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Ray-Offor E, Egboh SM, Ijah RFOA, Hany Emile S, Wexner SD. Colonic Diverticulosis at Colonoscopy in Africa: A Systematic Review and Meta-Analysis of Pooled Estimates. Dig Surg 2024; 41:63-78. [PMID: 38377978 DOI: 10.1159/000536587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/15/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION There is need to ascertain any epidemiologic shift of diverticulosis among Africans with traditionally high fiber diet consumption patterns and rare diverticulosis prevalence. METHODS We systematically searched PubMed, Scopus, Cochrane Library, African Journal Online (AJOL), and Google Scholar. Eligibility criteria included full-text observational and experimental human colonoscopy studies on asymptomatic and symptomatic African population from 1985 to 2022. Case reports, conference abstracts, dissertations, systematic reviews, and studies lacking colonoscopy findings were excluded. NIH quality assessment tool for observational cohort and cross-sectional studies was used to assess risk of bias. Meta-analysis was performed using the random-effect model. Heterogeneity was assessed using inconsistency (I2) statistics. RESULTS Thirty studies were included. Pooled prevalence rate of colonic diverticulosis in the last decade (2012-2022) has increased to 9.7% (95% CI 6.5-13.4; I2 = 97.3%) from 3.5% (95% CI 1.4-6.4; I2 = 62.7%). The highest regional prevalence rate was in West African studies at 11.3% (95% CI 7.6-14.9; I2 = 96.2%). Proportion of individuals with diverticulosis ≥50 years and male sex were 86.9% (95% CI 80.5-92.1) and 65.2% (95% CI 55.0-74.8), respectively. The left colon had the highest diverticulosis frequency (37% [148/400]). Bleeding/inflammation complications were sparingly detected (OR 0.2 [95% CI 0.03-0.75; p < 0.0001]). CONCLUSION An increasing utilization of colonoscopy revealed approximately a threefold increase in the prevalence rate of colonic diverticulosis in Africa. This pathology was most common in males aged >50. Left colon was predominantly affected. Further studies are needed to demonstrate the effect of westernization of diet.
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Affiliation(s)
- Emeka Ray-Offor
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Department of Surgery, University of Port Harcourt Choba, Choba, Nigeria
| | - Stella-Maris Egboh
- Department of Internal Medicine, Federal Medical Centre Yenagoa, Yenagoa, Nigeria
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rex F O A Ijah
- Department of Surgery, Rivers State University/University Teaching Hospital, Port Harcourt, Nigeria
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
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Odeghe EA, Owoseni OO, Chukwudike ES, Adeniyi OF, Adigun BE, Oyeleke GK, Oluyemi AO, Lesi OA. Appropriateness and diagnostic yield of open access gastroscopy in two tertiary centers in South-western Nigeria. Afr Health Sci 2023; 23:386-392. [PMID: 38223609 PMCID: PMC10782350 DOI: 10.4314/ahs.v23i2.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background There is need for the appropriate use of gastroscopy. Objective To determine the appropriateness of upper gastrointestinal endoscopy, and its association with significant endoscopy findings in our environment. Methods This was a prospective study of subjects who underwent gastroscopy at two centers in south-western Nigeria between August 2020 and August 2021. Indications were classified as either appropriate or inappropriate according to the ASGE guidelines, gastroscopic findings as either significant or not significant, patients as either elderly (≥ 60 years) or not, inpatients or outpatients, and referrals as either gastroenterologist referral, or not. Results There were 227 subjects, 131 (57.7%) females, mean age 45 ± 13.7 years. Fifteen percent were elderly, 65.6% were gastroenterologist referrals, 14.1% were inpatients, while 45.8% had co-morbidities. Endoscopy was appropriately indicated in 81.9%, and significant endoscopy findings were detected in 95.6%. Appropriateness was not associated with significant endoscopy findings. The sensitivity, specificity and AUROC of the ASGE guidelines were 10%, 82%, and 0.46 respectively. Conclusion According to our study, most procedures are appropriately indicated. However, appropriateness did not determine endoscopy yield. Larger studies are needed to determine the utility of the ASGE guidelines in our environment.
