Inflammatory bowel disease in Nigerians: Still a rare diagnosis?

Abstract

Inflammatory bowel disease (IBD) has been thought to have a low incidence among subSaharan Africans mainly because of the sporadic cases reported from the continent in comparison with the larger numbers reported from North America and Western European countries. Is this difference based on real demographic susceptibilities or a reflection of lower level of healthcare delivery? Three cases of ulcerative colitis and one case of Crohn's disease diagnosed in a tertiary institution in northern Nigeria in the span of three years are reported. Their presentation coincided with the creation of the Gastrointestinal Surgery Unit of our hospital and with it the availability of endoscopic diagnostic procedures. All four patients were indigenous Nigerians. Our findings suggest that IBD may be more common in this part of the world than previously thought. With an increased awareness of the disease in our population, a greater utilization of modern medicine as against alternative medicine and with wider availability of diagnostic tools in our hospitals, it is our guess that more cases may be found in the future to dispel the belief that Africans are somewhat immune to this affliction.

Diagnostic Yield of Colonoscopy

“…A single case of ulcerative colitis was recorded during the study period and no case of Crohn's disease was seen. This confirms that inflammatory bowel disease IBD is still rare in Nigeria with few reports of sporadic cases [18,19]. However, in Nile Delta, Egypt, IBD has been reported in 25% of cases, haemorrhoids 18% and diverticulosis 2% [11].…”

Inflammatory Bowel Disease: An Expanding Global Health Problem

“…Genetics is thought to play a role, as evidenced by the greater prevalence of CD in Ashkenazi than Sephardic Jewish populations 110. Now, it is a global disease and its incidence in developing nations is rising 42,111–113. Despite inadequate epidemiological data from developing parts of the world, the prevalence and incidence among blacks, Asians, and Hispanics has been reported with increasing frequencies40–42,111,114 suggesting that the trend is indeed increasing worldwide 42,52,112–116.…”

“…The industrialization and urbanization of societies are associated with changes in sanitation, occupations, microbiota, diet, lifestyle behaviors, medications, and pollution exposures, which have all been implicated as potential environmental risk factors for IBD 12. In developing nations, IBD was largely unknown; however, as these nations are transitioning to more industrial and urbanized societies, the incidence of IBD has begun to increase 42,114,115…”

An Examination of Diet for the Maintenance of Remission in Inflammatory Bowel Disease

“…Although still rarer, an increasing incidence of IBD is also being identified in South Africa, South America and Saudi Arabia [64,65,66]. The dramatic rise in incidence of IBD, particularly in South Asia, India and Japan, where traditionally there was a low incidence, suggests that environmental factors, such as the Western diet pattern, play an important role in disease pathogenesis [67,68,69].…”