South African Gastroenterology Review - Volume 8, Issue 1, 2010
Volume 8, Issue 1, 2010
Author Christo Van RensburgSource: South African Gastroenterology Review 8 (2010)More Less
Obesity is a global epidemic and has become an increasing problem in developing countries such as South Africa. The overall prevalence of being overweight (BMI >25) and obesity (BMI >30) in South Africa is high, with more than 29% of men and 56% of women being classified as overweight or obese. Obesity and its co-morbidities negatively impacts on the lives of many South Africans and the burden of the disease further contributes to increasing healthcare costs.
Source: South African Gastroenterology Review 8, pp 5 –8 (2010)More Less
Every disease susceptibility or medical condition is caused, regulated or influenced by genes and obesity is no exception. Although overeating in combination with low physical activity is the main cause of obesity, genetically determined influences on energy balance regulation also play an important role. Individuals exposed to the same environmental risk factors or treatment strategies do not necessarily develop the same disease or show the same reaction to treatment. Obesity forms the core element of a group of metabolic abnormalities defined as the metabolic syndrome, which underlies many chronic diseases of lifestyle treated by clinicians on a daily basis. The success of obesity prevention and treatment partly depends on the genetic make-up of the individual. Different genes may underlie different clinical outcomes due to interaction with diet as the main environmental factor. It is therefore important to know how certain genomic and lifestyle factors combine in different people to precipitate weight gain or weight regain. In future, genetic risk factors underlying different forms of obesity (e.g. morbid obesity, childhood obesity and weight retention after birth) could be identified as causative or contributing factors and possible targets for treatment. Alternatively, genetic testing can focus on a set number of genes involved in key metabolic pathways underlying different forms of obesity. This overview introduces the concept of pathology supported genetic testing in patients with the metabolic syndrome linked to a long-term health-outcome research project.
Source: South African Gastroenterology Review 8, pp 9 –13 (2010)More Less
Obesity is not a new condition. The associated morbidity and mortality has been known for 2 500 years. What is new is it's growing prevalence. Worldwide there is an increase in the percentage of people that are overweight. It affects both the developed and developing world and South Africa is no exception. In South Africa 29% of men and 56% of women are classified as overweight (BMI >25) or obese (BMI >30). The prevalence is higher than reported in any other African country.
In a sample of 7 726 South African women aged 15-95 years old, a BMI of >25 (overweight and obese) was most prevalent amongst black women (58.5%), followed by women of mixed ancestry (52%), white women (49.2%) and then Indian women (48.9%). A dissimilar pattern was seen in men. In a sample of 5 401 South African men aged 15-95 years, the prevalence of a BMI >25 was highest in white men (54.5%), followed by Indian men (32.7%) and men of mixed ancestry (31%), with the lowest prevalence in African men (25%). Central obesity was found in 9.2% of men and was more prevalent in older men and white men.
There appears to be a changing perception of obesity, as illustrated by a population survey study in which fewer overweight and obese individuals defined themselves as overweight in 2007 when compared to 1999, despite a significant increase in the prevalence of obesity.
Weight control seems so simple. It is a matter of intake versus expenditure. Other factors complicate matters, however. Energy intake has a strong behavioural component, and is influenced by hunger, satiety and nutrient absorption. Energy expenditure has a lesser, but still very important, behavioural component. It is influenced by metabolic rate, thermogenesis and activity. Treatments for obesity either decrease energy intake or increase energy expenditure. Those that decrease energy intake have a greater potential for causing weight loss than those that increase energy expenditure through exercise.
This article will focus on the management of obesity. Before initiating treatment for obesity, the following should be considered. Firstly, the risks of treatment should be evaluated. The risks involved in pharmacological therapy are low, but are more pronounced in bariatric surgery, and therefore risk versus benefit and whether treatment is appropriate in the patient, should be determined. Both overall and central adiposity should be assessed.
Author E. WilkenSource: South African Gastroenterology Review 8, pp 17 –19 (2010)More Less
Ascites is derived from the Greek word "askos", meaning bag or sack. Approximately 85% of patients (in the USA) with ascites have liver cirrhosis. Ascites may be reversible in the setting of alcoholic hepatitis if the patient ceases consumption of alcohol, as well as in non-alcoholic cirrhosis, with effective therapy.
Source: South African Gastroenterology Review 8, pp 20 –25 (2010)More Less
The hepatitis C virus (HCV) is a global public health problem and a leading cause of chronic liver disease and the past decade has seen several significant advances in the management of persons infected with the virus.
