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Article ; Online: Michael Charles Kew - Frontrunner in Hepatology.

Kassianides, Chris / Dusheiko, Geoffrey / Di Bisceglie, Adrian / Hoofnagle, Jay H

2021

Language	English
Publishing date	2021-12-06
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	605953-3
ISSN	1600-0641 ; 0168-8278
ISSN (online)	1600-0641
ISSN	0168-8278
DOI	10.1016/j.jhep.2021.11.019
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Article ; Online: Inflammatory bowel disease in sub-Saharan Africa: epidemiology, risk factors, and challenges in diagnosis.

Watermeyer, Gillian / Katsidzira, Leolin / Setshedi, Mashiko / Devani, Smita / Mudombi, Wisdom / Kassianides, Chris

The lancet. Gastroenterology & hepatology

2022 Volume 7, Issue 10, Page(s) 952–961

Abstract: Over the past century, the incidence of inflammatory bowel disease (IBD) in high-income countries has shown a sharp rise that then plateaued, and a similar trend has been observed in newly industrialised countries. IBD has long been considered uncommon ... ...

Abstract	Over the past century, the incidence of inflammatory bowel disease (IBD) in high-income countries has shown a sharp rise that then plateaued, and a similar trend has been observed in newly industrialised countries. IBD has long been considered uncommon in sub-Saharan Africa, possibly reflecting low exposure to environmental risk factors described in high-income populations. Alternatively, individuals living in sub-Saharan Africa might have a different genetic disposition. However, some cases of IBD might remain undetected in sub-Saharan Africa because of a lack of awareness, deficiencies in diagnostic and clinical capacity, and a substantial rate of misdiagnosis due to the high burden of infectious diseases. There are few published data describing the natural history of IBD in sub-Saharan Africa, and the true burden of the disease remains largely unknown, although there is some evidence that the incidence of IBD is rising in this region. This Series paper summarises the present understanding of IBD and challenges facing clinicians when diagnosing this disease in sub-Saharan Africa.
MeSH term(s)	Africa South of the Sahara/epidemiology ; Humans ; Incidence ; Inflammatory Bowel Diseases/diagnosis ; Inflammatory Bowel Diseases/epidemiology ; Risk Factors
Language	English
Publishing date	2022-06-30
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2468-1253
ISSN (online)	2468-1253
DOI	10.1016/S2468-1253(22)00047-4
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Article: Challenges in the diagnosis and management of IBD: a sub-Saharan African perspective.

Watermeyer, Gill / Katsidzira, Leolin / Nsokolo, Bright / Isaac Alatise, Olusegun / Duduyemi, Babatunde M / Kassianides, Chris / Hodges, Phoebe

Therapeutic advances in gastroenterology

2023 Volume 16, Page(s) 17562848231184986

Abstract: With the exception of South Africa, inflammatory bowel disease (IBD) has long been considered uncommon in sub-Saharan Africa (SSA) with a dearth of peer-reviewed publications from the subcontinent. This most likely reflects underreporting as some cases ... ...

Abstract	With the exception of South Africa, inflammatory bowel disease (IBD) has long been considered uncommon in sub-Saharan Africa (SSA) with a dearth of peer-reviewed publications from the subcontinent. This most likely reflects underreporting as some cases may be missed due to the high burden of infectious diseases which may closely mimic IBD. In addition, many countries in SSA have limited endoscopic capacity, inadequate access to diagnostic imaging and a notable scarcity of histopathologists, radiologists and gastroenterologists. Beyond these obstacles, which significantly impact patient care, there are many other challenges in SSA, particularly the unavailability of key IBD therapies. In this review, we discuss barriers in diagnosing and managing IBD in SSA, as well as some of the initiatives currently in place to address these short comings.
Language	English
Publishing date	2023-07-12
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2440710-0
ISSN	1756-2848 ; 1756-283X
ISSN (online)	1756-2848
ISSN	1756-283X
DOI	10.1177/17562848231184986
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Article ; Online: Managing cirrhosis with limited resources: perspectives from sub-Saharan Africa.

