The potential for quality assurance systems to save costs and lives: the case of early infant diagnosis of HIV.

OBJECTIVES: Scaling up of point-of-care testing (POCT) for early infant diagnosis of HIV (EID) could reduce the large gap in infant testing. However, suboptimal POCT EID could have limited impact and potentially high avoidable costs. This study models the cost-effectiveness of a quality assurance system to address testing performance and screening interruptions, due to, for example, supply stockouts, in Kenya, Senegal, South Africa, Uganda and Zimbabwe, with varying HIV epidemics and different health systems. METHODS: We modelled a quality assurance system-raised EID quality from suboptimal levels: that is, from misdiagnosis rates of 5%, 10% and 20% and EID testing interruptions in months, to uninterrupted optimal performance (98.5% sensitivity, 99.9% specificity). For each country, we estimated the 1-year impact and cost-effectiveness (US$/DALY averted) of improved scenarios in averting missed HIV infections and unneeded HIV treatment costs for false-positive diagnoses. RESULTS: The modelled 1-year costs of a national POCT quality assurance system range from US$ 69 359 in South Africa to US$ 334 341 in Zimbabwe. At the country level, quality assurance systems could potentially avert between 36 and 711 missed infections (i.e. false negatives) per year and unneeded treatment costs between US$ 5808 and US$ 739 030. CONCLUSIONS: The model estimates adding effective quality assurance systems are cost-saving in four of the five countries within the first year. Starting EQA requires an initial investment but will provide a positive return on investment within five years by averting the costs of misdiagnoses and would be even more efficient if implemented across multiple applications of POCT.

OBJECTIFS: L'intensification du dépistage au point des soins (DPS) pour le diagnostic précoce du VIH chez le nourrisson (DPVN) pourrait réduire le grand écart dans le dépistage des nourrissons. Cependant, un DPVN DPS sous-optimal pourrait avoir un impact limité et des coûts évitables potentiellement élevés. Cette étude modélise la rentabilité d'un système d'assurance qualité pour traiter les performances des tests et les interruptions de dépistage, dues par exemple à des ruptures de stock, au Kenya, au Sénégal, en Afrique du Sud, en Ouganda et au Zimbabwe, avec des épidémies variables du VIH et des systèmes de santé différents. MÉTHODES: Nous avons modélisé une qualité de DPVN soulevée par le système d'assurance qualité à partir de niveaux sous-optimaux: c'est-à-dire des taux d'erreurs de diagnostic de 5%, 10% et 20% et des interruptions des tests de DPVN en mois, à des performances optimales ininterrompues (sensibilité de 98,5%, spécificité de 99,9%). Pour chaque pays, nous avons estimé l'impact sur un an et la rentabilité (en USD/DALY évitée) de scénarios améliorés pour éviter les infections à VIH manquées et les coûts inutiles de traitement du VIH pour les diagnostics faux positifs. RÉSULTATS: Les coûts modélisés sur un an d'un système national d'assurance qualité DPS vont de 69.359 USD en Afrique du Sud à 334.341 USD au Zimbabwe. Au niveau des pays, les systèmes d'assurance de la qualité pourraient potentiellement éviter entre 36 et 711 infections manquées (c'est-à-dire des faux négatifs) par an et des coûts de traitement inutiles entre 5.808 et 739.030 USD. CONCLUSIONS: Le modèle estime que l'ajout de systèmes d'assurance qualité efficaces permet de réaliser des économies dans quatre des cinq pays au cours de la première année. Le lancement de l'assurance qualité nécessite un investissement initial, mais fournira un retour sur investissement positif dans les cinq ans en évitant les coûts des diagnostics erronés et serait encore plus efficace s'il était mis en œuvre dans plusieurs applications de DPS.

[Use of dried blood spots in early diagnosis of HIV-1 infection in children born to HIV-infected mothers as part of the prevention of mother-to-child transmission in Benin]. / Utilisation des prélèvements capillaires sur buvard dans le diagnostic précoce de l'infection à VIH-1 chez des enfants nés de mères infectées dans le cadre de la prévention de la transmission mère-enfant au Bénin.

