Histopathological pattern of endoscopic gastric biopsies in dyspeptic patients in a Nigerian population

Background and Objective: Dyspepsia is one of the most common complaints encountered in the general outpatient and gastroenterology clinics in Nigeria. Histopathological assessment of endoscopic gastric mucosa biopsy is crucial to delineate the exact cause of dyspepsia to guide patients' management. This study aimed to determine and document the histopathological basis of dyspepsia among dyspeptic patients at our facility. Material sand Methods: This was a three year descriptive retrospective study and the materials consisted of all gastric endoscopic biopsies taken from clinically diagnosed dyspeptic patients sent to the Department of Histopathology of the Federal Medical Centre, Owerri, Nigeria. Results: The biopsies were from 64 (53.2%) male patients and 56 (46.8%) female patients, giving a male to female ratio of 1.14:1. The age range of the patients was 28-82 years with a mean of 56 years at presentation. Helicobacter Pylori (H. Pylori) bacilli were identified in the samples of 42 (35%) patients but absent in samples of 78 (65%) patients. The histopathological pattern of the aetiological basis of dyspepsia in this study consisted of gastritis (96, 80%), functional (17, 14.2%), adenocarcinoma (4, 3.3%) and polyps (3, 2.5%). H. Pylori bacilli were seen only in patients with gastritis (42/96, 43.8%), and it affected 19 (45.2%) male patients and 23 (54.8%) female patients. Chronic active H. Pylori associated gastritis (24, 25%) was the most common form of gastritis seen during the study period. Conclusion: The main organic cause of dyspepsia in our setting was chronic gastric followed in the distant by gastric adenocarcinoma and polyp. Dyspepsia and H. Pylori associated gastritis did not show a significant gender predilection

Depression, anxiety and stress symptoms in patients presenting with dyspepsia at a regional hospital in KwaZulu-Natal province

Background: Depression, anxiety and stress (DAS) have been shown to be co-morbid with dyspepsia. Local data on the factors associated with these co-morbidities could inform the role of psychiatric intervention in affected patients.Aim: The aim of this study was to describe the frequency of undiagnosed DAS and their associated protective and risk correlates in a sample of patients undergoing endoscopies for dyspepsia.Setting: The study was conducted at a regional hospital's gastro-intestinal unit in KwaZulu-Natal province.Method: A cross-sectional survey was conducted on 201 in- and outpatients with symptoms of dyspepsia awaiting endoscopy. Information on DAS symptomatology (using the DASS-21 screening questionnaire, as well as socio-demographic and clinical data) were collected.Analyses: Following a descriptive analysis of the participants' socio-demographic and clinical details, linear regression models were fitted to identify potential risk and protective correlates linked to DAS symptomatology.Results: The mean age of participants (N = 201) was 48.89 years, of whom approximately two-thirds (n = 133; 66.17%) were women, 97% (n = 195) were African and 64.68% (n = 130) resided in rural areas. Anxiety was the most prevalent symptom category (n = 149; 74.13%) versus depression (n = 96; 47.76%) and stress (n = 68; 33.83%) in each category of symptom (mild to extremely) severity. In the severe and extremely severe range, anxiety existed without co-morbid depression or stress in 61.19% of anxious patients. Alcohol use was significantly associated with all three symptom categories (p < 0.01).Conclusions: Given high frequencies of depression and anxiety in patients undergoing endoscopies for dyspepsia, screening for common mental disorders is essential

Functional Dyspepsia - An Updated Review

Functional dyspepsia (FD) refers to upper abdominal symptoms like upper abdominal or retrosternal pain or discomfort; heart burn; nausea; etc. The symptoms are common; but often poorly understood and mistaken for conditions like chronic gastritis and peptic ulcer disease. Worldwide; the prevalence of dyspepsia is about 20-30 [1]. In the department of internal medicine at the Ruhengeri hospital; there have been 16.4 outpatient cases and 16.1 cases of admissions (Jan-June-2014). A high number of cases would be in other hospitals as well. The causes postulated are the increased production of acid; visceral hypersensitivity; H. pylori infection; emotional stress; reduced immunity; etc. The diagnosis is based on exclusion of organic causes for similar symptoms. The treatment is mainly with lifestyle modifications; and the pharmacological therapy consists of antacids; antiflatulents; prokinetic drugs; cytoprotective drugs; and proton pump inhibitors. It can be recommended that greater awareness needs to be generated among physicians regarding FD. They in turn can counsel patients and lay stress on lifestyle and preventive factors to improve this described condition

