• Africa
• Duodenal ulcer
• Gastric ulcer
• Meta-analysis
• Pattern
• Peptic ulcer disease
• Prevalence
• Systematic review

• Humans
• Prevalence
• Peptic Ulcer/epidemiology
• Peptic Ulcer/microbiology
• Africa/epidemiology
• Helicobacter Infections/epidemiology
• Helicobacter Infections/complications
• Helicobacter pylori
• Stomach Ulcer/epidemiology
• Duodenal Ulcer/epidemiology

• Female
• Humans
• Africa/epidemiology
• Endoscopy, Gastrointestinal
• Gastroesophageal Reflux/diagnosis
• Gastroesophageal Reflux/epidemiology
• Gastroesophageal Reflux/pathology
• Gastrointestinal Diseases/epidemiology
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Diseases/pathology
• Prevalence
• Upper Gastrointestinal Tract/diagnostic imaging
• Upper Gastrointestinal Tract/pathology

Introduction

Although the global incidence of upper gastrointestinal bleeding (UGIB) appears to have reduced substantially in the past few decades, acute UGIB still carries significant morbidity and mortality worldwide. There are currently no published data on UGIB in Ogun State, Nigeria. This study examined the endoscopic findings in patients with UGIB in Ogun State. 

Methodology

The study was a retrospective cross-sectional survey of patients with UGIB who had upper gastrointestinal endoscopy at three endoscopy centers in Ogun State, Southwest Nigeria, from January 2015 to December 2021. Patients’ data, which included age, gender, and endoscopic findings, were extracted from the endoscopy registers into a spreadsheet and analyzed statistically. Summary statistics included means ± standard deviation for continuous variables and frequencies and percentages for categorical variables. Categorical variables were compared for differences by chi-square test or Fisher’s exact test as appropriate. The statistical significance cutoff was p-value <0.05.

Results

A total of 171 had endoscopy for UGIB during the period under review but 168 had complete data. Out of the 168, 113 (67.3%) were males, giving a male-to-female ratio of 2:1. The mean age of the patients was 52.4 ± 18.1 years, with an age range of 7-85 years. The modal age group was ≥60 years (75; 39.9%). The most common endoscopic finding was peptic ulcer disease (77; 45.8%), followed by esophagogastric varices (27; 16.1%), erosive mucosal disease (25; 14.9 %), portal hypertensive gastropathy (15; 8.9%), suspected malignancies (11; 6.6%), hemorrhagic gastritis (7; 4.2%), gastric antral vascular ectasia (2; 1.2%), and Mallory-Weiss tear (1; 0.6%), respectively. Forty-four patients (26.2%) had no lesion that could explain UGIB. 

Conclusion

Peptic ulcer disease was the most common cause of UGIB among our patient population, and the elderly male patients were the most affected.

Upper gastrointestinal (UGI) bleed is a common surgical disease in sub-Saharan Africa where there is often a lack of diagnostic and interventional adjuncts such as endoscopy. This study sought to characterize the role of endoscopy in management of acute UGI bleeding.

This is a prospective observational analysis of adults presenting with an UGI bleed to a tertiary center in Lilongwe, Malawi, over two years. Patients were classified as having no endoscopy, diagnostic endoscopy, or endoscopy with variceal banding. Bivariate, survival analysis, and logistic regression analyses were used to compare intervention cohorts.

293 patients were included with 49 patients (16.7%) receiving endoscopy with banding, 65 (22.2%) patients receiving diagnostic endoscopy only, and 179 (61.1%) receiving no endoscopy. Upon survival analysis comparing to the no endoscopy group, cox hazard modelling showed an adjusted hazard ratio over 30 days of 0.12 (95% CI 0.02, 0.88, p=0.038) for the endoscopic banding group and a hazard ratio of 0.39 (95% CI 0.13, 1.16, p=0.090) for the diagnostic endoscopy only group. Physical exam findings consistent with cirrhosis and decreasing age were independent predictors of an endoscopic diagnosis of variceal bleeding.

