Upper gastrointestinal endoscopy in central Australian Aborigines

Abstract

Objectives: To examine the upper gastrointestinal endoscopic findings in Australian Aborigines in central Australia; to determine if peptic ulceration occurs in this group; and to discover whether this population shares Helicobacter pylori as a risk factor for peptic ulceration.Methods: A retrospective analysis of the records of all Aboriginal patients undergoing endoscopy at a general hospital over a two-year period.Results: Eighty-five endoscopies were performed in 64 patients. Haematemesis and melaena was the indication for 24 patients (more commonly in men) and a cause was identified in 83% of these patients; varices were the cause in 17%. Pain was an indication for 25 patients (more commonly in females) and abnormalities were detected in 64%. Peptic ulceration was found in nine patients and a further 23 had gastritis or duodenitis. Cases of oesophageal, gastric and duodenal malignancy were seen, as well as late complications of simple diseases, including gastric outlet obstruction, oesophageal stricture and cholecystoduodenal fistula formation. Of 17 gastric biopsies with evidence of inflammation, H. pylori was found in 15 (88%).Conclusion: This, the first study of upper gastrointestinal endoscopy in Aborigines, shows its usefulness in the investigation of their gastrointestinal complaints. Oesophageal varices were found to be an important cause of bleeding. Peptic ulceration associated with H. pylori was found to be common. (Med J Aust 1994; 160: 182-184) T he indications for and findings of upper gastrointestinal endoscopy in general clinical practice are well known.' but there are no published data relating to Aboriginal subjects. We undertook a review of our experience over two years and present the findings here. MethodsA retrospective review of all gastroscopies performed on Aboriginal patients from 1 January 1991 to 31 December 1992 was undertaken from endoscopy work records. At the time of endoscopy, information was recorded on ethnicity, age, sex, indications for the procedure, endoscopic findings and whether biopsies were taken. Biopsy results were obtained from pathology records, and all slides were reviewed by one of us (C P) for the presence of spiral organisms presumed to be Helicobacter pylori. Any patient undergoing more than one endoscopy was classified according to the original indication.

Prevalence of Helicobacter pylori in Indigenous Western Australians: comparison between urban and remote rural populations

“…Similarly, a 1988 serological study of north‐east Arnhem Land communities showed that less than 1% of those tested had evidence of the infection 6 . In 1994, a retrospective review carried out in Alice Springs found that upper gastrointestinal endoscopies were performed far less frequently in Indigenous patients 7 . Nevertheless, 14% of Indigenous patients who underwent gastroscopy had peptic ulcers, 36% had evidence of gastritis or duodenitis, and one had a malignant ulcer.…”

Epidemiology ofHelicobacter pyloriin Australia: a scoping review

“…Patients with non-GI related conditions, for example coronary heart disease ( Coles et al, 2003 ), diabetes ( Schimke et al, 2009 ), sudden infant death syndrome (SIDS) ( Ho et al, 2001 ), multiple sclerosis ( Pedrini et al, 2015 ) and HIV/AIDS ( Edwards et al, 1991 ) were also commonly investigated. Specific cultural groups studied included both urban and rural Aboriginal populations (8.0% of the included publications) ( Windsor et al, 2005 ; Dwyer et al, 1988b ; Pringle et al, 2015 ; Mollison et al, 1994 ; McDonald et al, 2004 ; Ritchie et al, 2009 ), newly arrived migrants (10.6% of included studies) ( Dwyer et al, 1988a ; Gibney et al, 2009 ; Chaves et al, 2009 ; Cherian et al, 2008 ; Mutch et al, 2012 ; Johnston, Smith & Roydhouse, 2012 ; Abdul Rahim et al, 2017 ; Benson, Rahim & Agrawal, 2017 ), ethnic groups such as members of the Chinese population of Melbourne (2.6% of included studies) ( Chow et al, 1995 ; Lin et al, 1991 ), and institutionalised populations (2.6% of included studies) ( Lambert et al, 1995 ; Wallace, Webb & Schluter, 2002 ). Several studies investigated groups of health professionals, hypothesised to be at greater risk of contracting H. pylori , including dentists ( Lin et al, 1998b ) gastroenterologists ( Lin et al, 1994 ) and nurses ( Robertson, Cade & Clancy, 1999 ).…”

“…Male AIDS patients ( Edwards et al, 1991 ) and females with multiple sclerosis ( Pedrini et al, 2015 ) were also found to have a low prevalence of H. pylori infection. Gastric cancer patients ( Dugué et al, 2019 ; Mitchell et al, 2008 ), institutionalised individuals ( Lambert et al, 1995 ; Wallace, Webb & Schluter, 2002 ), refugees ( Chaves et al, 2009 ; Cherian et al, 2008 ; Johnston, Smith & Roydhouse, 2012 ) and Aboriginal and Torres Strait Islander populations ( Windsor et al, 2005 ; Mollison et al, 1994 ; McDonald et al, 2004 ) typically had high prevalence of H. pylori infection. Recent prevalence estimates are lacking for vulnerable groups.…”