Upper Gastrointestinal Endoscopy Findings in Patients Referred with Upper Gastrointestinal Symptoms in Eldoret; Kenya: a Retrospective Review

Background: Dyspepsia is one of the major indications for upper gastrointestinal endoscopy. Other indications include dysphagia; odynophagia and gastrointestinal bleeding. Endoscopy is an expensive procedure that is out of reach of many patients in resource constrained region such as western Kenya. We reviewed endoscopy records from both public and private health institutions spanning ten years. Objective: To determine the pattern of referral and endoscopy diagnoses in patients referred for upper gastrointestinal endoscopy in Eldoret; Kenya. Design: Retrospective chart review. Setting: Moi Teaching and Referral Hospital; private hospitals and private clinics in Eldoret; Kenya Subjects: One thousand six hundred and ninety (1690) Patients who underwent upper GI endoscopy from 1993 to 2003 were reviewed after obtaining clearances from the respective institutions. Information on age; sex; symptoms; and endoscopy diagnosis were extracted and subjected to statistical analysis. Results: The most common symptom was dyspepsia in 1059 (62.7) followed by dysphagia in 224 (13.3). Others were referred with diagnosis of cancer of the stomach or oesophagus. Common endoscopy diagnoses were cancer of the oesophagus in 199 (11.8) and duodenal ulcer in 186 (11.0). The majority of the patients (30.4) had normal endoscopy findings. Of the 1059 patients with dyspepsia; only 154 (14.5) had duodenal ulcer and 34 (3.2) had gastric ulcers; the majority; 37.2 had normal endoscopy findings. Conclusion: Dyspepsia was main reason for referral; but the majority of such patients had normal findings. Cancer of the oesophagus was the main diagnosis in patients with dysphagia. In view of the cost of endoscopy; only those with dyspepsia and alarm symptoms be referred for the procedure

Prevalence of Helicobacter Pylori Caga and Vaca Allelic Variants and Associated Disease Outcomes in Kenyan Patients with Dyspepsia

Although Helicobacter pylori has been linked to various gastric disorders in Western countries and Asia; its aetiopathological role in African populations is controversial. The aim of this study was to investigate the role of H. pylori and its virulence genotypes in gastrointestinal diseases in Kenyan patients with dyspepsia. Gastric biopsy specimens were obtained for DNA isolation and histopathological analysis. Amplification was performed using specific oligonucleotide primers. H. pylori positivity was determined by H. pylori stool antigen test; rapid urease test; and histology and molecular diagnostic tools. H. pylori was detected with high frequency in patients with gastritis; peptic ulcer disease (PUD) and gastro-oesophageal reflux disease. This implies a significant risk of the development of these pathologies (p-value = 0.0000 in all cases). H. pylori strains with cagA occurred more frequently in PUD (65.2). vacA s1a genotype appeared to play a more significant pathological role (82.6 PUD) than the other variants (p-value = 0.0142). The prevalence of vacA m1 was significantly higher in gastritis cases (p-value = 0.0253). vacA m2 was found to be significantly associated with gastritis (p-value = 0.0253). This finding may point to the fact that H. pylori vacA m1 and vacA m2 are independently associated with an increased risk for gastritis. Indications are that H. pylori prevalence in Kenya may be declining. The independently occurring H. pylori genotypes; as opposed to simultaneous carriage; could be the reason for the low distribution of H. pylori pathologies

Upper Gastrointestinal Endoscopic Findings and Prevalence of Helicobacter Pylori Check for this Species in other Resources Infection among Adult Patients with Dyspepsia in Northern Tanzania