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Affiliation(s)
- Emuobor A Odeghe
- Medicine department, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | | | | | | | | | - Ganiyat K Oyeleke
- Medicine department, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Olufunmilayo A Lesi
- Medicine department, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
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Naseer O, Bashir Rishi M, Gelia AM, Saad Taggaz K, Zawia AM, Sadeq Elarifi M, Alsaghir ID. Clinical Characteristics and Main Findings of Colonoscopy in Tripoli Central Hospital: A Cross-Sectional Study of 1858 Patients. Cureus 2023; 15:e34983. [PMID: 36938214 PMCID: PMC10019830 DOI: 10.7759/cureus.34983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction Colonoscopy is used to detect colorectal abnormalities, including inflammatory bowel disease, polyps, cancers, and other colorectal lesions. We aimed to analyze the demographic and clinical characteristics, main findings, and indications of patients who underwent colonoscopy in the Surgery department of Tripoli Central Hospital in Libya. Methods The study data were retrospectively extracted from the medical in and out-patient records of individuals who underwent colonoscopy procedures between December 2009 and December 2016 in the general surgery department of Tripoli General Hospital. Results A total of 1858 patients underwent colonoscopy during the study period with a mean age of 51.7 ± 18.5 years. Hematochezia was the most common patient complaint (530; 28.5%), followed by constipation (354; 19.1%), and weight loss (178; 9.6%), respectively. Seven-hundred sixty-five (765; 41.2%) participants completed the procedure, 420 (22.6%) did not, and 673 (36.2%) participants failed the colonoscopy. The most common reasons for procedure failure were failed preparation (609; 55.7%), followed by patient intolerance (251; 23.0%), and obstructive lesions (229; 21.0%). The most common finding was colonic masses, followed by polyps (29.0% and 20.8%, respectively). Conclusion This study describes the characteristics of colonoscopy patients in the largest surgical center in Libya over seven years. Hematochezia and chronic constipation were the most common complaints among the participants with reported complaints. Half of the colonoscopy procedures are incomplete or failed due to the lack of patient preparation. Colonic masses and polyps were the most common among the reported colonoscopic findings. Future research to increase the quality of colonoscopy service and patient preparations in Libya is required.
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Affiliation(s)
- Osama Naseer
- General Surgery Department, Tripoli Central Hospital, Tripoli, LBY
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Ayodele SO, Aremu SK. The Cost of Setting Up an ENT Endoscopic Practice in Lower Middle-Income Countries of Sub-Saharan Africa. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:104-108. [PMID: 36213808 PMCID: PMC9536405 DOI: 10.4103/jwas.jwas_57_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/13/2022] [Indexed: 06/16/2023]
Abstract
Ear, nose, and throat (ENT) surgeons in developing countries are constrained to practicing with lower technology, lower cost surgery, and reliance on outdated surgical techniques carried out with improvised instruments when compared with their counterparts in the developed world. In this review, we planned to lay open the bottle necks militating against setting up an ENT endoscopy practice in our setting with possible outcomes. The literature search was carried out to retrieve relevant published articles, books, and guidelines. Unpublished literatures were excluded. The search was limited to articles in English. ENT clinical practice in lower middle-income countries (LMICs) where there are limited or no ENT endoscopic setup due to high cost of procurement and maintenance, human resources, lack of subspecialty training, and inadequate funding by policy makers poses major challenges that can militate against the provision of adequate and effective surgical management. A continually improved management practices will positively affect the organisational structure, efficiency, and safety of a system. That is, an affordable and standard ENT endoscopic setup will go a long way to improve the access to training and practice for both ENT clinical and surgical purposes. The expansion of ENT endoscopic specialist training will improve both the diagnostic and therapeutic acumen in ENT practice in LMICs. The budget for health and the health-funding systems of our institutions must receive special and specific attentions tailored towards putting our health facilities in better shapes, subspecialty training, and procurement of state-of-the-art endoscopic equipment with proper plans on maintenance culture.
