Fatty Liver, Colorectal Cancer and Gut Infections: Why India's Digestive Disease Burden Is Changing

India is facing a double burden of digestive diseases as fatty liver, colorectal cancer and chronic gastrointestinal disorders rise alongside H pylori, intestinal worms. Obesity, diabetes, unhealthy diets and delayed diagnosis are driving the shift.

India is facing a double burden of digestive diseases

India is seeing a major shift in its digestive health burden. While improvements in sanitation, vaccination and public health have helped control several infectious diseases, metabolic and lifestyle-related conditions are rising rapidly.

Doctors say the country is now dealing with both old and new challenges at the same time. Persistent infections such as Helicobacter pylori and intestinal worm infestations continue to affect millions, while fatty liver disease, colorectal cancer, inflammatory bowel disease and coeliac disease are becoming increasingly common.

The changing pattern will be a key focus at the World Congress of Gastroenterology (WCOG) 2026, scheduled to be held in India for the first time from September 30 to October 3 at Yashobhoomi in Dwarka, Delhi.

Why fatty liver disease is becoming a major concern

One of the biggest concerns is the rapid rise of fatty liver disease. An AIIMS-led systematic review and meta-analysis found fatty liver disease in 38.6 per cent of Indian adults and 35.4 per cent of children.

The condition occurs when excess fat builds up in the liver. It is closely linked to obesity, type 2 diabetes, high blood pressure and other metabolic problems.

What makes fatty liver particularly worrying is that it can progress silently. Many people may have no obvious symptoms until significant liver damage has already occurred.

A recent study also found clinically significant liver fibrosis in one in four people with type 2 diabetes, highlighting the close link between metabolic disease and liver health.

India included fatty liver disease in its National Programme for Prevention and Control of Non-Communicable Diseases in 2021 and later introduced guidelines to help detect it at the primary-care level. However, doctors say screening and early awareness remain major challenges.

Lifestyle changes are increasing metabolic risks

Rapid urbanisation and changing lifestyles are playing an important role.

Sedentary jobs, reduced physical activity, unhealthy diets and rising obesity have increased the risk of metabolic diseases. Diets high in refined carbohydrates, processed foods and unhealthy fats can also contribute to obesity and insulin resistance.

India's growing burden of diabetes is another major factor. The combination of diabetes, excess body weight and hypertension increases the risk of fatty liver and its complications.

Doctors say treatment alone will not be enough. Prevention, healthier diets, regular exercise and early screening will need to become a larger part of the country's healthcare approach.

Why colorectal cancer is being detected more often

Colorectal cancer is another growing concern. India recorded an estimated 40,430 new colorectal cancer cases among men and 24,433 among women in 2022.

Doctors are also reporting more cases among younger adults.

The reasons behind this trend are complex and may involve changes in diet, obesity levels, physical inactivity and other lifestyle factors. Greater access to diagnostic tests may also be leading to more cases being identified.

Experts say one major problem is the tendency to ignore early warning signs. Blood in the stool, unexplained weight loss and persistent changes in bowel habits are sometimes dismissed as minor digestive problems.

Doctors stress that symptoms lasting more than two or three weeks should be medically evaluated rather than ignored.

Old infections have not disappeared

Despite the rise of lifestyle-related diseases, India continues to face a significant burden from gastrointestinal infections.

Helicobacter pylori, a bacterial infection linked to peptic ulcers and an increased risk of gastric cancer, remains widespread. Intestinal worm infections also continue to affect children and can contribute to anaemia, poor nutrition and impaired growth.

This creates what doctors describe as a double burden. The health system must continue addressing infectious diseases while also preparing for a growing number of chronic illnesses that require long-term monitoring and treatment.

Diseases once considered uncommon are now being recognised

Conditions such as coeliac disease and inflammatory bowel disease, including Crohn's disease and ulcerative colitis, are also being diagnosed more frequently.

A community-based AIIMS study found coeliac disease in around one in 96 people in northern India.

Experts say some of the increase may be due to better awareness and improved diagnostic facilities. However, changing environmental and lifestyle factors may also be contributing.

For patients, delayed diagnosis can make these conditions more difficult to manage. Symptoms such as persistent diarrhoea, abdominal pain, bloating, unexplained weight loss and blood in stools should not be repeatedly ignored or treated without proper evaluation.

The focus must shift towards early detection

India's changing digestive disease burden shows why prevention and early diagnosis are becoming increasingly important.

Doctors say the country has skilled specialists and advanced medical technology, but many patients still seek help only after symptoms become severe.

The message from experts ahead of WCOG 2026 is clear: persistent gastrointestinal symptoms should be taken seriously.

Early testing can help identify fatty liver disease, cancer and chronic digestive disorders before they cause major complications. At the same time, healthier lifestyles and stronger public awareness could reduce the risk of several metabolic diseases.

As India continues to fight old infections, it must also prepare for a future in which obesity, diabetes, fatty liver and digestive cancers form a much larger part of the country's healthcare burden.

(With inputs from agencies)