Dyspepsia is a common presenting complaint of various upper gastrointestinal disorders. The symptoms of causes of dyspepsia often overlap and this makes etiological diagnosis difficult. Endoscopy is the ideal procedure for identifying organic diseases of the foregut. Helicobacter pylori infection is associated with various upper gastrointestinal pathologies. A cross-sectional study was conducted to determine endoscopic findings and H. pylori status in two hundred and eight consecutive dyspeptic adult patients between June 2009 and April 2010 at Kilimanjaro Christian medical Centre; a referral and teaching hospital in northern Tanzania. The most commonly identified endoscopic findings were gastritis (61.10); Gastroesophageal reflux disease (GERD) (57); and Peptic ulcer disease (PUD) (24.1). Gastric cancer was identified in 6.7 of patients and all of them were aged 40 years and above (p=0.00). H. pylori infection was detected in 65 (n=130) of patients. H. pylori infection was present in 57 (n=24) of patients who were tested within six months after eradication therapy. Gastritis and duodenal ulcer were statistically significantly associated with H. pylori (p0.001). No association was found between GERD and H. pylori infection (p0.05). Gastritis; GERD; and PUD are the leading causes of dyspepsia. H. pylori infection is present in significant proportion of dyspeptic patients. Patients with Gastritis and PUD should undergo empirical eradication therapy if a confirmatory test is not available. Patients with dyspepsia who are over 40 years of age should undergo Endoscopy (EGD) for initial work up. Study on antimicrobial susceptibility pattern of H. pylori is recommended to guide choices for evidence based treatment option

Who should be screened to reduce the endoscopy workload in Mulago Hospital?

A retrospective study of 330 patients who had been endoscoped in Mulago hospital was done. It was found that of these 119 (36.1) were normal endoscopically. Normal endoscopy was significantly associated with patients presenting with dyspepsia. Dyspepsia was common in the age group 13-45 years compared to the age group 46-85 years. The older age group; 46-85 years; had a singificantly higher prevalence of serious disease. It is concluded that it is the younger patients with dyspepsia who should be screened to reduce the endoscopy workload. Published guidelines should be used to assist in the screening process

Who should be screened to reduce the endoscopy workload in Mulago Hospital?

A retrospective study of 330 patients who had been endoscoped in Mulago Hospital was done. It was found that of these 119(36.1) were normal endoscopically. Normal endoscopy was significantly associated with patients presenting with dyspepsia. Dyspepsia was commoner in the age group 13-45 years compared to the age group 46-85 years. The older age group; 46-85 years; had a significantly higher prevalence of serious disease. It is concluded that it is the younger patients with dyspepsia who should be screened to reduce the endoscopy workload. Published guidelines should be used to assist in the screening process

Upper gastrointestinal endoscopic findings in adolescents at Lacor hospital; Uganda

Background and Objectives: Fiberoptic endoscopy is a highly efficient diagnostic tool; which is now being increasingly used; in the pediatric age group.This study has been carried out to demonstrate indications for and common findings of endoscopy in children. Materials and Methods:We retrospectively reviewed the medical records for endoscopy indication and result of children who had endoscopy between Jan 2000 to June 2005. Results:We analyzed 135 children who were referred for upper gastrointestinal endoscopy.There were 38 boys and 97 girls.The mean age was 16 years (SD+/-1.4293).The main indications comprised epigastric pain (67.4); dyspepsia (11.9); hematemesis (8.9); recurrent abdominal pain (3) recurrent vomiting (3); and miscellaneous (5.8). Endoscopic diagnose included duodenal ulcer (14.8) and gastritis (12.6); duodenal scarring (5.2); bile reflux (5.2) duodenitis (4.4) and miscellaneous 6.4. Conclusion:In Upper gastrointestinal endoscopy is a diagnostic procedure in children with gastrointestinal disorder. Gastritis and duodenal disease are commonly seen in children; hence must be included in differential diagnosis of children with digestive complaints and its management