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Affiliation(s)
- Samuel Oluyomi Ayodele
- ENT Department, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun, Nigeria
| | - Shuaib Kayode Aremu
- College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti, Nigeria
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Ilic M, Ilic I. Epidemiology of stomach cancer. World J Gastroenterol 2022; 28:1187-1203. [PMID: 35431510 PMCID: PMC8968487 DOI: 10.3748/wjg.v28.i12.1187] [Citation(s) in RCA: 112] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/30/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
Despite a decline in incidence and mortality during the last decades, stomach cancer is one of the main health challenges worldwide. According to the GLOBOCAN 2020 estimates, stomach cancer caused approximately 800000 deaths (accounting for 7.7% of all cancer deaths), and ranks as the fourth leading cause of cancer deaths in both genders combined. About 1.1 million new cases of stomach cancer were diagnosed in 2020 (accounting for 5.6% of all cancer cases). About 75% of all new cases and all deaths from stomach cancer are reported in Asia. Stomach cancer is one of the most lethal malignant tumors, with a five-year survival rate of around 20%. There are some well-established risk factors for stomach cancer: Helicobacter pylori infection, dietary factors, tobacco, obesity, and radiation. To date, the most important way of preventing stomach cancer is reduced exposure to risk factors, as well as screening and early detection. Further research on risk factors can help identify various opportunities for more effective prevention. Screening programs for stomach cancer have been implemented in a few countries, either as a national or opportunistic screening of high-risk individuals only. Generally, due to its high aggressiveness and heterogeneity, stomach cancer still remains a severe global health problem.
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Affiliation(s)
- Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia
| | - Irena Ilic
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
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Oluseyi Akande K, Oke TO, Afuwape O, Adigun TA, Akere A, Aje A, Ola SO, Otegbayo JA. Spectrum and pattern of distribution of findings in patients with dyspepsia undergoing oesophago-gastro-duodenoscopy at a Tertiary Hospital in Ibadan, south west, Nigeria. ALEXANDRIA JOURNAL OF MEDICINE 2021. [DOI: 10.1080/20905068.2021.1913890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Affiliation(s)
- Kolawole Oluseyi Akande
- Department of Medicine, College of Medicine, Gastroenterology & Hepatology Unit, University of Ibadan, Ibadan, Nigeria
| | - Temitope Olufemi Oke
- Department of Medicine, Gastroenterology & Hepatology Unit, University College Hospital, Ibadan, Nigeria
| | - Oludolapo Afuwape
- Department of Surgery, College of Medicine, Division of Gastrointestinal Surgery, University of Ibadan, Ibadan, Nigeria
| | | | - Adegboyega Akere
- Department of Medicine, College of Medicine, Gastroenterology & Hepatology Unit, University of Ibadan, Ibadan, Nigeria
| | - Ajibola Aje
- Department of Medicine, Gastroenterology & Hepatology Unit, University College Hospital, Ibadan, Nigeria
| | - Samuel Olawale Ola
- Department of Medicine, College of Medicine, Gastroenterology & Hepatology Unit, University of Ibadan, Ibadan, Nigeria
| | - Jesse Abiodun Otegbayo
- Department of Medicine, College of Medicine, Gastroenterology & Hepatology Unit, University of Ibadan, Ibadan, Nigeria
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Knapp GC, Alatise O, Olopade B, Samson M, Olasehinde O, Wuraola F, Odujoko OO, Komolafe AO, Arije OO, Castle PE, Smith JJ, Weiser MR, Kingham TP. Feasibility and performance of the fecal immunochemical test (FIT) for average-risk colorectal cancer screening in Nigeria. PLoS One 2021; 16:e0243587. [PMID: 33434195 PMCID: PMC7802943 DOI: 10.1371/journal.pone.0243587] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction There is a paucity of prospective data on the performance of the fecal immunochemical test (FIT) for colorectal cancer (CRC) screening in sub-Saharan Africa. The aim of this exploratory analysis was to evaluate the feasibility and performance of FIT in Nigeria. Methods This was a prospective, single-arm study. A convenience sample of asymptomatic, average-risk individuals between 40–75 years of age were enrolled at Obafemi Awolowo University Teaching Hospital. Study participants returned in 48 hours with a specimen for ova and parasite (O&P) and qualitative FIT (50ug/g) testing. Participants with a positive FIT had follow-up colonoscopy and those with intestinal parasites were provided treatment. Results Between May-June 2019, 379 individuals enrolled with a median age of 51 years (IQR 46–58). In total, 87.6% (n = 332) returned for FIT testing. FIT positivity was 20.5% (95% CI = 16.3%-25.2%). Sixty-one (89.7%) of participants with a positive FIT had a follow-up colonoscopy (n = 61), of whom 9.8% (95%CI:3.7–20.2%) had an adenoma and 4.9% (95%CI:1.0–13.7%) had advanced adenomas. Presence of intestinal parasites was inversely related to FIT positivity (6.5% with vs. 21.1% without parasites, p = 0.05). Eighty-two percent of participants found the FIT easy to use and 100% would recommend the test to eligible family or friends if available. Conclusions Asymptomatic, FIT-based CRC screening was feasible and well tolerated in this exploratory analysis. However, the high FIT positivity and low positive predictive value for advanced neoplasia raises concerns about its practicality and cost effectiveness in a low-resource setting such as Nigeria.
