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Chennai, Sep 23: 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.