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

      , ,
      SAMJ: South African Medical Journal
      South African Medical Association

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          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 (SA) 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, SA. Demographic and clinical variables at diagnosis of CD were collected and analysed for statistical associations with 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 sample 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 were 72.7%, 47.4%, 66.7% and 54.6%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of penetrating disease for SCD were 85.7%, 41.7%, 30.0% and 91.0%, respectively 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 development of SCD and should be further investigate

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          3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: Diagnosis and Medical Management.

          This paper is the first in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn's disease and concerns the methodology of the consensus process, and the classification, diagnosis and medical management of active and quiescent Crohn's disease. Surgical management as well as special situations including management of perianal Crohn's disease of this ECCO Consensus are covered in a subsequent second paper [Gionchetti et al JCC 2016].
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            In recent years, investigators have readdressed the complex issues involved in the classification of inflammatory bowel diseases. In 2003, a Working Party of investigators with an interest in the issues involved in disease subclassification was formed with the aim of summarising recent developments in disease classification and establishing an integrated clinical, molecular, and serological classification of inflammatory bowel disease. The results of the Working Party were reported at the 2005 Montreal World Congress of Gastroenterology. Here we highlight the key issues that have emerged from discussions of the Montreal Working Party and the relevance to clinical practice and research activities.
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              ACG Clinical Guideline: Management of Crohn’s Disease in Adults

              Crohn's disease is an idiopathic inflammatory disorder of unknown etiology with genetic, immunologic, and environmental influences. The incidence of Crohn's disease has steadily increased over the past several decades. The diagnosis and treatment of patients with Crohn's disease has evolved since the last practice guideline was published. These guidelines represent the official practice recommendations of the American College of Gastroenterology and were developed under the auspices of the Practice Parameters Committee for the management of adult patients with Crohn's disease. These guidelines are established for clinical practice with the intent of suggesting preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When exercising clinical judgment, health-care providers should incorporate this guideline along with patient's needs, desires, and their values in order to fully and appropriately care for patients with Crohn's disease. This guideline is intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. To evaluate the level of evidence and strength of recommendations, we used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time.

                Author and article information

                SAMJ: South African Medical Journal
                SAMJ, S. Afr. med. j.
                South African Medical Association (Pretoria, Gauteng, South Africa )
                April 2024
                : 114
                : 4
                : 40-45
                [03] Durban orgnameUniversity of KwaZulu-Natal orgdiv1Nelson R. Mandela School of Medicine orgdiv2Gastrointestinal Cancer Research Group South Africa
                [01] Durban orgnameUniversity of KwaZulu-Natal orgdiv1Nelson R. Mandela School of Medicine orgdiv2Department of Gastroenterology South Africa
                [02] Cape Town orgnameStellenbosch University orgdiv1Faculty of Medicine and Health Sciences orgdiv2Department of Global Health South Africa
                S0256-95742024000400008 S0256-9574(24)11400400008

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 48, Pages: 6

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