Abstract

Thesis

Pattern of Clinical Presentation and Management of Inflammatory Bowel Disease

Mohamed Abdalla Elamin Abdelgader, Abdelgadir Suliman Ibrahim, Sara Elfadel Abbas, Awadalla Abdelwahid Suliman*, Mohamed Suliman I Ahmed, Safa Mohamed Ibrahim and Abdelmoneim Altayeb Abdo

Published: 12 September, 2023 | Volume 7 - Issue 1 | Pages: 011-018

Background: Inflammatory bowel disease (IBD) is characterized by non-specific chronic relapsing inflammation of the gastrointestinal tract and extra-intestinal manifestations. It includes Crohn’s disease (CD) ulcerative colitis (UC) and unclassified colitis.
Objective: To assess the clinical presentations and management of inflammatory bowel disease in Sudanese patients.
Methodology: Prospective, cross-section hospital-based study was conducted at Soba University Hospital (SUH) and Ibn Sina Hospital, in a period from December 2016 to March 2017. 
Data was entered and analyzed with SPSS, an interview questionnaire containing demographic, clinical, type of IBD, treatment, and complications.
Results: A total of 64 IBD patients were included, 50% were diagnosed with UC, 28.1% with CD and 21.9% unclassified type. 
The most frequent age in UC patients was 41 – 50 years 34.4%, in CD was 31- 40 years 38.9% and for the unclassified type was 51 – 70 years 57.2%. 
The female was higher in CD while males were higher in Ulcerative colitis disease, symptoms were diarrhea, rectal bleeding, abdominal pain, rectal pain, tenesmus and fatigue. 
Study participants received 5 amino salicylic acid, and steroids, especially in the oral formulation. Minimal usage of topical forms, azathioprine, and biological agents. 
Conclusion: The study concluded UC is more common than CD. This should be taken into account as an important update for internal medicine professionals to adjust their expectations and lines of diagnosis, and management. The emergence of the unclassified type in Sudan requires good communication between the pathologists and the physicians and MDT meetings in every patient with suspicion of IBD.

Read Full Article HTML DOI: 10.29328/journal.acgh.1001040 Cite this Article Read Full Article PDF

Keywords:

