ABSTRACT
BACKGROUND: Diagnosis of upper gastrointestinal (UGI) diseases is often made on clinical grounds alone in Nigeria due to lack of endoscopic facilities. The validity of using such diagnosis is presently unknown. OBJECTIVE: The study aimed to determine: age and sex distribution of patients presenting for UGI endoscopy; pattern of clinical and endoscopic diagnoses in patients with UGI diseases; and, the validity of clinic-based diagnosis. METHODS: Medical records of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria for UGI endoscopy between September 1999 and August 2003 were reviewed. Data was analysed for sensitivity, specificity, positive predictive value, and negative predictive value of clinical diagnosis using endoscopic diagnosis as "gold" standard. RESULTS: Males constituted 53.4% of subjects and mean age was 45 years (+/- 1.69 SD). Peptic ulcer disease (PUD) constituted 67.6% of referral diagnosis but 33.9% of endoscopic diagnosis. PUD had the highest sensitivity value (0.72) while gastritis had the least (0.04). Specificity ranged from 0.40 for PUD to 1.00 for corrosive oesophagitis. Positive predictive value ranged from 0.29 (oesophageal cancer) to 0.67 (corrosive oesophagitis) and negative predictive value ranged from 0.66 for gastritis to 0.99 for corrosive oesophagitis. CONCLUSION: The validity of clinical diagnosis in UGI conditions varied widely, and in general, there is poor agreement between clinical and endoscopic diagnoses.
Subject(s)
Endoscopy, Gastrointestinal/methods , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiology , Physical Examination/methods , Adolescent , Adult , Age Distribution , Aged , Analysis of Variance , Chi-Square Distribution , Child , Child, Preschool , Cohort Studies , Developing Countries , Female , Humans , Incidence , Male , Middle Aged , Nigeria , Reproducibility of Results , Retrospective Studies , Risk Assessment , Sensitivity and Specificity , Severity of Illness Index , Sex Distribution , Survival Analysis , Young AdultABSTRACT
BACKGROUND: There are few histopathologists in West African region. Histology results on gastric mucosal biopsies for Helicobacter pylori (HP) usually take between one to two weeks to be out. On the other hand, clo-test results for Helicobacter pylori can be read between 5 minutes to 24 hours. Is one justified to commence therapy based on the clo-test ahead of the histology result? Where there is no histopathology services as in many centers in West Africa can one rely on clo-test alone? AIM: To evaluate the correlation between clo-test (urease) and histological findings of gastric mucosal biopsies. DESIGN: Prospective study. SETTING: Endoscopic unit of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. PATIENTS: Twenty duodenal ulcer (DU) patients seen consecutively in the endoscopy unit. INTERVENTION: Upper gastrointestinal tract endoscopy, antral biopsies for the clo-test and histopathology. RESULT: There was 100% correlation between the clo-test and histological findings among all the 20 patients. CONCLUSION: Clo-test (urease) is reliable enough to be used to commence therapy aimed at ulcer healing and HP eradication.
