Background: South Asians have been recently identified as having rapidly rising incidence of inflammatory bowel disease (IBD). There is a paucity of data regarding the phenotypic and genotypic associations of IBD among the patients of this region. Due to the rising disease prevalence, a study on South Asian population can disclose more information about the etiopathogenetic causes of the disease. Methods: Here we did a review article of IBD among South Asians. In order to get a correct sense of factors associated with the disease, we have reviewed approximately 150 articles through the PubMed search and google scholar. Results: We attempted to find temporal trends of IBD among south Asian population, compared phenotype and genotype of IBD among South Asians and western patients and looked at the patterns of IBD presentation in different countries of South Asia. We have also reviewed the differences in the incidence of IBD among South Asian immigrants and discussed the treatment challenges of IBD among this special population. Conclusion: We identified that both patients in South Asia as well as South Asian patients living in Western countries are at greater risk for all types of IBD. This geographical region provides an opportunity for revealing possible etiopathogenetic factors. Further population-based studies, comparison of studies in South Asians and immigrants from South Asian countries, and large-scale biologic treatment models need to be accelerated to control the disease burden in South Asians, as well as to achieve reduced burden globally.
KeywordsInflammatory Bowel DiseaseSouth AsiansPhenotype and Genotype
Ananthakrishnan, A.N. (2013) Environmental Triggers for Inflammatory Bowel Disease. Current Gastroenterology Reports, 15, 302. https://doi.org/10.1007/s11894-012-0302-4
Carr, I. and Mayberry, J.F. (1999) The Effects of Migration on Ulcerative Colitis: A Three-Year Prospective Study among Europeans and First- and Second-Generation South Asians in Leicester (1991-1994). The American Journal of Gastroenterology, 94, 2918-2922. https://doi.org/10.1111/j.1572-0241.1999.01438.x
Tsironi, E., Feakins, R.M., Probert, C.S., et al. (2004) Incidence of Inflammatory Bowel Disease Is Rising and Abdominal Tuberculosis Is Falling in Bangladeshis in East London, United Kingdom. The American Journal of Gastroenterology, 99, 1749-1755. https://doi.org/10.1111/j.1572-0241.2004.30445.x
Pinsk, V., Lemberg, D.A., Grewal, K., et al. (2007) Inflammatory Bowel Disease in the South Asian Pediatric Population of British Columbia. The American Journal of Gastroenterology, 102, 1077-1083. https://doi.org/10.1111/j.1572-0241.2007.01124.x
Danese, S. and Fiocchi, C. (2006) Etiopathogenesis of Inflammatory Bowel Diseases. World Journal of Gastroenterology, 12, 4807-4812. https://doi.org/10.3748/wjg.v12.i30.4807
de Souza, H.S.P. (2017) Etiopathogenesis of Inflammatory Bowel Disease: Today and Tomorrow. Current Opinion in Gastroenterology, 33, 222-229. https://doi.org/10.1097/MOG.0000000000000364
Aleksandrova, K., Romero-Mosquera, B. and Hernandez, V. (2017) Diet, Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention. Nutrients, 9, 962. https://doi.org/10.3390/nu9090962
Ng, S.C., Shi, H.Y., Hamidi, N., et al. (2017) Worldwide Incidence and Prevalence of Inflammatory Bowel Disease in the 21st Century: A Systematic Review of Population-Based Studies. The Lancet, 390, 2769-2778. https://doi.org/10.1016/S0140-6736(17)32448-0