Pattern; Clinical; Presentation; Management; Inflammatory bowel; Disease

References

  1. Ukwenya AY, Ahmed A, Odigie VI, Mohammed A. Inflammatory bowel disease in Nigerians: still a rare diagnosis? Ann Afr Med. 2011 Apr-Jun;10(2):175-9. doi: 10.4103/1596-3519.82067. PMID: 21691027.
  2. Xia B, Crusius J, Meuwissen S, Pe?a A. Inflammatory bowel disease: definition, epidemiology, etiologic aspects, and immunogenetic studies. World J Gastroenterol. 1998 Oct;4(5):446-458. doi: 10.3748/wjg.v4.i5.446. PMID: 11819343; PMCID: PMC4767749.
  3. Verstockt B, Bressler B, Martinez-Lozano H, McGovern D, Silverberg MS. Time to Revisit Disease Classification in Inflammatory Bowel Disease: Is the Current Classification of Inflammatory Bowel Disease Good Enough for Optimal Clinical Management? Gastroenterology. 2022 Apr;162(5):1370-1382. doi: 10.1053/j.gastro.2021.12.246. Epub 2022 Jan 4. PMID: 34995534.
  4. Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006 Jun;55(6):749-53. doi: 10.1136/gut.2005.082909. PMID: 16698746; PMCID: PMC1856208.
  5. Ramos GP, Papadakis KA. Mechanisms of Disease: Inflammatory Bowel Diseases. Mayo Clin Proc. 2019 Jan;94(1):155-165. doi: 10.1016/j.mayocp.2018.09.013. PMID: 30611442; PMCID: PMC6386158.
  6. Farrokhyar F, Swarbrick ET, Irvine EJ. A critical review of epidemiological studies in inflammatory bowel disease. Scand J Gastroenterol. 2001 Jan;36(1):2-15. doi: 10.1080/00365520150218002. Erratum in: Scand J Gastroenterol 2001 Jun;36(6):facing 561. PMID: 11218235.
  7. Bernstein CN, Shanahan F. Disorders of a modern lifestyle: reconciling the epidemiology of inflammatory bowel diseases. Gut. 2008 Sep;57(9):1185-91. doi: 10.1136/gut.2007.122143. Epub 2008 May 30. PMID: 18515412.
  8. Agrawal D, Rukkannagari S, Kethu S. Pathogenesis and clinical approach to extraintestinal manifestations of inflammatory bowel disease. Minerva Gastroenterol Dietol. 2007 Sep;53(3):233-48. PMID: 17912186.
  9. Oh SJ, Choi Y, Kim CR, Park JH, Lee JH, Lee DY. An Atypical Extraintestinal Manifestation in a Child with Ulcerative Colitis: Cutaneous Leukocytoclastic Vasculitis. Ann Dermatol. 2020 Feb;32(1):90-91. doi: 10.5021/ad.2020.32.1.90. Epub 2019 Dec 27. PMID: 33911718; PMCID: PMC7992630.
  10. Harbord M, Annese V, Vavricka SR, Allez M, Barreiro-de Acosta M, Boberg KM, Burisch J, De Vos M, De Vries AM, Dick AD, Juillerat P, Karlsen TH, Koutroubakis I, Lakatos PL, Orchard T, Papay P, Raine T, Reinshagen M, Thaci D, Tilg H, Carbonnel F; European Crohn’s and Colitis Organisation. The First European Evidence-based Consensus on Extra-intestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis. 2016 Mar;10(3):239-54. doi: 10.1093/ecco-jcc/jjv213. Epub 2015 Nov 27. PMID: 26614685; PMCID: PMC4957476.
  11. Yu YR, Rodriguez JR. Clinical presentation of Crohn's, ulcerative colitis, and indeterminate colitis: Symptoms, extraintestinal manifestations, and disease phenotypes. Semin Pediatr Surg. 2017 Dec;26(6):349-355. doi: 10.1053/j.sempedsurg.2017.10.003. Epub 2017 Oct 5. PMID: 29126502.
  12. Conrad K, Roggenbuck D, Laass MW. Diagnosis and classification of ulcerative colitis. Autoimmun Rev. 2014 Apr-May;13(4-5):463-6. doi: 10.1016/j.autrev.2014.01.028. Epub 2014 Jan 11. PMID: 24424198.
  13. Esmat S, El Nady M, Elfekki M, Elsherif Y, Naga M. Epidemiological and clinical characteristics of inflammatory bowel diseases in Cairo, Egypt. World J Gastroenterol. 2014 Jan 21;20(3):814-21. doi: 10.3748/wjg.v20.i3.814. PMID: 24574754; PMCID: PMC3921490.
  14. Kappelman MD, Rifas-Shiman SL, Kleinman K, Ollendorf D, Bousvaros A, Grand RJ, Finkelstein JA. The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol. 2007 Dec;5(12):1424-9. doi: 10.1016/j.cgh.2007.07.012. Epub 2007 Sep 29. PMID: 17904915.
