5 Things to Know About Ulcerative Colitis in Minorities

An estimated 3 million people in the United States have inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease, and the vast majority of diagnoses have been in white people.

But according to a review published in August 2016 in the journal Inflammatory Bowel Diseases, IBD, including pancolitis (a form of UC that affects the entire colon), is increasing among minority populations. Other research, published in May 2021 in the International Journal of Colorectal Disease, found that Hispanic Americans are as likely to have IBD as non-Hispanic white Americans.

It’s a trend that’s being observed by gastroenterologists across the country. For example, while John Rivas, MD, a gastroenterologist and liver specialist with Digestive and Liver Disease Consultants of South Florida in Hollywood, Florida, sees patients of all races and ethnicities, he’s noticed an increase in UC among minorities, specifically in people with a South American background.

“Part of the reason for this uptick isn’t necessarily that minorities didn’t previously suffer from UC,” says Dr. Rivas, “but it could be due to the fact that most studies didn’t include minorities in the study sample.” Now that researchers are studying IBD in minorities, it may appear as though it’s increasing among this population, he says.

Even with this apparent increase, awareness is still low. Here are five things to know.

1. UC can be overlooked.

For decades, UC was vastly considered to be an autoimmune disorder that occurs more often in white people and people of Ashkenazi origin. “When a patient of Hispanic or Asian descent comes to [a doctor] with symptoms that present themselves in not just UC but maybe other conditions, [the doctor might not] consider IBD,” says Rivas. “So ulcerative colitis could be overlooked.”

2. Some people may not speak up about their symptoms.

“Having a chronic condition such as ulcerative colitis can be really taboo, so they may not be as open about their symptoms,” says Rivas. “Some patients may suffer for years before they finally see a doctor and are diagnosed.”

He often sees minority patients five or six years after they first noticed their symptoms; some have hidden how they’ve been feeling from family and friends because they are too embarrassed to speak up.

3. In Hispanic and Asian Americans, UC may affect more of the colon.

“Hispanic and Asian patients [who have UC] may have more extensive colon involvement than Caucasians,” explains Dana Lukin, MD, clinical director of translational research for the Jill Roberts Center for Inflammatory Bowel Disease at NewYork-Presbyterian Hospital and Weill Cornell Medicine. “This might result in more ongoing symptoms, [such as] diarrhea, anemia, and weight loss.”

That may be due to the longer lag time in seeking medical help, says Rivas. “By the time they come to the hospital, the disease is too far gone and there are a lot of complications, such as bacteria getting into the bloodstream, causing sepsis,” he says. “Or they end up getting a total colectomy.”

4. An ‘American diet’ could play a role in triggering UC flares.

Processed and fast foods have gained popularity in the United States, and their ever-increasing availability might contribute to UC symptoms in non-white people, says Dr. Lukin.

“There might have been a more pronounced difference in the diets consumed by different ethnic and racial groups [previously],” he explains. “But, as dietary trends and the [low] cost of processed food, refined carbohydrates, and higher-fat foods have enabled more widespread consumption of these items, the incidence of UC in non-Caucasian patients has started to increase significantly.”

While diet alone doesn’t cause IBD, certain foods, including high-fat foods such as butter and cream, can irritate the digestive tract and trigger cramping, bloating, and diarrhea, according to the Crohn’s & Colitis Foundation.

5. UC may show up later in life.

“Some studies have detected a higher incidence of UC in Hispanic patients, and this tends to present at a later age than in Caucasians,” says Lukin. One study, published in the journal Digestive Diseases and Sciences, found this to be true of both Hispanics and Asian Americans.

And a study published in the same journal found that African Americans were significantly older than white people when they were diagnosed with UC — by an average of 8 years. This may differ from Crohn’s disease, though: The researchers noted that African Americans and white people tended to be diagnosed with Crohn’s disease at the same age.

While researchers aren’t always able to pinpoint why this is the case, the 2016 review found that white patients were more likely to have a family history of IBD than African Americans, Hispanics, or Asians, and people who had a family history of the condition tended to experience symptoms earlier.

Rivas suspects that part of the reason UC can appear later in life among minorities is that some may not seek medical help until the condition worsens and starts interfering with their day-to-day lives.