Biologic therapy for paediatric inflammatory bowel disease in Ghana: a case series

Abstract

Background: Inflammatory bowel disease (IBD) comprises Crohn’s disease and ulcerative colitis. It is a chronic inflammatory disease of the gastrointestinal tract (GIT) that can affect all ages. Globally, paediatric IBD is rising, with approximately 10% of IBD cases diagnosed in children < 16 years. Paediatric IBD can present in various atypical forms, making recognition challenging to distinguish from other intestinal pathologies. In Africa, children with IBD present a considerable diagnostic challenge.

Methods: Four patients in Ghana were diagnosed with IBD following clinical, laboratory, and special investigations, confirmed by upper and lower gastrointestinal endoscopy and histology. Three patients were initially managed with oral therapy but did not achieve remission and became steroid dependent. One patient was started on a biologic at the time of diagnosis.

Results: All four patients were eventually managed with infliximab (IFX), an anti-tumour necrosis factor alpha (TNFα) agent. Their clinical features improved remarkably.

Conclusion: Biologic therapy is effective in improving the outcome and quality of life of African children, but it is extremely expensive. Access to these agents can be improved through partnerships with non-governmental organisations and support groups with an interest in paediatric IBD.