The prevalence of HCV infection in South Africa is not known but has been estimated to be between 0.1 and 1.7 %.
Phylogenetic analysis of the HCV has revealed 6 main genotypes and most published data relate to genotypes 1, 2 and 3. Genotypes 4, 5 and 6 however represent > 20 % of HCV infections worldwide. Genotype 5 is found predominantly in South Africa where it represents up to 40 % of all HCV genotypes.
Chronic hepatitis C is an important cause of end stage liver disease and individuals with HCV-related cirrhosis have a 30 % risk of developing hepatic decompensation in 10 years and a 1 - 3 % per annum risk of developing hepatocellular carcinoma (HCC).
Male gender, infection at an advanced age, obesity, consumption of > 50 g alcohol per day and co-infection with the human immunodeficiency virus (HIV) are predictive of more rapid progression to fibrosis.
This document is based largely on the American Association for the Study of Liver Diseases (AASLD) 2009 Practice Guidelines and aims to provide clinicians with evidence based approaches to the management of HCV infection. It is recognized that reasonable physicians may deviate from the strategy and remain within acceptable standards of treatment.
Author Stephen GroblerSource: South African Gastroenterology Review 8, pp 26 –27 (2010)More Less
We have stagnated since third-part payors started calling the shots and the Competition Commissioner reigned in the abilities of service providers to negotiate fees. The surrogate replacement process to determine a cost-based Reference Price List (RPL) has turned out to be slow, laborious, expensive and flawed. Our painstaking private practice cost studies have been vilified by the Department of Health (DoH). The most basic of concepts, that of tiered consultations, has been stalled for more than five years. No new codes or amendments have been allowed. The SAMA system has been shunted out, to be replaced by a still-to-be-determined coding system that we, the profession, will have to pay for!
Author Nazeer Ahmed Ismail ChopdatSource: South African Gastroenterology Review 8, pp 28 –29 (2010)More Less
Wow, an absolutely fabulous weekend! I believe the dream and vision to develop such a programme was thought of by Dr Chris Kassianides, in August 2009, and to finally see it culminate into a successful reality is in itself a great achievement.
I can still remember when Karin Fenton sent me an e mail with the provisional invitation. I was so excited that it was an opportunity to meet my new friends that I made on my trip to Amsterdam, not so long ago, I couldn't wait.
The day had finally come and I left for the airport during the early hours of the morning. After arriving in Cape Town, we were met by a driver, Graham, who was to take us to Stellenbosch. What a character, his typical Cape accent and humor kept us entertained all the way to our destination - The Spier Hotel.
Author Otto BuchelSource: South African Gastroenterology Review 8, pp 30 –31 (2010)More Less
When I settled my buzzing head on the seat of Royal Dutch Airlines flight KL 592, scheduled for 00h45 on the 9th of December 2009, I realised how close I had been to missing the plane. Like some of my colleagues, I had correctly noted the date of departure, but had failed to notice that it was in fact an early morning flight and not an evening flight as I had assumed on carelessly scanning over my e-ticket some days before. Of course, now the rush was over, I was on the plane and my mobile phone was off. Soon I would be cruising 10 km above Africa, to the land of clogs and tulips, and there was nothing that anyone could do about it. I was unavailable. As it turned out the flight was uneventful and we disembarked at Schipol airport in Amsterdam, to face the extremely business like immigration police. Like good South Africans we were not daunted - security is our middle name. Having provided all the correct answers we were finally on our way to the long awaited and most essential of early morning indulgences - the first cup of coffee. A cup of Dutch coffee, masterfully brewed (the Dutch certainly have standards), and the smell of smoggy winter air outside the terminal building and we knew we were in Europe.
Source: South African Gastroenterology Review 8 (2010)More Less
The GIT Clinic is one of several special clinics which were established during the 1950's and 60's at Groote Schuur Hospital to accommodate the increasing trend towards sub-specialisation in Medicine. The Clinic was founded during 1959 by Dr I N (Solly) Marks on his return from the United Kingdom and United States where he spent 9 years doing further post-graduate training and research. Under his remarkable leadership and vision, which spanned 3 decades, the Clinic has grown into an internationally recognised gastrointestinal unit with the emphasis on clinical research. One of the major strengths of the Clinic is the strong medico-surgical partnership from its inception and in particular when the surgical presence was formalized in 1982 and with the move to the New Building in 1990.
Source: South African Gastroenterology Review 8 (2010)More Less