Sonderup, Mark W / Kamath, Patrick S / Awuku, Yaw A / Desalegn, Hailemichael / Gogela, Neliswa / Katsidzira, Leolin / Tzeuton, Christian / Bobat, Bilal / Kassianides, Chris / Spearman, C Wendy

The lancet. Gastroenterology & hepatology

2024 Volume 9, Issue 2, Page(s) 170–184

Abstract: Cirrhosis represents the end stage of chronic liver disease. Sub-Saharan Africa, a resource-constrained region, has a high burden of chronic liver disease, with causes including chronic viral hepatitis, excessive alcohol use, and metabolic dysfunction- ... ...

Abstract	Cirrhosis represents the end stage of chronic liver disease. Sub-Saharan Africa, a resource-constrained region, has a high burden of chronic liver disease, with causes including chronic viral hepatitis, excessive alcohol use, and metabolic dysfunction-associated steatotic liver disease (MASLD), the risk of which is burgeoning. The development of liver cirrhosis predicts for morbidity and mortality, driven by both liver dysfunction and the consequences of portal hypertension. Compensated cirrhosis portends a better prognosis than decompensated cirrhosis, highlighting the need for the early diagnosis of cirrhosis and its causes. With resource challenges, the diagnosis and management of cirrhosis is demanding, but less costly and less invasive interventions with substantial benefits, ranging from simple blood tests to transient elastography, are feasible in such settings. Simple interventions are also available to manage the complex manifestations of decompensation, such as β blockers in variceal bleeding prophylaxis, salt restriction and appropriate diuretic use in ascites, and lactulose and generic rifaximin in hepatic encephalopathy. Ultimately, managing the underlying causative factors of liver disease is key in improving prognosis. Management demands expanded policy interventions to increase screening and treatment for hepatitis B and C and reduce alcohol use and the metabolic factors driving MASLD. Furthermore, the skills needed for more specialised interventions, such as transjugular intrahepatic portosystemic shunt procedures and even liver transplantation, warrant planning, increased capacity, and support for regional centres of excellence. Such centres are already being developed in sub-Saharan Africa, demonstrating what can be achieved with dedicated initiatives and individuals.
MeSH term(s)	Humans ; Esophageal and Gastric Varices ; Gastrointestinal Hemorrhage/diagnosis ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/therapy ; Liver Cirrhosis/complications ; Liver Cirrhosis/diagnosis ; Liver Cirrhosis/therapy ; Hypertension, Portal/diagnosis ; Hypertension, Portal/etiology ; Hypertension, Portal/therapy ; Liver Transplantation/adverse effects
Language	English
Publishing date	2024-01-12
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2468-1253
ISSN (online)	2468-1253
DOI	10.1016/S2468-1253(23)00279-0
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Article ; Online: Inflammatory bowel disease in children in sub-Saharan Africa.

Epstein, David / Kassianides, Chris / Gaibee, Zeenat / Watermeyer, Gillian / Griffiths, Anne

Paediatrics and international child health

2020 Volume 40, Issue 3, Page(s) 141–142

MeSH term(s)	Africa South of the Sahara ; Child ; Humans ; Inflammatory Bowel Diseases ; Nigeria
Language	English
Publishing date	2020-08-09
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	2649065-1
ISSN	2046-9055 ; 2046-9047
ISSN (online)	2046-9055
ISSN	2046-9047
DOI	10.1080/20469047.2020.1787020
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Zs.A 1674: Show issues

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Article ; Online: Challenges in the management of inflammatory bowel disease in sub-Saharan Africa.

Watermeyer, Gillian / Awuku, Yaw / Fredericks, Ernst / Epstein, David / Setshedi, Mashiko / Devani, Smita / Mudombi, Wisdom / Kassianides, Chris / Katsidzira, Leolin

The lancet. Gastroenterology & hepatology

2022 Volume 7, Issue 10, Page(s) 962–972

Abstract: Inflammatory bowel disease (IBD) is generally considered a disease of high-income countries and is regarded as rare in sub-Saharan Africa. However, this assumption is almost certainly an underestimate, and the high burden of communicable diseases makes ... ...

