Challenges in the management of inflammatory bowel disease in sub-Saharan Africa

Watermeyer, Gillian; Awuku, Yaw Asante; Fredericks, Ernst; Epstein, David; Setshedi, Mashiko; Devani, Smita; Mudombi, Wisdom; Kassianides, Chris; Katsidzira, Leolin

doi:10.1016/s2468-1253(22)00048-6

Cited by 8 publications

(20 citation statements)

References 72 publications

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“…20 In multiple cohort studies, thiopurine treatment in IBD patients has also been linked to an increased incidence of skin malignancies, notably non-melanoma skin cancer (NMSCs). 21,22 All the malignancies associated with the usage of these drugs are depicted in ►Fig. 1.…”

Section: Thiopurinesmentioning

confidence: 99%

Current Treatment Strategies for Inflammatory Bowel Disease Patients at the Risk of Developing Cancer: A Comprehensive Review

Achutha,

Desai

2023

Journal of Coloproctology

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Inflammatory bowel disease (IBD) is a chronic condition that affects the digestive tract and can lead to inflammation and damage to the intestinal lining. IBD patients with cancer encounter difficulties since cancer treatment weakens their immune systems. A multidisciplinary strategy that strikes a balance between the requirement to manage IBD symptoms and the potential effects of treatment on cancer is necessary for effective care of IBD in cancer patients. To reduce inflammation and avoid problems, IBD in cancer patients is often managed by closely monitoring IBD symptoms in conjunction with the necessary medication and surgical intervention. Anti-inflammatory medications, immunomodulators, and biologic therapies may be used for medical care, and surgical options may include resection of the diseased intestine or removal of the entire colon. The current study provides a paradigm for shared decision-making involving the patient, gastroenterologist, and oncologist while considering recent findings on the safety of IBD medicines, cancer, and recurrent cancer risk in individuals with IBD. We hope to summarize the pertinent research in this review and offer useful advice.

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Section: Thiopurinesmentioning

confidence: 99%

Current Treatment Strategies for Inflammatory Bowel Disease Patients at the Risk of Developing Cancer: A Comprehensive Review

Achutha,

Desai

2023

Journal of Coloproctology

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“…Gastrointestinal endoscopy plays a central role in the diagnosis of IBD and although there are some centres in SSA that offer advanced endoscopy on par with high-income regions (Figures 4 and 5), access in many countries still presents a major challenge for multiple reasons, such as shortages of trained staff (both endoscopists and endoscopy nursing staff), lack of equipment, challenges in equipment maintenance, cost of the procedures and lack of judicious patient selection for endoscopic procedures among physicians. 6,22…”

Section: Gastrointestinal Endoscopy Services In Ssamentioning

confidence: 99%

“…22 While detailed information on medicine usage is lacking, treatment options appear to be limited for most countries in SSA, with substantial reliance on corticosteroids and aminosalicylates. 22,58–61 Although, systemic corticosteroids remain the foundation of therapy for induction of remission in moderate-to severe UC and CD, 1 they are often also used for long-term treatment in many countries as orthodox, guideline-based alternatives are often unavailable or are unaffordable. In general UC appears to be more common in SSA than CD, and as such, aminosalicylates are the most widely prescribed long-term therapy, especially sulphasalazine which is less costly than mesalazine products.…”

Section: The Management Of Ibd In Ssamentioning

confidence: 99%

“…In general UC appears to be more common in SSA than CD, and as such, aminosalicylates are the most widely prescribed long-term therapy, especially sulphasalazine which is less costly than mesalazine products. 22 Aminosalicylates are effective in mild-to-moderate UC for induction and maintenance of remission but have limited efficacy in CD. 1 Despite the lack of evidence, many patients with CD in SSA are treated with sulphasalazine as it is often all that is available.…”

Section: The Management Of Ibd In Ssamentioning

confidence: 99%

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Challenges in the diagnosis and management of IBD: a sub-Saharan African perspective

Watermeyer

Katsidzira

Nsokolo

et al. 2023

Therap Adv Gastroenterol

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With the exception of South Africa, inflammatory bowel disease (IBD) has long been considered uncommon in sub-Saharan Africa (SSA) with a dearth of peer-reviewed publications from the subcontinent. This most likely reflects underreporting as some cases may be missed due to the high burden of infectious diseases which may closely mimic IBD. In addition, many countries in SSA have limited endoscopic capacity, inadequate access to diagnostic imaging and a notable scarcity of histopathologists, radiologists and gastroenterologists. Beyond these obstacles, which significantly impact patient care, there are many other challenges in SSA, particularly the unavailability of key IBD therapies. In this review, we discuss barriers in diagnosing and managing IBD in SSA, as well as some of the initiatives currently in place to address these short comings.

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“…The challenges are exacerbated by limitations on endoscopic capability and a lack of skilled diagnostic pathologists. 8 Over decades, significant research progress has been accomplished in the field of IBD in order to unravel the IBD pathogenesis. Genetic, genomics and molecular biology advances have provided the most relevant data in terms of genes involved, gene-gene and gene-environment interactions, molecular pathways, and immunity and microbiota factors.…”

Section: Introductionmentioning

confidence: 99%

A Review on Inflammatory Bowel Diseases: Recent Molecular Pathophysiology Advances

Abdulla¹,

Mohammed²

2022

BTT

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Inflammatory bowel diseases are considered immune disorders with a complex genetic architecture involving constantly changing endogenous and exogenous factors. The rapid evolution of genomic technologies and the emergence of newly discovered molecular actors are compelling the research community to reevaluate the knowledge and molecular processes. The human intestinal tract contains intestinal human microbiota consisting of commensal, pathogenic, and symbiotic strains leading to immune responses that can contribute and lead to both systemic and intestinal disorders including IBD. In this review, we attempted to highlight some updates of the new IBD features related to genomics, microbiota, new emerging therapies and some major established IBD risk factors.

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Challenges in the management of inflammatory bowel disease in sub-Saharan Africa

Cited by 8 publications

References 72 publications

Current Treatment Strategies for Inflammatory Bowel Disease Patients at the Risk of Developing Cancer: A Comprehensive Review

Current Treatment Strategies for Inflammatory Bowel Disease Patients at the Risk of Developing Cancer: A Comprehensive Review

Challenges in the diagnosis and management of IBD: a sub-Saharan African perspective

A Review on Inflammatory Bowel Diseases: Recent Molecular Pathophysiology Advances

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