Esophagogastric varices are a common cause of UGI bleeding in sub-Saharan Africa and can be predicted with age and physical exam findings. Endoscopy with variceal banding has a survival benefit for patients presenting with acute UGI bleed even with relatively low utilization. Appropriately triaging patients with likely variceal bleeding and improving endoscopy capacity would likely have a significant impact on mortality.

• endoscopy
• sub-Saharan Africa
• upper gastrointestinal bleeding

• Gastrointestinal diseases
• Global health
• Health care delivery
• Health services
• Healthcare workforce
• Medical education
• Operative/statistics and numerical data
• Surgical procedures

• Cancer in Africa
• Esophageal cancer in Africa
• Esophageal squamous cell carcinoma
• Systematic review

• Adult
• Africa
• Age Factors
• Aged
• Alcohol Drinking/adverse effects
• Alcohol Drinking/epidemiology
• Chemoradiotherapy, Adjuvant
• Esophageal Neoplasms/epidemiology
• Esophageal Neoplasms/etiology
• Esophageal Neoplasms/therapy
• Esophagectomy
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Prevalence
• Prognosis
• Risk Factors
• Sex Factors
• Socioeconomic Factors
• Survival Rate
• Tobacco Smoking/adverse effects
• Tobacco Smoking/epidemiology
• Treatment Outcome

• Colorectal cancer
• cancer in Africa
• colon cancer
• non-communicable diseases
• rectal cancer

AIM: To identify risk factors associated with esophageal cancer in Zambia and association between dietary intake and urinary 8-iso prostaglandin F2α (8-isoPGF2α).

METHODS: We conducted a prospective, case control study at the University Teaching Hospital. Subjects included both individuals admitted to the hospital and those presenting for an outpatient upper endoscopy. Esophageal cancer cases were compared to age and sex-matched controls. Cases were defined as patients with biopsy proven esophageal cancer; controls were defined as subjects without endoscopic evidence of esophageal cancer. Clinical and dietary data were collected using a standard questionnaire, developed a priori. Blood was collected for human immunodeficiency virus (HIV) serology. Urine was collected, and 8-isoPGF2α was measured primarily by enzyme-linked immunosorbent assay and expressed as a ratio to creatinine.

RESULTS: Forty five controls (mean age 54.2 ± 15.3, 31 male) and 27 cases (mean age 54.6 ± 16.4, 17 males) were studied. Body mass index was lower in cases (median 16.8) than controls (median 23.2), P = 0.01. Histopathologically, 25/27 (93%) were squamous cell carcinoma and 2/27 (7%) adenocarcinoma. More cases smoked cigarettes (OR = 11.24, 95%CI: 1.37-92.4, P = 0.02) but alcohol consumption and HIV seropositivity did not differ significantly (P = 0.14 for both). Fruit, vegetables and fish consumption did not differ significantly between groups (P = 0.11, 0.12, and 0.10, respectively). Mean isoprostane level was significantly higher in cases (0.03 ng/mg creatinine) than controls (0.01 ng/mg creatinine) (OR = 2.35, 95%CI: 1.19-4.65, P = 0.014).

CONCLUSION: Smoking and isoprostane levels were significantly associated with esophageal cancer in Zambians, but diet, HIV status, and alcohol consumption were not.

• Gastrointestinal cancer
• Non-communicable diseases
• Zambia

• Adult
• Aged
• Alcohol Drinking/adverse effects
• Alcohol Drinking/epidemiology
• Biopsy
• Carcinoma, Squamous Cell/epidemiology
• Carcinoma, Squamous Cell/pathology
• Carcinoma, Squamous Cell/urine
• Case-Control Studies
• Diet/adverse effects
• Endemic Diseases
• Esophageal Neoplasms/epidemiology
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/urine
• Esophageal Squamous Cell Carcinoma
• Esophagoscopy
• Female
• HIV Infections/epidemiology
• Hospitals, University
• Humans
• Isoprostanes/urine
• Life Style
• Logistic Models
• Male
• Middle Aged
• Odds Ratio
• Prospective Studies
• Risk Assessment
• Risk Factors
• Smoking/adverse effects
• Smoking/epidemiology
• Zambia/epidemiology

