Inflammatory Bowel Disease in Children: Experience and Constraints in a Resource-limited Setting

Abstract

Introduction: Inflammatory bowel disease (IBD), though well described in the Caucasian population, is rarely encountered in the black African children. The aim of this study was to increase the awareness of this emerging condition in African children and highlight the constraints of management in a resourcelimited setting like Nigeria.Methods: This study included an audit of children with IBD who were seen between January 2015 and February 2020 at the Lagos University Teaching Hospital (LUTH). The clinical records of children aged one to 16 years who presented with recurrent abdominal pain, weight loss, and gastrointestinal (GI) bleeding with clinical suspicion of IBD were reviewed. Clinical features, endoscopic findings, histopathologic findings, and treatment were documented.Results: Eight children with IBD were seen during the study period. The median age was 12.0 years (range: five to 15 years). The most common reported concerns in the children were chronic abdominal pain [seen in four patients (50%)] and bloody diarrhea [seen in three patients (42.30%)]. Weight loss and arthritis were seen in three (37.5%) and one (12.5%) children, respectively. Endoscopy confirmed two cases of Crohn's disease (CD), three cases of ulcerative colitis (UC), and three cases of indeterminate colitis (IC). The children with CD were treated with steroids and exclusive enteral nutrition, with one patient receiving methotrexate, while the UC and IC patients received 5-aminosalicylate therapy. Conclusion:Although IBD is uncommon in Nigeria, a high index of suspicion is vital to enable early diagnosis and appropriate treatment. Management in the African setting is severely constrained by limited access to endoscopy facilities and nonavailability of other effective treatment options such as biologic agents.

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

“…Following recent initiatives to raise awareness of IBD in SSA a number of case series and cohort studies have been published which have added to the numbers identified in the aforementioned systematic reviews, suggesting that the incidence of IBD in the subcontinent is likely on the increase. 27,31–34,82,83…”

“…81 Following recent initiatives to raise awareness of IBD in SSA a number of case series and cohort studies have been published which have added to the numbers identified in the aforementioned systematic reviews, suggesting that the incidence of IBD in the subcontinent is likely on the increase. 27,[31][32][33][34]82,83 While comprehensive epidemiological data are lacking, there are many plausible environmental explanations for this observation, such as changes in diet from the traditional African diet rich in fibre, fruit and vegetables, to a more westernized diet high in sugar, saturated fat, emulsifiers and preservatives which appear to increase the risk of developing IBD. 6 In addition, the widespread eradication of Helminth infections, Schistosomiasis and Helicobacter pylori, which may confer a protective effect, could have contributed to an increase in cases in SSA.…”

Survey showed that very few paediatric residents in Southwest Nigeria were interested in specialising in gastroenterology

“…Other gastrointestinal disorders, such as coeliac disease and inflammatory bowel disease, were previously thought to be non‐existent or rare in sub‐Saharan Africa. However, they are increasingly being recorded in some of these African countries due to greater awareness and improved diagnostic capability 4–7 . Accurate diagnosis and effective treatment for some of these disorders require special skills, which may not be available without trained paediatric gastroenterologists 1 .…”

“…However, they are increasingly being recorded in some of these African countries due to greater awareness and improved diagnostic capability. [4][5][6][7] Accurate diagnosis and effective treatment for some of these disorders require special skills, which may not be available without trained paediatric gastroenterologists. 1 Paediatric gastroenterology is in its infancy in Africa, but South Africa and Egypt have the edge over other countries.…”