Profile of Inflammatory Bowel Disease in a Tertiary Care Centre of Eastern Nepal

摘要

Inflammatory Bowel Disease (IBD) is a chronic, relapsing inflammatory disorder of gastrointestinal tract that encompasses chronic Ulcerative Colitis (UC) and Crohn?s Disease (CD). Traditionally, it was believed to occur mainly in western countries like North America and Europe, but now perhaps with increasing westernisation, it has become a global disease with accelerating incidence in Africa and Asian countries like India and Nepal, which has also mirrored the growth compared to its neighbouring countries, where there has been an increased detection of this disease over the past few years.Aim: To review the experience in the disease profile and management of IBD in our surgical unit.Materials and Methods: This was a retrospective analysis of prospectively maintained data from January 2009 to May 2017 at BP Koirala Institute of Health Sciences, a tertiary care centre at the Eastern region of Nepal. The patients were grouped into two periods (first: January 2009 to March 2015; second: April 2015 to May 2017). We managed 30 cases (UC-19 and CD-11) in the surgical unit.Results: Eleven vs nineteen IBD patients were managed in the first and second time periods respectively. The median age of the patient with UC was 45.1 years. The most common presenting symptom was rectal bleeding. Pancolitis and left sided colitis was each seen in 42% and 52.6% of patients, respectively. Severe to fulminant colitis was seen in 36% of patients. Seven patients requiring surgical intervention (staged restorative total proctocolectomy-6 and total proctocolectomy with end ileostomy-1), while the remaining 12 cases were managed with a non operative treatment. Similarly, the median age of patient with CD was 55 years. The most common presenting symptom was pain abdomen. Eight patients had predominant small bowel involvement, two colonic, while one patient had both small and large bowel involvement. All patients required surgical intervention for symptoms related to it. At one year of follow-up, three patients had recurrence, two requiring initiation of anti-tumour necrosis factor therapy.Conclusion: IBD is no more a rare disease in a country like Nepal. With the global rise in incidence, there has been increased detection of IBD cases at our centre (9.5 cases/year in the second period vs 1.8 cases/year in the first period) probably due to increased awareness and establishment of a separate Gastrointestinal unit with a specialist team trained from high volume centre.