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Ray-Offor E, Egboh SM, Ijah RFOA, Hany Emile S, Wexner SD. Colonic Diverticulosis at Colonoscopy in Africa: A Systematic Review and Meta-Analysis of Pooled Estimates. Dig Surg 2024; 41:63-78. [PMID: 38377978 DOI: 10.1159/000536587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/15/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION There is need to ascertain any epidemiologic shift of diverticulosis among Africans with traditionally high fiber diet consumption patterns and rare diverticulosis prevalence. METHODS We systematically searched PubMed, Scopus, Cochrane Library, African Journal Online (AJOL), and Google Scholar. Eligibility criteria included full-text observational and experimental human colonoscopy studies on asymptomatic and symptomatic African population from 1985 to 2022. Case reports, conference abstracts, dissertations, systematic reviews, and studies lacking colonoscopy findings were excluded. NIH quality assessment tool for observational cohort and cross-sectional studies was used to assess risk of bias. Meta-analysis was performed using the random-effect model. Heterogeneity was assessed using inconsistency (I2) statistics. RESULTS Thirty studies were included. Pooled prevalence rate of colonic diverticulosis in the last decade (2012-2022) has increased to 9.7% (95% CI 6.5-13.4; I2 = 97.3%) from 3.5% (95% CI 1.4-6.4; I2 = 62.7%). The highest regional prevalence rate was in West African studies at 11.3% (95% CI 7.6-14.9; I2 = 96.2%). Proportion of individuals with diverticulosis ≥50 years and male sex were 86.9% (95% CI 80.5-92.1) and 65.2% (95% CI 55.0-74.8), respectively. The left colon had the highest diverticulosis frequency (37% [148/400]). Bleeding/inflammation complications were sparingly detected (OR 0.2 [95% CI 0.03-0.75; p < 0.0001]). CONCLUSION An increasing utilization of colonoscopy revealed approximately a threefold increase in the prevalence rate of colonic diverticulosis in Africa. This pathology was most common in males aged >50. Left colon was predominantly affected. Further studies are needed to demonstrate the effect of westernization of diet.
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Affiliation(s)
- Emeka Ray-Offor
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Department of Surgery, University of Port Harcourt Choba, Choba, Nigeria
| | - Stella-Maris Egboh
- Department of Internal Medicine, Federal Medical Centre Yenagoa, Yenagoa, Nigeria
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rex F O A Ijah
- Department of Surgery, Rivers State University/University Teaching Hospital, Port Harcourt, Nigeria
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
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Watermeyer G, Katsidzira L, Nsokolo B, Isaac Alatise O, Duduyemi BM, Kassianides C, Hodges P. Challenges in the diagnosis and management of IBD: a sub-Saharan African perspective. Therap Adv Gastroenterol 2023; 16:17562848231184986. [PMID: 37457138 PMCID: PMC10345935 DOI: 10.1177/17562848231184986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
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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Affiliation(s)
| | - Leolin Katsidzira
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Bright Nsokolo
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Olusegun Isaac Alatise
- Division of Gastrointestinal/Surgical Oncology, Department of Surgery, Obafemi Awolowo University/Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
| | - Babatunde M. Duduyemi
- Department of Pathology, College of Medicine and Allied Health Sciences/Teaching Hospitals Complex Highest University of Sierra Leone, Freetown, Sierra Leone
| | - Chris Kassianides
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Phoebe Hodges
- Barts and the London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
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de-León-Rendón JL, López-Pérez RY, Gracida-Mancilla NI, Jiménez-Bobadilla B, Alarcón-Bernés L, Mendoza-Ramírez S, Villanueva-Herrero JA. The controlling nutritional status score: A promising tool for nutritional screening and predicting severity in ulcerative colitis patients. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 86:110-117. [PMID: 33261942 DOI: 10.1016/j.rgmx.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/28/2020] [Accepted: 05/14/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND AIMS The controlling nutritional status (CONUT) score has previously been shown to be useful for nutritional assessment and the prediction of several inflammatory and neoplastic diseases. The aim of the present study was to evaluate the potential use of the CONUT score as a method for nutritional screening and predicting severity in ulcerative colitis (UC). MATERIALS AND METHODS The study was conducted on 60 patients diagnosed with UC. Demographic, clinical, and biochemical patient characteristics were collected from their clinical records, and disease severity was assessed using the Truelove and Witts scale (TWS). The risks for malnutrition were evaluated through the nutritional risk index and the CONUT score. RESULTS More than 90% of the UC patients presented with malnutrition risk, according to the scores analyzed. Patients with a high (>6points) CONUT score presented with moderate-to-severe activity on the TWS. A higher CONUT score was also associated with an increase in C-reactive protein (CRP) (P=.002) and erythrocyte sedimentation rate (ESR) (P=.009). The data analysis was performed utilizing the SPSS version 19 program. CONCLUSIONS The CONUT score could be a promising tool for evaluating nutritional status in UC patients and predicting UC severity.