  15. Hein R, Köster I, Bollschweiler E, Schubert I. Prevalence of inflammatory bowel disease: estimates for 2010 and trends in Germany from a large insurance-based regional cohort. Scand J Gastroenterol. 2014 Nov;49(11):1325-35. doi: 10.3109/00365521.2014.962605. Epub 2014 Sep 26. PMID: 25259808.
  16. Ibrahim M. Inflammatory Bowel Disease in Sudanese Patients: A Pathological Study (Doctoral dissertation, UOFK).
  17. M'Koma AE. Inflammatory bowel disease: an expanding global health problem. Clin Med Insights Gastroenterol. 2013 Aug 14;6:33-47. doi: 10.4137/CGast.S12731. PMID: 24833941; PMCID: PMC4020403.
  18. Moum B, Vatn MH, Ekbom A, Fausa O, Aadland E, Lygren I, Sauar J, Schulz T. Incidence of inflammatory bowel disease in southeastern Norway: evaluation of methods after 1 year of registration. Southeastern Norway IBD Study Group of Gastroenterologists. Digestion. 1995;56(5):377-81. doi: 10.1159/000201262. Erratum in: Digestion 1996;57(2):104. PMID: 8549880.
  19. Gower-Rousseau C, Vasseur F, Fumery M, Savoye G, Salleron J, Dauchet L, Turck D, Cortot A, Peyrin-Biroulet L, Colombel JF. Epidemiology of inflammatory bowel diseases: new insights from a French population-based registry (EPIMAD). Dig Liver Dis. 2013 Feb;45(2):89-94. doi: 10.1016/j.dld.2012.09.005. Epub 2012 Oct 27. PMID: 23107487.
  20. Ponder A, Long MD. A clinical review of recent findings in the epidemiology of inflammatory bowel disease. Clin Epidemiol. 2013 Jul 25;5:237-47. doi: 10.2147/CLEP.S33961. PMID: 23922506; PMCID: PMC3728155.
  21. Soon IS, Molodecky NA, Rabi DM, Ghali WA, Barkema HW, Kaplan GG. The relationship between urban environment and the inflammatory bowel diseases: a systematic review and meta-analysis. BMC Gastroenterol. 2012 May 24;12:51. doi: 10.1186/1471-230X-12-51. PMID: 22624994; PMCID: PMC3517531.
  22. Mahid SS, Minor KS, Soto RE, Hornung CA, Galandiuk S. Smoking and inflammatory bowel disease: a meta-analysis. Mayo Clin Proc. 2006 Nov;81(11):1462-71. doi: 10.4065/81.11.1462. Erratum in: Mayo Clin Proc. 2007 Jul;82(7):890. PMID: 17120402.
  23. Ahmaida A, Al-Shaikhi S. Childhood Inflammatory Bowel Disease in Libya: Epidemiological and Clinical features. Libyan J Med. 2009 Jun 1;4(2):70-4. doi: 10.4176/081210. PMID: 21483512; PMCID: PMC3066718.
  24. Xia B, Shivananda S, Zhang GS, Yi JY, Crusius J, Peka AS. Inflammatory bowel disease in the Hubei Province of China. World J Gastroenterol. 1997 Jun 15;3(2):119-20. doi: 10.3748/wjg.v3.i2.119. PMID: 27041967; PMCID: PMC4801915.
  25. Ray G. Inflammatory bowel disease in India--changing paradigms. Int J Colorectal Dis. 2011 May;26(5):635-44. doi: 10.1007/s00384-010-1084-5. Epub 2010 Nov 10. PMID: 21063715.
  26. Mohammed Vashist N, Samaan M, Mosli MH, Parker CE, MacDonald JK, Nelson SA, Zou GY, Feagan BG, Khanna R, Jairath V. Endoscopic scoring indices for evaluation of disease activity in ulcerative colitis. Cochrane Database Syst Rev. 2018 Jan 16;1(1):CD011450. doi: 10.1002/14651858.CD011450.pub2. PMID: 29338066; PMCID: PMC6491285.
  27. Chen H, Wu L, Wang M, Shao B, Ye L, Zhang Y, Cao Q. Use of the ulcerative colitis endoscopic index of severity and Mayo endoscopic score for predicting the therapeutic effect of mesalazine in patients with ulcerative colitis. Laparosc. Endosc Robot Surg. 2021; 4: 33-39.
  28. Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, Mitton S, Orchard T, Rutter M, Younge L, Lees C, Ho GT, Satsangi J, Bloom S; IBD Section of the British Society of Gastroenterology. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011 May;60(5):571-607. doi: 10.1136/gut.2010.224154. PMID: 21464096.
