D0379 - Inflammatory Bowel Disease in Sub-Saharan Africa Setting: Experience From a Large Tertiary Center in Ethiopia

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Amir Sultan Seid, MD

Addis Ababa University, World Gastroenterology Organization, Addis Ababa Training Center
Minneapolis, MN

Neway Fekade, MD¹, Yohannes Birhanu, MD², Amir Sultan Seid, MD²
¹Addis Ababa University, Addis Ababa, Adis Abeba, Ethiopia; ²Addis Ababa University, World Gastroenterology Organization, Addis Ababa Training Center, Addis Ababa, Adis Abeba, Ethiopia

Introduction: Inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn’s disease (CD). Anecdotal evidence indicates there is an increment in the prevalence of the condition in the sub-Saharan Africa region. This region is projected to account for half of the world’s population growth over the next 30 years according to the United Nations.

Methods: A cross-sectional study was conducted on patients having a follow-up with a diagnosis of IBD at the largest hospital in Ethiopia over one year. Data on sociodemographic, clinical parameters, initial therapy type, clinical course, and surgical interventions were assessed. Data was gathered through a review of medical records and patient interviews, and a standardized questionnaire was applied. The collected data was analyzed using SPSS v. 26.

Results: A total of 102 IBD patients (29 UC, 73 CD and a ratio of 2.5:1) with female predominance, 57% (n = 58) were identified. The M-to-F ratio was 1:1.2 for CD and 1:1.6 for UC. The mean age at diagnosis was 26.4 years for CD and 33 years for UC. Only 5.9% of patients had a family history of IBD, and no association between smoking with IBD was found. EIMs were reported in 16.6%. In patients with CD, the ileo-colon type was the most common disease phenotype (38%), the inflammatory type was the most common disease behavior (49.3%); and 18.6% of patients had a history of bowel resection. In patients with UC, left-sided colitis was the predominant disease extent (69.0%). The majority of the patients were on steroids and immunomodulators. Statistically significant difference was seen between UC & CD in the age of onset, family history of the disease, and anti-TB drug use.

Discussion: The present study reported the largest number of patients in the sub-Saharan Africa region with IBD. CD was the commonest IBD type in the Ethiopian context, unlike other developing countries. Improvement in diagnostic services as well as changing lifestyle patterns could lead to an increment in the diagnosis of the condition in the continent.

Characteristics			Type of IBD				P value
			UC N=29		CD N=73	Total N=102
Age of diagnosis (years), n (%)	Adolescence (< 19)		0		10 (13.7)	10 (9.8)	0.003
	Young Adults (19–35)		20 (69)		57 (78)	77 (75.5)	0.02
	Middle –Aged Adults (36–55)		9 (31)		6 (8.3)	15 (14.7)	0.02
	Older Adults ( > 55		0		0	0
Mean age at diagnosis (years) (±SD)			33 ± 11.2		26.4 ± 9.8	28.3 ± 10.6	0.04
Duration of disease (Years), n (%)	Short (< 5 years)		21(72.4)		60(82.1)	81(79.4)	0.33
	Long (5-10 years)		7(24.1)		10(13.6)	17(16.7)
	( > 10 years)		1(3.4)		3(4.1)	4(3.9)
Interval between symptom onset and diagnosis (in months), n (%)	1-5 months		7(24.1)		11(15)	18(17.6)	0.400
	6-10 months		4(13.7)		13(17.8)	17(16.7)
	11-15 months		1(3.4)		12(16.3)	13(12.7)
	> 20 months		5(17.2)		12(16.3)	17(16.7)
	Couldn’t inform/be retrieved		12(41.3)		25(34.2)	37(36.2)
Abdominal pain, n (%)				21(72.4)	60(82.1)	81(79.4)	0.3
Chronic diarrhea without blood, n (%)				6(20.6)	46(63)	52(50.9)	0.001
Bloody diarrhea/exclusive rectal bleeding, n (%)				23(79.3)	8(10.9)	31(30.3)	< 0.001
Mucoid stool, n (%)				7(24.1)	13(17.8)	20(19.6)	0.4
Weight loss, n (%)				15(51.7)	42(57.5)	57(55.8)	0.5
UGI symptoms*, n (%)				2(6.8)	21(28.7)	23(22.5)	0.03
Peri anal symptoms, n (%)		Draining Fistula		0	9 (12.3)	NA	0.03
		Anorectal pain		1(3.4)	1(1.3)	2(1.9)
		Fecal urgency/incontinence		1(3.4)	1(1.3)	2(1.9)
Perianal disease in CD, n (%)					11 (15.1)
EIM, n (%)		Total		8(27.5)	9(12.3)	17(16.6)	0.2
		Type of EIM		Joint (16), 1 (pyoderma gangrenosum)

Table: Clinical Characteristics of IBD Patients

Disclosures:

Neway Fekade indicated no relevant financial relationships.

Yohannes Birhanu indicated no relevant financial relationships.

Amir Sultan Seid indicated no relevant financial relationships.

Neway Fekade, MD¹, Yohannes Birhanu, MD², Amir Sultan Seid, MD². D0379 - Inflammatory Bowel Disease in Sub-Saharan Africa Setting: Experience From a Large Tertiary Center in Ethiopia, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.