Nigerian Journal of Gastroenterology and Hepatology

Spectrum of endoscopic findings in patients with Helicobacter pylori infection in a Nigerian tertiary institution

Fri, 08 Dec 2023 00:00:00 +0000

Background and Objectives: Helicobacter pylori is a widely prevalent infection considered a significant public health challenge. Nigeria has the highest worldwide H. pylori prevalence. It is a notable cause of gastric cancer; thus, prompt diagnosis and treatment are required for eradication. The study aimed to determine the spectrum of endoscopic findings in patients with H. pylori infection at the University of Calabar Teaching Hospital.

Materials and Methods: This was a retrospective cross-sectional study over a 4-year period on dyspeptic patients who presented at the hospital. Diagnosis of H. pylori infection was made through non-invasive techniques and patients who tested positive for H. pylori and were further assessed with upper gastrointestinal endoscopy were included in the study. A descriptive analysis of the data obtained was carried out using SPSS version 20.

Results: One hundred and twenty-nine patients tested positive for H. pylori infection (46%) out of the two hundred and eighty dyspeptic patients evaluated during the period under study. However, only fifty-two (52) out of 129 dyspeptic patients who tested positive for H. pylori had upper gastrointestinal endoscopy and thus met the inclusion criteria. Upper gastrointestinal endoscopy revealed predominantly gastritis 37 (71.15%). This was followed by esophagitis in two (7.7%), duodenal ulcer two (3.8%), gastric ulcer three (5.8%), gastro-duodenitis four (7.7%), and gastric malignancy in two (3.8%) patients.

Conclusion: Our study revealed that gastritis was the predominant endoscopic finding in patients with H. pylori infection. This finding is particularly significant because of the risk of development of gastric cancer in these patients from recurrent episodes of gastritis following late diagnosis and inappropriate treatment.

The Prognostic Significance of the Rockall score evaluation in patients admitted for upper gastrointestinal bleeding in Yaoundé (Cameroon)

Fri, 08 Dec 2023 00:00:00 +0000

Background and Objectives: Upper gastrointestinal bleeding (UGIB) is a major emergency. The Rockall score (RS) could be a tool to predict the outcome of patients regarding their risk of re-bleeding and/or death 30 days after admission. This study aimed to evaluate the prognostic value of the RS in patients admitted for UGIB in Yaoundé (Cameroon).

Materials and Methods: We conducted a retrospective cohort study at two emergency units inYaoundé. We included 101 patients admitted from 2020 to 2021 for a UGIB and obtained the sociodemographic, clinical, and paraclinical data. The outcome 30 days after the admission was assessed (re-bleeding and/or death). We calculated the RS and analyzed the association of an RS ≥ 5 with the death of the patient and/or a re-bleeding 30 days after admission.

Results: The mean age of patients was 48.5 years, 75 of the 101 were males (74.3%). The main bleeding lesions were portal hypertension in 35 patients (34.7%), gastric ulcers in 32 patients (31.7%), and duodenal ulcers in 30 patients (29.7%). During the 30 days after the admission, we recorded re-bleeding in 21 patients (20.8%) and death in 9 patients (8.9%). The RS was ≥ 5 in 49 patients (48.5%), and this was significantly associated with the re-bleeding (RR 4.5; CI 95% 1.631–12.459; P = 0.001) and with the death (P = 0.001).

Conclusion: The RS ≥ 5 is associated with a risk of re-bleeding and/or death in patients admitted for a UGIB in Yaoundé regardless of the aetiology.

Upper gastrointestinal endoscopy findings in adults with dyspepsia younger than 60 years in Lagos, Nigeria

Fri, 08 Dec 2023 00:00:00 +0000

Background and Objectives: Recent guidelines from international gastroenterology bodies recommend that upper gastrointestinal endoscopy (UGIE) should not be routinely performed in patients with dyspepsia who are younger than 60 years old as the yield for major abnormalities is low. The objectives of this study were to determine the spectrum of UGIE findings in patients with dyspepsia who are younger than 60 years and to document the association of alarm features with UGIE findings in them.

Materials and Methods: This is a retrospective study of the UGIE records of adult patients younger than 60 years with dyspepsia at five centers in Lagos, Nigeria, between June 2016 and December 2020. UGIE findings were categorized as major (gastric or duodenal ulcers, esophageal varices, masses suspected to be cancer, strictures, and foreign bodies), minor (erosions or inflammation), or normal.

Results: There were 1499 adult patients with dyspepsia who were younger than 60 years, 796 (53.1%) females, mean age 40.9±9.8 years, and 158 (10.5%) with at least one alarm feature. Major findings were seen in 194 (12.9%), minor findings in 1023 (68.2%), and no abnormalities were seen in 282 (18.8%). Alarm features, or age 40 years and above, were associated with major findings. Half of all gastric cancers were seen in patients younger than 50 years, and of these, 70% occurred within the 40–49 age group.

Conclusion: This study shows that the prevalence of UGIE findings in patients with dyspepsia who are younger than 60 years is high, and major findings are common in those with alarm features or who are aged 40 years and above. We recommend endoscopy for the evaluation of dyspepsia in those who have alarm features or are aged at least 40 years.