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Affiliation(s)
- J L de-León-Rendón
- Servicio de Coloproctología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México.
| | - R Y López-Pérez
- Servicio de Gastroenterología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - N I Gracida-Mancilla
- Servicio de Cirugía General, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - B Jiménez-Bobadilla
- Servicio de Coloproctología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - L Alarcón-Bernés
- Servicio de Cirugía General, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - S Mendoza-Ramírez
- Servicio de Patología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - J A Villanueva-Herrero
- Servicio de Coloproctología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
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de-León-Rendón J, López-Pérez R, Gracida-Mancilla N, Jiménez-Bobadilla B, Alarcón-Bernés L, Mendoza-Ramírez S, Villanueva-Herrero J. The controlling nutritional status score: A promising tool for nutritional screening and predicting severity in ulcerative colitis patients. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2021. [DOI: 10.1016/j.rgmxen.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Oluyemi A, Odeghe E, Adeniyi O. Colonoscopy findings in lower gastrointestinal bleeding in Lagos: A comparative study based on age. Niger J Clin Pract 2020; 23:1656-1659. [PMID: 33355817 DOI: 10.4103/njcp.njcp_341_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Lower gastrointestinal bleeding (LGIB) (hematochezia) is an important indication for colonoscopy, and may be caused by hemorrhoids, diverticulosis, and tumors. Aims The aim of this study was to compare the endoscopic findings in the young (<50 years) versus older subjects (≥50 years) with LGIB in Nigeria. Subjects and Methods This was a retrospective study of the endoscopic findings of all adults with LGIB from January 2017 to December 2019 in Lagos, Nigeria. The records of two centers that deliver outpatient gastrointestinal endoscopic services were ploughed for biodata, presenting complaints and findings in these individuals. These data were then analyzed and are thus presented. Results A total of 1,774 colonoscopies performed during this period, 793 were for LGIB. Of those with LGIB, 548 (69.1%) were males, 245 (30.9%) were female, mean age was 50.7 (±14) years, and 403 (50.8%) were younger than 50 years old. The most frequent findings in patients younger than 50 years were hemorrhoids (316, 78.4%), tumors (35, 8.7%), and polyps (27, 6.7%), while in the older patients, they were hemorrhoids (259, 66.4%), tumors (74, 19%) and diverticulosis (55, 14.1%). Younger age was significantly associated with the presence of hemorrhoids (P < 0.005), while older age was significantly associated with the presence of tumors (P < 0.005) and diverticulosis (P < 0.005). Conclusion Our study showed that hemorrhoids, tumors, and diverticulosis were the most common causes of LGIB in Nigerian patients - with younger age being significantly associated with hemorrhoids, and older age with tumors and diverticulosis. A third of the tumors in this study were found in younger patients. Unfortunately, this finding of such a high proportion of colorectal tumors being found in young Africans has been shown in previous reports - this work should help heighten concern and provoke further scientific probing into the phenomenon with a view to encouraging policy to help truncate its existence.
