South African Gastroenterology Review

Editorial

Mark Sonderup — 2023-05-18

The first edition of our “Red Journal” for 2023 has arrived. The year is accelerating at a pace, and all agree that we are now firmly in the post pandemic phase and that practice is very busy. The full brunt of the effects of lockdown policy and people avoiding routine care, has led to unprecedented increases in patients seeking care. Data from the US and UK suggests increase rates of new cancer detection on screening endoscopy, that declined massively during COVID. We don’t have such data yet from South Africa, but anecdotally there appears to be a similar trend locally. Compounding this is the disastrous effects of electricity blackouts, colloquially called loadshedding. Our hospitals in which we work are dependent on generators to keep our systems running, this influences costs, felt acutely in the private sector. In the public sector, after much debate (for reasons that are unclear as the exemption seems obvious), hospitals are in the process of being exempted from loadshedding or ringfenced for continuous supply. In essence, 2023 has continued the challenges of the previous year, albeit in a
different guise.

Current perspectives on IBD-associated colorectal cancer

IE Francis — 2023-05-18

Ulcerative colitis (UC) and Crohn’s disease (CD) represent the main phenotypes of inflammatory bowel disease (IBD), which are chronic relapsing and remitting inflammatory conditions of the gastrointestinal tract. The development of IBD is associated with westernization, with increasing incidence over recent decades being more pronounced in newly industrialized regions such as South America, North Africa, and Southeast Asia1. Although published data from sub-Saharan Africa (SSA) suggests that IBD is uncommon in the region2, 3, the most plausible explanation for these low rates is under-reporting of cases, with unpublished
real-world data supporting an increase in the incidence. Furthermore, with an increasing population average lifespan, the prevalence of IBD globally is on the rise4, with the downstream effect of a parallel increase in the prevalence of colorectal cancer (CRC).

Hepatocellular Carcinoma in pregnancy

E Gatley — 2023-05-18

Despite hepatocellular carcinoma (HCC) being the third leading cause of all cancer deaths globally, its occurrence in pregnancy is rare, with an annual incidence of 1 per 100 000.1, 2 This is likely underestimated, particularly in sub-Saharan Africa (SSA) where hepatitis B virus (HBV), the most common aetiology of HCC, remains endemic. The course of HCC in pregnancy is thought to be accelerated due to several factors, and outcomes are generally worse than in the general population.1, 2 We highlight this in a recent patient referred to our facility.

Protein losing enteropathy in children - a Tunisian case series

A Elleuch — 2023-05-18

Protein-losing enteropathy (PLE) is a relatively rare entity with several causes and associations characterized by an excessive loss of protein from the gastrointestinal tract. The clinical presentation is variable and depends on the underlying cause. Given its rarity, under diagnosis may exist. The clinical presentation is ubiquitous due to the wide range of causes. The dominant clinical features is oedema, with or without pleural and pericardial effusions. Biochemically hypoalbuminemia, with invariable normal renal and liver function, is characteristic2,3. Diagnostic confirmation is based on the determination of fecal alpha-1 antitrypsin clearance. An appropriate evaluation for an aetiology is key to prompt management thereby limiting morbidity and even mortality

Celiac disease in the Sidi Bel Abbes region of Northwestern Algeria

R Asma — 2023-05-18

This study aimed to determine the incidence and prevalence of coeliac disease (CD) among the population of Sidi Bel Abbes region in Northwestern Algeria. A retrospective analysis was performed on CD patients from records between 2015 and 2020. One hundred fi fty-six (156) patients were included in the study (mean age 32.4 ± 1.3 years). The CD incidence decreased from 12.9 per 100 000 person-years in 2015 to 8.5 per 100 000 person-years in 2020. It was signifi cantly higher in the age groups of 15-29 years compared to those of 4-14, p=0.04 and >56 years, p=0.004. The CD incidence was signifi cant greater in women than men with a value of 7.3 per 100 000 person years, p=0.0002. The CD prevalence was 0,063%. The decrease of CD frequency could be explained by limited diagnosis given the ubiquitous clinical picture and sometimes asymptomatic nature of CD.

Non-Melanoma skin cancer risk associated with Thiopurine use in Infl ammatory Bowel Disease

DC Peterson — 2023-05-18

Three Years of Improving IBD Care Through Research, Education and Advocacy

David Epstein — 2023-05-18

IBD Africa is a non-profit organisation founded in 2019 with a mandate to improve the care of people living in Southern and sub-Saharan Africa through Research, Education and Advocacy. Launched at SAGES in 2019 IBD Africa has grown into a dynamic and innovative organisation and is making a difference to the lives of people living with IBD.