Diseases of the digestive system affecting oesophagus, stomach, intestines, liver and pancreas constitute a major problem in India.  There is no national survey data for digestive diseases.  It is often loosely said ‘every other person in India suffers with digestive disorders’… This may be an exaggeration, but certainly, it is true to say that digestive diseases are far more common in India, than in England and USA.  A rough estimate of the magnitude of the digestive disorders in our country can be obtained by quoting the figures from USA and England; (a) It has been estimated that one half of the population of the United states has digestive disorders. Digestive disease is number one as a cause of hospitalisation and number three as a cause of death in USA. (b) In great Britain,  one in ten patients who consult General practitioner and one in six patients getting admissions in district hospital suffer with digestive diseases.  It is certain that socioeconomic and environmental factors of our country are responsible for a much greater prevalence of digestive disorders than reported from the Western part of the world.

Digestive diseases commonly affect the persons at the prime period of their life i.e. in the young and most productive part of the life and the children during the crucial stage of growth and development.  The less privileged class of the population living in rural areas and less developed part of cities are easy victims to the digestive diseases.  This class constitutes nearly 80-85 percent of our total population which is supposed to get priority attention in our present policy of health, education and other development programmes. 

Most of the digestive diseases are chronic or recurrent and lead to more disability than acute transient illness.  They are less often the cause of dramatic death which can catch the eyes of the public or administrators but they are responsible for prolonged suffering.  Digestive diseases are considered as number two cause of days lost from work in USA and possibly it may be number one in India.  Chronic disability due to digestive disorder lowers the production capacity.  It is suggested that digestive disorder coupled with malnutrition is one of the most important detriment to the economic progress in our country. 

Our digestive system is challenged by a number of injurious agents viz. Infections, malnutrition, spices and alcohol, drug addiction and nervous tension.  Our digestive organs lose the battle and patients suffer with diarrhoea and dysentery or gastroenteritis, peptic ulcer, hepatitis, liver abscess, cirrhosis of the liver, gall stones, malabsorption, pancreatitis and irritable bowel syndrome.  Prevalence and incidence of each of these disease is not well worked out in India. 

Acute infectious gastroenteritis is the commonest ailment amongst patients attending the private practitioners, primary health centers and district hospitals in summer months.  This is related to fast putrefaction of food in hot weather and rapid growth of the infectious organism. 

Cholera is most severe form of gastroenteritis and it still exists in India.  Parasitic infections of the instestine are widely prevalent in our country, particularly in rural population.  A survey in rural population of a hill district in North India revealed the presence of parasitic infection in 66 percent of the population.  Mixed infection was present in 33 percent. Amoebiasis, hookworm, ascariasis and giardiasis were present in 25%, 20%, 33%, and 11% respectively.  In hospital population in AIIMS prevalence of the parasitic infection has been found to be amoebiasis 10% hookworm 9% giardiasis 9% and ascariasis 8%.  The health hazards of parasitic infections are well established.  Mixed parasitic infection of intestine is most important contributory factor to malnutrition. Anemia due to hookworm disease is most serious problem of chronic suffering and disability in our rural population.  Giardiasis and ascariasis are important causes of chronic illness, poor absorption of food and impaired growth and development of the children in India.  Intestinal amoebiasis leads to lasting disability due to psychic problems.  Control and eradication of intestinal parasitic infection is a serious, priority and challenging health problem of India. 

Peptic ulcer is a world wide problem and its prevalence in India is quite high.  Several field studies from different  parts of our country suggest its occurence in 4 to 10 per thousand population.  Tamil nadu, Andhra, Jammu and Kashmir are considered to be very high risk areas.  The exact cause of peptic ulcer is not known, the disease results in chronic suffering, loss of working hours and occasional fatality. Smoking, alcoholism, and spices help to chronicity of the disease and often precipitate serious complications of ulcer. Gastritis and duodenitis, a sister disease of peptic ulcer or possibly a precursor to ulcer disease is possible far more common in our country than peptic ulcer.  This is responsible for chronic dyspepsia, disturbing the physical and mental health of the patients. 

