Browsing by Author "Thomson, Sandie"

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    Open Access
    The incidence of tuberculosis in the inflammatory bowel disease registry in Cape Town, South Africa
    (2021) Pema, Mitesh Kanthi; Thomson, Sandie; Epstein, David
    Background/Objectives: The risk of tuberculosis (TB) in inflammatory bowel disease (IBD) patients using immunosuppressive therapy (IST) is higher than the background population in developed countries. Corresponding data in areas of high endemicity like South Africa (SA) is limited. Our objectives were to calculate the incidence, identify predictors and determine clinical characteristics of TB common to IBD patients living in this environment. Methods: In this retrospective study, patients that developed active TB after their IBD diagnosis between 1948 and 2017 were selected from the SA IBD Registry. Incidence rates were calculated for the study population and for cases prescribed TNF-a (tumour necrosis factor-alpha) blockers. A multivariable logistic regression model, using non-TB IBD patients as controls, was applied to determine risk factors for infection. We analysed IBD and TB clinical features as well as screening tests for latent TB (LTB). Results: 42 TB cases (4%) out of 1041 consented IBD patients were identified. Incidence rates (IRs) for active infection per 100 000 person years (PY) of follow-up were 330 and 2749, for the cohort and TNF-a blocker users respectively. Patients with Crohn's disease (CD) (adjusted Odds Ratio (aOR) = 2.00, 95% confidence interval (CI): 0.92- 4.36), a smoking history (aOR = 1.44, 95% CI: 0.66-3.14), attendance at public hospitals (aOR = 1.81, 95% CI: 0.75-4.37) and a history of TNF-a blocker use (aOR = 2.45, 95% CI: 0.88- 6.80) were at greater risk for infection, although none were statistically significant. The median time to TB diagnosis was 96.7 months (interquartile range (IQR): 42.2-164.8) for the cohort and 11.3 months (IQR: 8.1-29.2) for biologics users. Over half the TB cases occurred in patients that live in districts with predominantly low-income households. The lung was the most common site affected. Latent TB infection (LTBI) occurred in twenty-four patients that were prescribed IST. Ten received isoniazid prophylaxis therapy (IPT) and one later developed active TB. Conclusion: TB is a significant problem in our IBD population. The establishment of local guidelines is recommended to assist clinicians with risk stratification and management of latent and active disease, especially in patients being considered for TNF-a blockers.
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    The prevalence and characteristics of incidental colorectal polyps in patients undergoing colonoscopy at a South African tertiary institution
    (2022) Kruger, Jean-Jacques; Thomson, Sandie
    Background There is a lack of data on the frequency, and pattern of colorectal adenomas in subSaharan Africa, to guide diagnostic and preventative strategies for CRC in the region. This study aimed to describe polyp characteristics, and adenoma frequency in patients at average risk of CRC undergoing colonoscopy for bowel symptoms at a tertiary hospital in South Africa. Methods Colonoscopy records from the prospective endoscopy database at Groote Schuur Hospital for the period August 2014 to February 2017 were retrieved. The presence of polyps, and their morphology, size, site and number in relation to ethnicity, symptoms, and colonoscopy quality indicators were analysed. The histological type and grade were obtained from laboratory records, and analysed. The primary endpoint was the adenoma detection rate. Age, gender, ethnicity, symptoms, bowel preparation, and caecal intubation rates were also compared between patients with adenomas, and those without adenomas. Results Of 1334 colonoscopies, 342 were in patients at increased risk of premalignant lesions, and these were excluded from analysis. Polyps were identified in 172 of the remaining 992 patients (17.3%), whose self-declared ethnicity was: mixed race 76%, white 12%, black African 11%, and Asian 1%. The quality of the bowel preparation and caecal intubation rate was similar between patients with polyps and those without. Individuals with polyps were older than those without polyps (mean age 61. 5 ±12,9 versus 56.3 ±17,4 years, p< 0.002). On histology of these polyps, 119 were adenomas, 26 hyperplastic and 27 normal. The majority of the adenomas were tubular (80%), and only 6% had high grade dysplasia. Half (51%) of the adenomas were in the proximal colon, and the overall adenoma detection rate was 12%. The adenoma detection rate (prevalence) was highest in white, and Asian South Africans (18% each), followed by mixed race (13%), and much lower in black South Africans (5%). Conclusions This study provides a benchmark adenoma detection rate for our catchment population and potentially across Africa. There is evidence of a continuing differential colorectal neoplasia risk according to ethnicity, with fewer adenomas being detected in black South Africans.