• P30 CA091842 NCI NIH HHS
• R24 TW007988 FIC NIH HHS
• R24TW007988 FIC NIH HHS

• EBNA-1
• EBV- EA
• Epstein-Barr virus
• Gastric cancer
• HIV

• Adenocarcinoma/epidemiology
• Adenocarcinoma/pathology
• Adenocarcinoma/virology
• Adult
• Antigens, Viral/immunology
• Case-Control Studies
• Epstein-Barr Virus Infections/complications
• Epstein-Barr Virus Infections/epidemiology
• Epstein-Barr Virus Infections/immunology
• Epstein-Barr Virus Nuclear Antigens/immunology
• Female
• HIV Infections/epidemiology
• HIV Infections/virology
• Humans
• Male
• Middle Aged
• Precancerous Conditions/epidemiology
• Precancerous Conditions/virology
• Retrospective Studies
• Seroepidemiologic Studies
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/pathology
• Stomach Neoplasms/virology
• Zambia/epidemiology

• Wellcome Trust
• WT087537MA Wellcome Trust

There a shortage of robust information about profiles of gastrointestinal disease in sub-Saharan Africa. The endoscopy unit of the University Teaching Hospital in Lusaka has been running without interruption since 1977 and this 38-year record is largely intact. We report an analysis of endoscopic findings over this period.

Written endoscopy records from 29th September 1977 to 16th December 2014 were recovered, computerised, coded by two experienced endoscopists and analysed. Temporal trends were analysed using tables, graphs, and unconditional logistic regression, with age, sex of patient, decade, and endoscopist as independent variables to adjust for inter-observer variation.

Sixteen thousand nine hundred fifty-three records were identified and analysed. Diagnosis of gastric ulcer rose by 22 %, and that of duodenal ulcer fell by 14 % per decade. Endoscopically diagnosed oesophageal cancer increased by 32 % per decade, but gastric cancer rose only in patients under 60 years of age (21 % per decade). Oesophageal varices were the commonest finding in patients presenting with haematemesis, increasing by 14 % per decade in that patient group. Two HIV-related diagnoses, oesophageal candidiasis and Kaposi’s sarcoma, rose from almost zero to very high levels in the 1990s but fell substantially after 2005 when anti-retroviral therapy became widely available.

This useful dataset suggests that there are important trends in some endoscopic findings over four decades. These trends are not explained by inter-observer variation. Reasons for the divergent trends in incidence of peptic ulceration and apparent trends in diagnosis of upper gastrointestinal cancers merit further exploration.

There is emerging evidence that esophageal cancer occurs in younger adults in sub-Saharan Africa than in Europe or North America. The burden of human immunodeficiency virus (HIV) is also high in this region. We postulated that HIV and human papillomavirus (HPV) infections might contribute to esophageal squamous cell carcinoma (OSCC) risk. This was a case–control study based at the University Teaching Hospital in Lusaka, Zambia. Cases were patients with confirmed OSCC and controls had completely normal upper endoscopic evaluations. A total of 222 patients were included to analyze the influence of HIV infection; of these, 100 patients were used to analyze the influence of HPV infection, alcohol, smoking, and exposure to wood smoke. The presence of HIV infection was determined using antibody kits, and HPV infection was detected by polymerase chain reaction. HIV infection on its own conferred increased risk of developing OSCC (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.0–5.1; P = 0.03). The OR was stronger when only people under 60 years were included (OR 4.3; 95% CI 1.5–13.2; P = 0.003). Cooking with charcoal or firewood, and cigarette smoking, both increased the odds of developing OSCC ([OR 3.5; 95% CI 1.4–9.3; P = 0.004] and [OR 9.1; 95% CI 3.0–30.4; P < 0.001], respectively). There was no significant difference in HPV detection or alcohol intake between cases and controls. We conclude that HIV infection and exposure to domestic and cigarette smoke are risk factors for OSCC, and HPV immunization unlikely to reduce OSCC incidence in Zambia.

