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. 3 I NOVEMBER 2017
2017 is rapidly drawing to a close with healthcare challenges increasing the burden on our scarce resources in South Africa. Dr Demetriou highlights the challenges and options of colon cancer in South Africa and with increasing access to endoscopy services I am sure that the prevalence of gastrointestinal malignancies would reflect that seen in other developed countries. Dr Naidoo’s article also highlights our unique spectrum of disease in our patients.
Cert Gastroenterology(SA) Phys
Congratulations to Prof Sandie Thomson who has been awarded the title of a Master of the MWGO by the World Gastroenterology Organisation (WGO) at the recent World Congress of Gastroenterology in Orlando. This award honours Professor Thomson’s exceptional professional and personal contributions to the field of gastroenterology and its related disciplines – especially his efforts in the less welldeveloped regions of the world and in service to the populations WGO is focused on.
The year kicked off with a successful SAGES Congress in Pretoria in August 2016. Council met on 4 occasions for the normal conduct of business. Unfortunately I was unable to attend the Committee meetings of the WGO (Abu Dhabi December 2016) or AMAGE (Addis Ababa July 2017) due to health concerns. Damon Bizos kindly agreed to represent SAGES at these meetings and he reported
on these in his annual report at our AGM. The various training centres in South Africa continue the gastroenterology training of physicians from several African countries. Two such trainees recently successfully completed the Certificate in Gastroenterology (Medical) examination. There are currently 5 sub-Saharan fellows in training – 3 surgical (all at GSH/UCT) and 2 medical (1 at TBH/US and 1 at Bara/Wits). The WGO continues to assist these trainees with an annual stipend of USD 5,000.00 each.
As we started as the new Sages Council my first thought was: “We are standing in the shadow of giants!” The truth is that we are in fact standing on the shoulders of giants – our predecessors, to give us vision for the future for this esteemed society – the South African Gastroenterology Society!
J van Zyl
Over the last 25 years there have been systematic improvements in the overall survival of patients with metastatic colorectal cancer (mCRC), the median overall survival of patients has gone from 6 months to approximately 36 months.1 While 5 Flurouracil has remained at the core of treatment protocols newer chemotherapy and targeted agents and combination protocols have resulted in incremental improvements. The sequencing of the various protocols is the current challenge which still needs to be fully defined.
Epidemiology of Colorectal Cancer
Colorectal Cancer accounts for over 9% of all cancer incidence. It is the third most common cancer worldwide and is the 4th most commonest cause of death. Colorectal Cancer survival is highly dependent on earlier stage of presentation.
GS Demetriou, S Hansa
Iron deficiency anaemia is a common clinical problem referred to gastroenterologists for diagnostic evaluation. While hookworm infestation is a known cause of chronic gastrointestinal blood loss, affected patients are usually asymptomatic and only 10% develop anaemia.1,2 Herein we present a case of recurrent profound iron deficiency anaemia caused by hookworm infestation.
J Naicker, VG Naidoo, KA Newton, N Magula
Following the 10th anniversary last year of the founding of the Gastroenterology Foundation of South Africa, the focus over the next few years will be on our activites in Sub- Saharan Africa (SSA) and the establishment of GHASSA – The Gastroenterology and Hepatology Association of Sub-Saharan Africa Society. This will be announced at the annual Liver Interest group meeting in
December 2017 in Cape Town which will be devoted to the screening and treatment guidance for HCC in SSA in collaboration with SSA Hepatologists and Hepatobiliary Surgeons.
Best Oral Clinical 1st Prize:
CD73 expression in tissue granulomas is significantly increased in intestinal tuberculosis (ITB) when compared to Crohn’s disease (CD) in a South African cohort
It was a dark and gloomy morning when we embarked for our colonoscopy upskilling workshop at Greys Hospital in Pietermaritzburg on 20 September 2017. Immediate defrosting followed thanks to the sunny reception plus hot coffee we received from the staff at Greys hospital. A wide spectrum of healthcare workers with varying experience attended. It was somewhat daunting trying to “upskill” the head of surgery as well as the resident gastroenterologist but they were supportive and encouraging.
M Naidoo, VG Naidoo
The Ghana Association for the Study of Liver and Digestive Diseases (GASLIDD) held their Third Annual General Scientific Meeting at the Elmina Beach Resort, Cape Coast, Ghana from 1-2 September 2017. Chris Kassianides, Chairman of the Gastro Foundation of South Africa together with Dr Richard Anthony, chairperson of the Local Organizing Committee of the Cape Coast Chapter of GASLIDD and supported by EASL (Professors Frank Tacke and Marco Marzioni) put together an excellent 2 day meeting with the theme of “The Burden of Liver and Gastrointestinal malignancies in Ghana: The role of the GI Practitioner”.
A now established highlight on the academic calendar, the IBD1 interest group,
hosted by the Gastro Foundation and kindly funded by Cipla, Janssen, Medtronic and Takeda took place in Cape Town during the month of September. A diverse array of speakers succinctly brought together important aspects of both the medical and surgical management of complex IBD patients, dealing with problems that we as gastroenterologists lead our patients through daily.
The 55th congress of the South African Gastroenterology Society was held in Port Elizabeth at the Boardwalk Conference and Convention Centre from 05 – 08 August 2017. This was a combined congress with the Association of Surgeons of South Africa (ASSA) and the South African Gastro-Intestinal Nursing Society (SAGINS). Pre-congress events included two main events: 1. Abbvie symposium on IBD where Dr Sobrata Ghosh gave an in-depth review on current IBD trends and treatments. The ‘selfreported patient outcomes’ concept was well received locally. 2. The second event was the Postgraduate course titled: ‘The Best of UEGW’, hosted by the Gastro Foundation. This event is always well attended and caters to a broad audience of medical and surgical gastroenterology. Of particular interest this year was the focus on biological treatment in IBD and patient centred tailoring of therapy.
Starting before birth and continuing through life, we live in harmony with bacteria and other organisms in the gut, collectively known as the gut microbiota. This living organ is the subject of novel research by Professor Harry Sokol, a gastroenterologist specialising in diseases of the gut from Saint-Antoine Hospital in Paris, and guest speaker at the Yoghurt Summit held earlier this year. The gut microbiota has numerous metabolic activities. These include nutrient and vitamin production, energy production for the host, immune system stimulation and regulation, and fermenting of dietary fibres.
- 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