Crohn’s Disease in South Asia

Umesh Jayarajah, N M Navarathne, Ishan M de Zoysa, Nishanthan Subramaniam, Nandadeva Samarasekera, Suranjith L Seneviratne


Crohn’s disease (CD) is a highly complex disease of unknown aetiology. We analysed the epidemiology, clinical characteristics, diagnosis, treatment and pathogenesis of Crohn’s disease in South Asia compared to the rest of the world.The PubMed database and Google scholar were searched till March 2016 for articles on CD. Articles dealing with CD in South Asians were reviewed by the authors, critically analyzed and then summarized.

There is a lower incidence of CD in South Asia compared to the West and disease characteristics differ. Although novel genetic factors associated with CD have been identified, significant gaps exist in relation to disease pathogenesis, molecular genetic mechanisms and the use of evidence based treatment modalities.

Our review provides a comprehensive overview of existing knowledge on CD in South Asia and identifies gaps in knowledge for future research 



Crohn’s disease, South Asia, Epidemiology, genetics, clinical features, treatment

Full Text:



Ng SC (2013) Inflammatory Bowel Disease in Asia. Gastroenterology & hepatology 9 (1):28-30

de Silva HJ, de Silva NR, de Silva AP, Jewell DP (2008) Emergence of inflammatory bowel disease 'beyond the West': do prosperity and improved hygiene have a role? Transactions of the Royal Society of Tropical Medicine and Hygiene 102 (9):857-860. doi:10.1016/j.trstmh.2008.03.016

Niriella MA, De Silva AP, Dayaratne AH, Ariyasinghe MH, Navarathne MM, Peiris RS, Samarasekara DN, Satharasinghe RL, Rajindrajith S, Dassanayake AS, Wickramasinghe AR, de Silva HJ (2010) Prevalence of inflammatory bowel disease in two districts of Sri Lanka: a hospital based survey. BMC gastroenterology 10:32. doi:10.1186/1471-230X-10-32

Kasturiratne A, Mufeena MN, Mettananda KC, Fernandopulle N, Rajindrajith S, Waraketiya PR, Weerasinghe SK, Ranaweera A, Hewavisenthi SJ, de Silva AP, de Silva HJ (2014) Incidence of inflammatory bowel disease in Gampaha district: details of the Sri Lankan component of the Asia-Pacific Crohn's and colitis epidemiology study. The Ceylon medical 59 (1):16-18. doi:10.4038/cmj.v59i1.6734

Probert CSJ, Jayanthi V, Mayberry JF (1991) Inflammatory Bowel Disease in Indian Migrants in Fiji. Digestion 50 (2):82-84

JAYANTHI V, PROBERT C, PINDER D, WICKS A, MAYBERRY J (1992) Epidemiology of Crohn's Disease in Indian Migrants and the Indigenous Population in Leicestershire. QJM : monthly of the Association of Physicians 82 (2):125-138

Probert C, Mayberry J, Mann R (1990) Inflammatory bowel disease in the rural Indian subcontinent: a survey of patients attending mission hospitals. Digestion 47 (1):42-46

Ng SC (2015) Emerging leadership lecture: Inflammatory bowel disease in Asia: Emergence of a “Western” disease. of gastroenterology and hepatology 30 (3):440-445. doi:10.1111/jgh.12859

Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, Benchimol EI, Panaccione R, Ghosh S, Barkema HW, Kaplan GG (2012) Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 142 (1):46-54.e42; quiz e30. doi:10.1053/j.gastro.2011.10.001

Amarapurkar DN, Patel ND, Rane PS (2008) Diagnosis of Crohn’s disease in India where tuberculosis is widely prevalent. World of gastroenterology: WJG 14 (5):741

Benjamin J, Makharia GK, Ahuja V, Kalaivani M, Joshi YK (2008) Intestinal permeability and its association with the patient and disease characteristics in Crohn’s disease. World of gastroenterology: WJG 14 (9):1399

