Inflammatory bowel disease in India-changing paradigms

Inflammatory bowel disease is an emerging problem in Asia including India. Clinical data on this disease from eastern India and on its temporal trends in India is scarce. Existing Indian data on inflammatory bowel disease were retrieved using PubMed and a comparison of earlier data (up to 1980s) was made with more recent data (1990s and later) and our own data to find any significant differences. Our data included clinical data of 40 and ten consecutive patients with ulcerative colitis and Crohn's disease, respectively, collected prospectively from January 2003 to June 2009. For those whose symptoms started before 2003, data collection was partly retrospective. It included demography, symptoms and duration at presentation, follow-up findings, course, extraintestinal manifestations, treatment outcome and complications. Data were analysed by descriptive and analytical statistics. Sixty-five percent of our ulcerative colitis patients presented with pancolitis, majority had severe clinical, endoscopic and histologic disease commensurate with other recent studies but in contrast to milder presentation in earlier studies. Of our patients, 27.5% developed pseudopolyposis of colon, two within 1 year of disease onset; 10% developed cancer colon for whom disease duration of 10 years or more was the only significant risk factor. Majority of our patients with Crohn's disease had mild inflammatory disease involving small gut which was controlled with aminosalicylates. Obscure lower GI bleed was an important mode of presentation. Ulcerative colitis is presenting with increasing severity and extent in recent times. Rapid development of colonic pseudopolyposis was observed.