Use of endoscopy in diagnosis and management of patients with dysphagia in an African setting

Abstract

The objectives of this study were to define the utility of esophagogastroduodenoscopy in the diagnosis and management of patients presenting with dysphagia and to determine the relative incidence of the various causes of dysphagia in Sudan. This is a prospective, cross-sectional, descriptive, hospital-based study carried out at the endoscopy unit of Soba University Hospital, Khartoum, Sudan. All patients complaining of dysphagia underwent upper gastrointestinal endoscopy with therapeutic intervention when necessary. A total of 114 patients were enrolled in the study, with a mean age of 47 years SD +/- 19 and a male to female ratio of 1 : 1.04. A benign condition was diagnosed in 56% of the cases; this included esophageal strictures in 21% of the cases and achalasia in 14%. Malignant causes were mainly due to esophageal cancer (40.4%) and cancer of the stomach cardia (3.5%). Therapeutic intervention was attempted in 83% of the cases. Risk factors predictive of a malignant etiology were age over 40 years (P < 0.000), dysphagia lasting between 1 month and 1 year (P < 0.000), and weight loss (P < 0.000). A barium study was performed in 35 cases (31%) prior to endoscopic examination and proved to be inaccurate in three cases (8.6%). Upper gastrointestinal endoscopy in our African setting is an accurate and useful investigation in the diagnosis and management of patients presenting with dysphagia. Patients over the age of 40 years presenting with dysphagia and weight loss are more likely to have a neoplastic disease and should be referred for urgent endoscopy.

Esophageal Cancer in the Sudan: Focus on the Screening for EBV and the Surgical Management

“…Many risk factors, including EBV, may be involved in the development of esophageal cancer. Although there is no a clear-cut association between EBV infection and EC, but there is evidence that EBV infection may contribute to esophageal cancer in certain high-risk populations [12]. However, in the present study we found a prevalence of 21.5% of infection of EBV among Sudanese patients with EC.…”

“…Relatively higher prevalence rates were previously reported in some studies. In study from German investigated 37 patients with esophageal carcinoma (Esophageal squamous cell carcinomas (n=23) and adenocarcinoma (n=14)) for the presence of human EBV DNA, EBV was detected in 35% of squamous cell carcinomas and 36% of adenocarcinoma [12]. Nevertheless in the present study EBV positive was found in 27.3% of the cases of the adenocarcinoma and 21% of the cases of SCC.…”

“…However, in the Sudan, there was great improvement in the early postoperative mortality from 27% in 1986 to 10% in recent reports. The surgical treatment presented a quick symptoms of relief which suited most patients coming from distant locations and couldn't afford to stay for extended periods in the Capital [12]. The limitations in the present study include; its retrospective settings and that fact it didn't measure other factors that contribute to the etiology of EC cancer, such as smoking, alcohol use, and other viruses (HPV).…”

“…In a recent study a total of 114 patients were enrolled in the study, with a mean age of 47 years SD +/-19 and a male to female ratio of 1: 1.04. Malignant causes were mainly due to esophageal cancer (40.4%) and cancer of the stomach cardia (3.5%).Therapeutic intervention was attempted in 83% of the cases [12]. A recent published study investigated 100 consecutive patients who experienced esophagectomy in Shaab Hospital in Khartoum during the period June 2003-Aug 2007.…”

Esophagogastroduodenoscopy in a Public Referral Hospital in Lilongwe, Malawi: Spectrum of Disease and Associated Risk Factors

“…Dysphagia often is characteristic of malignancy [1,10], whereas epigastric or abdominal pain often are associated with normal findings [11,12]. However, indications and endoscopic diagnoses vary widely within sub-Saharan Africa.…”