The goal of this study was to evaluate using the molecular diagnosis, infection transmission rate of HIV in children born to HIV-1 positive mothers as part of the prevention of mother-to-child transmission (PMTCT) in Benin. The sample consisted of 524 dried blood spots (DBS) of children born to HIV-1 positive mothers, from 30 sites (PMTCT) taken between October 2009 and June 2010. The diagnosis of HIV-1 was performed by the qualitative detection of viral nucleic acids (RNA and DNA) in DBS on filter paper using the Abbott RealTime(®) HIV-1 Qualitative assay. We found that 51 DBS were positive (9.7%) and 473 were negative (90.3%). The failure rate of PMTCT among 420 mothers who received antiretroviral prophylaxis was 6.7% (28/420). This failure rate was significantly higher among children born to infected mothers on antiretroviral monotherapy than on triple therapy (HAART). The results of our study enrich the data in the literature on highly active antiretroviral chemoprophylaxis to reduce the transmission of HIV-1 from mother to child.

[The flexibility of family medicine]. / La flexibilité en médecine générale.

We are a European academic group of family doctors and we propose a definition of flexibility in family medicine. A review of the literature shows that flexibility and complexity are emerging concepts in the field of family practice. The outcomes of a workshop at the WONCA-Europe congress in 2014 are discussed. The flexibility is a capability of the general practitioner to deal with complex clinical situations in a biomedical and societal changing world. Flexibility is framed by ethics. It could improve the quality of care, be useful against burnout and used in medical research. In conclusion, family medicine should adopt a specific definition of the flexibility describing its specificity, a useful and teachable capacity.

[Severe acute colitis: two fatal cases in Dakar]. / La colite aiguë grave : deux observations mortelles à Dakar.

OBJECTIVE: Severe acute colitis (SAC) is one of the major complications of inflammatory bowel disease (IBD), especially ulcerative colitis, and it is life-threatening. Although IBD is considered rare in sub-Saharan Africa, we report 2 fatal cases of SAC in Senegalese patients with ulcerative colitis in Dakar. CASES: One patient was a 73-year-old man and the other a 35-year-old woman. In both cases, the diagnosis was preceded by a chronic dysenteric syndrome (febrile in the woman). Despite antibiotic treatment for potential infectious colitis, both patients' condition worsened. Second-line treatment of parenteral corticosteroids did not prevent the occurrence of intestinal perforation for the man, who developed multiorgan failure. The woman developed toxic megacolon during antibiotic treatment, and it was fatal despite bolus corticosteroids: cardiovascular collapse with shock (case 2) occurred before emergency surgery could begin. Conclusion: in subtropical zones where infectious colitis predominates, it is important to consider the diagnosis of SAC in patients with ulcerative colitis and to begin appropriate treatment despite the fear of infection and the difficulty of accessibility to endoscopic exploration.

[Spontaneous bacterial peritonitis in Dakar, Senegal: study of 55 patients with cirrhosis]. / Infection spontanée du liquide d'ascite à Dakar, Sénégal : étude de cinquante-cinq patients cirrhotiques.

OBJECTIVES: To report the prevalence of spontaneous bacterial peritonitis (SBP) and its clinical and laboratory features in patients with cirrhosis followed at the Aristide Le Dantec Hospital in Dakar (Senegal). PATIENTS AND METHODS: From May through December, 2010, we prospectively included patients with cirrhosis and a first episode of ascites on clinical examination. Diagnostic abdominal paracentesis was performed in all cases to determine the macroscopic appearance of the fluid, protein concentration, and cell count, and to culture the ascitic fluid in a blood culture bottle. SBP was diagnosed when the fluid contained more than 250 polymorphonuclear leukocytes per cubic millimeter of fluid. The data were analyzed with Epi-Info software, version 3.5.2. Comparisons used Fisher's exact and Chi-square tests, with significance set at p < 0.05. RESULTS: The study included 55 patients with cirrhosis, with a mean age of 45 years and a male/female sex ratio of 1.89 (36 men). The prevalence of SBP was 27.3%. Factors significantly associated with SBP were female gender, malnutrition, turbid appearance of the ascites, and neutrophilia. In samples from patients with SBP, the mean protein concentration was 20.7 g/L, the white cell count was 1797/mm(3), and the neutrophil count 1,102/mm(3). Ascitic fluid culture was positive in 20% of the SBP cases (n=3). CONCLUSION: In Dakar, cirrhosis is found especially in young adults, and the prevalence of SBP in our population was 27.3%. Improved technical equipment would improve the hospital's ability to determine the causes of cirrhosis and identify the various germs responsible for SBP.

Genomic analysis of three African strains of Bacillus anthracis demonstrates that they are part of the clonal expansion of an exclusively pathogenic bacterium.

