Gastro-duodenal disease in Africa: Literature review and clinical data from Accra, Ghana

Abstract

Gastroduodenal disease (GDD) was initially thought to be uncommon in Africa. Amongst others, lack of access to optimal health infrastructure and suspicion of conventional medicine resulted in the reported prevalence of GDD being significantly lower than that in other areas of the world. Following the increasing availability of flexible upper gastro-intestinal endoscopy, it has now become apparent that GDD, especially peptic ulcer disease (PUD), is prevalent across the continent of Africa. Recognised risk factors for gastric cancer (GCA) include Helicobater pylori ( H. pylori ), diet, Epstein-Barr virus infection and industrial chemical exposure, while those for PUD are H. pylori , non-steroidal anti-inflammatory drug (NSAID)-use, smoking and alcohol consumption. Of these, H. pylori is generally accepted to be causally related to the development of atrophic gastritis (AG), intestinal metaplasia (IM), PUD and distal GCA. Here, we perform a systematic review of the patterns of GDD across Africa obtained with endoscopy, and complement the analysis with new data obtained on pre-malignant gastric his-topathological lesions in Accra, Ghana which was compared with previous data from Maputo, Mozambique. As there is a general lack of structured cohort studies in Africa, we also considered endoscopy-based hospital or tertiary centre studies of symptomatic individuals. In Africa, there is considerable heterogeneity in the prevalence of PUD with no clear geographical patterns. Furthermore, there are differences in PUD within-country despite universally endemic H. pylori infection. PUD is not uncommon in Africa. Most of the African tertiary-centre studies had higher prevalence of PUD when compared with similar studies in western countries. An additional intriguing observation is a recent, ongoing decline in PUD in some African countries where H. pylori infection is still high. One possible reason for the high, sustained prevalence of PUD may be the significant use of NSAIDs in local or over-the-counter preparations. The prevalence of AG and IM, were similar or modestly higher over rates in western countries but lower than those seen in Asia. . In our new data, sampling of 136 patients in Accra detected evidence of pre-malignant lesions (AG and/or IM) in 20 individuals (14.7%). Likewise, the prevalence of pre-malignant lesions, in a sample of 109 patients from Maputo, were 8.3% AG and 8.3% IM. While H. pylori is endemic in Africa, the observed prevalence for GCA is rather low. However, cancer data is drawn from country cancer registries that are not comprehensive due to considerable variation in the availability of efficient local cancer reporting systems, diagnostic health facilities and expertise. Validation of cases and their source as well as specificity of outcome definitions are not explicit in most studies further contributing to uncertainty about the precise incidence rates of G...

Inmunotipificación de linfocitos en mucosa gástrica de pacientes infectados por H. pylori en dos regiones geográficas con contraste en el riesgo de desarrollar cáncer gástrico

“…En Tumaco fue más frecuente la gastritis no atrófica similar a la descrita en pacientes con ulcera duodenal causada por H. pylori que tiene una gastritis de predominio en el antro gástrico sin pérdida de glándulas (atrofia), denominada gastritis no atrófica o gastritis antral difusa, y se ha demostrado en otras investigaciones que dichos pacientes no presentaran tasas elevadas de cáncer gástrico 10 . En Pasto la gastritis predominante fue acompañada por atrofia multifocal y metaplasia intestinal, en estas condiciones puede ser frecuente la ulcera gástrica con riesgo elevado de cáncer gástrico 21 .…”

Knowledge, Attitude, and Practice of Health Care Workers in the Management of Peptic Ulcer at the Paul VI and the Bogodogo District Hospitals, in Burkina Faso

“…In Sub Saharan Africa, PUD is an important issue and impacts diversely the populations (Archampong et al, 2019). Studies carried out in Mali, the Republic of Côte d'Ivoire, Burundi and Congo Brazzaville found prevalences of 10.10%, 6.80%, 44.90%, and 30.40%, respectively (Togola et al, 2015, DIARRA et al, 2009, NDABA-NEZE et al, 1990, IBARA et al, 1993.…”

Upper gastrointestinal endoscopy findings in Mbale Regional Referral Hospital, Eastern Uganda: a 10-year retrospective analysis

“…Upper GI endoscopy is the only method of obtaining tissue biopsy for formal diagnosis of OC. Peptic ulcer disease has a high prevalence in East Africa 1 . PUD requires early diagnosis and treatment as complications such as bleeding or perforation can carry significant morbidity and mortality 11 .…”

“…Symptoms attributable to the upper gastrointestinal (UGI) tract such as dysphagia, dyspepsia and haematemesis have previously been reported as common in East Africa 1 . The limited investigation capacity and possible lower community awareness may be responsible for lack of data on prevalence, risk factors, early definitive diagnosis, disease progression, and outcomes of UGI pathology in these settings.…”