• Charcoal
• HIV
• HPV
• esophageal cancer
• firewood

Characteristics of patients undergoing Upper GI endoscopy (UGIE) in Kumasi, Ghana are largely unknown. This paper reviews the work of three endoscopy units in Kumasi.

A review of the records of patients undergoing diagnostic UGIE in the three centers from October 2006 to December 2011 was undertaken.

3110 completed UGIE were performed over the period. In 80% of the patients the primary indication for UGIE was dyspepsia occurring without any other symptom. In 50% of patients UGIE findings were normal. Peptic ulcer disease, the most common positive finding, was diagnosed in 27.4% of patients. The odds ratio (O.R) of yielding a positive endoscopic finding for patients presenting with recurrent vomiting, dyspepsia associated with weight loss and UGI bleeding were 3.87 (95% C.I: 2.23-6.69), 1.72 (95% C.I: 1.03-2.87) and 1.81 (95% C.I: 1.03-3.16) respectively. Dyspepsia without any other symptom, on the other hand, yielded a positive endoscopic finding with O.R of 0.67 (95% CI: 0.57-0.80). Alarm symptoms (UGI bleeding, recurrent vomiting, dysphagia or weight loss associated with dyspepsia) yielded a positive endoscopic finding with an O.R of 2.34 (95% C.I: 1.74-3.13).

Most patients in Kumasi underwent UGIE because of dyspepsia in the absence of any other symptom. These patients were more likely to have normal endoscopic findings. The opposite was true for those presenting with alarm symptoms. Our results suggest that initial UGIE may be preferentially offered to patients presenting with alarm symptoms especially in resource-poor settings such as ours.

• Kumasi
• Upper gastrointestinal
• endoscopy

Gastric cancer is the fourth most common cancer and second most common cause of cancer death worldwide. Globally, gastric cancer poses a significant public health burden - both economically and socially. In 2008, the economic burden from premature cancer deaths and disability was $895 billion and gastric cancer was the second highest cancer responsible for healthy life lost. With the expected increase in cancer deaths and non-communicable diseases, these costs are expected to rise and impact patient care. World Health Organization, estimates a 15% increase in non-communicable disease worldwide, with more than 20% increase occurring in Africa between 2010 and 2020. Mali, West Africa, is ranked 15^th highest incidence of gastric cancer worldwide at a rate of 20.3/100000, yet very scarce published data evaluating etiology, prevention or management exist. It is understood that risk factors of gastric cancer are multifactorial and include infectious agents (Helicobacter pylori, Epstein-Barr virus), genetic, dietary, and environmental factors (alcohol, smoking). Interestingly, African patients with gastric cancer are younger, in their 3^rd-4^th decade, and present at a late stage of the disease. There is sparse data regarding gastric cancer in Africa due to lack of data collection and under-reporting, which impacts incidence and mortality rates. Currently, GLOBOCAN, an International Agency for Research on Cancer resource, is the most comprehensive available resource allowing comparison between nations. In resource limited settings, with already restricted healthcare funding, data is needed to establish programs in Africa that increase gastric cancer awareness, curtail the economic burden, and improve patient management and survival outcomes.

• Gastric cancer
• Africa
• Cancer outcomes
• Cancer survival
• Cancer management
• Non-communicable diseases

• Africa/epidemiology
• Age Factors
• Humans
• Incidence
• International Cooperation
• Public Health
• Risk Factors
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/epidemiology
• Treatment Outcome

Schistosomiasis is a major cause of morbidity and mortality, with over 200 million people infected worldwide. Eighty-five percent of cases are in Africa. The hepatosplenic form develops over time by an immune reaction to trapped Schistosoma mansoni eggs in the portal system leading to liver fibrosis, portal hypertension and oesophageal varices. Most patients presenting to the University Teaching Hospital in Lusaka with oesophageal varices, come from Western province, but no formal studies have been carried out in this area assessing the burden of hepatosplenic pathology. We aimed to define the extent of the problem in Kaoma district, western Zambia, and to correlate signs and symptoms with serology.

