Trends in upper gastrointestinal diagnosis over four decades in Lusaka, Zambia: a retrospective analysis of endoscopic findings

Abstract

Background and aimsThere 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.MethodsWritten 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.ResultsSixteen 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.ConclusionsThis 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.

The Practice of Interventional Gastrointestinal Endoscopy at a Tertiary Referral Hospital

“…Portal hypertension secondary to schistosomal fibrosis is still common in Kenya complicating into upper GI bleeding (9). Kayamba et al in a study on trends of upper GI endoscopy in Zambia, showed that Esophageal varices were the commonest finding in patients presenting with haematemesis, increasing by 14 % per decade in that patient group (19) Evolution from injection sclerotherapy to endoscopic variceal ligation is portrayed in our findings as well as other studies (12,20). All patients with esophageal varices underwent variceal band ligation.…”

Tranexamic acid for acute gastrointestinal bleeding (The HALT-IT trial): Statistical analysis plan for an international, randomised, double blind, placebo-controlled trial

“…Peptic ulcer disease and erosions due to Helicobacter pylori infection and NSAID use are common causes of GI bleeding worldwide [1,6,10,12,18,[21][22][23][24][25]. Bleeding from gastro-oesophageal varices due to liver cirrhosis is an increasing cause of bleeding in the West, but is also a major cause in parts of South America, Asia, Africa and the Middle East where there is high prevalence of hepatitis or schistosomiasis [26][27][28][29][30][31][32][33]. Symptoms of GI bleeding include hematemesis and coffee grounds vomitus, melaena and the passage of fresh red blood in the stool, and clinical signs of shock such as hypotension and tachycardia.…”

Tranexamic acid for acute gastrointestinal bleeding (The HALT-IT trial): Statistical analysis plan for an international, randomised, double blind, placebo-controlled trial

“…Peptic ulcer disease and erosions due to Helicobacter pylori infection and non-steroidal antiinflammatory drug (NSAID) use are common causes of GI bleeding worldwide [1,6,10,12,18,[21][22][23][24][25]. Bleeding from gastro-oesophageal varices due to liver cirrhosis is an increasing cause of bleeding in the West, but is also a major cause in parts of South America, Asia, Africa and the Middle East where there is high prevalence of hepatitis or schistosomiasis [26][27][28][29][30][31][32][33]. Symptoms of GI bleeding include haematemesis and coffee ground vomitus, melaena and the passage of fresh red blood in the stool, and clinical signs of shock such as hypotension and tachycardia.…”