Abstract	Inflammatory bowel disease (IBD) is generally considered a disease of high-income countries and is regarded as rare in sub-Saharan Africa. However, this assumption is almost certainly an underestimate, and the high burden of communicable diseases makes IBD in sub-Saharan Africa difficult to detect. Furthermore, some gastrointestinal infections can closely mimic IBD, contributing to delays in diagnosis and complicating therapeutic decision making. Constraints in endoscopic capacity alongside a scarcity of qualified diagnostic pathologists add to the difficulties. Implementing evidence-based guidelines recommended by international societies is challenging, mostly due to high costs and unavailability of medication. However, cost-effective approaches can still be implemented to manage IBD in sub-Saharan Africa as the predominant disease phenotype is mild-to-moderate ulcerative colitis, which often responds to treatment with basic medication. In this Series paper, we summarise the current management of IBD in sub-Saharan Africa and propose how it can be tailored to suit the epidemiological and socioeconomic specificities of the region. We also discuss measures required to address existing challenges, such as educating health-care workers about the diagnosis and management of IBD or improving endoscopic capacity.
MeSH term(s)	Africa South of the Sahara/epidemiology ; Chronic Disease ; Colitis, Ulcerative ; Humans ; Inflammatory Bowel Diseases/diagnosis ; Inflammatory Bowel Diseases/epidemiology ; Inflammatory Bowel Diseases/therapy
Language	English
Publishing date	2022-06-30
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2468-1253
ISSN (online)	2468-1253
DOI	10.1016/S2468-1253(22)00048-6
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Article ; Online: Treatment of hepatocellular carcinoma in sub-Saharan Africa: challenges and solutions.

Jonas, Eduard / Bernon, Marc / Robertson, Barbara / Kassianides, Chris / Keli, Elie / Asare, Kwaku Offei / Alatise, Isaac Olusegun / Okello, Michael / Blondel, Nana Oumarou / Mulehane, Kenedy Ondede / Abubeker, Zeki Abdurahman / Nogoud, Alaaeldin Awad / Nashidengo, Pueya Rashid / Chihaka, Onesai / Tzeuton, Christian / Dusheiko, Geoffrey / Sonderup, Mark / Spearman, C Wendy

The lancet. Gastroenterology & hepatology

2022 Volume 7, Issue 11, Page(s) 1049–1060

Abstract: Most patients who develop hepatocellular carcinoma reside in resource-poor countries, a category that includes most countries in sub-Saharan Africa. Age-standardised incidence rates of hepatocellular carcinoma in western, central, eastern, and southern ... ...

Abstract	Most patients who develop hepatocellular carcinoma reside in resource-poor countries, a category that includes most countries in sub-Saharan Africa. Age-standardised incidence rates of hepatocellular carcinoma in western, central, eastern, and southern Africa is 6·53 per 100 000 inhabitants to 11·1 per 100 000 inhabitants. In high-income countries, around 40% of patients are diagnosed at an early stage, in which interventions with curative intent or palliative interventions are possible. By contrast, 95% of patients with hepatocellular carcinoma in sub-Saharan Africa present with advanced or terminal disease. In high-income countries, targets of 30-40% that have been set for intervention with curative intent are regularly met, with expected 5-year overall survival rates in the region of 70%. These outcomes are in sharp contrast with the very small proportion of patients in sub-Saharan Africa who are treated with curative intent. Primary prevention through the eradication and reduction of risk factors is still suboptimal because of logistical challenges. The challenges facing primary prevention, in combination with difficult-to-manage historic and emerging risk factors, such as ethanol overconsumption and metabolic dysfunction-associated liver disease, mandates secondary prevention for populations at risk through screening and surveillance. Although the increased treatment needs yielded by screening and surveillance in high-income countries are manageable by the incremental expansion of existing interventional resources, the lack of resources in sub-Saharan Africa will undermine the possible benefits of secondary prevention. An estimate of the projected effect of the introduction and expansion of screening and surveillance, resulting in stage migration and possibilities for active interventions for hepatocellular carcinoma, would facilitate optimal planning and development of resources.
MeSH term(s)	Africa South of the Sahara/epidemiology ; Carcinoma, Hepatocellular/epidemiology ; Carcinoma, Hepatocellular/prevention & control ; Ethanol ; Humans ; Incidence ; Liver Neoplasms/epidemiology ; Liver Neoplasms/prevention & control
Chemical Substances	Ethanol (3K9958V90M)
Language	English
Publishing date	2022-07-08
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2468-1253
ISSN (online)	2468-1253
DOI	10.1016/S2468-1253(22)00042-5
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Article ; Online: Epidemiology, risk factors, social determinants of health, and current management for non-alcoholic fatty liver disease in sub-Saharan Africa.

