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THE TIMES OF INDIA

New disease comes to city

CHENNAI: Balaji Subramanian (25), who works in a BPO in Chennai, had no
clue how he ended up with incessant abdominal pain, loose motion and blood
in stool. He doesn't eat street food, and insists on bottled water even
when he dines in a star hotel . Worse, even doctors didn't have a reason
for several months. After a couple of wrong diagnoses - ulcers due to
acidity and then tuberculosis of the intestine - Subramanian was found to
suffer from Crohn's disease.

A relatively new disease that affects teenagers and young adults, Crohn's
is making its presence felt in Indian cities. While diabetes is no longer
considered a disorder of only the wealthy city dweller, Crohn's , though
of much lesser prevalence, virtually takes its place as a disease that
exclusively affects the young (15-30 years), hygienic urbanite.

Seventy five years after it was first reported in the US, at least four
consortia of experts in three continents are struggling to pinpoint the
real cause of the disease. In the US, the prevalence is 148 per 100,000
people. Indians adopting western lifestyles and food habits is suspected
to be the reason for the disease showing up here.
"Ten years ago, we saw hardly one or two cases of Crohn's a year. Now, we
get more than two cases a month," says Dr R Surendran, head of the
department of surgical gastroenterology at Stanley Medical College. Being
a referral hospital which does research on Crohn's , Christian Medical
College, Vellore, gets five times more patients.

"We diagnose at least five Crohn's cases every fortnight . In the absence
of a registry , we don't know the actual prevalence of the disease . But
it is every gastroenterologist's gut feeling that Crohn's cases are on the
rise. For reasons under study, most of the patients are from well to do
families with good hygiene and modern food habits," says Dr B S
Ramakrishna , a gastroenterologist at CMC.

There have been several theories about the cause, most of them related to
modern lifestyle, including junk food, refrigeration and high levels of
hygiene. While some consider it an autoimmune disease (the body attacking
its own cells), others doubt if it is caused by a microbe that continues
to remain elusive.
A CMC team led by Dr Ramakrishna is doing research on the possible genetic
reasons of the disease. The CMC team is studying the 'hygiene hypothesis,'
which puts people with better hygiene at a higher risk of contracting
Crohn's .

Here is the logic: Better hygiene means the body is not used to many
pathogens and hence likely to have an inert immune system. And that
explains why some Western countries are trying to contain Crohn's disease
using eggs of worms generally found in Indians owing to lack of hygiene.

Dr Rosie Vennila, microbiologist at Stanley Medical College, disagrees
with the hygiene hypothesis. "There could be a harmful microbe causing the
disease or a harmless microbe that triggers an autoimmune reaction , but
we are not sure which one does that. The human gut has several billions of
them and it is a laborious task to pinpoint it. We do have some suspects,
like the tubercle bacillus, but we haven't yet got the culprit," she says.

Diagnosis (often biopsy) of the disease is difficult as the symptoms are
the same as those of tuberculosis (TB) that affects the gut, including
lesions in the intestine which leads to bleeding. Treatment of the
disease, using steroids and anti-cancer drugs, has its side effects. While
long term treatment using steroids can cause degeneration of bones,
extended use of anti-cancer drugs can pose the threat of cancer.