Background: The incidence/prevalence rates of Inflammatory Bowel Disease (IBD) are rising in Asian countries with India probably topping the list. Improved physician awareness and better diagnostic modalities lone are not likely to account fully for this rise. Clinical and experimental evidence supports an association between IBD and a large number of seemingly unrelated environmental factors, which include smoking, improved sanitation, westernized life style, industrialization and improved socio-economic status, changed dietary pattern, altered microbial exposure, stress, intestinal permeability, exposure to infections, exposure to medications (antibiotics (especially during childhood), NSAIDs, hormonal therapy) and appendectomy. There is a need to study the role of various environmental factors influencing the disease.

Novelty: We are proposing a population based epidemiological study to determine the disease burden and evaluate IBD associated environmental factors in north Indian population. Though good epidemiological studies are available from Western worldin relation to environmental factors, the information available from India is inadequate possibly due to lack of population based registries, limitation of access to health care facilities, limited availability of diagnostic tests, and infectious diseases confounding the diagnosis.

Objective: We proposed to: 1. To estimate the prevalence of IBD in Punjab

2. To study and compare the role of various environmental factors in the development of IBD

Methods: This would be a questionnaire based population study, which will include screening of around 50,000 individuals. A survey will be conducted in the state of Punjab, India. Punjab is divided into three major geographical areas, Doaba, Majha, and Malwa which contain a total of 23 districts. Trained survey teams consisting of a doctor, a phlebotomist, and two field workers will visit selected households and administer the survey questionnaire, after obtaining informed consent and assent from children willing to participate. The study questionnaire will be administered as a face-to-face interview and inquire about socio-demographic data, medical history, lifestyle information, environmental factors [place of residence, living conditions, hygiene (including access to safe drinking water and toilet facilities), exposure to pets/farm animals, exposure to infections, exposure to medications (antibiotics, NSAIDs, hormonal therapy), etc.] and symptoms suggestive of IBD.

Those with prolonged diarrhoea (≥ 4 weeks) with or without rectal bleeding will be considered as suspected cases. These suspected cases will be subjected to faecal calprotectin. Confirmatory tests will include video sigmoidoscopy/colonoscopy, rectal biopsy and/or CT enterography. In addition, patients’ already diagnosed and receiving treatment for IBD, encountered during the survey, will be reviewed.

Expected outcome: Environmental influences exert important roles on the pathogenesis and natural history of IBD. This study aims to provide key mechanistic insights into how environmental and lifestyle influences may modify susceptibility to IBD.

Keywords

Inflammatory bowel disease, environmental factors, dietary practices, colonoscopy, faecal calprotectin

Abbreviations

IBD: Inflammatory bowel disease

NSAIDs: Non-steroidal anti-inflammatory drugs

Objectives of the Project (1500)

To estimate the prevalence of IBD in Punjab

To study the role of various environmental factors in the development of IBD

Expected output and outcome of the proposal (1500)

1. To estimate the prevalence of IBD (Ulcerative colitis and Crohn’s Disease) in Punjab (India).

2.To access the role of environmental factors as a risk factor in the development of IBD.