Epidemiology, Pathogenesis and Treatment of Ulcerative Colitis in South Asia

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


Ulcerative colitis (UC) is a chronic inflammatory disorder of the colon and rectum. Its prevalence is on the rise in many non-Western countries and several factors such as changes in lifestyle and improvements in hygiene may account for this. The cultural and ethnic background of South Asia is different from Western countries and other parts of Asia. We have reviewed the scientific literature on UC in South Asia and describe its epidemiology, clinical characteristics, molecular mechanisms, diagnosis and treatment. 


Ulcerative colitis, South Asia, Inflammatory bowel disease, genetics, pathogenesis

Full Text:



Puri AS: Epidemiology of Ulcerative Colitis in South Asia. Intestinal research 2013, 11(4):250-255.

de Silva HJ, de Silva NR, de Silva AP, Jewell DP: 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 2008, 102(9):857-860.

Tandon BN, Mathur AK, Mohapatra LN, Tandon HD, Wig KL: A study of the prevalence and clinical pattern of non-specific ulcerative colitis in northern India. Gut 1965, 6(5):448-453.

Chuttani HK, Nigam SP, Sama SK, Dhanda PC, Gupta PS: Ulcerative colitis in the tropics. British medical 1967, 4(5573):204-207.

Maroo MK, Nag NK, Sortur SV, Patil RS: Ulcerative colitis in Southern Maharashtra. of the Indian Medical Association 1974, 63(11):350-354.

Alam MN, Islam N, Shamsuddin M: Ulcerative colitis in Bangladesh. Bangladesh Medical Research Council bulletin 1975, 1(2):103-109.

Niriella MA, De Silva AP, Dayaratne AH, Ariyasinghe MH, Navarathne MM, Peiris RS, Samarasekara DN, Satharasinghe RL, Rajindrajith S, Dassanayake AS et al: Prevalence of inflammatory bowel disease in two districts of Sri Lanka: a hospital based survey. BMC gastroenterology 2010, 10:32.

Ng SC, Tang W, Ching JY, Wong M, Chow CM, Hui AJ, Wong TC, Leung VK, Tsang SW, Yu HH et al: Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study. Gastroenterology 2013, 145(1):158-165.e152.

Khosla SN, Girdhar NK, Lal S, Mishra DS: Epidemiology of ulcerative colitis in hospital and select general population of northern India. The of the Association of Physicians of India 1986, 34(6):405-407.

Sood A, Midha V, Sood N, Bhatia AS, Avasthi G: Incidence and prevalence of ulcerative colitis in Punjab, North India. Gut 2003, 52(11):1587-1590.

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

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

Senanayake SM, Fernandopulle AN, Niriella MA, Wijesinghe NT, Ranaweera A, Mufeena MN, Pathmeswaran A, Nawarathne NM, de Silva AP, de Silva HJ: The long-term outcomes of a cohort of Sri Lankan patients with ulcerative colitis: a retrospective study at two national referral centers and review of literature. Clinical and experimental gastroenterology 2013, 6:195-200.

Subasinghe D, Nawarathna NM, Samarasekera DN: 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 2011, 15(9):1562-1567.

Makharia GK, Ramakrishna BS, Abraham P, Choudhuri G, Misra SP, Ahuja V, Bhatia SJ, Bhasin DK, Dadhich S, Dhali GK et al: Survey of inflammatory bowel diseases in India. Indian of gastroenterology : official of the Indian Society of Gastroenterology 2012, 31(6):299-306.

Gunisetty S, Tiwari SK, Bardia A, Phanibhushan M, Satti V, Habeeb MA, Khan AA: The epidemiology and prevalence of Ulcerative colitis in the South of India. 2012.

Venkataraman S, Mohan V, Ramakrishna BS, Peter S, Chacko A, Chandy G, Kurian G, Kurian S, Mathan M, Mathan VI et al: Risk of colorectal cancer in ulcerative colitis in India. of gastroenterology and hepatology 2005, 20(5):705-709.

Qureshi H, Zuberi SJ, Banatwala N, Anwar A, Shamsi Z, Khan MN: Ulcerative colitis in Karachi. of gastroenterology and hepatology 1989, 4(4):313-316.

Chowdhury MS, Khan MR, Mahmuduzzaman M, Rahman MZ, Ishaque SM, Miah AR, Roy PK, Raihan MA: Disease extent and local complication of ulcerative colitis in Bangladeshi population. Mymensingh medical : MMJ 2014, 23(4):720-723.

Fernandopulle ANR, Mayadunne PB, Navarathne NMM: The Prevalence of Clostridium difficile Infection in a Cohort of Sri Lankan Patients with Acute Severe Ulcerative Colitis. Gastroenterol Hepatol Open Access 2014, 1(2): 00008.

