Inflammatory bowel disease (IBD) in rural and urban India: results from community colonoscopic evaluation of more than 30,000 symptomatic patients.

BACKGROUND: Traditionally, infectious diarrhoea has been the major cause of lower GI symptoms across the developing world. Increasing urbanization has been implicated for the rising IBD cases despite very limited data in the rural setting. We aimed to assess the relative proportion of IBD and other intestinal diseases among symptomatic patients from rural and urban India.

METHODS: Patients with lower GI symptoms attending urban out-patient clinics and/or specially conducted mobile rural health camps were evaluated using basic laboratory parameters, abdominal ultrasound and colonoscopy. Data including patient demographics, symptom profile, rural/urban residence and final diagnosis were analyzed. Current data was compared with previous rural survey in 2006.

FINDINGS: Of 32,021 patients investigated, 30,835 with complete dataset [67% male; 21% (6362) rural median 44 years:6-78 years] were included. Predominant symptoms were chronic abdominal pain (55%), change in bowel habit (45%), rectal bleeding (16%), chronic diarrhoea (13%), un-intended weight loss (9%) and anaemia (3%). Final diagnoses included IBD: (1687; 5.4%; 2.2% ulcerative colitis (UC), 3.2% Crohn's disease, CD), intestinal tuberculosis (364; 1.2%), infective colitis (1427; 4.6%), colorectal cancer (488; 1.6%) and polyps (2372; 7.7%). Proportions of UC (2.1% rural, 2.3% urban, p = 0.66) and CD (3.5% rural, 3.1%,urban, p = 0.12) were similar in both groups. There was no rural-urban divide in the relative proportion of other intestinal diseases.

INTERPRETATION: IBD accounts for more than 5% of patients presenting with lower GI symptoms, a rate that is higher than that of infectious colitis. The proportion of IBD cases was not different between the rural and urban populations. These data appear to indicate the changing disease prevalence patterns in India that require further research.

FUNDING: The study was funded by Leona M. and Harry B. Helmsley Charitable Trust.