M’Koma, A.E. (2013) Inflammatory Bowel Disease: An Expanding Global Health Problem. Clinical Medicine Insights: Gastroenterology, 6, 33-47. https://doi.org/10.4137/CGast.S12731
Mak, W.Y., Zhao, M., Ng, S.C., et al. (2020) The Epidemiology of Inflammatory Bowel Disease: East Meets West. Journal of Gastroenterology and Hepatology, 35, 380-389. https://doi.org/10.1111/jgh.14872
Goh, K. and Xiao, S.D. (2009) Inflammatory Bowel Disease: A Survey of the Epidemiology in Asia. Journal of Digestive Diseases, 10, 1-6. https://doi.org/10.1111/j.1751-2980.2008.00355.x
Kedia, S. and Ahuja, V. (2017) Epidemiology of Inflammatory Bowel Disease in India: The Great Shift East. Inflammatory Intestinal Diseases, 2, 102-115. https://doi.org/10.1159/000465522
Probert, C.S., Mayberry, J.F. and Mann, R. (1990) Inflammatory Bowel Disease in the Rural Indian Subcontinent: A Survey of Patients Attending Mission Hospitals. Digestion, 47, 42-46. https://doi.org/10.1159/000200475
Sood, A., Midha, V., Sood, N., et al. (2003) Incidence and Prevalence of Ulcerative Colitis in Punjab, North India. Gut, 52, 1587-1590. https://doi.org/10.1136/gut.52.11.1587
Das, K., Ghoshal, U.C., Dhali, G.K., et al. (2009) Crohn’s Disease in India: A Multicenter Study from a Country Where Tuberculosis Is Endemic. Digestive Diseases and Sciences, 54, 1099-1107. https://doi.org/10.1007/s10620-008-0469-6
Niriella, M.A., De Silva, A.P., Dayaratne, A.H., et al. (2010) Prevalence of Inflammatory Bowel Disease in Two Districts of Sri Lanka: A Hospital Based Survey. BMC Gastroenterology, 10, 32. https://doi.org/10.1186/1471-230X-10-32
Niriella, M.A., Liyanage, I.K., Kodisinghe, S.K., et al. (2021) Changing Phenotype, Early Clinical Course and Clinical Predictors of Inflammatory Bowel Disease in Sri Lanka: A Retrospective, Tertiary Care-Based, Multi-Centre Study. BMC Gastroenterology, 21, 71. https://doi.org/10.1186/s12876-021-01644-5
Karki, S., Karak, A.K., Sinha, A.K., et al. (2009) Crohn Disease in Nepal: True Rarity or Gross Underdiagnosis? BMJ Case Reports, 2009, bcr10.2008.1117. https://doi.org/10.1136/bcr.10.2008.1117
Alam, M.N., Islam, N. and Shamsuddin, M. (1975) Ulcerative Colitis in Bangladesh. Bangladesh Medical Research Council Bulletin, 1, 103-109.
Qureshi, M. and Abbas, Z. (2015) Clinical Presentation of Ulcerative Colitis in Pakistani Adults. Euroasian Journal of Hepato-Gastroenterology, 5, 127-130. https://doi.org/10.5005/jp-journals-10018-1151
Makharia ,G.K., Ramakrishna, B.S., Abraham, P., et al. (2012) Survey of Inflammatory Bowel Diseases in India. Indian Journal of Gastroenterology, 31, 299-306. https://doi.org/10.1007/s12664-012-0258-1
Banerjee, R., Pal, P., Nugent, Z., et al. (2020) IBD in India: Similar Phenotype but Different Demographics than the West. Journal of Clinical Gastroenterology, 54, 725-732. https://doi.org/10.1097/MCG.0000000000001282
Loftus, E.V. (2004) Clinical Epidemiology of Inflammatory Bowel Disease: Incidence, Prevalence, and Environmental Influences. Gastroenterology, 126, 1504-1517. https://doi.org/10.1053/j.gastro.2004.01.063
Loftus, C.G., Loftus, E.V., Harmsen, W.S., et al. (2007) Update on the Incidence and Prevalence of Crohn’s Disease and Ulcerative Colitis in Olmsted County, Minnesota, 1940-2000. Inflammatory Bowel Diseases, 13, 254-261. https://doi.org/10.1002/ibd.20029
