The global burden of IBD: from 2015 to 2025

Journal name:
Nature Reviews Gastroenterology & Hepatology
Year published:
Published online


Over 1 million residents in the USA and 2.5 million in Europe are estimated to have IBD, with substantial costs for health care. These estimates do not factor in the 'real' price of IBD, which can impede career aspirations, instil social stigma and impair quality of life in patients. The majority of patients are diagnosed early in life and the incidence continues to rise; therefore, the effect of IBD on health-care systems will rise exponentially. Moreover, IBD has emerged in newly industrialized countries in Asia, South America and Middle East and has evolved into a global disease with rising prevalence in every continent. Understanding the worldwide epidemiological patterns of IBD will prepare us to manage the burden of IBD over time. The goal of this article is to establish the current epidemiology of IBD in the Western world, contrast it with the increase in IBD in newly industrialized countries and forecast the global effects of IBD in 2025.

At a glance


  1. Historical timelines of Crohn's disease and ulcerative colitis throughout the
    Figure 1: Historical timelines of Crohn's disease and ulcerative colitis throughout the world.
  2. The global prevalence of IBD in 2015.
    Figure 2: The global prevalence of IBD in 2015.

    Data from Molodecky et al.4 Adapted from an image provided by PresenterMedia.


  1. Kirsner, J. B. Historical aspects of inflammatory bowel disease. J. Clin. Gastroenterol. 10, 286297 (1988).
  2. Kirsner, J. B. Historical origins of current IBD concepts. World J. Gastroenterol. 7, 175184 (2001).
  3. Mulder, D. J., Noble, A. J., Justinich, C. J. & Duffin, J. M. A tale of two diseases: the history of inflammatory bowel disease. J. Crohns Colitis 8, 341348 (2014).
  4. Molodecky, N. A. et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 142, 4654. e42 (2012).
  5. Wilks, S. Morbid appearances in the intestine of Miss Bankes. London Medical Gazette 2, 264265 (1859).
  6. Wilks, S. & Moxon, W. Lectures on Pathological Anatomy. 2nd ed. (Longmans, 1875).
  7. Lockhart-Mummery, J. P. A discussion on ulcerative colitis. Proc. R. Soc. Med. 2, 9294 (1909).
  8. Crohn, B. B., Ginzburg, L. & Oppenheimer, G. D. Regional ileitis: a pathologic and clinical entity. JAMA 99, 13231329 (1932).
  9. Benchimol, E. I. et al. Increasing incidence of paediatric inflammatory bowel disease in Ontario, Canada: evidence from health administrative data. Gut 58, 14901497 (2009).
  10. Benchimol, E. I. et al. Changing age demographics of inflammatory bowel disease in Ontario, Canada: a population-based cohort study of epidemiology trends. Inflamm. Bowel Dis. 20, 17611769 (2014).
  11. Loftus, E. V., Jr. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology 126, 15041517 (2004).
  12. Kappelman, M. D. et al. Direct health care costs of Crohn's disease and ulcerative colitis in US children and adults. Gastroenterology 135, 19071913 (2008).
  13. Kappelman, M., Moore, K., Allen, J. & Cook, S. Recent trends in the prevalence of Crohn's disease and ulcerative colitis in a commercially insured US population. Dig. Dis. Sci. 58, 519525 (2013).
  14. Rocchi, A. et al. Inflammatory bowel disease: a Canadian burden of illness review. Can. J. Gastroenterol. 26, 811817 (2012).
  15. Burisch, J., Jess, T., Martinato, M. & Lakatos, P. L. The burden of inflammatory bowel disease in Europe. J. Crohns Colitis 7, 322337 (2013).
  16. Frolkis, A. D. et al. Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology 145, 9961006 (2013).
  17. Frolkis, A. D. et al. Cumulative incidence of second intestinal resection in Crohn's disease: a systematic review and meta-analysis of population-based studies. Am. J. Gastroenterol. 109, 17391748 (2014).
  18. Marchetti, M. & Liberato, N. L. Biological therapies in Crohn's disease: are they cost-effective? A critical appraisal of model-based analyses. Expert Rev. Pharmacoecon. Outcomes Res. 14, 815824 (2014).
