Amosy E M'Koma
Biography
Professor (Tenured) of Surgery, Surgical Sciences, Pathology and Cancer Biology,USA
Principal Investigator: NIH-funded project in inflammatory bowel disease since 2010.
Research Interest
Unit Director: Gastrointestinal Diseases/Disorders: MD & PhD Programs, Clinical Skills.
Colorectal Physician Scientist (Basic, Clinical,Transformational & Translational)
Academic Society College’s Master: MD Program to Medical Students.
Consultant Scientist Reviewer: NIH and DOD Study sections.
Abstract
Abstract
Current Global Challenges of Inflammatory Bowel Disease as an Emergent Worldwide Disease
While inflammatory bowel disease (IBD) has been well reported in the developed industrialized parts of the world, there is little to no study data from low-middle-income nations in sub-Saharan Africa, South America, and Asia. We performed a systematic review of the literature, extracting relevant publications. We found only 331 documented IBD cases in sub-Saharan Africa mostly from South Africa, with 34 publications until August 2019. The majority were ulcerative colitis (UC) cases, and the rest were case reports or small case series; the largest from Nigeria comprised 32 patients. The epidemiological paucity/opacity of documented cases possibly reflects underdiagnoses, underreporting, lack of dedicated registries, inadequate facilities, and shortage of specialized health professionals. Major deficiencies in diagnostic and clinical capacity were noted, a serious gap, which needs to be addressed.
IBD, i.e., ulcerative colitis and Crohn’s disease is now acknowledged as a global emergent disease [1,2]. IBD incidence is swiftly evolving in low-middle-income countries in sub-Saharan Africa, South America, and Asia and is often misdiagnosed as a parasitic or infectious disease. Trials in IBD, therefore, should adequately represent diverse groups concerning age, gender, surrounding place of residence, lifestyle, race, and ethnicity to establish the worldwide applicability and generalizability of their outcomes. The evidence that IBD is widely affecting a much younger population presents a serious concern. Meta-analyses conducted in patients acquiring IBD at a young age reveal a trend for their increased risk of developing colitis-associated colorectal cancer (CACRC) since the cumulative incidence rates of CACRC in IBD patients diagnosed in childhood are higher than those observed in adults. In addition, CACRC has a worse prognosis than sporadic colorectal cancer (SCRC), even when the stage at diagnosis is accounted for. This is consistent with evidence that IBD negatively impacts colorectal cancer (CRC) survival. A continuing increase in IBD incidence worldwide associated with early childhood onset coupled with the diseases’ longevity and an increase in oncologic translational transformation suggests a rising disease burden, morbidity, and healthcare costs. Painstakingly, IBD and its associated neoplastic transformation appear inevitable, which may significantly impact pediatric gastroenterology and adult CRC care. Due to an infrastructure gap in access to care between low-middle-income countries vs. developed nations and the uneven representation of IBD across socioeconomic strata, a plan is needed in low-middle-income countries to address these emerging serious challenges. In this presentation, I report on the current Global IBD Epidemiology and Epidemiological Opacity and Diagnosis Challenges/Gaps/Barriers in low-middle-income countries.