Bacillus anthracis is the causative agent of anthrax and is classified as a 'Category A' biological weapon. Six complete genomes of B. anthracis (A0248, Ames, Ames Ancestor, CDC684, H0491, and Sterne) are currently available. In this report, we add three African strain genomes: Sen2Col2, Sen3 and Gmb1. To study the pan-genome of B. anthracis, we used bioinformatics tools, such as Cluster of Orthologous Groups, and performed phylogenetic analysis. We found that the three African strains contained the pX01 and pX02 plasmids, the nonsense mutation in the plcR gene and the four known prophages. These strains are most similar to the CDC684 strain and belong to the A cluster. We estimated that the B. anthracis pan-genome has 2893 core genes (99% of the genome size) and 85 accessory genes. We validated the hypothesis that B. anthracis has a closed pan-genome and found that the three African strains carry the two plasmids associated with bacterial virulence. The pan-genome nature of B. anthracis confirms its lack of exchange (similar to Clostridium tetani) and supports its exclusively pathogenic role, despite its survival in the environment. Moreover, thanks to the study of the core content single nucleotide polymorphisms, we can see that our three African strains diverged very recently from the other B. anthracis strains.

[Reemergence of contagious bovine pleuropneumonia in Senegal]. / Réémergence de la péripneumonie contagieuse bovine au Sénégal.

The authors have described an epizootic infection of contagious bovine pleuropneumonia (CBPP), caused by Mycoplasma mycoides subsp. mycoides biotype Small Colony (MmmSC), that has affected Ndama bovine in Lounthy village, a locality based in Bala city in the Eastern part of Senegal, during the post-rainy season in November 2012. After the cessation of vaccination, a hotbed of suspicion of CBPP was identified on November 3rd 2012 in the village of Lounthy: out of the total of 98 cattle, 13 animals were sick and 5 of them died. These studies have been done according to clinical aspects, serological, bacteriological and molecular analysis of the samples. This reemergent disease will give new orientations for CBPP control in Senegal, where it was supposed the disease has been eradicated since 2005.

[Esophageal variceal band ligation in Dakar, Senegal]. / La ligature élastique des varices œsophagiennes à Dakar (Sénégal).

After a preliminary study in the gastrointestinal endoscopy center of the Aristide-Le-Dantec Teaching Hospital in Dakar, Senegal, demonstrated the feasibility and effectiveness of endoscopic ligation of esophageal varices, this procedure entered regular use for management of patients admitted for upper digestive tract bleeding due to these varices. This study sought to assess its effectiveness. Patients and method. This study, conducted from July 2005 through January 2010, included all patients with upper digestive tract bleeding due to rupture of esophageal varices. Results. In all, 140 patients with a mean age of 36 years [range: 16-75] were admitted for this diagnosis and included in the study: 93 men and 47 women (sex-ratio = 1.98). The presence of at least one clinical sign of portal hypertension was noted in 72% of cases. Esophageal varices were graded as stage III in 75.7% of cases. The underlying cause of portal hypertension was cirrhosis in 94.3%, presumptively due to hepatitis B virus among 37.1%. The varices were successfully eradicated in 64 patients (45.7%). The mean number of sessions required was 2 [range: 2-4] in patients with stage II and 3.4 [range, 3-8] in patients with stage III varices, and the mean number of bands applied per session was 5.1 [range: 2-6] and 5.6 [range: 2-10], respectively. The interval between sessions was 4 weeks [range: 3 -12]. Bleeding recurred in 8 patients (5.7%) before eradication was achieved; 4 (2.8%) of them died. Conclusion. Esophageal variceal ligation is an effective therapeutic and prophylactic procedure for management of esophageal varices in Senegal.

Creation of a therapeutic digestive endoscopy suite in Senegal: renovation, training and university certification. Results of a Belgian-Senegalese inter-university project.

