Inflammatory Bowel Diseases Are On The Rise – Why Is This Happening?

The number of people with inflammatory bowel disease (IBD) like Crohn's and colitis is increasing dramatically, studies have found. But what could be behind it?

The number of people suffering from inflammatory bowel disease (IBD) is rising rapidly, according to research. IBD is an umbrella term for chronic conditions involving inflammation of the gut, which can cause physical damage to it. The most common conditions are ulcerative colitis and Crohn’s disease.

More than three million people across Europe are impacted by inflammatory bowel diseases. The severity of the symptoms – frequent (sometimes bloody) diarrhoea, severe stomach pain and extreme fatigue – and the long-lasting nature of it can have a debilitating impact on the lives of sufferers.

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The difference between Crohn’s and colitis is where the inflammation occurs. Crohn’s causes inflammation of the digestive system (anywhere between the oesophagus and anus), while colitis causes inflammation and ulceration of the inner lining of the colon and rectum (the large bowel).

There is no known cure for IBD, so patients often need complex and costly treatments throughout their lives.

Prevalence of IBD is expected to grow by almost a quarter by 2025, according to researchers from Sandwell and West Birmingham hospitals NHS trust and the University of Birmingham, who also warned that people with IBD are at a higher risk of developing colorectal cancer.

And it seems it’s not just a problem in the UK – a separate study funded by the Bill & Melinda Gates Foundation revealed the number of global cases of IBD rose from 3.7 million in 1990 to 6.8 million in 2017.

What does the latest research tell us?

Researchers examined IBD cases from the beginning of the century to get data on ulcerative colitis and Crohn’s disease prevalence in the UK. They presented their findings at the United European Gastroenterology (UEG) conference in Barcelona in October 2019.

Data from The Health Improvement Network, a nationally representative UK primary care database, showed that IBD prevalence is three times higher than previously reported.

Ulcerative colitis and Crohn’s disease prevalence increased by 55% and 83% respectively between 2000 and 2017, the data showed. Meanwhile, IBD prevalence is predicted to rise by almost a quarter between 2017 to 2025.

Prevalence is likely to rise “substantially” over the next decade, said Dr Dominic King, from the University of Birmingham.

“This predicted rise in prevalence may place an even greater strain on already overburdened healthcare systems,” said Dr King, who added that “the burden of IBD” is compounded further by its link with colorectal cancer.

The study also found that patients suffering from Crohn’s disease had a 23% increased risk of developing colorectal cancer compared to matched controls, while ulcerative colitis patients had an elevated risk of 43%.

“The rise in prevalence of IBD could therefore potentially lead to an associated rise in colorectal cancer cases,” Dr King said.

What do previous studies say?

Higher rates of depression and reduced workforce participation in patients with ulcerative colitis and Crohn’s disease has been reported in previous studies, with an estimated 44% of IBD sufferers claiming they had lost or quit their job because of the illness.

They also face stigma and abuse. A survey by Crohn’s & Colitis UK found half of people living with the conditions have been shamed for using a disabled toilet. Of these, 61% have faced verbal and sometimes physical abuse.

What could be causing this rise?

Not much is known about the causes of IBD. There is some research to suggest that IBD is caused by a combination of factors: a person’s genes, an abnormal reaction of the immune system, and something triggered in the environment which then causes inflammation (things like viruses, bacteria, diet and stress). If all these factors align the right way, an individual who may have a genetic predisposition is likely to develop IBD.

But more research is needed to determine why rates are rising so fast. Is it that we’re more aware now of these issues and less embarrassed to seek help, therefore prompting a rise in diagnoses?

One theory behind the rise, suggested by the Benaroya Research Institute, is that the “seemingly endless supply of sanitary and cleansing products”, which eliminate 99.99% of bacteria, may have altered the diversity of friendly bacteria that have settled in our bowels – therefore making us more susceptible.

Another is that it’s a result of our lifestyles. Professor Gilaad Kaplan, a gastroenterologist and epidemiologist at the University of Calgary in Canada, previously said of IBD: “More striking, is the observation that as newly industrialised countries have transitioned towards a westernised society, inflammatory bowel disease emerges and its incidence rises rapidly.” This points to environmental factors such as westernised diets, improved hygiene status, increased use of antibiotics and exposure to pollution.

But ultimately the reason for the rise remains a “mystery”, Professor Andrew Goddard, president of the Royal College of Physicians, tells HuffPost UK.

“As well as increased recognition there are probably other things contributing. Changing diet and its effect on the microbiome and changes of exposure to bacteria/other infections early in life are the two prime suspects but other possibilities include antibiotic overuse in both children and in farming, air pollution and other environmental toxins as yet unidentified,” he suggests.

Salvo Leone, president of the European Federation of Crohn’s and Ulcerative Colitis Associations (EFCCA), hailed the latest study’s findings as “alarming” – “particularly if we consider the fact that Crohn’s disease and ulcerative colitis are lifelong diseases that can begin at a young age [IBD is usually diagnosed between the ages of 15 and 40 years old] and have a huge impact on a patient’s quality of life,” he said.

“The cost to society, either through direct medical costs or indirect costs such as lost days at work, lost educational opportunities, or caring for an affected family member, are enormous.”

Leone called for renewed efforts in developing effective treatment and disease management strategies that allow patients and their families to lead happier and healthier lives.