Hong Kong warned of surge in inflammatory bowel disease rates

The number of Hongkongers suffering from incurable chronic gut conditions could surge by 150 per cent over a 20-year period due to unhealthy diets, high in sugar and fat, according to a global study.
Scientists from the study that was co-led by researchers from Hong Kong and Canada raised the alarm after a projection model estimated that the prevalence of inflammatory bowel disease in the city would rise from 40 cases per 100,000 people in 2014 to 100 in 2034.
'The 150 per cent increase in the total number in terms of prevalence – this is quite scary,' said Professor Ng Siew Chien, associate dean of the Chinese University of Hong Kong's medical school and an expert in gastroenterology who co-led the study.
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'We call this probably an explosion.'
Researchers found that the rates were related to economic development and that less developed places, such as Malaysia and mainland China, had lower rates than Hong Kong, although they were also trending upwards.
IBD refers to a group of conditions that cause swelling and inflammation of tissue in the digestive tract, with Crohn's disease and ulcerative colitis being the two most common types.
Common symptoms of such conditions include diarrhoea, abdominal pains and cramps, and blood in the stool. IBD sufferers are also more likely to develop serious illnesses such as colon cancer.
The researchers' projection model is based on real-world data collected from more than 500 studies in 82 regions that took place between 1920 and 2024.
It also anticipated a rise in the local incidence rate for IBD, which involves the number of new cases per 100,000 people.
While the rate in Hong Kong was 0.1 in 1985, it rose to about three in 2013 and is estimated to have exceeded four in 2023.
The figures placed the city in the second part of a four-stage model outlined in the study, meaning it was experiencing a phase of 'acceleration in incidence' in IBD cases.
Other jurisdictions that were seeing similar trends to Hong Kong included many relatively newly industrialised nations in Asia and Latin America, such as mainland China, Japan and South Korea.
In the mainland, the rate of new cases rose from two per 100,000 people in 2010, to 15 in 2020. The total number of IBD patients in the country is expected to exceed 1.5 million by this year, according to Ng.
The study, which was published in top scientific journal Nature last month, placed countries with low incidence and prevalence rates, such as many places in Africa, in the stage one category.
Most countries in North America, Europe and Oceania were classified as being in stage three, meaning the number of new cases had already slowed down, but the total number of patients had steadily increased.
While such conditions are not fatal and can be managed with medications and treatments, they cannot be cured. Serious cases can require surgery to remove a patient's colon and rectum, who must then carry a pouch to collect their waste.
The late Shinzo Abe resigned as the prime minister of Japan in 2020 due to his struggles with ulcerative colitis.
Study co-leader Professor Gilaad Kaplan, a gastroenterologist from the medical school of Canada's University of Calgary, said increases in new cases of IBD correlated with economic advancement.
'The earlier a country transitions into economic advancements, the earlier we see that trigger into stage two,' he said.
Kaplan said that while higher incidence and prevalence rates were due to improved detection and diagnostic tools in economically advanced regions, environmental factors also played a crucial role.
A person's diet was one of the strongest pillars under the category of environmental factors that contributed to a rise in cases, Kaplan and Ng said.
Diets that were high in fat, sugar, ultra-processed foods, additives and colourings could change the health of a person's gut, she said.
'These foods actually affect our gut microbiome, which is the bacteria and viruses inside our gut,' the researcher said.
'They can induce [and] increase bacteria that can cause inflammation ... These bacteria produce toxins and chemicals inside the gut, and then it makes the gut very thin.'
Ng explained that the resulting toxins and inflammatory responses inside the gut could then disturb one's immune system.
She added that a growing number of IBD patients could see the local healthcare system face an increased economic burden, citing her own separate analysis on the topic.
The academic noted that the average medical cost for a patient with the condition was about HK$40,000 to HK$50,000 (US$6,380) a year, about twice the amount paid by someone suffering from type 2 diabetes.
Kaplan, meanwhile, said that IBD patients would get older and become more challenging to manage if they developed other conditions such as diabetes or dementia.
Both researchers called for preventive actions to slow down IBD's growing prevalence and incidence rates.
'Our models show that if we can prevent the incidence of new diagnoses, even just by a small amount, that has a huge impact on blunting the overall growth or prevalence of the disease,' Kaplan said.
He added that people could stave off such conditions by adopting a healthy, whole food diet, while officials could create policies that increased the availability of healthy foods.
Sharing her tips on preventing the condition among the children of IBD patients, Ng said: 'Less processed food; just cook everything from scratch. Try not to use so many antibiotics if you can, because that changes the gut microbiome as well.'
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