Study flags Canada’s growing burden of chronic gut disease

A person suffering from stomach pain is seen in this stock image. (Pexels)

Canada could be facing a dramatic rise in inflammatory bowel disease (IBD) over the next two decades, according to a new global study.

Published in Nature Portfolio last month and co-led by researchers from the University of Calgary, the research analyzed data from more than 500 population-based studies from 82 countries, spanning more than 100 years.

The study suggests that by 2045, Canada will not only see more diagnoses of IBD, but a sharp increase in the number of people already living with the chronic illness.

The study identifies four stages of IBD evolution around the world, placing Canada in the third phase, known as “compounding prevalence.” This phase is marked by a growing number of people living with IBD, especially among the senior population.

“What we see in compounding prevalence is that the incidence – the number of new diagnoses per year – is relatively stable in Canada, at about 30 per 100,000 people,” Gilaad Kaplan, lead author of the study and professor at the University of Calgary told CTVNews.ca in a phone interview Thursday.

In 2025, the prevalence of IBD in Canada is projected to be 0.8 per cent of the population. According to Kaplan, the number is expected to climb to approximately 1 per cent by the 2030s and into the 2040s.

“We think by the 2030s, over 400,000 Canadians will be living with IBD,” he said.

Kaplan says this poses unique challenges for Canada’s health-care system. As a practicing gastroenterologist, he sees the impacts of these trends first hand.

“We’re managing new diagnoses in young individuals, but we’re also seeing an aging IBD population,” Kaplan explained. “People diagnosed with Crohn’s in their 30s in the 1990s will be in their 70s by the 2030s. That means we’ll have to manage IBD alongside age-related comorbidities like cardiovascular disease, cancer and dementia.”

Kaplan addressed the study as a “global picture,” stating that an international team of IBD specialists from all of the world built a comprehensive map of how this disease is evolving and how countries can respond.

What is inflammatory bowel disease?

Once considered a disease of the Western world, Kaplan said it’s now a truly global condition.

IBD typically starts between 20 and 40 years of age and can cause lifelong symptoms. The study says IBD was first recognized in the 19th century, and in the early 20th century, was considered “a rare disease among the descendants of Europeans who colonized North America and Oceania.”

The global spread of IBD closely followed patterns of industrialization and westernization after the Second World War, the study says. Initially concentrated in high-income nations, IBD began appearing in newly industrialized countries in Asia, Latin America, and the Middle East in the late 20th century and early 21st centuries.

“As societies become industrialized, urbanized and westernized, we see changes in diet, lifestyle and environment,” Kaplan said. “This alters microbiome, which plays a major role in setting the stage for IBD to emerge in genetically susceptible individuals.”

The study also suggests that environmental and lifestyle factors – such as urbanization, westernized diets and sanitation – play a role in the disease’s evolution.

IBD is not the same as irritable bowel syndrome (IBS), according to Health Canada.

The health agency said symptoms can be similar, but IBS does not cause inflammation or other physical damage like ulcers to the bowel. Many people with IBD also have IBS, it added.

Highest rates

Canada already has one of the highest rates of IBD globally. The chronic conditions that fall under that category – most notably Crohn’s disease and ulcerative colitis – cause inflammation of the digestive tract, leading to symptoms like abdominal pain, diarrhea, weight loss and fatigue. There is currently no cure.

As for what causes IBD, Health Canada says it’s still unknown.

“Researchers believe that genetics and environmental factors interact to change your microbiome (the population of bacteria living in your body),” the health agency said on its website.

According to the study, the rising prevalence of IBD may continue as people live longer with the disease. While this signals better disease management, it also creates long-term strain on health resources. A major concern is how to provide comprehensive, continuous care to an aging population of people living with IBD.

Kaplan said the goal was to provide global health leaders with a clear roadmap for anticipating the burden of IBD in both developed and developing countries. As the IBD population ages, Kaplan says the rate of growth is expected to slow, moving toward Stage 4.

A blueprint for action

While the study’s implications are global, its relevance to Canada is urgent.

Kaplan and co-lead author Siew Ng, a professor from the Chinese University of Hong Kong, stress that IBD should now be considered a public health priority in Canada, given its “compounding prevalence.”

In Canada, addressing these challenges requires a parallel strategy: prevention and innovation in care, Kaplan said.

“On one hand, research should focus on preventive health to explore what the environmental causes of IBD – like diet – so we can focus on preventing the disease,” Kaplan said. “But we also need to prepare healthcare systems to provide accessible, equitable and affordable care for all patients.

They argue that countries in this phase must overhaul systems to support those already living with the diseases, rather than simply prepare for new cases. This includes providing access to specialized care, mental heath services, nutrition, and long-term management support.

The authors stress that knowing where countries are categorized in the IBD phases gives them a better chance of managing the disease.

Kaplan adds that Canada’s leadership in IBD care and research is also an opportunity.

“We’re seen as a guiding light globally,” Kaplan said. “Countries like those in Asia and Latin America are just now seeing a rise in IBD. We can learn from (it) and can give us clues to which is environmentally driving the disease and change those things in practice in Canada.

While Canada is not yet at Stage 4, the study expects it to reach this point in the coming decades, if current trends hold.