The SOUTH AFRICAN GASTROENTEROLOGY REVIEW is written by specialists in the field. Its aim is to publish articles pertinent to the practicing Gastroenterologist in South Africa. The South African Gastroenterology Review is distributed to a broad spectrum of clinicians who have an interest in clinical gastroenterolgy and hepatology. The views expressed in individual articles are the personal views of the Authors and are not necessarily shared by the Editors, the Advertisers or the Publisher. No articles may be reproduced in any way without the written consent of the Publisher.

VOLUME 15  I NO. 2  I AUGUST 2017

As I wended my way back from attending the 8th AMAGE Congress in Addis Ababa I reflected on the state of gastroenterology in Sub Saharan Africa (SSA). The Congress with 310 attendees was entitled “Challenges Facing Gastroenterology Practice in Africa and the Middle East”. With more gastroenterologists at the Mayo Clinic than in the whole of SSA, what are we doing and what can we do to improve the care of patients with gastroenterological diseases? Several of us have been chipping away at this for over two decades.

S Thomson

Introduction
Pancreatitis is an inflammatory condition of the pancreas that can present as acute, recurrent acute or chronic pancreatitis (CP). Acute pancreatitis (AP) is characterized by two of the following criteria as per the revised Atlanta 2 international consensus: a sudden onset of epigastric pain, elevated lipase (or pancreas-specific amylase) of three times the upper limit of normal and characteristic findings on preferably a contrasted computed tomography, MRI or ultrasound. In CP, irreversible fibroinflammation and replacement of pancreatic parenchyma tissue by fibrous connective tissue result in pain and progressive exocrine and endocrine insufficiency.

RP Nashidengo, I Crous, E Jonas, K Fieggen, SR Thomson

Introduction
Choledochal cysts (CDC) are rare dilatations of the intrahepatic and/or the extrahepatic ducts without an acute obstruction. It was first described by Vater and Ezler in 1723. The incidence varies with geographical location. In the western world, the reported incidence is between 1 in 100 000 and 1 150 000. It is ten times more common in Asia, were the highest incidence has been recorded in Japan (1 in 13 000). CDC are considered a disorder of childhood and infancy, however the age at presentation varies from the new-born period to 80 years old. Approximately 75% occur in females. About 25% of CDC are diagnosed antenatal or within the first year of life, 60% during the first decade of life and 20% go undiagnosed into adulthood.

OB Chihaka, JC Kloppers, E Jonas, JEJ Krige, SR Thomson

Introduction
The European brand of research-intensive universities in the early twentieth century became the model for American Universities such as Harvard and Cornell. Sub-Saharan Africa with countries like Mozambique, with rapidly growing economies, needs to adapt and adopt such a model to improve the training process at their universities. Developing countries shoulder a considerable burden of gastroenterological disease. Recently, the economic successes of China and India have lessened poverty for millions of people with resultant improvement in health care indices. Mozambique has faced unstable governments,
sectarian violence, and post civil war challenges including inadequate water supplies and sanitation. These negative factors are resolving and the country is improving socially and economically.

P Modcoicar, L Mondlane, L Dimande, CJJ Mulder

Case report
A fifty-four year old woman underwent colonoscopy due to symptoms of altered bowel habit and weight loss. There was a malignant looking lesion at her rectosigmoid junction [Fig. 1a] which was confirmed histologically to be a moderately differentiated adenocarcinoma. Although the blood results were normal, her CT scan and MRI [Fig 2a] showed an apple core lesion at rectosigmoid junction which was deemed to be Stage IIIC (T4aN2aM0).

M Tun, NB Singh, AJ Mahmood, RS Mistry

We are approaching the first anniversary of this process launched at the SAGES annual congress in August 2016. The existence of this process came about following the identification of gaps and weaknesses in the previous process in place at the time. The previous process was not exactly SAGES driven nor inclusive and catered only for one medical aid, Discovery Health. The new application process was meant to be open and inclusive and moreover, cater to the needs of a broader funder base. From the planning stages, we encouraged member participation, especially with regards to the requirements on the application form.

E Fredericks

“I have had 3 Crohn’s operations but never received any medication for Crohn’s disease”

“I take Prednisone 20mg every day for my Crohn’s disease, and have done so for years”

“I must pay a R2, 000 co-payment every time I go for a colonoscopy while I thought a PMB condition, such as ulcerative colitis, should be covered in full”

“My medical aid says 5-ASA tablets and suppositories are a duplication of treatment. I pay for my suppositories myself but can no longer afford them”

“PENTASA 1000MG suppositories are reserved for the management of acute flares (3-6 weeks duration) where patients cannot tolerate oral preparations.” –
Bonitas Medical Scheme

D Epstein

In this my last year at the helm I was pleased to have a large say in who was to be honoured as our 4th Solly Marks Visiting Professor. Peter Cotton was the
recipient. The son of a rural family physician Peter graduated in 1963 from Cambridge University and St. Thomas Hospital Medical School where, as a trainee, he developed the Endoscopy Laboratory and introduced the practice of ERCP to the UK from Japan in 1971. In 1973 he was appointed Director of Gastroenterology at the Middlesex Hospital and Medical School, where he integrated medical and surgical gastroenterology, pioneering endoscopic therapy particularly ERCP.

S Thomson

The inaugural ERCP training course is part of several endoscopy training initiatives undertaken by Professors Sandie Thomson and Damon Bizos to help provide a standard teaching framework and hopefully going forward enable competency assessment. This course was the first in our country and we were
fortunate to have one of the founding fathers of ERCP – Professor Peter Cotton as international faculty together with Srisha Hebbar, a therapeutic endoscopist from the Royal Stoke University Hospital and one of the lead ERCP trainers
on the UK Joint Advisory Group on GI Endoscopy. Professor Cotton has an illustrious career spanning over 60 years and it was an honour to have the individual who coined the term ERCP as one of the leads in the course.

J Devar

  • Prof Reid Ally
  • University of the Witwatersrand
  • Prof Christo van Rensburg
  • University of Stellenbosch
  • Prof SR Thomson
  • University of Cape Town
  • Prof Paul Goldberg
  • University of Cape Town
  • Dr C Kassianides
  • Private practice
  • Prof Jake Krige
  • University of Cape Town
  • Dr Schalk van der Merwe
  • Private practice & University of Pretoria
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