For a long time, Crohn’s disease appeared to be a medical problem concentrated in white populations. Crohn’s is an inflammatory condition affecting the intestines that can cause painful symptoms as well as serious complications. But the disease is beginning to be seen differently in minority communities and within medical circles, too.
Research in recent years suggests that this type of irritable bowel syndrome (IBD) is becoming more common in other ethnic groups. This is prompting the need to look closer at how often Crohn’s is diagnosed. Researchers also want to know how Crohn’s is viewed and treated among people of color, who may have previously been diagnosed and studied less than other groups by the medical community.
Research suggests, for example, that there are particularly big differences in the way white and African American populations see and experience Crohn’s. This may be explained by cultural differences, socioeconomic factors, and family support, among other things. The way minorities see Crohn’s appears to be greatly influenced by a long-term stigma (or feeling of shame) around this condition.
Crohn’s disease is a chronic condition that usually requires careful, lifelong management of what you eat. However, a range of cultural concerns related to religious and dietary habits may affect how the disease is seen and treated in certain populations.
Some foods and beverages that may be popular among certain populations are also on the list of foods most people with Crohn’s should avoid. These include:
- Caffeine and alcohol
- Fried or greasy foods
- Spicy foods
- Sugar-sweetened drinks
- Whole-fat dairy
Stress and smoking are also risk factors for developing Crohn’s. They can also make symptoms worse.
Access to Health Care and Health Information
As with many medical conditions, Crohn’s disease treatment and education can vary a good bit from one community to another, based on socioeconomic factors and consistent access to good health care.
In a comparison of white and African American people with IBD, researchers found that a higher percentage of white people than Black people saw a gastroenterologist (a doctor who specializes in stomach and intestinal conditions) for IBD treatment. There were similar gaps in getting referrals to see an IBD specialist and in worries about the costs of health care.
In some cases, language barriers may stand in the way of getting proper care and guidance in living with Crohn’s. Not knowing enough about health conditions among non-English speaking people in the United States can also contribute to differences in getting important information and treatment of Crohn’s disease.
The Need for Change
Several features of Crohn’s disease can contribute to misunderstandings about the condition. Symptoms such as abdominal pain and diarrhea are common to many other health problems, so it can be easy to dismiss these symptoms as something else. Crohn’s also tends to have alternating periods of symptom flare-ups and symptom-free remission. That further adds to confusion about the disease.
And finally, because Crohn’s is often diagnosed during adolescence, it can come with embarrassment and other negative feelings. That can keep people from getting treatment and managing their Crohn’s. Some children may express feelings of anxiety because of their symptoms. But not enough study has been done to link CD with depression, anxiety, and school struggles, among other challenges, that can stay with kids for years.
In non-white populations, the stigma and embarrassment around Crohn’s and other IBD conditions are of great concern. Research suggests that as many as half of the non-white people diagnosed with IBD have seen discriminatory behaviors from people in their own communities. These Crohn’s experiences are associated with worse outcomes. And researchers say more study is needed to better understand how stigma affects minorities because they haven't been represented well enough in research.
Without effective treatment and lifestyle changes, Crohn’s disease can lead to several serious health problems, including ulcers, anal fissures, and malnutrition, among other things. It’s important to understand that this is not just “stomach trouble.” It’s a disease that doesn’t go away. But it can be managed.
To provide greater knowledge of Crohn’s disease and improved access to care, people can:
- Look for culturally aware information about Crohn’s and the other main form of IBD, ulcerative colitis. This includes obtaining culturally appropriate food recommendations.
- See a gastroenterologist if you have been diagnosed with Crohn’s or suspect you may have it. If language is a barrier, try to have a family member or friend accompany you to the appointment to act as an interpreter. Ask the doctor’s office if there is anyone on staff who speaks your primary language.
- Work with public health organizations that may provide assistance with medical transportation, reduced prices for prescription drugs, and health education.
- Work with a nutritionist or dietitian who can offer tips about your diet to reduce the intensity and frequency of Crohn’s flare-ups.
For anyone affected by Crohn’s disease, it’s important to recognize the psychological impact of the condition and address that along with the physical effects. Psychological counseling (including talk therapy) and learning ways to deal with how the condition can affect your mental health can help people with Crohn’s manage the condition better. A key part of this effort is to educate family members, social networks, and even health care providers about the realities of living with Crohn’s disease.
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American Journal of Gastroenterology: “Racial disparities in utilization of specialist care and medications in inflammatory bowel disease.”
BMC Gastroenterology: “Experiences of ethnic minority patients who are living with a primary chronic bowel condition: a systematic scoping review with narrative synthesis,” “The evolution of IBD perceived engagement and care needs across the life-cycle: a scoping review.”
Inflammatory Bowel Diseases: “Effect of race and ethnicity on perceptions of inflammatory bowel disease,” “Stigma perceptions in non-white IBD patients and relationships with patient outcomes.”
International Journal of Environmental Research and Public Health: “A Feeling of Otherness: A Qualitative Research Synthesis Exploring the Lived Experiences of Stigma in Individuals with Inflammatory Bowel Disease.”
Therapeutic Advances in Gastroenterology: “Incidence of inflammatory bowel disease by race and ethnicity in a population-based inception cohort from 1970 through 2010,” “Social barriers influence inflammatory bowel disease (IBD) outcomes and disproportionately affect Hispanics and non-Hispanic Blacks with IBD.”