Crohn’s disease in low and lower-middle income countries: A scoping review

Abstract

BACKGROUND While Crohn’s disease has been studied extensively in high-income countries, its epidemiology and care in low and lower-middle income countries (LLMICs) is not well established due to a lack of disease registries and diagnostic capacity. AIM To describe the published burden, diagnostic/treatment capacity, service utilization, challenges/barriers to individuals with Crohn’s in LLMICs and their providers. METHODS We conducted a scoping review utilizing a full search strategy was developed and conducted in PubMed, Embase and World Health Organization Global Index Medicus. Two independent reviewers screened the titles and abstracts of all of the publications found in this search, reviewed selected publications, and extracted relevant data, which underwent descriptive review and was analyzed in Excel. RESULTS The database search yielded 4486 publications, 216 of which were determined to be relevant to the research questions. Of all 79 LLMICs, only 21 (26.6%) have publications describing individuals with Crohn’s. Overall, the highest number of studies came from India, followed by Tunisia, and Egypt. The mean number of Crohn’s patients reported per study is 57.84 and the median is 22, with a wide range from one to 980. CONCLUSION This scoping review has shown that, although there is a severe lack of population-based data about Crohn’s in LLMICs, there is a signal of Crohn’s in these settings around the world.

Inflammatory Bowel Disease and Neutrophil–Lymphocyte Ratio: A Systematic Scoping Review

“…The prevalence of inflammatory bowel disease (IBD) is increasing worldwide [ 1 ]. Estimated costs of the disease have rapidly increased [ 2 , 3 ], and rising expenditures contribute to health disparities [ 3 , 4 , 5 , 6 ]. The costs of care, both direct and out-of-pocket, are estimated to be up to three-fold higher in patients with IBD compared to non-IBD controls [ 3 ].…”

“…) [ 7 ], is a key predictor of these rising expenditures [ 3 ]. Predictably, high out-of-pocket costs for testing and treatment, for insured and uninsured patients alike [ 8 ], can limit access to care, particularly in low and lower-middle income countries [ 6 ]. Accurate and cost-effective approaches for IBD management are priorities for patients, clinicians, payers, and other key stakeholders [ 2 ].…”

“…The expense of biologic drugs (e.g., infliximab) in particular, which can cost up to roughly $26,270 USD per patient annually (This value is generated from Beilman et al's [7] $33,000 CAD estimate using Olsen & Associates (OANDA) currency converter on 27 July 2021. https://www1.oanda.com/currency/converter/) [7], is a key predictor of these rising expenditures [3]. Predictably, high out-of-pocket costs for testing and treatment, for insured and uninsured patients alike [8], can limit access to care, particularly in low and lower-middle income countries [6]. Accurate and cost-effective approaches for IBD management are priorities for patients, clinicians, payers, and other key stakeholders [2].…”

A Novel Neutrophil-Based Biomarker to Monitor Disease Activity and Predict Response to Infliximab Therapy in Patients With Ulcerative Colitis

“…Inflammatory bowel disease (IBD) is characterized by chronic and relapsing inflammation in the gastrointestinal tract, including two eminent forms, ulcerative colitis (UC) and Crohn's disease (CD). The prevalence of IBD is rapidly growing worldwide and rising health expenditures ( 1 – 4 ), leading to a substantial healthcare burden ( 5 ). In addition, IBD is medically refractory and has become a great clinical challenge.…”

Transtorno Mental E Isolamento Social Provocado Pelo Covid-19: Uma Revisão Integrativa

“…Entretanto, tem sido relatado que a porção do íleo terminal e cólon são os locais mais afetados pela DC, embora possa afetar qualquer outra porção do trato gastrointestinal (VEAUTHIER; HORNECKER, 2018).A etiologia da doença de Crohn é mal compreendida, porém sabe-se que envolve defeitos na imunidade da mucosa e na função da barreira epitelial em indivíduos geneticamente susceptíveis, ocasionando a resposta inflamatória inadequada aos micróbios intestinais. Outros fatores podem contribuir significativamente para a patogênese da DC, como aspectos ambientais, estresse, uso de anticoncepcionais, tabagismo, deita rica em lipídeos, uso regular de anti-inflamatórios não esteroidais (AINES) e disbiose da microbiota intestinal (LI;SHI, 2018;RAJBHANDARI et al, 2020; WOO, 2015).O diagnóstico da DC é estabelecido pelo exame clínico, testes laboratoriais, como exame de fezes, hemograma, função pancreática e transaminases, e achados radiológicos, que podem ser evidenciados pela endoscopia digestiva, colonoscopia e gastroscopia. Além desses, a biopsia pode ser realizada para análise da mucosa do cólon (FREEMAN, 2014; MARAZUELA GARCÍA; LÓPEZ-FRÍAS LÓPEZ-JU-RADO;VICENTE BÁRTULOS, 2019;ROFIFAH, 2020).Lesões na cavidade oral estão presente em 0,5% a 20% dos pacientes acometidos pela Doença de Crohn, podendo ser o primeiro sítio de manifestação, sendo capaz de servir como indicadoras para o diagnóstico da doença.…”