Spearman, C Wendy / Afihene, Mary / Betiku, Omolade / Bobat, Bilal / Cunha, Lina / Kassianides, Chris / Katsidzira, Leolin / Mekonnen, Hailemichael D / Ocama, Ponsiano / Ojo, Olusegun / Paruk, Imran / Tzeuton, Christian / Sonderup, Mark W

The lancet. Gastroenterology & hepatology

2021 Volume 6, Issue 12, Page(s) 1036–1046

Abstract: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease globally and is estimated to affect approximately 25% of the world's population. Data about the prevalence and incidence of NAFLD in Africa are scarce, but the ... ...

Abstract	Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease globally and is estimated to affect approximately 25% of the world's population. Data about the prevalence and incidence of NAFLD in Africa are scarce, but the prevalence is estimated to be 13·5% for the general population. This is likely to be an underestimate considering the increasing burden of non-communicable diseases, particularly the rising prevalence of obesity and type 2 diabetes, driven by the overlapping challenges of food insecurity, nutritional transition, and associated increased consumption of calorie-dense foods. Establishing the true prevalence of NAFLD, raising public awareness around the risk factors behind the increase in NAFLD, and proactively addressing all components of metabolic syndrome will be important to combat this silent epidemic, which will have long-term health-care costs and economic consequences for the region.
MeSH term(s)	Adult ; Africa South of the Sahara/epidemiology ; Awareness ; Cost of Illness ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/epidemiology ; Disease Management ; Dyslipidemias/complications ; Dyslipidemias/epidemiology ; Female ; Gastrointestinal Microbiome ; Health Care Costs ; Humans ; Hypertension/complications ; Hypertension/epidemiology ; Incidence ; Male ; Metabolic Syndrome/complications ; Middle Aged ; Non-alcoholic Fatty Liver Disease/epidemiology ; Non-alcoholic Fatty Liver Disease/therapy ; Noncommunicable Diseases/economics ; Noncommunicable Diseases/epidemiology ; Obesity/complications ; Obesity/epidemiology ; Polycystic Ovary Syndrome/complications ; Polycystic Ovary Syndrome/epidemiology ; Prevalence ; Prognosis ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/epidemiology ; Risk Factors ; Social Determinants of Health/trends
Language	English
Publishing date	2021-09-09
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ISSN	2468-1253
ISSN (online)	2468-1253
DOI	10.1016/S2468-1253(21)00275-2
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Health-care provision and policy for non-alcoholic fatty liver disease in sub-Saharan Africa.

Spearman, C Wendy / Abdo, Abdelmounem / Ambali, Aggrey / Awuku, Yaw A / Kassianides, Chris / Lesi, Olufunmilayo A / Ndomondo-Sigonda, Margareth / Onyekwere, Charles A / Rwegasha, John / Shewaye, Abate B / Sonderup, Mark W

The lancet. Gastroenterology & hepatology

2021 Volume 6, Issue 12, Page(s) 1047–1056

Abstract: Sub-Saharan Africa, which has a population of more than 1 billion people, carries 24% of the global burden of disease and spends the least on health care of any region, relying heavily on international development assistance to deliver health care for ... ...

