A clinical audit of inflammatory bowel disease in a South African tertiary institution : review

Background: Traditionally, inflammatory bowel disease has been a disease entity associated with European ancestry. Despite claims of rarity, numerous studies have emerged which indicate that the prevalence of IBD has increased in various ethnic groups worldwide. We illustrate that IBD is indeed a multi-ethnic disease and the clinical characteristics of IBD in our setting are presented in this study. Methods: A retrospective cross-sectional descriptive study of the medical records of IBD patients presenting to the Department of Gastroenterology, area 554 of the Charlotte Makexe Johannesburg Academic Hospital was undertaken. One hundred twenty-six patients with IBD referred to this tertiary gastrointestinal centre from 2005 through 2010, were assessed. Demographic and historical characteristics, clinical features as well as drug and surgical interventions were assessed according to a predetermined patient data collection form. Results: Analyses demonstrated that 63.5% of the sample had UC, 34.1% had CD and 2.4% were diagnosed as having IC, with a female to male ratio of 1.4: 1. There were comparable numbers of White, Indian and Black patients with UC but very few Black patients contributed to the CD burden. Moreover, CD was established as a more severe disease entity as manifest by a higher proportion of extra-intestinal manifestations, in addition to higher complication and surgery rates in this group. Conclusion: Our findings show that although Caucasians still represent the greater fraction of IBD cases, the numbers of Black South Africans affected by this disease have grown. Moreover, in contrast to earlier studies, we found that disease in Black patients is milder compared to White and Indian counterparts. We have been able to illustrate that IBD is in fact a multi-racial disease entity as shown to affect various ethnic groups.