Langholz, E., Munkholm, P., Nielsen, O.H., et al. (1991) Incidence and Prevalence of Ulcerative Colitis in Copenhagen County from 1962 to 1987. Scandinavian Journal of Gastroenterology, 26, 1247-1256. https://doi.org/10.3109/00365529108998621
Ng, S.C., Tang, W., Ching, J.Y., et al. (2013) Incidence and Phenotype of Inflammatory Bowel Disease Based on Results from the Asia-Pacific Crohn’s and Colitis Epidemiology Study. Gastroenterology, 145, 158-165.e2. https://doi.org/10.1053/j.gastro.2013.04.007
Kalaria, R., Desai, D., Abraham, P., et al. (2016) Temporal Change in Phenotypic Behaviour in Patients with Crohn’s Disease: Do Indian Patients Behave Differently from Western and Other Asian Patients? Journal of Crohn’s and Colitis, 10, 255-261. https://doi.org/10.1093/ecco-jcc/jjv202
Pugazhendhi, S., Sahu, M.K., Subramanian, V., et al. (2011) Environmental Factors Associated with Crohn’s Disease in India. Indian Journal of Gastroenterology, 30, 264-269. https://doi.org/10.1007/s12664-011-0145-1
Gaya, D.R., Russell, R.K., Nimmo, E.R., et al. (2006) New Genes in Inflammatory Bowel Disease: Lessons for Complex Diseases? The Lancet, 367, 1271-1284. https://doi.org/10.1016/S0140-6736(06)68345-1
Juyal, G., Prasad, P., Senapati, S., et al. (2011) An Investigation of Genome-Wide Studies Reported Susceptibility Loci for Ulcerative Colitis Shows Limited Replication in North Indians. PLOS ONE, 6, e16565. https://doi.org/10.1371/journal.pone.0016565
Pugazhendhi, S., Santhanam, S., Venkataraman, J., et al. (2013) NOD2 Gene Mutations Associate Weakly with Ulcerative Colitis but Not with Crohn’s Disease in Indian Patients with Inflammatory Bowel Disease. Gene, 512, 309-313. https://doi.org/10.1016/j.gene.2012.10.015
Pugazhendhi, S., Amte, A., Balamurugan, R., et al. (2008) Common NOD2 Mutations Are Absent in Patients with Crohn’s Disease in India. Indian Journal of Gastroenterology, 27, 201-203.
Mahurkar, S., Banerjee, R., Rani, V.S., et al. (2011) Common Variants in NOD2 and IL23R Are Not Associated with Inflammatory Bowel Disease in Indians. Journal of Gastroenterology and Hepatology, 26, 694-699. https://doi.org/10.1111/j.1440-1746.2010.06533.x
Juyal, G., Amre, D., Midha, V., et al. (2007) Evidence of Allelic Heterogeneity for Associations between the NOD2/CARD15 Gene and Ulcerative Colitis among North Indians. Alimentary Pharmacology & Therapeutics, 26, 1325-1332. https://doi.org/10.1111/j.1365-2036.2007.03524.x
Juyal, G., Midha, V., Amre, D., et al. (2009) Associations between Common Variants in the MDR1 (ABCB1) Gene and Ulcerative Colitis among North Indians. Pharmacogenet Genomics, 19, 77-85. https://doi.org/10.1097/FPC.0b013e32831a9abe
Ahirwar, D.K., Kesarwani, P., Singh, R., et al. (2012) Role of Tumor Necrosis Factor-Alpha (C-863A) Polymorphism in Pathogenesis of Inflammatory Bowel Disease in Northern India. Journal of Gastrointestinal Cancer, 43, 196-204. https://doi.org/10.1007/s12029-010-9238-9
Tamang, R., Singh, L. and Thangaraj, K. (2012) Complex Genetic Origin of Indian Populations and Its Implications. Journal of Biosciences, 37, 911-919. https://doi.org/10.1007/s12038-012-9256-9
Baskaran, K., Pugazhendhi, S. and Ramakrishna, B.S. (2014) Protective Association of Tumor Necrosis Factor Superfamily 15 (TNFSF15) Polymorphic Haplotype with Ulcerative Colitis and Crohn’s Disease in an Indian Population. PLOS ONE, 9, e114665. https://doi.org/10.1371/journal.pone.0114665