Therapeutic digestive endoscopy did not exist in sub-Saharan Africa before 2005. However, the prevalence of digestive diseases that could potentially benefit from basic endoscopic treatment is very high in this region. Portal hypertension with variceal bleeding and severe dysphagia associated with benign or malignant upper gastrointestinal tract diseases are prominent in these countries. The aim of the Project described in this report was to create a digestive endoscopy facility in Dakar (Senegal, West Africa), that would also provide local training in therapeutic endoscopy to doctors and nurses and facilitate regional autonomy with the opening of a University Certification in Gastroenterology. It took about 10 years to achieve these targets - 5 years to prepare realistic aims that took into account local needs, available local resources, and funding, and 4 years for the Project itself (2005-2009). At the present time, Senegalese colleagues and nurses are autonomous for basic therapeutic procedures in the upper and lower gastrointestinal tract. Two years after the end of funding, the rate of therapeutic activity has increased from 0% in 2005 to 12 % of digestive endoscopic activity in 2011. Key points of success were preparation, confidence of medical personnel, university involvement, shared funding, local multidisciplinary training, and facilitation of autonomy. Belgian healthcare workers were present on-site in Dakar for a total of about 6 months over the 4-year Project period, with an annual budget of less than € 80000. The Project has enabled an efficient North-South collaboration with a minimal budget, which has changed the healthcare provision of digestive endoscopy in Senegal, and has also provided autonomy, and facilitated the development of South-South cooperation.

Clinical relevance of cagA and vacA gene polymorphisms in Helicobacter pylori isolates from Senegalese patients.

The molecular epidemiology of Helicobacter pylori in Africa is poorly documented. From January 2007 to December 2008, we investigated 187 patients with gastric symptoms in one of the main tertiary hospitals in Dakar, Senegal. One hundred and seventeen patients were culture-positive for H. pylori. Polymorphisms in vacA and cagA status were investigated by PCR; the 3'-region of cagA was sequenced, and EPIYA motifs were identified. Bacterial heterogeneity within individuals was extensively assessed by using an approach based on vacA and cagA heterogeneity. Fourteen per cent of H. pylori-positive patients displayed evidence of mixed infection, which may affect disease outcome. Patients with multiple vacA alleles were excluded from subsequent analyses. Among the final study population of 105 patients, 29 had gastritis only, 61 had ulcerated lesions, and 15 had suspicion of neoplasia based on endoscopic findings. All cases of suspected neoplasia were histologically confirmed as gastric cancer (GC). The cagA gene was present in 73.3% of isolates. CagA proteins contained zero (3.7%), one (93.9%) or two (2.4%) EPIYA-C segments, and all were western CagA. Most of the isolates possessed presumed high-vacuolization isotypes (s1i1m1 (57.1%) or s1i1m2 (21.9%)). Despite the small number of cases, GC was associated with cagA (p 0.03), two EPIYA-C segments in the C-terminal region of CagA (p 0.03), and the s1 vacA allele (p 0.002). Multiple EPIYA-C segments were less frequent than reported in other countries, possibly contributing to the low incidence of GC in Senegal.

[Endoscopic features of esophageal cancer in Dakar, Senegal: study of 76 observations]. / Aspects endoscopiques du cancer de l'oesophage à Dakar (Sénégal): étude de 76 observations.

OBJECTIVE: In response to the lack of cancer register and paucity of publications on esophageal cancer in Senegal, this retrospective descriptive single-center study was undertaken to determine epidemiological, clinical, endoscopic and histological features of the disease at a digestive endoscopy center in Dakar. PATIENTS AND METHOD: Reports describing upper digestive tract endoscopy procedures performed at the Aristide Le Dantec Teaching Hospital in Dakar between January 2006 and December 2009 were reviewed. Cases involving histologically confirmed esophageal cancer were compiled and patient data including age, sex, and indication for endoscopy as well as endoscopic and histological findings were analyzed. RESULTS: A total of 78 reports were collected including 76 patients with suitable data for analysis. Esophageal cancer accounted for 0.97% of upper digestive tract endoscopy procedures performed. Mean patient age was 49 years and the sex-ratio was 1.9. The main indication for endoscopy was dysphagia (92.1%). The most frequent endoscopic finding involved budding lesions with (42%) or without (29%) ulceration. The most common location was the middle third of the esophagus (50%). The most frequent histological type was squamous cell carcinoma (92.1%). CONCLUSION: Esophageal cancer observed at the endoscopy center of the Aristide Le Dantec Teaching Hospital in Dakar mainly affects young male adults. Lesions are generally located in the middle third of the esophagus and corresponded to squamous cell cancer. There is a need to establish a cancer register and to conduct multicentric studies to gain insight into risk factors for esophageal cancer in Senegal.

[Helicobacter pylori and gastroduodenal lesions in Dakar, Senegal]. / Helicobacter pylori et pathologie gastroduodenale a Dakar (Sénégal).

