Prevalence and predictors of severe Crohn’s disease at a tertiary hospital in South Africa

Authors

  • C Gounden Department of Gastroenterology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
  • V Naidoo Department of Gastroenterology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
  • Y Moodley Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

DOI:

https://doi.org/10.7196/SAMJ.2024.v114i4.1667

Keywords:

Severe Crohn’s disease, prevalence, predictors, ileocecal location, penetrating disease

Abstract

Background

Predicting severe Crohn's disease (SCD) can assist in planning risk reduction therapy for SCD, thereby improving disease outcomes.

Objective

To determine the prevalence and predictors of SCD in a sample of South African patients.

Methods

This was a retrospective chart review of patients with Crohn's disease (CD) attending the Gastroenterology Unit at a tertiary hospital in Durban, South Africa. Demographic and clinical variables at diagnosis of CD were collected and analysed for statistical association with development of SCD (defined as the presence of >/= 1 of the following over the course of CD: complex perianal disease, colonic resection >/= 2 small bowel resections, a single small bowel resection > 50cm, or construction of a definitive stoma). The prognostic utility of statistically significant variables was investigated by establishing their sensitivity, specificity, and predictive values for SCD. 

Results

The study consisted of 93 patients. The rate of SCD was 64.5%, with 63.3 % of patients developing SCD within 1 year of CD diagnosis. Ileocolonic location (p = 0.046) and penetrating disease at initial diagnosis of CD (p = 0.021) were statistically associated with SCD. The sensitivity, specificity, positive predictive value, and negative predictive value of ileocolonic location for SCD was 72.7%, 47.4%, 66.7% and 54.6%. The sensitivity, specificity, positive predictive value, and negative predictive value of penetrating disease for SCD was 85.7%, 41.7%, 30.0% and 91.0%.

Conclusion

Most patients with CD developed SCD within 1 year of their CD diagnosis. CD with a penetrating phenotype at diagnosis is a good predictor for the devleopment of SCD and should be further investigated. 

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Published

2024-04-18

Issue

Section

Research

How to Cite

1.
Gounden C, Naidoo V, Moodley Y. Prevalence and predictors of severe Crohn’s disease at a tertiary hospital in South Africa. S Afr Med J [Internet]. 2024 Apr. 18 [cited 2024 Dec. 1];114(4). Available from: https://samajournals.co.za/index.php/samj/article/view/1667

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