Inflammatory bowel disease (IBD) is a relatively new entrant in the Indian sub-continent, as bacterial, mycobacterial, or protozoal infections accounted for the vast majority of enteric and colonic diseases in the past. Over the last six decades there has been a paradigm shift in the nature of intestinal diseases in India, which can be directly attributed to the improvement in socio-economic status since India achieved its independence in 1947. The other major factor for the increased recognition of IBD in India has been the development of super-specialty centers which over the years have trained a large number of gastroenterologists, who have created an awareness of IBD in the Indian subcontinent. Currently there are at least 21 centers in India which offer a post-doctoral degree in the super-specialty of gastroenterology in India. Although this appears to be a large number, it is woefully short of covering the needs of a nation which has a population exceeding 1.2 billion. To cover the severe deficiency of specialists in various fields due to the limited availability of seats at the post-doctoral level, the Indian government started diploma courses in almost all super-specialties in the 1990s under an autonomous body called the National Board of Examinations [1]. Needless to say, this innovative idea has become a huge success and has gone a long way in reducing the shortfall of trained specialists in many parts of India.

Similarly, endoscopy was first introduced in India in the mid-1980s at a few select centers; however over the next three decades endoscopy services have become available not only in the metro cities but also in the smaller cities all over the country. India does, however, have the dubious distinction that no Board certification is required by a physician for offering this service in the public domain. This has resulted in several physicians and surgeons performing endoscopic procedures even though they have received no formal training in endoscopy. This is the prime reason for the wide disparity in the competence of endoscopists in India. The disparity is much more marked in colonoscopic procedures as compared to upper GI endoscopic procedures.

The first report of ulcerative colitis (UC) in India came in the 1930s. It remained an esoteric disease till Khosla et al. showed a relatively high prevalence rate of 44 per 100 K in the northern part of the country [2]. At about the same time, it was recognized that there was a high prevalence of IBD in Indian migrants to the UK that was at par or even higher than the native Caucasian population [3]. Sood et al. undertook another study in the Indian state of Punjab and confirmed two findings: first, that the prevalence of the disease was nearly identical to the earlier study by Khosla et al. and second, that the ethnic group of Punjabis were more prone to develop IBD, as shown by the migrant studies from the UK [4]. More recently, the Indian Society of Gastroenterology constituted a task force to evaluate the epidemiology and clinical spectrum of IBD [5, 6]. Since the task force data was derived from a questionnaire filled by practicing gastroenterologists, the information derived from it cannot be as authentic as actual field surveys and epidemiological studies.