Browsing by Author "Watermeyer, Gillian"

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    The association between childhood environmental exposures and the subsequent development of Crohn's Disease in the Western Cape, South Africa
    (Public Library of Science, 2014) Basson, Abigail; Swart, Rina; Jordaan, Esme; Mazinu, Mikateko; Watermeyer, Gillian
    BACKGROUND: Environmental factors during childhood are thought to play a role in the aetiolgy of Crohn's Disease (CD). However the association between age at time of exposure and the subsequent development of CD in South Africa is unknown. METHODS: A case control study of all consecutive CD patients seen at 2 large inflammatory bowel disease (IBD) referral centers in the Western Cape, South Africa between September 2011 and January 2013 was performed. Numerous environmental exposures during 3 age intervals; 0-5, 6-10 and 11-18 years were extracted using an investigator administered questionnaire. An agreement analysis was performed to determine the reliability of questionnaire data for all the relevant variables. RESULTS: This study included 194 CD patients and 213 controls. On multiple logistic regression analysis, a number of childhood environmental exposures during the 3 age interval were significantly associated with the risk of developing CD. During the age interval 6-10 years, never having had consumed unpasteurized milk (OR = 5.84; 95% CI, 2.73-13.53) and never having a donkey, horse, sheep or cow on the property (OR = 2.48; 95% CI, 1.09-5.98) significantly increased the risk of developing future CD. During the age interval 11-18 years, an independent risk-association was identified for; never having consumed unpasteurized milk (OR = 2.60; 95% CI, 1.17-6.10) and second-hand cigarette smoke exposure (OR = 1.93; 95% CI, 1.13-3.35). CONCLUSION: This study demonstrates that both limited microbial exposures and exposure to second-hand cigarette smoke during childhood is associated with future development of CD.
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    The Association between Race and Crohn's Disease Phenotype in the Western Cape Population of South Africa, Defined by the Montreal Classification System
    (Public Library of Science, 2014) Basson, Abigail; Swart, Rina; Jordaan, Esme; Mazinu, Mikateko; Watermeyer, Gillian
    BACKGROUND: Inter-racial differences in disease characteristics and in the management of Crohn's disease (CD) have been described in African American and Asian subjects, however for the racial groups in South Africa, no such recent literature exists. METHODS: A cross sectional study of all consecutive CD patients seen at 2 large inflammatory bowel disease (IBD) referral centers in the Western Cape, South Africa between September 2011 and January 2013 was performed. Numerous demographic and clinical variables at diagnosis and date of study enrolment were identified using an investigator administered questionnaire as well as clinical examination and patient case notes. Using predefined definitions, disease behavior was stratified as ‘complicated’ or ‘uncomplicated’. RESULTS: One hundred and ninety four CD subjects were identified; 35 (18%) were white, 152 (78%) were Cape Coloured and 7(4%) were black. On multiple logistic regression analysis Cape Coloureds were significantly more likely to develop ‘complicated’ CD (60% vs. 9%, p = 0.023) during the disease course when compared to white subjects. In addition, significantly more white subjects had successfully discontinued cigarette smoking at study enrolment (31% vs. 7% reduction, p = 0.02). No additional inter-racial differences were found. A low proportion of IBD family history was observed among the non-white subjects. CONCLUSIONS: Cape Coloured patients were significantly more likely to develop ‘complicated’ CD over time when compared to whites.
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    Predicting poor outcome Crohn's disease at the time of first diagnosis
    (2013) Watermeyer, Gillian; Myer, Landon
    Over time, the majority of patients with Crohn's disease (CD) will develop irreversible gastrointestinal (GIT) damage, notably strictures or fistulas, impacting negatively on quality of life and resulting in hospitilisation and surgery. Early and aggressive drug therapy with immunomodulators (IMMs) and biologics may alter the likelihood of these complications and improve long-term outcomes. However, this approach is extremely expensive and carries its own battery of side-effects such as infections and malignancy. In addition there are a sizable number of patients with CD who will have a benign disease course and never require potent medical therapies or surgical intervention. As a result, there has recently been a surge of interest in early identification of those people who are at risk of developing complicated disease. The aim of our study was thus to indentify predictive factors for poor outcome CD in a South African setting, in order to select those who would most benefit from early and aggressive medical therapies.
