safety of Fecal Transplantation Versus Targeted Therapies in Ulcerative Colitis: Network Meta-Analysis
Vuyyuru, S. K., Kedia, S., Kalaivani, M., Sahu, P., Kante, B., Kumar, P., Ranjan, M. K., Makharia, G. K., Ananthakrishnan, A. N., & Ahuja, V. (2021) · Future Microbiology · doi:10.2217/fmb-2020-0242 · Cited by 19 · see citing works
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Authors: Kedia, S., & Ahuja, V.
Affiliations: All India Institute of Medical Sciences (IN)
ORCID: Kedia, Saurabh
Ahuja, Vineet
Venue: Inflammatory Intestinal Diseases
Publisher: S. Karger AG
Published: 2017
Volume: 2
Issue: 2
Pages: 102-115
ISSN: 2296-9365 (ISSN-L)
2296-9403
DOI: 10.1159/000465522
PMC: PMC5988149
OpenAlex: W2604483966
Cited by: 165
References: 103
Citations by year: 2026: 13 · 2025: 12 · 2024: 16 · 2023: 29 · 2022: 26 · 2021: 19 · 2020: 29 · 2019: 13 · 2018: 5 · 2017: 3
FWCI: 9.05
Type: journal article
Language: en
Open access: gold
doi.org
Licence: www.karger.com/Services/SiteLicenses (vor)
www.karger.com/Services/SiteLicenses (tdm)
Locations: Inflammatory Intestinal Diseases (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Keywords: inflammatory bowel disease, IBD epidemiology, India, Asian countries, Westernization, hygiene hypothesis, gut microbiota, genetic risk, IBD incidence, immigrant children, colorectal cancer risk, family history (medicine), disease burden

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Epidemiology of Inflammatory Bowel Disease in India: The Great Shift East

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