Hepatitis and Cirrhosis of the Liver

Viral hepatitis is a cosmopolitan disease and several epidemics have been reported in India, the worst being that of Delhi in 1955-56.  It has serious and often fatal prognosis during the 6 to 9 months of pregnancy. It is known to be caused by two types of viruses.  A and B.  Virus B is known to have a worse prognosis, due to more likehood of acute fulminant course and chronic long tern sequelae of the disease.  Fulmiinant viral hepatitis is the commonest cause of death due to digestive diseases in the hospital patients.  It is yet not established that viral hepatitis leads to cirrhosis of the liver, but the possibility is still being actively studied.  Cirrhosis of the liver is generally an irreversible disease and usually has a fatal end, after few years of chronic illness.  A peculiar type of cirrhosis, known as Indian childhood cirrhosis is a serious disease, affecting young children and once established almost always leading to a fatal end.  Again the cause of this disease is not known and the treatment is very unsatisfactory.  Hepatitis and cirrhosis are also considered serious liver diseases even in Western countries; former is known to be reported in about 75,000 patients a year and latter one is responsible for 23,000 deaths a year in USA. These figures certainly will be several times more for India. 

Chronic cholecystitis and cholelithiasis is a very common disease of North India.  It is estimated that this disease is seven times more common in North India than in South India.  Exact prevalence of this common disease in North India is not known but it seems to be more prevalent that in Western countries.  It is estimated that in USA gall stones affect about fifteen million Americans and cost them close to half a billion dollars a year in medical care.  Etiology of gall stones is not known.  Dietary factors particularly ‘fats’ seems to play some part.  Gallstones are responsible for chronic dyspepsia, dramatic illness with acute abdominal pain and jaundice.  Association of chronic cholecystitis and cholelithisasis with cancer of the gall bladder is very alarming. The prevention of fatal disease of cancer of the gall bladder can best be attempted by early detection and surgical resection of gall bladder or patients having cholelithiasis. 

Chronic pancreatitis with stones in the pancreatic duct and destruction of the pancreas is very common in certain parts of south India.  A detailed study of this serious disease producing prolonged suffering and fatal end has been carried out in Kerala.  The etiology of pancreatitis is not known.  Nutritional factors have been incriminated but not proved.  The disease affects young persons and they develop abdominal pain, diarrhoea, skin disease and severe form of diabetes.  In few years time, the end is fatal.  Treatment is generally symptomatic and specific therapy to check the progress of the disease is not possible. 

One of the important disorders responsible for undernutrition in India is that of Malabsorption Syndrome.  It has been recorded in epidemic from in South India (Vellore) but in endemic form it is prevalent all over India.  The cause of this condition is not known, patients usually young get diarrhoea and weight loss due to poor absorption of food they eat.  It is a serious problem, as already vast proportion of our population does not get adequate to eat and they cannot bear the loss of minimal food available to them.  Patients continue to suffer with chronic illness as the treatment is only symptomatic and cure is yet not possible. 

Abdominal tuberculosis, affecting the intestine and other abdominal organs is rather quite common all over India, particularly in North India.  This need not be associated with active tuberculosis of the lung.  In fact, through prevalence of pulmonary tuberculosis is declining due to several active antituberculosis programmes, abdominal tuberculosis seems to be still widely prevalent amongst hospital admission.  Patients suffer with prolonged ill health and despite good anti-tubercular treatment they may end up for surgical treatment.   Luckily regional enteritis a somewhat similar but far more serious inflammatory disease of small intestine is very rare in India, though it is very common in Western countries.  A sister disease, ulcerative colitic presenting as bloody diarrhoea, difficult to control and rarely cured is now recognised more frequently in our country than was known a decade back. 

Stress and strains of life find easy vent to gastrointestinal disorders.  These conditions are considered ‘bread earner’ to gastroenterologists but are responsible for substantial economic loss to the country. 

Incidence of cancer of the oral cavity and the oesophagus is quite high in India; it is more than twice its occurrence in USA and UK and more than thrice its occurrence in Scandinavian countries.  Certain habits like tobacco and pan chewing are associated with high incidence of oropharyngeal and oesophageal cancer in India; Cancer of the other parts of gastrointestinal tract is relatively low in our country. 

In conclusion Digestive System in India suffers with number of diseases due to infections which can be considered of great public health importance.  A large number of digestive diseases of unknown etiology are also quite common in India.  These conditions generally produce chronic ill health and lasting disability.   Facilities for proper management of digestive disorders are very poorly developed in our country.  Proper care to the digestive disease will help in ‘adding life to years… as well as years to life’.           
                

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