  19. Park, S. J., Kim, W. H. & Cheon, J. H. Clinical characteristics and treatment of inflammatory bowel disease: a comparison of Eastern and Western perspectives. World J. Gastroenterol. 20, 1152511537 (2014).
  20. Ng, S. C. Emerging Leadership Lecture: Inflammatory bowel disease in Asia: emergence of a “Western Disease”. J. Gastroenterol. Hepatol. 30, 440445 (2015).
  21. Ng, S. C. et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study. Gastroenterology 145, 158165. e152 (2013).
  22. Sood, A., Midha, V., Sood, N., Bhatia, A. S. & Avasthi, G. Incidence and prevalence of ulcerative colitis in Punjab, North India. Gut 52, 15871590 (2003).
  23. Tozun, N. et al. Clinical characteristics of inflammatory bowel disease in Turkey: a multicenter epidemiologic survey. J. Clin. Gastroenterol. 43, 5157 (2009).
  24. Victoria, C. R., Sassak, L. Y. & Nunes, H. R. Incidence and prevalence rates of inflammatory bowel diseases, in midwestern of Sao Paulo State, Brazil. Arq Gastroenterol. 46, 2025 (2009).
  25. Crafts, N. Productivity growth in the industrial revolution: A new growth accounting perspective. J. Econom. History 64, 521535 (2004).
  26. Bach, J. F. The effect of infections on susceptibility to autoimmune and allergic diseases. N. Engl. J. Med. 347, 911920 (2002).
  27. Burisch, J. et al. East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut 63, 588597 (2014).
  28. Vegh, Z. et al. Incidence and initial disease course of inflammatory bowel diseases in in Europe and Australia: results of the 2011 ECCO-EpiCom inception cohort. J. Crohns Colitis 8, 15061515 (2011).
  29. Bitton, A. et al. Epidemiology of inflammatory bowel disease in Quebec: recent trends. Inflamm. Bowel Dis. 20, 17701776 (2014).
  30. Leddin, D., Tamim, H. & Levy, A. R. Decreasing incidence of inflammatory bowel disease in Eastern Canada: a population database study. BMC Gastroenterol. 14, 140 (2014).
  31. Kaplan, G. G. Pitfalls and perils of using administrative databases to evaluate the incidence of inflammatory bowel disease overtime. Inflamm. Bowel Dis. 20, 17771779 (2014).
  32. Bitton, A. et al. Decline in IBD incidence in Quebec: part of the changing epidemiologic pattern in North America. Inflamm. Bowel Dis. 20, 17821783 (2014).
  33. Molodecky, N. A., Panaccione, R., Ghosh, S., Barkema, H. W. & Kaplan G. G.; Alberta Inflammatory Bowel Disease Consortium. Challenges associated with identifying the environmental determinants of the inflammatory bowel diseases. Inflamm. Bowel Dis. 17, 17921799 (2011).
  34. Hou, J. K., El-Serag, H. & Thirumurthi, S. Distribution and manifestations of inflammatory bowel disease in Asians, Hispanics, and African Americans: a systematic review. Am. J. Gastroenterol. 104, 21002109 (2009).
  35. Probert, C. S. et al. Prevalence and family risk of ulcerative colitis and Crohn's disease: an epidemiological study among Europeans and south Asians in Leicestershire. Gut 34, 15471551 (1993).
  36. Benchimol, E. et al. Inflammatory bowel disease in immigrants to Canada and their children: a population-based cohort study. Am. J. Gastroenterol. 110, 553563 (2015).
  37. Benchimol, E. et al. Asthma, type 1 and type 2 diabetes mellitus, and inflammatory bowel disease amongst South Asian immigrants to Canada and their children: A population-based cohort study. PLoS ONE 10, e0123599 (2015).
  38. Zwi, A. B. & Mills, A. Health policy in less developed countries: past trends and future directions. J. Int. Dev. 7, 299328 (1995).
  39. Lai, C. L., Wu, P. C., Wong, K. L. & Lok, A. S. F. Clinical features of ulcerative proctocolitis in Hong Kong Chinese: a review of three decades. Am. J. Proctol Gastroenterol. Colon Rectal Surg. 36, 1419 (1985).
  40. Zheng, J. J. et al. Crohn's disease in mainland China: a systematic analysis of 50 years of research. Chin. J. Dig. Dis. 6, 175181 (2005).
  41. Chow, D. K. et al. Long-term follow-up of ulcerative colitis in the Chinese population. Am. J. Gastroenterol. 104, 647654 (2009).