Das K, Ghoshal UC, Dhali GK, Benjamin J, Ahuja V, Makharia GK (2009) Crohn’s disease in India: a multicenter study from a country where tuberculosis is endemic. Digestive diseases and sciences 54 (5):1099-1107

Khan R, Abbas Z, Memon S, Hamid S, Shah H, Jafri W (2001) CLINICAL PRESENTATION OF CROHN'S DISEASE IN PAKISTAN. of gastroenterology and hepatology 16:21-21. doi:10.1111/j.1440-1746.2001.ca01-21.x

Pai C, Khandige GK (1999) Is Crohn's disease rare in India? Indian of gastroenterology: official of the Indian Society of Gastroenterology 19 (1):17-20

Subasinghe D, Nawarathna NM, Samarasekera DN (2011) Disease characteristics of inflammatory bowel disease (IBD): findings from a tertiary care centre in South Asia. of gastrointestinal surgery : official of the Society for Surgery of the Alimentary Tract 15 (9):1562-1567. doi:10.1007/s11605-011-1588-5

Goel A, Dutta AK, Pulimood AB, Eapen A, Chacko A (2013) Clinical profile and predictors of disease behavior and surgery in Indian patients with Crohn's disease. Indian of Gastroenterology 32 (3):184-189

Makharia GK, Ramakrishna BS, Abraham P, Choudhuri G, Misra SP, Ahuja V, Bhatia SJ, Bhasin DK, Dadhich S, Dhali GK, Desai DC, Ghoshal UC, Goswami BD, Issar SK, Jain AK, Jayanthi V, Loganathan G, Pai CG, Puri AS, Rana SS, Ray G, Singh SP, Sood A, Indian Society of Gastroenterology Task Force on Inflammatory Bowel D (2012) Survey of inflammatory bowel diseases in India. Indian of gastroenterology : official of the Indian Society of Gastroenterology 31 (6):299-306. doi:10.1007/s12664-012-0258-1

Pugazhendhi S, Sahu MK, Subramanian V, Pulimood A, Ramakrishna BS (2011) Environmental factors associated with Crohn’s disease in India. Indian of Gastroenterology 30 (6):264-269

Ftanian P, Ghoshal UC, Aggarwal F (2004) Etiological spectrum of sporadic malabsorption syndrome in northern Indian adults at a tertiary hospital.

Yadav P, Das P, Mirdha BR, Gupta SD, Bhatnagar S, Pandey RM, Makharia GK (2011) Current spectrum of malabsorption syndrome in adults in India. Indian of Gastroenterology 30 (1):22-28

Ghoshal UC, Mehrotra M, Kumar S, Ghoshal U, Krishnani N, Misra A, Aggarwal R, Choudhuri G (2012) Spectrum of malabsorption syndrome among adults & factors differentiating celiac disease & tropical malabsorption. The Indian of medical research 136 (3):451

Benjamin J, Makharia GK, Kalaivani M, Joshi YK (2008) Nutritional status of patients with Crohn’s disease. Indian of gastroenterology : official of the Indian Society of Gastroenterology 27 (5):195-200

de Silva AP, Karunanayake AL, Dissanayaka TGI, Dassanayake AS, Duminda HKKT, Pathmeswaran A, Wickramasinghe AR, de Silva HJ (2009) Osteoporosis in adult Sri Lankan inflammatory bowel disease patients. World of gastroenterology: WJG 15 (28):3528

Khadgawat R, Makharia GK, Puri K (2008) Evaluation of bone mineral density among patients with inflammatory bowel disease in a tertiary care setting in India. Indian of gastroenterology : official of the Indian Society of Gastroenterology 27 (3):103-106

Joseph A, George B, Pulimood A, Seshadri M, Chacko A (2009) 25 (OH) vitamin D level in Crohn’s disease: association with sun exposure & disease activity.