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Affiliation(s)
- Gregory C. Knapp
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- * E-mail:
| | - Olusegun Alatise
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Bolatito Olopade
- Department of Medical Microbiology and Parasitology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Marguerite Samson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Olalekan Olasehinde
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Funmilola Wuraola
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Oluwole O. Odujoko
- Department of Morbid Anatomy and Forensic Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Akinwunmi O. Komolafe
- Department of Morbid Anatomy and Forensic Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olujide O. Arije
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Philip E. Castle
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - J. Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Martin R. Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
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Holowatyj AN, Maude AS, Musa HS, Adamu A, Ibrahim S, Abdullahi A, Manko M, Aminu SM, Mohammed A, Idoko J, Ukwenya Y, Carpten J, Chandler PD, Hampel H, Faruk M. Patterns of Early-Onset Colorectal Cancer Among Nigerians and African Americans. JCO Glob Oncol 2020; 6:1647-1655. [PMID: 33141623 PMCID: PMC7713583 DOI: 10.1200/go.20.00272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Colorectal cancer (CRC) incidence rates are increasing among individuals < 50 years of age (early-onset CRC) globally with causes unknown. Racial/ethnic disparities in early-onset CRC have also grown more pronounced, because Black individuals have higher early-onset CRC incidence and poorer survival compared with White individuals. We describe the prevalence and burden of early-onset CRC among Africans in Nigeria and African Americans (AAs) in the United States. PATIENTS AND METHODS We identified Black individuals diagnosed with a first primary CRC ages 18 to 49 years between 1989 and 2017 at Ahmadu Bello University Teaching Hospital in Zaria, Nigeria (Nigerians), and in the United States (AAs) using the National Institutes of Health/National Cancer Institute's SEER program of cancer registries. Multivariable logistic regression models were used to investigate clinical and demographic differences between Nigerians and AAs with early-onset CRC, adjusted for age, sex, tumor site, and histology. RESULTS A total of 5,019 Black individuals were diagnosed with early-onset CRC over the study period (379 Nigerians; 4,640 AAs). Overall, approximately one third of young Black patients were diagnosed with rectal tumors (35.8%). Nigerian individuals with early-onset CRC were eight-fold more likely to be diagnosed with rectal tumors (odds ratio [OR], 8.14; 95% CI, 6.23 to 10.62; P < .0001) and more likely to be diagnosed at younger ages (OR, 0.87; 95% CI, 0.86 to 0.89; P < .0001) compared with young African Americans in adjusted models. CONCLUSION Compared with AA individuals diagnosed with early-onset CRC, Nigerian individuals harbor distinct features of early-onset CRC. Additional investigation of the histopathologic and biologic heterogeneity of early-onset CRCs among Black individuals is critical for understanding racial disparities in susceptibility and outcomes, which may have implications for tailored early-onset CRC prevention, detection, and treatment strategies.