  42. Frolkis, A. et al. Environment and the inflammatory bowel diseases. Can. J. Gastroenterol. 27, e18e24 (2013).
  43. Xavier, R. J. & Podolsky, D. K. Unravelling the pathogenesis of inflammatory bowel disease. Nature 448, 427434 (2007).
  44. Jostins, L. et al. Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease. Nature 491, 119124 (2012).
  45. Ananthakrishnan, A. N. Environmental risk factors for inflammatory bowel diseases: a review. Dig. Dis. Sci. 60, 290298 (2015).
  46. Knights, D., Lassen, K. G. & Xavier, R. J. Advances in inflammatory bowel disease pathogenesis: linking host genetics and the microbiome. Gut 62, 15051510 (2013).
  47. Ng, S. C. et al. Genetics of inflammatory bowel disease in Asia: systematic review and meta-analysis. Inflamm. Bowel Dis. 18, 11641176 (2012).
  48. Kaplan, G. G. IBD: Global variations in environmental risk factors for IBD. Nat. Rev. Gastroenterol. Hepatol. 11, 708709 (2014).
  49. Calkins, B. M. A meta-analysis of the role of smoking in inflammatory bowel disease. Dig. Dis. Sci. 34, 18411854 (1989).
  50. Cosnes, J., Beaugerie, L., Carbonnel, F. & Gendre, J. P. Smoking cessation and the course of Crohn's disease: an intervention study. Gastroenterology 120, 10931099 (2001).
  51. Sands, B. E. et al. Risk of early surgery for Crohn's disease: implications for early treatment strategies. Am. J. Gastroenterol. 98, 27122718 (2003).
  52. Coward, S. et al. Funding a smoking cessation program for Crohn's disease: an economic evaluation. Am. J. Gastroenterol. 110, 368377 (2015).
  53. Benjamin, J. L. et al. Smokers with active Crohn's disease have a clinically relevant dysbiosis of the gastrointestinal microbiota. Inflamm. Bowel Dis. 18, 10921100 (2012).
  54. Health & Social Care Information Center. Statistics on Smoking: England, 2015. National Statistics [online]
  55. Giovino, G. A. et al. Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. Lancet 380, 668679 (2012).
  56. Ng, S. C. et al. Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific. Gut 64, 10631071 (2014).
  57. Ananthakrishnan, A. N. Epidemiology and risk factors for IBD. Nat. Rev. Gastroenterol. Hepatol. 12, 205217 (2015).
  58. Ungaro, R. et al. Antibiotics associated with increased risk of new-onset Crohn's disease but not ulcerative colitis: a meta-analysis. Am. J. Gastroenterol. 109, 17281738 (2014).
  59. Klement, E., Cohen, R. V., Boxman, J., Joseph, A., Reif, S. Breastfeeding and risk of inflammatory bowel disease: a systematic review with meta-analysis. Am. J. Clin. Nutr. 80, 13421352 (2004).
  60. Soon, I. S. et al. The relationship between urban environment and the inflammatory bowel diseases: a systematic review and meta-analysis. BMC Gastroenterol. 12, 51 (2012).
  61. Ananthakrishnan, A. N. et al. A prospective study of long-term intake of dietary fiber and risk of Crohn's disease and ulcerative colitis. Gastroenterology 145, 970977 (2013).
  62. Pavlovic-Calic, N., Salkic, N. N., Gegic, A., Smajic, M. & Alibegovic, E. Crohn's disease in Tuzla region of Bosnia and Herzegovina: a 12-year study (1995–2006). Int. J. Colorectal Dis. 23, 957964 (2008).
  63. Quan, H. et al. International variation in the definition of 'main condition' in ICD-coded health data. Int. J. Qual. Health Care 26, 511515 (2014).
  64. Molodecky, N. A. & Kaplan, G. G. Environmental risk factors for inflammatory bowel disease. Gastroenterol. Hepatol. (N. Y.). 6, 339346 (2010).
  65. Hazlewood, G. S. et al. Comparative Effectiveness of immunosuppressants and biologics for inducing and maintaining remission in Crohn's disease: a network meta-analysis. Gastroenterology 148, 344354 e345 (2015).
  66. Feagan, B. G. et al. Vedolizumab as induction and maintenance therapy for ulcerative colitis. N. Engl. J. Med. 369, 699710 (2013).
  67. Sandborn, W. J. et al. Ustekinumab induction and maintenance therapy in refractory Crohn's disease. N. Engl. J. Med. 367, 15191528 (2012).
  68. Gerich, M. E. & McGovern, D. P. Towards personalized care in IBD. Nat. Rev. Gastroenterol. Hepatol. 11, 287299 (2014).