Sathiyasekaran M, Raju BB, Shivbalan S, Rajarajan K (2005) Pediatric Crohn's disease in south India. Indian pediatrics 42 (5):459

Sathiyasekaran M, Bavanandam S, Sankaranarayanan S, Mohan N, Geetha M, Wadhwa N, Kehar M, Biradar V (2014) A questionnaire survey of pediatric inflammatory bowel disease in India. Indian of Gastroenterology 33 (6):543-549

Prideaux L, Kamm MA, De Cruz PP, Chan FK, Ng SC (2012) Inflammatory bowel disease in Asia: a systematic review. of gastroenterology and hepatology 27 (8):1266-1280

Desai H, Gupte P (2004) Increasing incidence of Crohn's disease in India: is it related to improved sanitation? Indian of gastroenterology: official of the Indian Society of Gastroenterology 24 (1):23-24

Pugazhendhi S, Amte A, Balamurugan R, Subramanian V, Ramakrishna BS (2008) Common NOD2 mutations are absent in patients with Crohn's disease in India. Indian of Gastroenterology 27 (5):201-203

Pugazhendhi S, Santhanam S, Venkataraman J, Creveaux I, Ramakrishna BS (2013) NOD2 gene mutations associate weakly with ulcerative colitis but not with Crohn's disease in Indian patients with inflammatory bowel disease. Gene 512 (2):309-313. doi:10.1016/j.gene.2012.10.015

Mahurkar S, Banerjee R, Rani VS, Thakur N, Rao GV, Reddy DN, Chandak GR (2011) Common variants in NOD2 and IL23R are not associated with inflammatory bowel disease in Indians. of gastroenterology and hepatology 26 (4):694-699. doi:10.1111/j.1440-1746.2010.06533.x

Ahirwar DK, Kesarwani P, Singh R, Ghoshal UC, Mittal RD (2012) Role of tumor necrosis factor-alpha (C-863A) polymorphism in pathogenesis of inflammatory bowel disease in Northern India. of gastrointestinal cancer 43 (2):196-204

Prakash K, Varma D, Mahadevan P, Narayanan RG, Philip M (2008) Surgical treatment for small bowel Crohn's disease: an experience of 28 cases. Indian of Gastroenterology 27 (1):12

Kapoor V (1997) Koch's or Crohn's? International of clinical practice 51 (4):246-247

Pulimood AB, Peter S, Ramakrishna B, Chacko A, Jeyamani R, Jeyaseelan L, Kurian G (2005) Segmental colonoscopic biopsies in the differentiation of ileocolic tuberculosis from Crohn's disease. of gastroenterology and hepatology 20 (5):688-696

Ghoshal U, Ghoshal U, Singh H, Tiwari S (2007) Anti-Saccharomyces cerevisiae antibody is not useful to differentiate between Crohn's disease and intestinal tuberculosis in India. of postgraduate medicine 53 (3):166

Pulimood AB, Amarapurkar DN, Ghoshal U, Phillip M, Pai CG, Reddy DN, Nagi B, Ramakrishna BS (2011) Differentiation of Crohn’s disease from intestinal tuberculosis in India in 2010. World of gastroenterology: WJG 17 (4):433

Makharia GK, Srivastava S, Das P, Goswami P, Singh U, Tripathi M, Deo V, Aggarwal A, Tiwari RP, Sreenivas V (2010) Clinical, endoscopic, and histological differentiations between Crohn's disease and intestinal tuberculosis. The American of gastroenterology 105 (3):642-651

Kochhar R, Gupta V, Dutta U, Singh K, Kochhar R (2011) Infliximab induced endophthalmitis in a patient of fistulizing Crohn’s disease. Indian of Gastroenterology 30 (5):241-242

Davavala S, Desai D, Abraham P, Ashavaid T, Joshi A, Gupta T (2014) Prevalence of TPMT polymorphism in Indian patients requiring immunomodulator therapy and its clinical significance. Indian of Gastroenterology 33 (1):41-45. doi:10.1007/s12664-013-0374-6


  • There are currently no refbacks.

Copyright (c) 2017 Umesh Jayarajah, N M Navarathne, Ishan M de Zoysa, Nishanthan Subramaniam, Nandadeva Samarasekera, Suranjith L Seneviratne

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.