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Affiliation(s)
- Andreana N. Holowatyj
- Department of Medicine, Vanderbilt University Medical Center; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Aishatu Suleiman Maude
- Department of Haematology and Blood Transfusion, Faculty of Basic Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | | | - Ahmed Adamu
- Department of Surgery, Faculty of Basic Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Sani Ibrahim
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Adamu Abdullahi
- Department of Radiotherapy and Oncology, Faculty of Basic Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Muhammad Manko
- Department of Medicine, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Sirajo Mohammed Aminu
- Department of Haematology and Blood Transfusion, Faculty of Basic Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Abdullahi Mohammed
- Department of Pathology, College of Medical Sciences, Faculty of Basic Clinical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - John Idoko
- Department of Pathology, College of Medical Sciences, Faculty of Basic Clinical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Yahaya Ukwenya
- Department of Surgery, Faculty of Basic Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - John Carpten
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Paulette D. Chandler
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Heather Hampel
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Mohammed Faruk
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
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Knapp GC, Alatise OI, Olasehinde OO, Adeyeye A, Ayandipo OO, Weiser MR, Kingham TP. Is Colorectal Cancer Screening Appropriate in Nigeria? J Glob Oncol 2020; 5:1-10. [PMID: 31170018 PMCID: PMC6613663 DOI: 10.1200/jgo.19.00035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The global burden of colorectal cancer (CRC) will continue to increase for the foreseeable future, largely driven by increasing incidence and mortality in low- and middle-income countries (LMICs) such as Nigeria. METHODS We used the Wilson-Jungner framework (1968) to review the literature relevant to CRC screening in Nigeria and propose areas for future research and investment. RESULTS Screening is effective when the condition sought is both important and treatable within the system under evaluation. The incidence of CRC is likely increasing, although the exact burden of disease in Nigeria remains poorly understood and access to definitive diagnosis and treatment has not been systematically quantified. In high-income countries (HICs), CRC screening builds on a well-known natural history. In Nigeria, a higher proportion of CRC seems to demonstrate microsatellite instability, which is dissimilar to the molecular profile in HICs. Prospective trials, tissue banking, and next-generation sequencing should be leveraged to better understand these potential differences and the implications for screening. Fecal immunochemical test for hemoglobin (FIT) is recommended for LMICs that are considering CRC screening. However, FIT has not been validated in Nigeria, and questions about the impact of high ambient temperature, endemic parasitic infection, and feasibility remain unanswered. Prospective trials are needed to validate the efficacy of stool-based screening, and these trials should consider concomitant ova and parasite testing. CONCLUSION Using the Wilson-Jungner framework, additional work is needed before organized CRC screening will be effective in Nigeria. These deficits can be addressed without missing the window to mitigate the increasing burden of CRC in the medium to long term.
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Kayamba V, Nicholls K, Morgan C, Kelly P. A seven-year retrospective review of colonoscopy records from a single centre in Zambia. Malawi Med J 2018; 30:17-21. [PMID: 29868154 PMCID: PMC5974381 DOI: 10.4314/mmj.v30i1.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction Colorectal disease is common throughout the world, but the spectrum of diagnoses across Africa remains largely unexplored. There is anecdotal evidence of changing colorectal disease but this has not been systematically investigated. The aim of this study was to enhance our insight into the spectrum of colonoscopic diagnoses in Zambia. Methods We retrieved written colonoscopy reports from January 2008 to December 2015. Collected data were coded by experienced endoscopists and analysed by age, sex, referral source, indication and diagnosis. Results Included in this analysis were 573 colonoscopy reports. The most common diagnosis was haemorrhoids (n=151, 26%), followed by tumours (n=96,17%). Over this time period, the proportion of normal colonoscopies decreased by 32% (P<0.001), presumably due to introduction of screening of all requests, while the rate of polyp detection increased from 5% to 10% (P=0.006). The detection of polyps was highest in patients less than 16 years (OR 8.4; 95% CI 2.4–26.2, P<0.001). Of those with colorectal tumours, 33/96 (35%) were less than 45 years although the occurrence was higher with advancing age (P=0.02). Diverticular disease was more common in older age groups (median (IQR) age 70 (60–75) years, versus 47 (34–62) years for those without the disease; P=0.0001). Conclusion This audit has shown that more than a third of colorectal tumours seen during colonoscopy are in patients below the age of 45 years, with the occurrence of polyps being highest in those below 16 years. Diverticular disease is most common in older age groups.