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Affiliation(s)
- A Oluyemi
- ReMay Consultancy and Medical Services, Ikeja, Lagos, Nigeria
| | - E Odeghe
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - O Adeniyi
- Department of Pediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
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Kayamba V, Nicholls K, Morgan C, Kelly P. A seven-year retrospective review of colonoscopy records from a single centre in Zambia. Malawi Med J 2018; 30:17-21. [PMID: 29868154 PMCID: PMC5974381 DOI: 10.4314/mmj.v30i1.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction Colorectal disease is common throughout the world, but the spectrum of diagnoses across Africa remains largely unexplored. There is anecdotal evidence of changing colorectal disease but this has not been systematically investigated. The aim of this study was to enhance our insight into the spectrum of colonoscopic diagnoses in Zambia. Methods We retrieved written colonoscopy reports from January 2008 to December 2015. Collected data were coded by experienced endoscopists and analysed by age, sex, referral source, indication and diagnosis. Results Included in this analysis were 573 colonoscopy reports. The most common diagnosis was haemorrhoids (n=151, 26%), followed by tumours (n=96,17%). Over this time period, the proportion of normal colonoscopies decreased by 32% (P<0.001), presumably due to introduction of screening of all requests, while the rate of polyp detection increased from 5% to 10% (P=0.006). The detection of polyps was highest in patients less than 16 years (OR 8.4; 95% CI 2.4–26.2, P<0.001). Of those with colorectal tumours, 33/96 (35%) were less than 45 years although the occurrence was higher with advancing age (P=0.02). Diverticular disease was more common in older age groups (median (IQR) age 70 (60–75) years, versus 47 (34–62) years for those without the disease; P=0.0001). Conclusion This audit has shown that more than a third of colorectal tumours seen during colonoscopy are in patients below the age of 45 years, with the occurrence of polyps being highest in those below 16 years. Diverticular disease is most common in older age groups.
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Affiliation(s)
- Violet Kayamba
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Kate Nicholls
- Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, United Kingdom
| | - Catrin Morgan
- Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, United Kingdom
| | - Paul Kelly
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia.,Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, United Kingdom
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Akere A, Akande KO. Cecal intubation rate during colonoscopy at a tertiary hospital in South-West Nigeria: How frequent and what affects completion rate? Niger J Clin Pract 2017; 20:303-306. [PMID: 28256484 DOI: 10.4103/1119-3077.187334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Colonoscopy is useful in the diagnosis, treatment of colorectal diseases, and for colorectal cancer screening program. Complete colonoscopy is therefore crucial for the success of any screening program. One important measure of the quality of colonoscopy is the cecal intubation rate (CIR). AIM This was to assess the CIR at our endoscopy unit and evaluate the factors responsible for uncompleted cases. PATIENTS AND METHODS This was a prospective study at the endoscopy unit of the University College Hospital, Ibadan. All consenting patients referred for colonoscopy were recruited into the study. Colonoscopy was performed per protocol, and cecal intubation was considered successful when the medial wall of the cecum was intubated. RESULTS Total of 305 colonoscopies were performed comprising 168 (55.1%) males and 137 (44.9%) females. Mean age was 57.5 ± 14.0 years (range 15-90 years). The crude CIR was 89.2%, whereas the adjusted CIR was 95.1%. Completion rate was higher in males, in patients who were younger than 58 years and in patients with adequate bowel preparation. CONCLUSION CIR in our practice is high and comparable to the recommended rates. Female gender, age older than 58 years, and inadequate bowel preparation had a crude association with lower CIR, but this was not statistically significant.
