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 16 I NO. 1 I APRIL 2018
Given its role in metabolic regulation, the gastrointestinal tract constitutes a significant target in the management of Type 2 Diabetes Mellitus (T2D). Since the landmark paper by Dr. Walter Pories and his research team, numerous randomized clinical trials over the short and medium term demonstrated that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. In this issue of Gastro Review Jeanne Lubbe reports on the current evidence and the role of metabolic surgery in South Africa. Given the shocking findings for South Africa in a global obesity study that highlighted the massive problem not only in adults, but also in children with 13% overweight or obese – more than the global average of 5%, it is plausible that this modality will play a significant role in the future management of this problem.
C van Rensburg
Ulcerative colitis (UC) and Crohn’s Disease (CD) are the two commonest forms of inflammatory bowel disease (IBD). UC was first described in a case report by Sir Samuel Wilks in 1859.1 CD, on the other hand, was identified as a separate disease entity by Crohn and colleagues in 1932.2 Despite the many decades following initial reports, the pathogenesis of IBD remains largely unknown and therefore, the pathophysiology poorly understood.
F Ababio, E Fredericks, S Roux
In 1888, Sir William Osler first described a case of recurrent episodes of painless, non-pruritic swellings that occurred in a 24 year old female. These swellings typically lasted between one and four days and affected various parts of her body – hands, fingers, knees, elbows, face and lips. Whilst most episodes affected the face and limbs, other more severe episodes resulted in abdominal colic, nausea and vomiting. He noted that these episodes would often occur spontaneously, with no specific triggers identified. Osler then obtained a comprehensive family history, which revealed that these symptoms had been present in twenty-eight other family members in the preceding five generations. He then went on to make the following conclusions:
KM Coovadia, CJ van Rensburg
Obesity is universally defined according to body mass index (BMI) with a BMI of 25-29.9 kg/m classified as overweight. As BMI rises above 25, epidemiological studies from around the world have confirmed the linear weight-associated increased risk of death from all causes, most notably cardiovascular disease and malignancy. In the United States (US) there are indications that the steady increase in life expectancy observed over the past two centuries, will be halted due to the obesity epidemic.
Ulcerative colitis (UC) is a chronic, relapsing and remitting inflammatory disease of the colon and rectum. The aetiology and pathogenesis are unknown and treatment is geared towards induction and maintenance of remission. The extent of disease
involvement is important in UC as this determines treatment strategies and the risk for long-term complications. Current data showed that the rectum is involved in 30-50% of all patients with a further 20-30% involving the left colon. Proximal colitis (proximal to the splenic flexure) accounts for about 20-30%.
E Fredericks, G Watermeyer, D Epstein
The 8th Liver Interest Group annual meeting was held in Cape Town over the first weekend of December 2017, and this year’s meeting was special with the launch of the Gastroenterology and Hepatology association of Sub – Saharan Africa (GHASSA). The Association will be used to draw up and to publish Gastroenterology and Hepatology guidance for practitioners with regard to issues particularly relevant to Sub-Saharan Africa (SSA).
Whilst contemplating what to do in my retirement, I set off in January to a few places on the African continent courtesy of a variety of funders and surgical and medical gastroenterology past trainees and acquaintances over the years.
First stop Khartoum, Sudan the place of the Longest Kiss, the union of the White and the Blue Nile. Another adventure on the good ship Gastro Foundation with the
project being to take the best of UEGW 2017 video presentations as a postgraduate programme to their annual congress.
For the 9th annual Gastroenterology Foundation Fellows Weekend, 40 fellows and 27 faculty descended upon the Spier Conference Centre 2-4 February 2018. As a visiting medical GI fellow at Groote Schuur from Brown University in the United States, I was fortunate to be included on the Spier roster this year. When I received the invitation, I had no way of knowing it would become the highlight of my month in South Africa. Following introductory comments from Professor Sandie Thomson and Dr. Chris Kassianides Friday morning, we jumped right into the educational activities. The organizers had curated a series of prerecorded UEG (United European Gastroenterology) lectures and endoscopy videos to share with us. This proved to be an effective use of technology to mitigate the vast physical distance between the eager audience at Spier and European experts on topics like Helicobacter pylori and advanced endoscopic procedures in the elderly.
The purpose of the award is to honour the memory of Professor Solly Marks by recognizing clinicians or researchers of distinction in the field of gastroenterology/hepatology on an annual basis. This is an educational grant that is to be used for the upskilling of an individual and that will benefit the general good of gastroenterology in South Africa, as Prof Marks would have wanted. It is not to be used as a top up fund, but rather for a specific endeavour.
Viral Hepatitis causes an inflammation of the liver due to a viral infection. Most cases of Viral Hepatitis are contracted through one of five viruses including, hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis E virus (HEV). Of the five hepatitis viruses, all can cause acute hepatitis, however only HBV, HCV, and HDV frequently cause chronic hepatitis which can lead to liver cirrhosis and to liver cancer.
WHO Global Hepatitis Report, 2017
- 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