Yamazaki, K., McGovern, D., Ragoussis, J., et al. (2005) Single Nucleotide Polymorphisms in TNFSF15 Confer Susceptibility to Crohn’s Disease. Human Molecular Genetics, 14, 3499-3506. https://doi.org/10.1093/hmg/ddi379
Baskaran, K., Pugazhendhi, S. and Ramakrishna, B.S. (2014) Association of IRGM Gene Mutations with Inflammatory Bowel Disease in the Indian Population. PLOS ONE, 9, e106863. https://doi.org/10.1371/journal.pone.0106863
Niriella, M.A., Liyanage, I.K., Kodisinghe, S.K., et al. (2018) Genetic Associations of Inflammatory Bowel Disease in a South Asian Population. World Journal of Clinical Cases, 6, 908-915. https://doi.org/10.12998/wjcc.v6.i15.908
Nguyen, V.Q., Jiang, D., Hoffman, S.N., et al. (2017) Impact of Diagnostic Delay and Associated Factors on Clinical Outcomes in a U.S. Inflammatory Bowel Disease Cohort. Inflammatory Bowel Diseases, 23, 1825-1831. https://doi.org/10.1097/MIB.0000000000001257
Lee, D.W., Koo, J.S., Choe, J.W., et al. (2017) Diagnostic Delay in Inflammatory Bowel Disease Increases the Risk of Intestinal Surgery. World Journal of Gastroenterology, 23, 6474-6481. https://doi.org/10.3748/wjg.v23.i35.6474
Ng, S.C., Hirai, H.W., Tsoi, K.K., et al. (2014) Systematic Review with Meta-Analysis: Accuracy of Interferon-Gamma Releasing Assay and Anti-Saccharomyces cerevisiae Antibody in Differentiating Intestinal Tuberculosis from Crohn’s Disease in Asians. Journal of Gastroenterology and Hepatology, 29, 1664-1670. https://doi.org/10.1111/jgh.12645
Ek, W.E., D’Amato, M. and Halfvarson, J. (2014) The History of Genetics in Inflammatory Bowel Disease. Annals of Gastroenterology, 27, 294-303.
Jain, S., Kedia, S., Sethi, T., et al. (2018) Predictors of Long-Term Outcomes in Patients with Acute Severe Colitis: A Northern Indian Cohort Study. Journal of Gastroenterology and Hepatology, 33, 615-622. https://doi.org/10.1111/jgh.13921
Misra, R., Limdi, J., Cooney, R., et al. (2019) Ethnic Differences in Inflammatory Bowel Disease: Results from the United Kingdom Inception Cohort Epidemiology Study. World Journal of Gastroenterology, 25, 6145-6157. https://doi.org/10.3748/wjg.v25.i40.6145
Dinesen, L.C., Walsh, A.J., Protic, M.N., et al. (2010) The Pattern and Outcome of Acute Severe Colitis. Journal of Crohn’s and Colitis, 4, 431-437. https://doi.org/10.1016/j.crohns.2010.02.001
Kalubowila, U., Liyanaarachchi, T., Galketiya, K.B., et al. (2018) Epidemiology and Clinical Course of Inflammatory Bowel Disease in the Central Province of Sri Lanka: A Hospital-Based Study. JGH Open, 2, 129-133. https://doi.org/10.1002/jgh3.12058
Farrukh, A. and Mayberry, J.F. (2019) Inflammatory Bowel Disease and the South Asian Diaspora. JGH Open, 3, 358-360. https://doi.org/10.1002/jgh3.12149
Jangi, S., Ruan, A., Korzenik, J., et al. (2020) South Asian Patients with Inflammatory Bowel Disease in the United States Demonstrate More Fistulizing and Perianal Crohn Phenotype. Inflammatory Bowel Diseases, 26, 1933-1942. https://doi.org/10.1093/ibd/izaa029
Benchimol, E.I., Mack, D.R., Guttmann, A., et al. (2015) Inflammatory Bowel Disease in Immigrants to Canada and Their Children: A Population-Based Cohort Study. The American Journal of Gastroenterology, 110, 553-563. https://doi.org/10.1038/ajg.2015.52