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African Journal of Rheumatology

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Prevalence of gastroduodenal lesions in chronic nonsteroidal anti-inflammatory drug users presenting with dyspepsia at the Kenyatta National Hospital

W Wanjohi, E Ogutu, GO Oyoo, HM Kioko, K Radia, TM Mutie

Abstract


Background: Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) are among the most widely prescribed and used classes of drugs worldwide. They are known to cause gastroduodenal mucosal damage and can result in ulcerations, upper gastrointestinal bleeding, perforation and even death. However, no local data exist to show the prevalence.
Objectives: The main objective was to determine the prevalence of gastroduodenal lesions seen at endoscopy and histopathology in chronic NSAID users presenting with dyspepsia at the Kenyatta National Hospital.
Design: This was a hospital-based crosssectional study.
Methods: Seventy patients aged 13 years and above, on NSAIDs for 4 weeks or more, and presenting with dyspepsia were recruited and done for endoscopies. Six biopsy specimens were taken from each patient (2 from each of the following sites: - corpus, antrum and duodenum). One specimen from each site was subjected to the rapid urease test for H. pylori detection. The remaining three were subjected to histopathological evaluation.
Results: Forty male and 25 female patients aged between 16-77 years, with a mean age of 43.4 years were studied. At endoscopy, only 10 (13.9%) patients had normal gastroduodenal mucosa. Gastritis was the most prevalent lesion occurring in 50% of the patients. Peptic ulcer disease had a point prevalence of 30.5% (duodenal ulcers 22.2%, and gastric ulcers 8.3%). Other lesions at endoscopy were duodenitis 16.7%, gastric erosions 5.6%, duodenal erosions 1.4% and hemorrhagic gastritis 1.4%. At histopathology, only 5 (6.9%) patients had normal gastroduodenal mucosa. Chronic active gastritis was the most prevalent lesion at 77.8%. Other lesions were chronic gastritis 12.5%, chemical gastritis 6.9%, duodenitis 41.7% and intestinal metaplasia 4.2%. Prevalence of H. pylori in our study population was 50%. There was no association between the gastroduodenal lesions and H. pylori infection.
Conclusions: There was a high prevalence of gastroduodenal mucosal lesions both at histopathology (93.1%) and endoscopy (86.1%) in the chronic NSAID users.



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