Global Rise of IBD Should Prompt Changes in Care
- Once considered a disease of Western countries, inflammatory bowel disease (IBD) is now global
- The incidence of IBD has plateaued in Western countries but is rising sharply in newly industrialized countries in Asia and Latin America
- With no cure and relatively low mortality, the prevalence of IBD continues to increase in the West despite stabilization of incidence
- Addressing the future burden of IBD require a two-pronged strategy of modulating environmental risk factors and making therapies and diagnostics more accessible in newly industrialized countries
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Once considered a disease of Western countries, inflammatory bowel disease (IBD) is now global. Striking changes in its incidence and prevalence have broad implications for everything from understanding its pathogenesis to coping with greater demand on the health care system as patients with IBD age.
In Clinical Gastroenterology and Hepatology, Ashwin N. Ananthakrishnan, MBBS, MPH, director of the Crohn's and Colitis Center at Massachusetts General Hospital, and colleagues review trends in the epidemiology of IBD and how its future burden on health care systems might be allayed.
Incidence of IBD
The epidemiologic patterns of IBD differ by region. In Western countries, the incidence of IBD began rising steadily after World War II. At the turn of the 21st century, though, countries began reporting stabilization and even decreases of incidence. Although sporadic increases are still reported in some places, the overall incidence of IBD seems to have plateaued at 40–50 per 100,000 person-years.
In newly industrialized countries in Asia and Latin America, IBD was sparsely reported in the 20th century, but the incidence has been rising sharply since the turn of the century.
Compounding Prevalence Implications
With no cure and relatively low mortality, the prevalence of IBD continues to increase in the West despite the stabilization of incidence. If this epidemiological phenomenon, termed "compounding prevalence," occurs in newly industrialized countries, the number of people with IBD could spike to tens of millions of people.
Meanwhile, older adults represent the fasting growing demographic with IBD in Western countries, which will intensify the complexities of care.
To address the future global burden of disease, the IBD community should:
- Optimize diagnostics to permit recognition of disease before irreversible bowel damage occurs—this is especially important for low-incidence countries where competing diagnoses such as tuberculosis are more common
- Move toward replacing incremental step-up treatment with definitive treatment early in the disease course—particularly in countries where lifelong biologic therapy is impractical
- Develop less expensive, safer therapies that have more sustained benefit
- Develop simple, inexpensive tools for monitoring disease activity
- Validate interventions for primary and secondary disease prevention—particularly in high-risk individuals
A number of modifiable environmental exposures might alleviate the growing burden of IBD by reducing its incidence or changing its course. Exclusion diets are a prominent example, and the results of additional randomized, controlled trials are eagerly awaited.
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