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    Predictors of emergency colectomy in patients admitted to Groote Schuur Hospital with acute severe ulcerative colitis between1st January 2003 and 1st January 2013
    (2016) Mokhele, Nnete Nimrod; Watermeyer, Gillian
    INTRODUCTION: Acute Severe Ulcerative Colitis (ASUC) is a life threatening condition which requires urgent and aggressive medical therapy to reduce mortality, morbidity and avoid surgery; the mainstay of treatment is intravenous corticosteroids. To facilitate this process it is essential to identify patients at high risk of poor outcomes and emergency colectomy. Numerous risk factors predicting the need for surgery have described in the Western literature both at presentation and on day 3 of intravenous therapy, however there are no local data addressing this issue. As such it is unclear if these predictors are applicable in our setting. The aim of this study is thus to identify risk factors for emergency colectomy in patients admitted to Groote Schuur Hospital with ASUC. METHODS: A retrospective cohort study of 98 patients admitted with ASUC between January 2003 and January 2013 was performed. Clinical, demographic, laboratory, radiological and endoscopic factors on admission and 3 days thereafter were analysed as predictors of colectomy by univariate and multivariate analysis. Patients were followed up retrospectively for 90 days RESULTS: Twenty five percent of the cohort underwent emergency colectomy, 80% within 15 days of presentation. On univariate analysis factors on admission which predicted colectomy were exposure to oral corticosteroids (p=0.01), megacolon (p=0.049) or mucosal islands (p=0.04) on abdominal Xray, and a short duration from UC diagnosis until presentation with ASUC (p=0.04). There was no significant association between ethnicity, age at UC diagnosis, gender, family history of IBD, or smoking status. There was also no association with baseline haemoglobin or CRP. The only day 3 variable that significantly predicted colectomy was serum albumin (p=0.01).This was also the only variable to remain significant on multivariate analysis (OR 0.79, 95% CI 0.65-0.97, p=0.01). CONCLUSION: ASUC is a medical emergency, predicting which patients will likely require colectomy is a very valuable tool in guiding therapeutic management. In our study the only variable significantly associated with colectomy was hypoalbuminaemia on day 3. However given the small study numbers a larger prospective study would be of value in identifying additional risk factors.
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    Therapeutic drug monitoring of anti-TNF biologics in patients with Crohn's disease at Groote Schuur Hospital, Cape Town, South Africa
    (2024) Sungay, Mohamed Yaaseen; Watermeyer, Gillian; Setshedi, Mashiko
    Monoclonal antibodies targeting Tumour Necrosis Factor-α (TNF α) have revolutionised the management of Inflammatory Bowel Disease (IBD) and have proved highly effective in both inducing and maintaining remission in both ulcerative colitis (UC) and Crohn's disease (CD). The advent of Therapeutic Drug monitoring (TDM) in recent years has allowed further optimisation of their use. TDM involves the measurement of serum trough levels (TLs) and anti-drug antibodies (ADAs), with higher serum drug concentrations and the absence of ADAs associated with favourable therapeutic outcomes. Adjustment of anti-TNF therapy based on reactive TDM in patients who are either primary non-responders or have secondary loss of response to these biologics is associated with superior clinical outcomes when compared to empiric escalation of therapy. In this study we explore the efficacy of TDM since it was first implemented in our practice and the impact on clinical outcomes in patients with CD in our resource limited setting. Method A retrospective cohort study was performed on all patients with CD treated with an anti-TNF biologic, either infliximab or adalimumab, who underwent TDM since it was first implemented in the IBD clinic at Groote Schuur hospital, Cape Town, South Africa in between July 2018, and March 2023. Hospital records were analysed, and relevant demographic variables and clinical outcomes were extracted. Results Sixty-nine patients with Crohn's Disease started treatment with an Anti TNF, of which 53 were identified to have had undergone reactive TDM. Forty seven (90%) were treated with an immunomodulator prior to starting anti TNF therapy. The median time from initiation of anti TNFs to first TDM was 9.5 months (IQR5-35); 35 patients (67%) had sub-therapeutic trough levels at that time. No significant predictors of sub-therapeutic trough levels were identified, notably there was no association with disease activity, behaviour, location, or the presence of perianal disease. Adjustment of anti-TNF therapy based on reactive TDM was only performed in 24 patients (45.3%); in all other patients there was no adjustment to the anti TNF therapy. Escalation of biologic therapy based on TDM results in patients with sub- therapeutic TL and no ADAs did not impact clinical remission or response rates at 3 or 6 months of follow up. Conclusion In our cohort most patients that underwent TDM had sub-therapeutic trough levels; no significant predictors of sub-therapeutic trough levels were identified. Neither dose optimisation or switching to a 2nd anti-TNF proved effective in achieving clinical remission at either 3 or 6 months of follow up.