A symptom questionnaire, demographic survey and physical examination was conducted amongst patients presenting to Kaoma district outpatient clinics. To assess the prevalence of Schistosoma mansoni infections, blood was collected and screened for the presence of Schistosoma antibodies using Enzyme linked immunosorbent assay (ELISA). Of the 110 patients screened, 97 (88%) were ELISA positive. Forty-six percent (51/110) reported haematochezia and 7% experienced haematemesis (8/110). On physical examination 27% (30/110) hepatomegaly and 17% (30/110) splenomegaly was observed amongst participants but there were few correlations between serology and signs/symptoms. On questioning 68% (75/110) of participants knew nothing about schistosomiasis transmission.

Our serological and clinical data indicate a very heavy burden of schistosomiasis-related portal hypertension. Our evidence highlights a need for mass treatment in Kaoma to address and prevent extensive pathology of hepatosplenic schistosomiasis. Safe water and health education throughout Western Province are clearly also important.

AIM: To evaluate need for and efficacy of a structured gastroenterology didactic session in expanding awareness and understanding of digestive disorders.

METHODS: A four-day symposium was developed with didactic sessions (days 1, 2) and practical endoscopy (days 3, 4). Didactic sessions included case presentations highlighting pathophysiology and management. One nurse and four practicing gastroenterologists from the United Kingdom led lectures and supervised workshops with audience participation. Practical endoscopy focused on diagnostic and therapeutic procedures and their application to diagnosis and treatment of ailments of the gastrointestinal tract. Pre- and post-workshop questionnaires were distributed to participants during didactic sessions. A pre-workshop questionnaire gauged expectations and identified objectives to be met at the symposium. Post-workshop questionnaires were administered to assess efficacy of each session. Participants graded sessions from 1 (poor) to 5 (excellent) on quality of case presentations, knowledge, clarity and mode of presentation. We assessed if time allotted to each topic was sufficient, value of sessions, impact on practice and interest in future symposiums.

RESULTS: There were 46 attendees on day 1: 41% undergraduates, 41% residents, 11% consultants and 4% unspecified. Day 2 (a Saturday) had 24 participants: 17% undergraduates, 71% residents, 9% consultants, 4% unspecified. Primary pre-workshop symposium expectation was to gain knowledge in: general gastroenterology (55.5%), practical endoscopy (13.8%), pediatric gastroenterology (5%), epidemiology of gastrointestinal disorders specific to Zambia (6%), and interaction with international speakers (6%). The post-symposium questionnaire was answered by 19 participants, of whom 95% felt specific aims were met; all would attend future conferences and recommend to others.

CONCLUSION: The beneficial effect of a structured symposium in developing countries warrants further attention as a mechanism to improve disease awareness in areas where resources are limited.

• Gastroenterology training
• Resource-limited country
• Zambia
• Specialist training
• Postgraduate training
• Hepatology

• Africa, Southern/epidemiology
• Developing Countries
• Education, Medical, Continuing/methods
• Female
• Gastroenterology/education
• Gastrointestinal Diseases/epidemiology
• Gastrointestinal Diseases/physiopathology
• Gastrointestinal Diseases/therapy
• Health Resources
• Humans
• Male
• Prevalence
• Surveys and Questionnaires
• Zambia/epidemiology

• Endoscopy
• Lacor hospital
• upper gastrointestinal bleeding

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Child
• Cross-Sectional Studies
• Endoscopy, Digestive System
• Esophageal Neoplasms/diagnosis
• Esophageal Neoplasms/epidemiology
• Esophageal Neoplasms/etiology
• Esophageal and Gastric Varices/diagnosis
• Esophageal and Gastric Varices/epidemiology
• Esophageal and Gastric Varices/etiology
• Female
• Hospitals, Public
• Humans
• Logistic Models
• Malawi/epidemiology
• Male
• Middle Aged
• Multivariate Analysis
• Prevalence
• Referral and Consultation
• Retrospective Studies
• Risk Factors
• Young Adult

• UL1 TR002489 NCATS NIH HHS