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Affiliation(s)
- Violet Kayamba
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Kate Nicholls
- Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, United Kingdom
| | - Catrin Morgan
- Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, United Kingdom
| | - Paul Kelly
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia.,Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, United Kingdom
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Ngouala GABB, Bourgi L, Veiga JAID, Sakho A. [Upper gastrointestinal (UGI) endoscopy in Louga (Senegal): patients' profile and difficulties encountered]. Pan Afr Med J 2017; 27:211. [PMID: 28979613 PMCID: PMC5622805 DOI: 10.11604/pamj.2017.27.211.9586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/27/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Les objectifs de cette étude étaient de déterminer le profil épidémiologique, clinique et endoscopique des patients adressés pour endoscopie digestive haute à la clinique Magou de Louga et d'analyser les difficultés rencontrées. Méthodes il s'agit d'une étude rétrospective et descriptive qui analyse les comptes rendus de 248 gastroscopies réalisées entre le 1er janvier et le 31 decembre 2014. Résultats L'âge moyen était de 39,9 ans, le sex ratio était de 2,3 en faveur des femmes. La majorité des patients (56,5%) provenait d'une zone rurale. Les patients étaient surtout des femmes au foyer (55,2%). Les principaux prescripteurs étaient les médecins (77,8%). L'épi gastralgie était la principale indication. La hernie hiatale domine avec 33,1% suivi d'examen normaux 22,5% et le reflux gastrooesophagien isolé 12,5% des cas. Seulement 2 résultats anatomopathologiques sur 13 ont été reçus. Aucun contrôle endoscopique demandé n'a été fait. Conclusion Peu d'endoscopie digestive haute sont réalisées à Louga. Le profil type du patient est une femme au foyer jeune vivant en zone rurale se plaignant d'épi gastralgies dont l'examen endoscopique à défaut d'être normal retrouve une hernie hiatale ou reflux gastrooesophagien. Les difficultés sont liées aux résultats d'analyses anatomopathologiques non reçus et à l'absence de contrôle endoscopique après traitement.
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Affiliation(s)
| | - Loubna Bourgi
- Service de Médecine Centre Hospitalier Régional de Louga, Sénégal
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Oluyemi A, Awolola N, Oyedeji O. Clinicopathologic review of polyps biopsied at colonoscopy in Lagos, Nigeria. Pan Afr Med J 2016; 24:333. [PMID: 28154688 PMCID: PMC5267854 DOI: 10.11604/pamj.2016.24.333.9434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/27/2016] [Indexed: 12/18/2022] Open
Abstract
Introduction Colorectal polyps are known precursors of colorectal cancers. The increase in utilization of colonoscopy in Nigeria has meant a rise in the recently reported incidence of these lesions. The aim of this study is to evaluate the clinicopathological profile of colorectal polyps biopsied during the inaugural 12 month period of colonoscopy from a private endoscopy suite in Nigeria. Methods This is a retrospective review of all the clients who had polyps diagnosed at colonoscopy over a 12 month period (August 2014 –July 2015) at a private endoscopy suite in Lagos, Nigeria. This analysis of prospectively collected data was performed using clinical information from the endoscopy logs and pathology database system of a private endoscopy suite based in Lagos, Nigeria. Results A total of 125 colonoscopies were carried out over the stated period. Of these, 14 individuals had a total of 18 polyps- 4 clients (28.6% of the persons with polyps) had two polyps each. The polyp detection rate was 11.2% while the polyp per colonoscopy rate was 14.4%. Of these clients, males were 10 in number; giving a male to female ratio of 2.5:1. Their ages ranged from 37 to 77 years (mean= 57.3 years). The presenting complaint at colonoscopy was hematochezia in 11 (78.6%), new onset constipation in 2 (14.2%) and peri-anal pain in 1 patient (7.1%). The polyps were distributed as follows; 2 (11.1%) in the ascending colon, 1 (5.6%) each in the transverse and descending colons, 8 (44.4%) in the sigmoid colon, 6(33.3%) located in the rectum. Hence, there was left sided (15 of 18= 83.3%) preponderance. Pathologically, tubular (adenomatous) polyp with or without low grade dysplastic changes was diagnosed in 6 of the 18 polyps (giving an adenoma detection rate of 4.8%), 4 (22.2%) were inflammatory polyps, 1 (5.6%) was malignant and another had the rare inflammatory fibroid polyp. Five (27.8%) of the specimens were reported as non-specific colitis. Conclusion The study supports the present wisdom that polyps are clearly less prevalent in our environment when compared to the Western world. The increased prevalence with advancing age, in male subjects and of left sided lesions, is also in keeping with previous results from our environment. A case is also advanced for the increased deployment of endoscopy as a tool for the detection of these polyps and ultimately, the reduction of colorectal cancer in our population.