Kochhar R, Goenka MK, Kaushik SP, Gupta NM, Nagi B, Mehta SK: Colorectal carcinoma in Indian patients with idiopathic ulcerative colitis. European of cancer prevention : the official of the European Cancer Prevention Organisation (ECP) 1992, 1(4):293-296.

Subasinghe D, Wijekoon NS, Nawarathne NM, Samarasekera DN: Disease-related knowledge in inflammatory bowel disease: experience of a tertiary care centre in a developing country in South Asia. Singapore medical 2010, 51(6):484-489.

Ng SC, Tang W, Leong RW, Chen M, Ko Y, Studd C, Niewiadomski O, Bell S, Kamm MA, de Silva H: Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific. Gut 2014:gutjnl-2014-307410.

Mahid SS, Minor KS, Soto RE, Hornung CA, Galandiuk S: Smoking and Inflammatory Bowel Disease: A Meta-analysis. Mayo Clinic proceedings 2006, 81(11):1462-1471.

Gupta A, Thelma BK: Identification of critical variants within SLC44A4, an ulcerative colitis susceptibility gene identified in a GWAS in north Indians. Genes Immun 2016, 17(2):105-109.

Meena NK, Ahuja V, Meena K, Paul J: Association of TLR5 Gene Polymorphisms in Ulcerative Colitis Patients of North India and Their Role in Cytokine Homeostasis. PloS one 2015, 10(3):e0120697.

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

Juyal G, Amre D, Midha V, Sood A, Seidman E, Thelma BK: Evidence of allelic heterogeneity for associations between the NOD2/CARD15 gene and ulcerative colitis among North Indians. Alimentary pharmacology & therapeutics 2007, 26(10):1325-1332.

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

Petersen BS, August D, Abt R, Alddafari M, Atarod L, Baris S, Bhavsar H, Brinkert F, Buchta M, Bulashevska A, Chee R, Cordeiro AI, Dara N, Dückers G, Elmarsafy A, Frede N, Galal N, Gerner P, Glocker EO, Goldacker S, Hammermann J, Hasselblatt P, Havlicekova Z, Hübscher K, Jesenak M, Karaca NE, Karakoc-Aydiner E, Kharaghani MM, Kilic SS, Kiykim A, Klein C, Klemann C, Kobbe R, Kotlarz D, Laass MW, Leahy TR, Mesdaghi M, Mitton S, Neves JF, Öztürk B, Pereira LF, Rohr J, Restrepo JLR, Ruzaike G, Saleh N, Seneviratne SL, Senol E, Speckmann C, Tegtmeyer D, Thankam P, van der Werff Ten Bosch J, von Bernuth H, Zeissig S, Zeissig Y, Franke A, Grimbacher B. Targeted Gene Panel Sequencing for Early-onset Inflammatory Bowel Disease and Chronic Diarrhea. Inflamm Bowel Dis. 2017;23:2109-2120

Packwood K, Drewe E, Staples E, Webster D, Witte T, Litzman J, Egner W, Sargur R, Sewell W, Lopez-Granados E, Seneviratne SL, Powell RJ, Ferry BL, Chapel HM. NOD2 polymorphisms in clinical phenotypes of common variable immunodeficiency disorders. Clin Exp Immunol. 2010;161(3):536-41.

Ng SC, Tsoi KK, Kamm MA, Xia B, Wu J, Chan FK, Sung JJ: Genetics of inflammatory bowel disease in Asia: systematic review and meta-analysis. Inflammatory bowel diseases 2012, 18(6):1164-1176.

Sood A, Kaushal V, Midha V, Bhatia KL, Sood N, Malhotra V: The beneficial effect of azathioprine on maintenance of remission in severe ulcerative colitis. J Gastroenterol 2002, 37(4):270-274.

Sood A, Midha V, Sood N, Avasthi G: Azathioprine versus sulfasalazine in maintenance of remission in severe ulcerative colitis. Indian of gastroenterology : official of the Indian Society of Gastroenterology 2003, 22(3):79-81.

Sood A, Midha V, Sood N, Kaushal V: Role of azathioprine in severe ulcerative colitis: one-year, placebo-controlled, randomized trial. Indian of gastroenterology : official of the Indian Society of Gastroenterology 2000, 19(1):14-16.

Sood A, Midha V, Sood N, Awasthi G: A Prospective, Open-Label Trial Assessing Dexamethasone Pulse Therapy in Moderate to Severe Ulcerative Colitis. of clinical gastroenterology 2002, 35(4):328-331.

Ng SC, Zeng Z, Niewiadomski O, Tang W, Bell S, Kamm MA, Hu P, de Silva HJ, Niriella MA, Udara WY et al: Early Course of Inflammatory Bowel Disease in a Population-based Inception Cohort Study from 8 Countries in Asia and Australia. Gastroenterology 2016; 150: 86 - 95.

DOI: http://dx.doi.org/10.52155/ijpsat.v6.1.222


  • There are currently no refbacks.

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

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