INTRODUCTION: The bacteriological characteristics of Helicobacter pylori (HP) vary in function of time and place. The aim of this study was to update histological and bacteriological feature of HP infection in patients presenting gastroduodenal lesions in Dakar, Senegal. PATIENTS AND METHOD: This prospective study included patients with gastroduodenal lesions managed over a 6-month period in a digestive endoscopy center in Dakar. In all cases gastric biopsy was performed to obtain specimens for histological diagnosis according Sydney modified classification and HP culture with antibiogram. RESULTS: A total of 158 patients were included. Mean patient age was 48.7 years and the sex-ratio was 1.2. Endoscopic lesions were ulcer in 88 cases, gastritis in 54 cases and tumors in 16. Histological examination demonstrated chronic gastritis in 100% of cases, inflammatory activity in 79.1%, metaplasia in 78.5%, gastric atrophy in 41.1%, adenocarcinoma in 7.6%, dysplasia in 5.7%, and MALT lymphoma in 2.5% with presence of HP in 72.8% of cases. Cultures were positive for HP in 65.8% of cases. Antibiograms indicated that HP was sensitive to amoxicilline in 100% of cases, clarithromycine in 96.6%, ciprofloxacine in 84.1%, and métronidazole in 29.5%. CONCLUSION: Chronic gastritis is a constant feature of gastroduodenal lesions in Dakar. Histology combined with culture showed HP infection in 78.5% of cases. The antibiotic sensitivity of HP in Dakar has changed over the past decade.

[Contribution of coloscopy to diagnosis of rectal bleeding in Dakar (Senegal)]. / Apport de la coloscopie dans le diagnostic des rectorragies à Dakar (Sénégal).

INTRODUCTION: Rectal bleeding is a common reason for seeking medical attention and can lead to diagnosis of serious disease. The purpose of this report is to describe lesions discovered by coloscopy in patients assessed for rectal bleeding in Dakar, Senegal. PATIENTS AND METHODS: This retrospective study was carried out from January 2006 to December 2008 at the Aristide Le Dantec University Medical Center in Dakar. Coloscopy reports involving patients presenting with rectal bleeding were compiled. Age, quality of preparation, use of sedation, and lesions observed were analyzed. RESULTS: A total of 143 patients underwent coloscopy for rectal bleeding. Mean patient age was 51.3 years (range, 2 to 85 years) and the sex ratio was 1.7 (90 men). Preparation was considered as good in 55.5% of cases. Sedatives were used in 57% of cases. Coloscopy findings were normal in 9.8% of cases. The most common lesions were hemorrhoids (53.14%), rectocolitis (17.5%), cancer (11.9%), polyps (11.2%), and diverticulosis (11.2%). Multiple lesions were found in 20 patients (14%). CONCLUSION: Coloscopy for assessment of rectal bleeding in Dakar revealed a range of lesions with hemorrhoids and rectocolitis accounting for most.

[Nephrotic syndrom with focal and segmental glomerulosclerosis in Dakar: epidemiological and clinicopathological characteristics (about 134 cases)]. / Le syndrome néphrotique avec hyalinose segmentaire et focale a Dakar: aspects épidémiologiques et anatomocliniques (a propos de 134 cas).

Focal and segmental glomerulosclerosis (FSGS) is common and non-specific patterns of glomerular injury encountered in human renal biopsies. Cortico-resistant nephrotic syndrome is the main manifestation. We report epidemiological, clinical and pathological aspects of FSGS in Dakar. We report the results of a retrospective study about focal segmental glomerulosclerosis (FSGS) identified from 258 kidney biopsies performed in the medical clinic 1 of A. Le Dantec hospital from January 1993 to December 2003. FSG is found in 134 cases (52%), membranous glomerulonephritis in 32 cases (12,4%), minimal change disease in 20 cases (7.7%). Ninety eigths files were exploitable. FSGS has male gender predominance with a sex ratio of 3. Median age of patients is 28 years (15 and 79 years). Symptomatology is dominated by oedema in 86 cases (87,7%), hypertension in 12 cases (12.2%), hematuria in 5 cases (5.1%), nephrotic proteinuria in 65 cases (66,3%) and no nephrotic proteinuria in 33 cases (33.6%), renal failure in 25 cases (25%)and leucocyturia in 18 cases (18%). FSGS involving more than 50% of glomeruli is encountered in 41 cases (42%), severe interstitial fibrosis is associated in 26 cases. Different pathological aspects are: classical FSGS in 88 cases (88.7%), FSGS " collapsing" in 7 cases (7.1%), FSG "tip-lesion" in one case, FSGS associated to membranous glomerulosclerosis in 2 cases and to diabetic glomerulosclerosis in one case. FSGS is primitive in 88 cases (89,8%) and secondary in 10 cases (10.2%). FSGS is the most common primitive glomerulopathy in Dakar. Nephrotic syndrome is the main manifestation of this disease. Collapsing FSGS is not correlated with the HIV Infection.

