By Dr Pranab Gyawali, Consultant Gastroenterologist
Published: 23 August 2026
Short answer
Crohn's disease and ulcerative colitis are becoming more common in India, but there is no single proven explanation. Rapid changes in diet, urban living, antibiotic exposure, pollution, childhood environment and the gut microbiome are all being studied. Better recognition and diagnosis may explain part of the rise, but probably not all of it.
I recorded this short VLOG while walking through Hyderabad. The older city sits beside a rapidly developing modern one. That contrast made me think about a wider medical question: why is inflammatory bowel disease increasing across India and much of Asia?
Why did Hyderabad make me think about IBD?
Food, work, traffic, air quality, medication exposure and daily routines can all change within a generation.
At the same time, the global pattern of inflammatory bowel disease, or IBD, is changing. New diagnoses are beginning to level off in several Western countries, while Crohn's disease and ulcerative colitis continue to increase across much of Asia.
That does not prove that modern city life causes IBD. It gives researchers an important question: which parts of a changing environment matter?
Is IBD really increasing in India?
Yes. The best available evidence points in that direction, although exact numbers vary between studies and some estimates are based on modelling.
An analysis of Global Burden of Disease data estimated that the number of people living with IBD in India increased from about 130,000 in 1990 to about 270,000 in 2019. India's rates remained below the global average, but were increasing faster than the global trend.
A separate Hyderabad led study of more than 30,000 symptomatic patients found IBD in 5.4% of those investigated. In that selected group, IBD was diagnosed more often than infective colitis.
Is IBD only increasing in Indian cities?
Probably not. In the Hyderabad study, the proportion diagnosed with Crohn's disease or ulcerative colitis was similar among the rural and urban patients assessed.
The study was not a population survey, so it cannot tell us the true rural and urban prevalence. It does challenge the simple idea that IBD is only a disease of wealthy city populations.
Why might IBD be rising?
IBD develops through an interaction between genetic susceptibility, the immune system, the gut microbiome and environmental exposure. Researchers are examining several possible contributors:
- changes from traditional eating patterns towards more ultra processed food;
- lower dietary fibre and less variety in some diets;
- antibiotic exposure, particularly earlier in life;
- changing exposure to infections and microbes during childhood;
- air pollution and other environmental exposures;
- reduced physical activity, altered sleep and other effects of urbanisation;
- improved access to colonoscopy, imaging and specialist diagnosis.
This is a list of possibilities, not a proven formula. We cannot look at one person with IBD and identify a single food, antibiotic course or environmental change that caused it.
Does Indian food cause Crohn's disease or ulcerative colitis?
No single Indian food has been shown to cause IBD.
Diet may influence the microbiome and inflammatory environment, but it is only one part of a much wider picture. Someone who has developed Crohn's disease or ulcerative colitis should not respond by removing large groups of foods without a clear nutritional reason.
Could the rise simply reflect better diagnosis?
Better diagnosis is likely to explain some of the increase. More people now have access to colonoscopy, biopsies, small bowel imaging and specialist gastroenterology care.
But the broader change across newly industrialised countries is unlikely to be explained by diagnosis alone. The honest answer is that we still do not know how much each factor contributes.
When should someone be assessed for IBD?
Speak to a doctor if diarrhoea or a persistent change in bowel habit is accompanied by rectal bleeding, unexplained weight loss, anaemia, fever, waking at night to pass stool or a strong family history of IBD.
These symptoms do not automatically mean Crohn's disease or ulcerative colitis. Infection, coeliac disease, intestinal tuberculosis and other conditions can produce a similar picture and may require different tests.
My view
The rise of IBD in India is real enough to take seriously, but the explanation is not settled.
Hyderabad captures the question very well. A city can change quickly. Genes do not change at the same speed, so the environment and microbiome are likely to be important. The difficult part is identifying which exposures matter, at what stage of life and in whom. For now, the priorities are earlier recognition, accurate diagnosis and avoiding confident claims that one food or one feature of modern life is responsible.
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Frequently asked questions
Is IBD becoming more common in India?
Yes. Several studies indicate that Crohn's disease and ulcerative colitis are increasing in India and elsewhere in South Asia, although exact estimates differ.
Why is Crohn's disease increasing in India?
There is no single confirmed cause. Researchers are studying diet, antibiotics, pollution, urbanisation, childhood microbial exposure, the gut microbiome and improved diagnosis.
Is IBD only increasing in Indian cities?
No. A large study of symptomatic patients around Hyderabad found similar proportions of IBD among the rural and urban groups assessed. This was not a population prevalence study, so the finding needs careful interpretation.
Can Indian food cause IBD?
No single Indian food has been shown to cause Crohn's disease or ulcerative colitis. Diet may influence risk and the gut microbiome, but IBD develops through several interacting factors.
Can infection be mistaken for IBD in India?
Yes. Infective colitis and intestinal tuberculosis can resemble IBD. Diagnosis may require stool tests, colonoscopy with biopsies and, in selected cases, small bowel imaging.
Related reading
For a broader introduction, read about inflammatory bowel disease and the separate guides to Crohn's disease and ulcerative colitis. Further VLOGs examine whether we can predict severe IBD earlier, common Crohn's nutrition mistakes, and other topics in the IBD VLOG library.
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