Inflammatory Bowel Disease in Children: Experience and Constraints in a Resource-limited Setting.

Oluwafunmilayo F Adeniyi,Joanah M Ikobah,Mary Lawal,Yeside O Akinbolagbe,Vincent I Onywekwelu,Foluke A Olatona,Emuobor Odeghe

doi:10.7759/cureus.7848

Abstract

Introduction: Inflammatory bowel disease (IBD), though well described in the Caucasian population, is rarely encountered in the black African children. The aim of this study was to increase the awareness of this emerging condition in African children and highlight the constraints of management in a resource-limited setting like Nigeria.Methods: This study included an audit of children with IBD who were seen between January 2015 and February 2020 at the Lagos University Teaching Hospital (LUTH). The clinical records of children aged one to 16 years who presented with recurrent abdominal pain, weight loss, and gastrointestinal (GI) bleeding with clinical suspicion of IBD were reviewed. Clinical features, endoscopic findings, histopathologic findings, and treatment were documented.Results: Eight children with IBD were seen during the study period. The median age was 12.0 years (range: five to 15 years). The most common reported concerns in the children were chronic abdominal pain [seen in four patients (50%)] and bloody diarrhea [seen in three patients (42.30%)]. Weight loss and arthritis were seen in three (37.5%) and one (12.5%) children, respectively. Endoscopy confirmed two cases of Crohn’s disease (CD), three cases of ulcerative colitis (UC), and three cases of indeterminate colitis (IC). The children with CD were treated with steroids and exclusive enteral nutrition, with one patient receiving methotrexate, while the UC and IC patients received 5-aminosalicylate therapy.Conclusion: Although IBD is uncommon in Nigeria, a high index of suspicion is vital to enable early diagnosis and appropriate treatment. Management in the African setting is severely constrained by limited access to endoscopy facilities and nonavailability of other effective treatment options such as biologic agents.

Highlights

Inflammatory bowel disease (IBD), though well described in the Caucasian population, is rarely encountered in the black African children
The children with Crohn’s disease (CD) were treated with steroids and exclusive enteral nutrition, with one patient receiving methotrexate, while the ulcerative colitis (UC) and indeterminate colitis (IC) patients received 5-aminosalicylate therapy
Individuals with UC tend to present with recurrent abdominal pain, rectal bleeding, and bloody diarrhea, while patients with CD may present with extraintestinal manifestations such as poor growth, weight loss, musculoskeletal diseases, hepatobiliary diseases, ocular diseases, and renal diseases

Summary

Introduction

Inflammatory bowel disease (IBD), though well described in the Caucasian population, is rarely encountered in the black African children. Inflammatory bowel disease (IBD) is a disorder of the gastrointestinal (GI) tract characterized by chronic, relapsing, and intermittent inflammation [1], which can affect both adults and children. Endoscopic findings of UC tend to be more of a uniformly diffuse inflammation of the gut that involves the mucosa and submucosa, while CD typically shows patchy (skip) lesions, transmural gut involvement with or without abscesses, and granulomas [2,3]. The etiology of IBD, though not fully elucidated, is believed to be multifactorial and results from an interplay of genetic predisposition, environmental factors, and immune dysregulation, which results in chronic inflammation of the gut [2,3,4,5]

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