[Isolation and identification in Senegal of the most immunogenic protein soluble antigen of a Clostridium chauvoei strain]. / Isolement et identification au Sénégal d'un antigène soluble immunogène de Clostridium chauvoei, agent du charbon symptomatique des bovins.

Clostridium chauvoei is the pathogenic agent for blackleg, a toxinfection disease in bovine and small ruminants, always lethal and involving considerable economic losses. Some bacteriological, biochemical, immunological studies permitted to isolate identify the major soluble antigenic protein of this bacteria. It's a protein fragment of 70 kDa weight, the 19 fraction, excreted by the bacteria in a suitable culture medium. The 19 fraction of extracellular medium leads to antibodies production on guinea pigs revealed by the ELISA/antibody test.

[Autoimmune cholangitis or seronegative biliary cirrhosis: report of one case]. / Cholangite auto-immune ou cirrhose biliaire séronégative: une observation chez un homme.

INTRODUCTION: Auto-immune cholangitis appears by a table of cholestatic jaundice without anomalies of the hepatic bile ducts. It is a primitive biliary cirrhosis without antimitochondrial antibodies. This disease is reported at adult women in 90 % of cases. We report a 59 years old man case. OBSERVATION: The patient was admitted for a diffuse melanodermy, a physical asthenia and a slimming which preceded 4 months by a pruritus with cholestatic jaundice. Biology showed a normal rate of transaminase. Alkaline phosphatases and direct bilirubine were high. Hepatitis (B and C) and HIV serologies were negative. Abdominal ultrasound showed a homogeneous liver. There were no dilations of the bile ducts. Antimitochondrial antibodies were negative and the histological examination confirms diagnosis. CONCLUSION: Progress was good with ursodesoxycholic acid even if interval is short (5 months of evolution).

[Sero-epidemiological study of cowdriosis in Moorish zebu cattle from Senegal]. / Etude séro-épidémiologique de la cowdriose chez le zébu maure au Sénégal.

The seroprevalence against heartwater for maure zebus coming from Mali and Mauritania is analysed by indirect ELISA using the major antigenic protein number 1-B (MAP1-B). Sero-epidemiological results realized on maure zebu cattle give a good adequation between the abundance or absence of the vector tick in the two countries for 98% of prevalence in Mali (infected area) and 0% of prevalence in Mauritania (non infected area).

[Clinical and endoscopic features of solitary rectal ulcer syndrom in the digestive endoscopy unit of Hospital Aristide Le Dantec in Dakar]. / Aspects cliniques et endoscopiques du syndrome de l'ulcère solitaire du Rectum dans l'unité d'endoscopie digestive du CHU A. Le Dantec de Dakar: à propos de 11 cas.

INTRODUCTION: The solitary rectal ulcer syndrome is a rare disease. In Africa only few studies have been held on this subject. The aim of this study was to determine the epidemiological, clinical and endoscopic aspects of this syndrome in the digestive endoscopy unit of hospital Aristide Le Dantec in Dakar. PATIENTS AND METHOD: It was a retrospective study based on all the cases of solitary rectal ulcer regarding to the conclusion of endoscopic examination from January 1994 to June 2002. All the patients without histological confirmation were excluded. RESULTS: We had recruited 11 cases among 4250 endoscopic exam (0.26 %). The mean age was 40 years (extreme 23 to 63 years). Female to male ratio was 1.75 with 4 males and 7 females patients. The main indications of endoscopic examination were frequently associated and were dominated by intermittent bleeding (8 cases) chronic constipation (6 cases) and false chronic diarrhea with muco hemorrhagic discharge (4 cases). The mean duration of the symptoms was 5 years. Ulcers were ovoid or circular. Their mean diameter was 8 mm and they were located 8 cm above the anal margin. The lesion was unique in 55 % of the cases and concerned the anterior wall of the rectum in 74% of the cases. There was an internal rectal prolapse in 54% of the cases. CONCLUSION: The solitary rectal ulcer syndrome is not frequent in the endoscopy unit of hospital Aristide Le Dantec in Dakar. It affects mostly young adult female. The symptoms are chronic and non specific. In tropical areas the disease is frequently misdiagnosed as colic amoebiasis.