Annona senegalensis stem bark extracts attenuated doxorubicin-induced hepatotoxicity and mitochondrial oxidative damage in Wistar strain albino rats

Fri, 08 Dec 2023 00:00:00 +0000

Background and Objective: Doxorubicin (DOX)- an anthracycline is a well-known anticancer agent but its limitation lies in it hepato- and cardio-toxicity involving the mitochondrial redox pathway. Thus, there is need for chemoprotective agents to serve as interventions for militating against toxicity during cancer management. This study investigated the protective potential of Annona senegalensis stem bark extracts (ASE) on DOX-induced mitochondrial membrane damage and oxidative stress in albino rats’ livers.

Materials and Methods: ASE was subjected to phytochemical screening. Thirty male Wistar strain albino rats (13 weeks old; 150–160g) were randomly divided into Groups A (control) received distilled water, Groups B, C, D, E, and F received DOX-only (20mg/kg), DOX (20mg/kg) + ASE (100mg/kg), DOX (20mg/kg) + ASE (200mg/kg), DOX (20mg/kg) + ASE (400mg/kg), ASE (400mg/kg) only, respectively (n = 5 per group). Groups that received ASE were pre-administered for 7 days before intraperitoneal administration of DOX on day 7. Rats were sacrificed, oxidative stress and liver membrane damage were evaluated.

Results: Tannin, saponin, phenol, flavonoids, alkaloids, terpenoids, reducing sugar, and cardiac glycosides were present, while combined and free anthraquinone were absent in ASE. The total flavonoid, phenol, tannin, and reducing sugar content of ASE were 13.11±1.09, 27.19±0.61, 8.98±1.2, and 27.3±1.6mg gallic acid equivalent, respectively. Activities of catalase, superoxide dismutase, and level of glutathione in both hepatic mitochondrial membrane and post-mitochondrial fractions (PMF) increased concentration-dependently in ASE pretreated compared to DOX-only-treated animals. Malondialdehyde levels significantly (P < 0.05) decreased concentration-dependently.

Conclusions: ASE has chemoprotective potential on liver mitochondria and PMF against DOX-induced toxicity attributable to its constituent phytochemicals.

Gall bladder heterotopia: Uncommon two cases and review of variations

Fri, 08 Dec 2023 00:00:00 +0000

Background and Objectives: Heterotopia in the gallbladder is a rare condition where normal tissue occurs in an abnormal location. This case report aimed to describe two cases of heterotopia in the gallbladder, one with gastric mucosa and the other with pancreatic tissue. The objective is to provide a better understanding of the clinical presentation, histological findings, and associated anomalies of heterotopia in the gallbladder.

Materials and Methods: The cases were identified through patient records and macroscopic examination. Clinical data, radiological findings, and histopathological analysis were collected and analyzed.

Results: Case 1 presented with intermittent abdominal pain and was diagnosed with cholelithiasis. Gross examination revealed a gallbladder with ulcerated mucosa and a cystic area. Histological examination confirmed the presence of gastric heterotopia. Case 2 underwent laparoscopic cholecystectomy for a firm lesion in the neck of the gallbladder. Histopathological analysis showed chronic cholecystitis and heterotopic pancreatic tissue.

Conclusion: Heterotopia in the gallbladder is a rare condition associated with various types of heterotopic tissues. Gastric heterotopia is the most common type, followed by pancreatic, hepatic, thyroid, and adrenal heterotopias. The exact cause of heterotopia in the gallbladder is unknown, but it is believed to be a congenital disorder. Treatment options vary, and further studies are needed to understand the incidence and development of heterotopia in the gallbladder.

Selected Abstracts Presented At The Annual General Meeting And Scientific Conference Of The Society For Gastroenterology and Hepatology in Nigeria (Soghin), Enugu, July 2023

Fri, 08 Dec 2023 00:00:00 +0000

No Abstract

Atypical presentation of hydatid cyst with anchovy sauce liver aspirate

Fri, 08 Dec 2023 00:00:00 +0000

Background: Hydatid disease is a zoonotic parasitic infestation caused by cysts containing the larva stages of tapeworm of the genus Echinococcus. Cystic echinococcosis (CE) and alveolar echinococcosis are the two most important forms in humans. CE accounts for 95% of human infection and is usually a clear fluid cystic disease with the liver being the most frequently affected organ. Other organs that could be affected include the lungs, muscles, bone, spleen, heart, and brain.

Case Presentation: We report a case of a 53-year-old man who presented with 5-week history of cough, 2-week history of abdominal pain, and 1-day history of difficulty with breathing. Examination revealed a middle-aged man in respiratory distress with tender hepatomegaly and features of bilateral pleural effusion. An abdominal ultrasound scan revealed cysts in both lobes of the liver. He also had elevated liver enzymes as well as eosinophilia. The patient could not afford to do a serological test for hydatid cyst. The patient had percutaneous liver aspiration which revealed an anchovy paste aspirate. We initially entertained the possibility of an amoebic liver abscess for which he had antibiotics for one month without any improvement. We eventually considered hydatid cyst as our diagnosis, and he made a remarkable improvement after the commencement of a therapeutic trial of albendazole. Informed consent was obtained from the patient for this case report.

Conclusion: Hydatid cysts should be strongly considered as part of the differential diagnosis when in contact with any patient with cystic liver disease irrespective of the color or appearance of the liver aspirate.