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    The yield of colonoscopy in patients attending a tertiary hospital in Cape Town, South Africa
    (2021) Elhenghari, Emad; Setshedi, Mashiko; Thomson, Sandie
    Background: Colonoscopy is widely used for diagnosis, therapeutic intervention of conditions of the lower gastrointestinal tract and colorectal cancer screening. Given its widespread use and complications, colonoscopy should be performed for appropriate indications. The aim of this study was to determine the yield and appropriateness of colonoscopy at a tertiary hospital. Methods: Demographic, clinical and endoscopic data was retrieved from a prospective endoscopy database from 01 Jan 2014 to 31 December 2019. The variables collected were patient details (age, sex), clinical indication, symptoms, urgency of colonoscopy, sedation used, quality of bowel preparation, and findings. Results: The total number of patients was 4033 with median age of 56 (IQR 18-85), of whom 59.6% were female. Colonoscopy was performed for appropriate indications in 98% of cases (according to EPAGE II criteria). Older patients were more likely to be investigated for anaemia (OR=0.55, CI 0.43-0.70, p=0.000), and surveillance postpolypectomy (OR=0.57, CI 0.37-0.85, p=0.005), while patients under 50 had a colonoscopy for an IBD flare (OR=1.98, CI 1.49-2.6, p=0.000), or surveillance for HNPCC (OR=3.0, CI 2.1-4.3, p=0.000). Rectal bleeding was the commonest symptom (16.5%). Patients younger than 50 were more likely to present with abdominal pain (OR=1.3, CI 1.07-1.6, p=0.006), and diarrhoea (OR=1.8, CI 1.5-2.3, p=0.000), whilst those older than 50 were more likely to present with alteration of bowel habit (OR=0.63, CI 0.43-0.9, p=0.012), and loss of weight (OR=0.45, CI 0.33-0.60, p=0.000). Polyps were the commonest finding (15.4%); the prevalence of colorectal cancer and diverticular disease was 3.6% and 6.5% respectively. Patients younger than 50 were more likely to have inflammation (OR=2.6, CI 2.18-3.15, p=0.000), whilst those older than 50 were more likely to have diverticulae (OR=0.08, CI 0.05-0.14, p=0.000), polyps (OR=0.43, CI 0.35- 0.53, p=0.000) or a tumour (OR=0.47, CI 0.29-0.72, p=0.000). Although 69% of the bowel preparation was reported as good or adequate, there was no difference in the detection of lesions when compared to poor bowel preparation. The adjusted caecal intubation rate was 95.1%. Conclusion: Colonoscopy was performed in a relatively young cohort, predominantly for symptoms not screening. The study provides some epidemiologic data on common lower gastrointestinal conditions in a referral center, but also highlights some inefficiencies in the system. Furthermore, this study serves as an audit on the clinical service, a baseline from which improvements can be made.
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    Upper gastrointestinal bleed: a comparative outcomes study of pre and post implementation of management guidelines in the acute care surgery unit, Groote Schuur Hospital
    (2019) Aborkis, Ismail; Rayamajhi, Shreya; Thomson, Sandie
    Background: Upper gastrointestinal bleeding (UGIT) is a common presentation to hospital and can result in a significant morbidity, mortality and hospital costs. Consensus guidelines are present from various international expert bodies regarding the management of these patients and compliance with these guidelines is variable and is dependent on rigorous implementation and continuous audits. Aim: The primary aim of this study is to evaluate complaints to three aspects of management of UGITB (time of endoscopy ,use of dual endotherapy and haemoglubin trigger for transfusion) at Acute Care Surgery Unit, at Groote Schuur Hospital. Methods: This is a comparative study between a retrospective control group and a prospective cohort post implementation of a quality improvement program (QIP). Results: This study included 109 patients, 51 in the control and 58 in the QIP group. The two groups were statistically comparable in terms of demographics, clinical presentation, referral pattern and endoscopy finding. Over 80% in both groups had their endoscopy within 24 hours (Control 83.7%, QIP 81.6%). Time to endoscopy was not statistically significantly different between the Control and QIP groups for low and high-risk patients ((suspected varices or Modified Glasgow-Blatchford Score (MBS) >10)). However, when both groups are combined, patients with an MBS of >10 or more had a statistically shorter 'Time to scope’ by 8 hours than those with a score < 10 (p=0.02).