Inflammatory bowel disease in Accra: what new trends

Area of Science:

• Gastroenterology
• Epidemiology
• Internal Medicine

Background:

• Inflammatory bowel disease (IBD) is increasingly recognized in individuals of African descent, contrary to earlier beliefs of low incidence in Sub-Saharan Africa.
• IBD patterns are shifting, necessitating a closer examination of its prevalence and characteristics in diverse populations.

Purpose of the Study:

• To conduct a comparative assessment of Inflammatory Bowel Disease (IBD) patterns in Accra, Ghana, between 1997 and 2011.
• To analyze changes in clinical presentations and disease characteristics over two distinct seven-year periods.

Main Methods:

• A retrospective study design was employed, reviewing clinical data of follow-up patients at the Korle-Bu Teaching Hospital's Gastroenterology Unit.
• Comparative analysis of IBD patient data from two periods: February 1997–March 2004 (t1) and April 2004–May 2011 (t2).

Main Results:

• A 65% increase in new IBD cases was observed between t1 (17 patients) and t2 (28 patients).
• Severe diarrhea was a common presentation (70.4% in t1, 55.6% in t2), with 82% of t2 patients showing severe colon inflammation on initial colonoscopy.
• Most patients (70-80%) responded to medical therapy (steroids, sulfasalazine), and no colon resections were performed for steroid-refractory colitis.

Conclusions:

• IBD incidence in Accra significantly increased over the study period, showing a male predominance.
• Patients often presented late with severe disease manifestations but generally responded well to medical management.
• A notable rise in non-specific (indeterminate) colitis was observed in the later study period (t2).