  69. Bewtra, M., Kaiser, L. M., TenHave, T. & Lewis, J. D. Crohn's disease and ulcerative colitis are associated with elevated standardized mortality ratios: a meta-analysis. Inflamm. Bowel Dis. Mar. 19, 599613 (2013).
  70. Duricova, D. et al. Overall and cause-specific mortality in Crohn's disease: a meta-analysis of population-based studies. Inflamm Bowel Dis. 16, 347353 (2010).
  71. Singh, S. et al. Post-operative mortality among patients with inflammatory bowel diseases: a systematic review and meta-analysis of population-based studies. Gastroenterology
  72. Rezaie, R. et al. Time trends in prevalence and incidence of inflamhmatory bowel disease in Alberta: A population-based study. Can. J. Gastroenterol. 26, A133 (2012).
  73. Bernstein, C. N., Wajda, A. & Blanchard, J. F. The clustering of other chronic inflammatory diseases in inflammatory bowel disease: a population-based study. Gastroenterology 129, 827836 (2005).
  74. Bernstein, C. N., Wajda, A. & Blanchard, J. F. The incidence of arterial thromboembolic diseases in inflammatory bowel disease: a population-based study. Clin. Gastroenterol. Hepatol. 6, 4145 (2008).
  75. Bernstein, C. N., Blanchard, J. F., Leslie, W., Wajda, A. & Yu, B. N. The incidence of fracture among patients with inflammatory bowel disease. A population-based cohort study. Ann. Intern. Med. 133, 795799 (2000).
  76. Siegel, C. A., Marden, S. M., Persing, S. M., Larson, R. J. & Sands, B. E. Risk of lymphoma associated with combination anti-tumor necrosis factor and immunomodulator therapy for the treatment of Crohn's disease: a meta-analysis. Clin. Gastroenterol. Hepatol. 7, 874881 (2009).
  77. Aljebreen, A. M. et al. Clinical epidemiology and phenotypic characteristics of Crohn's disease in the central region of Saudi Arabia. Saudi J. Gastroenterol. 20, 162169 (2014).
  78. Zhao, J. et al. First prospective, population-based inflammatory bowel disease incidence study in mainland of China: the emergence of “Western” disease. Inflamm. Bowel Dis. 19, 18391845 (2013).
  79. Bodger, K., Kikuchi, T. & Hughes, D. Cost-effectiveness of biological therapy for Crohn's disease: Markov cohort analyses incorporating United Kingdom patient-level cost data. Aliment. Pharmacol. Therap. 30, 265274 (2009).
  80. Lee, J. K., Tang, D. H., Mollon, L. & Armstrong, E. P. Cost-effectiveness of biological agents used in ulcerative colitis. Best Pract. Res. Clin. Gastroenterol. 27, 949960 (2013).
  81. Fiorino, G. & Danese, S. The biosimilar road in inflammatory bowel disease: the right way? Best Pract. Res. Clin. Gastroenterol. 28, 465471 (2014).
  82. Brodszky, V., Baji, P., Balogh, O. & Pentek, M. Budget impact analysis of biosimilar infliximab (CT-P13) for the treatment of rheumatoid arthritis in six Central and Eastern European countries. Eur. J. Health Econ. 15 (Suppl. 1) S65S71 (2014).

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  1. Departments of Medicine and Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, 6D56 Calgary, AB, Canada T2N 4Z6.

    • Gilaad G. Kaplan

Competing interests statement

G.G.K. has previously served as a speaker for Abbvie, Jansen, Merck, Schering-Plough and UCB Pharma, and has previously participated in advisory board meetings for Abbvie, Jansen, Merck, Schering-Plough, Shire and UCB Pharma. G.G.K. has also received research support from Abbvie, GlaxoSmithKline, Merck and Shire.

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  • Gilaad G. Kaplan

    Gilaad Kaplan is an Associate Professor in the Cumming School of Medicine at the University of Calgary, Canada. Dr Kaplan is a gastroenterologist and epidemiologist who has devoted his career to studying the environmental determinants of gastrointestinal diseases such as the inflammatory bowel diseases (IBD), and improving the care of patients living with these conditions. Dr Kaplan is an Alberta-Innovates Health-Solutions Population Health Investigator.

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