IBD and Crohn's disease in the Global South.

Are cases rising or have poor people not been counted?

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About three million people have been diagnosed with Irritable Bowl Disease with either ulcerative colitis or Crohn’s Disease in the United States.

I recently joined the club.

It’s not our fault. It is not something we caught. Scientists who research the disease think is is an auto-immune problem, a combination of modern food processes and genetics.

My case is not the worst. For many it can be totally debilitating.

Environment and genes.

It appears more common among decendants of Ashkenazi (European) Jews.

I am a member of that club too.

This week I will start a treatment that includes a drug that the pharmaceutical company charges $4000 a dose for. It requires a lot of doses.

It can cost upwards of $50,000 a year.

Fortunately Medicare and my retired teacher’s health insurance will cover most of the cost.

“I’m thinking about those people who don’t have health insurance to pay for it,” I said to Anne.

Did I mention it is free in Canada where they have national health care?

“With no health insurance, they probably can’t afford to see a doctor and aren’t diagnosed,” Anne responded.

Anne’s right.

It turns out that it is not only true for poor people in the United States. It is true globally as well.

The conventional wisdom that Crohn’s and IBD is a disease of industrial developed countries has recently been challenged.

From the National Center of Biotechnology Information:

This scoping review demonstrates the lack of epidemiologic data on Crohn’s disease in low and lower-middle income countries, but that it does exist in these settings and presents unique challenges. There is a need for population-based research to fully understand the its burden among the world’s poorest people.

And this from Gastroenterology and Endoscopy News.

Information about the prevalence of Crohn’s disease in poor countries is lacking in the literature, and what has been published may greatly underestimate the burden of the disease there, according to a recent survey of gastroenterologists in the world’s most economically disadvantaged regions.

“Aside from a few countries like India and some in the Middle East, there is a dearth of data. Out of about 79 countries, we found published data on only 21,” Ruma Rajbhandari, MD, MPH, the director of the Liver Disease Center at Mount Auburn Hospital and an associate physician in the Division of Global Health Equity at Brigham and Women’s Hospital in Boston, told Gastroenterology & Endoscopy News. “That left us wondering where we could find this information.”

Like poor folks in the United States who may never be diagnosed because they lack basic health insurance, billions of people in lower and middle income countries (LLMICs) may be burdened by IBD and Crohn’s and have gone unstudied, not researched (and untreated).