Inflammatory Bowel Disease

What was once thought of as a western disease is now becoming a global health concern.

Since the middle of the 20th century, researchers have watched the incidence of inflammatory bowel disease (IBD) in most western regions — including North America, Europe, Australia and New Zealand — increase and then stabilize. In contrast, newly industrialized countries in Asia, South America and the Middle East have documented a dramatic rise in the number of people affected by IBD.

“IBD isn’t something that existed a few hundred years ago,” says Dr. Gilaad Kaplan (MD’00), an associate professor in the departments of Medicine and Community Health Sciences. “It’s a relatively modern disease of modern society. What’s happening in newly industrialized countries is very similar to what we saw in the western world between 50 to 70 years ago.”

Kaplan’s research focuses on understanding where IBD exists in the world, and how it’s evolving and changing. In 2012, he led a team that published a paper which looked at the global epidemiology of IBD. In October, Kaplan and his colleague Siew Ng, PhD, who works at the Chinese University of Hong Kong, published a five-year update on the paper in The Lancet and presented it at the World Congress of Gastroenterology in Orlando, Fla.

“Our research brings together data from all population-based studies reporting on IBD rates since 1990,” says Kaplan. “We’ve shown that there’s a link between IBD and the types of societal changes we see in newly industrialized countries. Now we need to understand what the exact triggers are so that we can better prepare, treat and hopefully prevent IBD.”

He explains that newly industrialized countries experience societal transformations that include migration from rural to urban areas, and a shift from agricultural to manufacturing industries. These changes trickle into other areas including lifestyle (poor diet and sedentary occupations) and new environmental exposures (increased pollution). Understanding the role these factors play in the onset of IBD will allow patients and medical communities to better manage the problem that’s caused by steadily climbing IBD rates.

“The biggest challenge is caring for more and more people; it’s costly and complex, and every year we’re adding more people to the base number,” says Kaplan. “IBD is a chronic, incurable disease that’s predominately diagnosed in young people, which causes us to see an annual increase in the number of people who have the disease.”

Currently, the prevalence of IBD in the western world is more than 0.3 per cent of the population with over 200,000 patients afflicted in Canada alone. The direct and indirect health care burden of managing IBD is substantial. Most patients are treated with medications, some costing roughly $30,000 per person, per year. Patients are on these drugs indefinitely and some end up needing surgery to remove parts of their bowel. And this estimate doesn’t factor in the “real” price of IBD. The disease can impede career aspirations, instill social stigma and impair quality of life, which also takes a toll on health care and community support funding.

“We need to address the fact that 10 years from now, the number of patients will be even higher than what it is today,” says Kaplan. “We’re not expanding the number of gastroenterologists or nurses, or the number of supporting programs that are in place. The disease is expanding faster than we are and one way to tackle this problem is to have fewer people diagnosed.”

In order to prevent IBD, Kaplan and his team believe that a co-ordinated solution involving research into interventions that modify the environment and more innovative care methods will be required to address the evolution of IBD throughout the world.

“Future research will focus on identifying environmental risk factors observed during the early stages of industrialization,” says Kaplan. “We’ll prioritize research into environmental intervention that helps prevent IBD. As the disease continues to become a global problem, we’re hopeful that a co-ordinated solution to prevent and treat IBD will be possible.”