Inflammatory bowel disease in Africa: what is the current state of knowledge?

Abstract

Inflammatory bowel disease (IBD) is increasingly recognized as a global disease in the twenty-first century; however, little is known about its epidemiology in Africa. We conducted a literature review in order to assess what is currently known on this subject, the results of which are reported here. Based on available observational studies, it appears that the incidence of IBD in Africa is rising, although comprehensive epidemiological data are lacking. This is likely due to multiple factors, including shifting trends in diet and exposure to environmental pathogens. Many challenges relating to IBD exist for healthcare systems in Africa, including the need for improved access to diagnostic facilities such as endoscopy and histopathology, and the potential economic burden of treatment. Intestinal TB also represents a significant confounding factor in the diagnosis of IBD in Africa.

Keywords: Crohn’s; epidemiology; inflammatory bowel disease; inflammatory bowel diseases; ulcerative colitis.

Figure 1

Map of TB incidence per 100 000 population. Pie charts represent areas with reported Crohn’s:UC ratio. Where ratios are not known, bar charts show numbers of cases reported (from countries where ≥10 cases are reported).

Figure 2

Endoscopic images (A–D) show appearances of intestinal tuberculosis, images (E–H) show colonic Crohn’s. Areas of atypical ulceration (see A) are suspicious for TB; however, this can also closely mimic Crohn’s (see the discrete and linear ulceration in E and G). Patency of the ileocaecal valve (see D) is said to be typical of intestinal TB. All pleomorphic ulcers must be biopsied and histological analysis must include TB culture or polymerase chain reaction.