Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2020; 26(43): 6891-6908
Published online Nov 21, 2020. doi: 10.3748/wjg.v26.i43.6891
Crohn’s disease in low and lower-middle income countries: A scoping review
Ruma Rajbhandari, Samantha Blakemore, Neil Gupta, Alma J Adler, Christopher Allen Noble, Sara Mannan, Klejda Nikolli, Alison Yih, Sameer Joshi, Gene Bukhman
Ruma Rajbhandari, Samantha Blakemore, Sara Mannan, Klejda Nikolli, Alison Yih, Gene Bukhman, Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
Ruma Rajbhandari, Neil Gupta, Alma J Adler, Christopher Allen Noble, Gene Bukhman, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02199, United States
Neil Gupta, Christopher Allen Noble, Gene Bukhman, Partners in Health, NCD Synergies, Boston, MA 02199, United States
Sameer Joshi, Western Reserve Health Education, Trumbull Regional Medical Center, Warren, OH 44483, United States
Author contributions: Rajbhandari R, Blakemore S, Adler AJ, Noble CA and Bukhman GB designed the research; Blakemore S, Mannan S, Nikolli K and Yih A performed the research; Rajbhandari R, Blakemore S, Mannan S, Nikolli K and Yih A analyzed the data; Rajbhandari R, Blakemore S, wrote the paper; Rajbhandari R, Adler JA, Gupta N, Bukhman G supervised the paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Ruma Rajbhandari, MD, MPH, Associate Physician, Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, United States.
Received: June 19, 2020
Peer-review started: June 19, 2020
First decision: August 22, 2020
Revised: September 4, 2020
Accepted: October 20, 2020
Article in press: October 20, 2020
Published online: November 21, 2020

While Crohn’s disease has been studied extensively in high-income countries, its epidemiology and care in low and lower-middle income countries (LLMICs) is not well established due to a lack of disease registries and diagnostic capacity.


To describe the published burden, diagnostic/treatment capacity, service utilization, challenges/barriers to individuals with Crohn’s in LLMICs and their providers.


We conducted a scoping review utilizing a full search strategy was developed and conducted in PubMed, Embase and World Health Organization Global Index Medicus. Two independent reviewers screened the titles and abstracts of all of the publications found in this search, reviewed selected publications, and extracted relevant data, which underwent descriptive review and was analyzed in Excel.


The database search yielded 4486 publications, 216 of which were determined to be relevant to the research questions. Of all 79 LLMICs, only 21 (26.6%) have publications describing individuals with Crohn’s. Overall, the highest number of studies came from India, followed by Tunisia, and Egypt. The mean number of Crohn’s patients reported per study is 57.84 and the median is 22, with a wide range from one to 980.


This scoping review has shown that, although there is a severe lack of population-based data about Crohn’s in LLMICs, there is a signal of Crohn’s in these settings around the world.

Keywords: Crohn’s disease, Low and lower-middle income countries, Scoping review, Service utilization, Diagnostic/Treatment capacity

Core Tip: This scoping review demonstrates the lack of epidemiologic data on Crohn’s disease in low and lower-middle income countries, but that it does exist in these settings and presents unique challenges. There is a need for population-based research to fully understand the its burden among the world’s poorest people.