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Affiliation(s)
- A Akere
- Department of Medicine, College of Medicine, University of Ibadan/University College Hospital, PMB 5116, Ibadan, Oyo State, Nigeria
| | - K O Akande
- Department of Medicine, College of Medicine, University of Ibadan/University College Hospital, PMB 5116, Ibadan, Oyo State, Nigeria
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Oluyemi A, Awolola N, Oyedeji O. Clinicopathologic review of polyps biopsied at colonoscopy in Lagos, Nigeria. Pan Afr Med J 2016; 24:333. [PMID: 28154688 PMCID: PMC5267854 DOI: 10.11604/pamj.2016.24.333.9434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/27/2016] [Indexed: 12/18/2022] Open
Abstract
Introduction Colorectal polyps are known precursors of colorectal cancers. The increase in utilization of colonoscopy in Nigeria has meant a rise in the recently reported incidence of these lesions. The aim of this study is to evaluate the clinicopathological profile of colorectal polyps biopsied during the inaugural 12 month period of colonoscopy from a private endoscopy suite in Nigeria. Methods This is a retrospective review of all the clients who had polyps diagnosed at colonoscopy over a 12 month period (August 2014 –July 2015) at a private endoscopy suite in Lagos, Nigeria. This analysis of prospectively collected data was performed using clinical information from the endoscopy logs and pathology database system of a private endoscopy suite based in Lagos, Nigeria. Results A total of 125 colonoscopies were carried out over the stated period. Of these, 14 individuals had a total of 18 polyps- 4 clients (28.6% of the persons with polyps) had two polyps each. The polyp detection rate was 11.2% while the polyp per colonoscopy rate was 14.4%. Of these clients, males were 10 in number; giving a male to female ratio of 2.5:1. Their ages ranged from 37 to 77 years (mean= 57.3 years). The presenting complaint at colonoscopy was hematochezia in 11 (78.6%), new onset constipation in 2 (14.2%) and peri-anal pain in 1 patient (7.1%). The polyps were distributed as follows; 2 (11.1%) in the ascending colon, 1 (5.6%) each in the transverse and descending colons, 8 (44.4%) in the sigmoid colon, 6(33.3%) located in the rectum. Hence, there was left sided (15 of 18= 83.3%) preponderance. Pathologically, tubular (adenomatous) polyp with or without low grade dysplastic changes was diagnosed in 6 of the 18 polyps (giving an adenoma detection rate of 4.8%), 4 (22.2%) were inflammatory polyps, 1 (5.6%) was malignant and another had the rare inflammatory fibroid polyp. Five (27.8%) of the specimens were reported as non-specific colitis. Conclusion The study supports the present wisdom that polyps are clearly less prevalent in our environment when compared to the Western world. The increased prevalence with advancing age, in male subjects and of left sided lesions, is also in keeping with previous results from our environment. A case is also advanced for the increased deployment of endoscopy as a tool for the detection of these polyps and ultimately, the reduction of colorectal cancer in our population.
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Affiliation(s)
| | - Nicholas Awolola
- College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Olufemi Oyedeji
- College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
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Abstract
Background: The upsurge in the reported cases of diverticular disease (DD) has led to a re-appraisal of the earlier held views that it was a rare entity in Nigeria. The advent of colonoscopy has contributed in no small way to this change. We sought to determine the clinical characteristics, indications for colonoscopy, and intra-procedural findings among these patients. Materials and Methods: A retrospective cross-sectional study was carried out on the colonoscopy records from four private endoscopy units based in Lagos State, Nigeria. The records were drawn from a 5-year period (August 2010 to July 2015). The endoscopy logs and reports were reviewed, and the bio data, indications, and colonoscopy findings were gleaned. Results: A total of 265 colonoscopies were carried out in the stated period. Of these, 28 (10.6%) had DD. Of the patients with DD, 5 (17.9%) were females while 23 (82.1%) were males. Their ages ranged from 46 to 94 years (mean = 68.2 ± 11 years). Fifteen patients had been referred for the procedure on account of hematochezia alone (15 = 53.6%). Other reasons for referral included abdominal pain alone (2 = 7%), hematochezia plus abdominal pain (5 = 17.9%), and change in bowel habits (3 = 10.8%). Ten (35%) patients had pan-colonic involvement. Regional disease involved the right side alone in only one case (3.5%) while the other combinations of sites are as follows; 6 (21.4%) in the sigmoid colon alone, 2 (7%) in the descending colon alone, 5 (17.9%) in the sigmoid–descending colon, 4 (14.3%) in the sigmoid-descending-transverse colon, thus the sigmoid colon was involved in 25 (89.3%) cases. Five cases (17.9%) had endoscopic features suggestive of diverticulitis. Conclusions: DD should no longer be regarded as a rare problem in the Nigerian patient. The study findings support the notion of higher prevalence among the elderly, in males, and of sigmoid colon involvement.
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Affiliation(s)
- Aderemi Oluyemi
- Gastroenterology Unit, ReMay Consultancy and Medical Services, Lagos State, Nigeria
| | - Emuobor Odeghe
- Gastroenterology Unit, Lagos University Teaching Hospital, Lagos State, Nigeria
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