Abstract	Sub-Saharan Africa, which has a population of more than 1 billion people, carries 24% of the global burden of disease and spends the least on health care of any region, relying heavily on international development assistance to deliver health care for HIV, tuberculosis, and malaria. The demographic and epidemiological transitions occurring in sub-Saharan Africa, with rising prevalences of obesity and diabetes, enhance the risk of non-alcoholic fatty liver disease (NAFLD), yet this remains an unrecognised complication of metabolic syndrome. There are no guidance documents on NAFLD from sub-Saharan Africa, and non-communicable disease (NCD) guidance documents do not include the associated burden of fatty liver disease. Combating the health and socioeconomic burden of NAFLD requires an integrated liver health approach, with task-shifting to primary health care. Using clear guidance documents to link education and management of HIV, viral hepatitis, NAFLD, and associated NCDs is also crucial to an integrated approach to infectious diseases and NCDs, which requires targeted funding from both governments and international development agencies.
MeSH term(s)	Africa South of the Sahara/epidemiology ; Aged ; COVID-19/complications ; COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19/virology ; Delivery of Health Care/economics ; Delivery of Health Care/legislation & jurisprudence ; Diabetes Mellitus/epidemiology ; Global Burden of Disease/economics ; Health Policy/trends ; Health Services Accessibility/statistics & numerical data ; Humans ; Metabolic Syndrome/complications ; Metabolic Syndrome/epidemiology ; Middle Aged ; Non-alcoholic Fatty Liver Disease/epidemiology ; Non-alcoholic Fatty Liver Disease/therapy ; Noncommunicable Diseases/epidemiology ; Obesity/complications ; Obesity/epidemiology ; Patient Education as Topic ; Prevalence ; Primary Health Care/methods ; Risk Factors ; Risk Reduction Behavior ; SARS-CoV-2/genetics ; Social Class
Language	English
Publishing date	2021-09-09
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2468-1253
ISSN (online)	2468-1253
DOI	10.1016/S2468-1253(21)00296-X
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Hepatocellular carcinoma: measures to improve the outlook in sub-Saharan Africa.

The lancet. Gastroenterology & hepatology

2022 Volume 7, Issue 11, Page(s) 1036–1048

Abstract: Hepatocellular carcinoma is a leading public health concern in sub-Saharan Africa, and it is most prevalent in young adults (median 45 years [IQR 35-57]). Overall, outcomes are poor, with a median survival of 2·5 months after presentation. Major risk ... ...

Abstract	Hepatocellular carcinoma is a leading public health concern in sub-Saharan Africa, and it is most prevalent in young adults (median 45 years [IQR 35-57]). Overall, outcomes are poor, with a median survival of 2·5 months after presentation. Major risk factors for hepatocellular carcinoma are hepatitis B virus (HBV), hepatitis C virus, aflatoxin B1 exposure, and alcohol consumption, with metabolic dysfunction-associated fatty liver disease slowly emerging as a risk factor over the past few years. Crucially, these risk factors are preventable and manageable with effective implementation of the HBV birth-dose vaccination, treatment of chronic viral hepatitis, provision of harm reduction services, and by decreasing aflatoxin B1 exposure and harmful alcohol consumption. Primary prevention is central to the management of hepatocellular carcinoma, especially in poorly resourced environments. Effective screening and surveillance programmes with recall policies need to be implemented, because detection and curative management of hepatocellular carcinoma is possible if it is detected at an early stage, even in countries with minimal resources, with appropriate upskilling of medical personnel. The establishment of centres of excellence with advanced diagnostic and therapeutic capabilities within countries should improve hepatocellular carcinoma outcomes and assist in driving the implementation of much needed systematic data systems focused on hepatocellular carcinoma to establish the accurate burden in sub-Saharan Africa. Such data would support the public health importance of hepatocellular carcinoma and provide a strong basis for advocacy, programme development, resource allocation, and monitoring of progress in reducing mortality.
MeSH term(s)	Aflatoxin B1 ; Africa South of the Sahara/epidemiology ; Carcinoma, Hepatocellular/diagnosis ; Carcinoma, Hepatocellular/epidemiology ; Carcinoma, Hepatocellular/etiology ; Hepatitis C/complications ; Hepatitis C/diagnosis ; Hepatitis C/epidemiology ; Humans ; Liver Neoplasms/diagnosis ; Liver Neoplasms/epidemiology ; Liver Neoplasms/prevention & control
Chemical Substances	Aflatoxin B1 (9N2N2Y55MH)
Language	English
Publishing date	2022-07-08
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2468-1253
ISSN (online)	2468-1253
DOI	10.1016/S2468-1253(22)00041-3
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