  29. Spinelli A, Bonovas S, Burisch J, Kucharzik T, Adamina M, Annese V, Bachmann O, Bettenworth D, Chaparro M, Czuber-Dochan W, Eder P, Ellul P, Fidalgo C, Fiorino G, Gionchetti P, Gisbert JP, Gordon H, Hedin C, Holubar S, Iacucci M, Karmiris K, Katsanos K, Kopylov U, Lakatos PL, Lytras T, Lyutakov I, Noor N, Pellino G, Piovani D, Savarino E, Selvaggi F, Verstockt B, Doherty G, Raine T, Panis Y. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J Crohns Colitis. 2022 Feb 23;16(2):179-189. doi: 10.1093/ecco-jcc/jjab177. PMID: 34635910.
  30. Alsoud D, Verstockt B, Fiocchi C, Vermeire S. Breaking the therapeutic ceiling in drug development in ulcerative colitis. Lancet Gastroenterol Hepatol. 2021 Jul;6(7):589-595. doi: 10.1016/S2468-1253(21)00065-0. Epub 2021 May 19. PMID: 34019798.
  31. Pearson DC, May GR, Fick GH, Sutherland LR. Azathioprine and 6-mercaptopurine in Crohn disease. A meta-analysis. Ann Intern Med. 1995 Jul 15;123(2):132-42. doi: 10.7326/0003-4819-123-2-199507150-00009. PMID: 7778826.
  32. Meyers S, Sachar DB: Medical therapy of Crohn’s disease. In: Inflammatory Bowel Disease. 4th edn. Eds.Kersnar JB, Shorter RG, Williams and Wilkins, Baltimore. 1995; 695-714.
  33. Pithadia AB, Jain S. Treatment of inflammatory bowel disease (IBD). Pharmacol Rep. 2011;63(3):629-42. doi: 10.1016/s1734-1140(11)70575-8. PMID: 21857074.
  34. Khalifa SE, Mudawi HM, Fedail SS. Presentation and management outcome of inflammatory bowel disease in Sudan. Trop Gastroenterol. 2005 Oct-Dec;26(4):194-6. PMID: 16737049.
  35. Benchimol EI, Seow CH, Steinhart AH, Griffiths AM. Traditional corticosteroids for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2008 Apr 16;2008(2):CD006792. doi: 10.1002/14651858.CD006792.pub2. PMID: 18425970; PMCID: PMC6718222.
  36. Ford AC, Bernstein CN, Khan KJ, Abreu MT, Marshall JK, Talley NJ, Moayyedi P. Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011 Apr;106(4):590-9; quiz 600. doi: 10.1038/ajg.2011.70. Epub 2011 Mar 15. PMID: 21407179.
  37. Steinhart AH, Ewe K, Griffiths AM, Modigliani R, Thomsen OO. Corticosteroids for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2003;(4):CD000301. doi: 10.1002/14651858.CD000301. PMID: 14583917.
  38. Irving PM, Gearry RB, Sparrow MP, Gibson PR. Review article: appropriate use of corticosteroids in Crohn's disease. Aliment Pharmacol Ther. 2007 Aug 1;26(3):313-29. doi: 10.1111/j.1365-2036.2007.03379.x. Erratum in: Aliment Pharmacol Ther. 2008 Mar 15;27(6):528-9. PMID: 17635367.
  39. Selinger CP, Parkes GC, Bassi A, Fogden E, Hayee B, Limdi JK, Ludlow H, McLaughlin S, Patel P, Smith M, Raine T. A multi-centre audit of excess steroid use in 1176 patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2017 Nov;46(10):964-973. doi: 10.1111/apt.14334. Epub 2017 Sep 26. PMID: 28949018.
  40. Gomollón F, Dignass A, Annese V, Tilg H, Van Assche G, Lindsay JO, Peyrin-Biroulet L, Cullen GJ, Daperno M, Kucharzik T, Rieder F, Almer S, Armuzzi A, Harbord M, Langhorst J, Sans M, Chowers Y, Fiorino G, Juillerat P, Mantzaris GJ, Rizzello F, Vavricka S, Gionchetti P; ECCO. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: Diagnosis and Medical Management. J Crohns Colitis. 2017 Jan;11(1):3-25. doi: 10.1093/ecco-jcc/jjw168. Epub 2016 Sep 22. PMID: 27660341.
  41. Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, Burisch J, Gecse KB, Hart AL, Hindryckx P, Langner C, Limdi JK, Pellino G, Zagórowicz E, Raine T, Harbord M, Rieder F; European Crohn’s and Colitis Organisation [ECCO]. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. J Crohns Colitis. 2017 Jun 1;11(6):649-670. doi: 10.1093/ecco-jcc/jjx008. Erratum in: J Crohns Colitis. 2022 Aug 16;: PMID: 28158501.
  42. Mallick B, Malik S. Use of Azathioprine in Ulcerative Colitis: A Comprehensive Review. Cureus. 2022 May 10;14(5):e24874. doi: 10.7759/cureus.24874. PMID: 35698683; PMCID: PMC9184176.

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