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Affiliation(s)
| | - Nicholas Awolola
- College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Olufemi Oyedeji
- College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
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Abstract
Background: The upsurge in the reported cases of diverticular disease (DD) has led to a re-appraisal of the earlier held views that it was a rare entity in Nigeria. The advent of colonoscopy has contributed in no small way to this change. We sought to determine the clinical characteristics, indications for colonoscopy, and intra-procedural findings among these patients. Materials and Methods: A retrospective cross-sectional study was carried out on the colonoscopy records from four private endoscopy units based in Lagos State, Nigeria. The records were drawn from a 5-year period (August 2010 to July 2015). The endoscopy logs and reports were reviewed, and the bio data, indications, and colonoscopy findings were gleaned. Results: A total of 265 colonoscopies were carried out in the stated period. Of these, 28 (10.6%) had DD. Of the patients with DD, 5 (17.9%) were females while 23 (82.1%) were males. Their ages ranged from 46 to 94 years (mean = 68.2 ± 11 years). Fifteen patients had been referred for the procedure on account of hematochezia alone (15 = 53.6%). Other reasons for referral included abdominal pain alone (2 = 7%), hematochezia plus abdominal pain (5 = 17.9%), and change in bowel habits (3 = 10.8%). Ten (35%) patients had pan-colonic involvement. Regional disease involved the right side alone in only one case (3.5%) while the other combinations of sites are as follows; 6 (21.4%) in the sigmoid colon alone, 2 (7%) in the descending colon alone, 5 (17.9%) in the sigmoid–descending colon, 4 (14.3%) in the sigmoid-descending-transverse colon, thus the sigmoid colon was involved in 25 (89.3%) cases. Five cases (17.9%) had endoscopic features suggestive of diverticulitis. Conclusions: DD should no longer be regarded as a rare problem in the Nigerian patient. The study findings support the notion of higher prevalence among the elderly, in males, and of sigmoid colon involvement.
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Affiliation(s)
- Aderemi Oluyemi
- Gastroenterology Unit, ReMay Consultancy and Medical Services, Lagos State, Nigeria
| | - Emuobor Odeghe
- Gastroenterology Unit, Lagos University Teaching Hospital, Lagos State, Nigeria
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14
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Obayo S, Muzoora C, Ocama P, Cooney MM, Wilson T, Probert CS. Upper gastrointestinal diseases in patients for endoscopy in South-Western Uganda. Afr Health Sci 2015; 15:959-66. [PMID: 26957987 DOI: 10.4314/ahs.v15i3.33] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is a paucity of published data regarding upper gastrointestinal diseases in Ugandans with upper gastrointestinal symptoms referred for endoscopy. OBJECTIVES To study the presenting complaints, pathology and Helicobacter pylori prevalence among patients with upper gastrointestinal symptoms in South-Western Uganda. METHODS Patients presenting with upper gastrointestinal symptoms underwent upper endoscopy and a urease test for Helicobacter Pylori, all suspicious lesions were biopsied for histopathology review as appropriate. RESULTS The most common presenting complaints were epigastric pain (51.6%), dysphagia (13.6%) and odynophagia (7.1%). The most common endoscopy finding was gastritis (40.2%), followed by normal examination (15.2%), oesophageal cancer (13.6%), gastric ulcer (7.6%) and gastric cancer (7.1%). Patients older than 40 years (n=110) had significant findings including gastritis (50.9%), oesophageal cancer (22.7%) and gastric cancer (11.8%). However in younger patients, with the age range of 18-40 years (n=74), most examinations were normal (92.9%). Of the 176 patients able to undergo Helicobacter pylori testing 75.6% were positive. Helicobacter pylori infection was associated with statistically significant increase in gastritis, oesophageal cancer, gastric ulcer, gastric cancer, and duodenal ulcers (p-values< 0.05). CONCLUSION Gastritis, ulcerative disease, and upper gastrointestinal malignancies are common in South-Western Ugandans and are associated with a high prevalence of Helicobacter pylori.
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Affiliation(s)
- Siraji Obayo
- Mbarara University Teaching Hospital, Mbarara, Uganda and the Uganda Cancer Institute, Kampala, Uganda
| | | | - Ponsiano Ocama
- Infectious Diseases Institute, Research; Makerere University
| | - Matthew M Cooney
- Case Western Reserve University, Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Tony Wilson
- Mbarara University Teaching Hospital, Mbarara Uganda
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15
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Lawson-Ananissoh LM, Bouglouga O, Bagny A, Kaaga L, Redah D. [Upper gastrointestinal endoscopy in 2795 patients at the university campus hospital of Lomé: peculiarities according to sex]. Pan Afr Med J 2014; 19:262. [PMID: 25852805 PMCID: PMC4382069 DOI: 10.11604/pamj.2014.19.262.4512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 10/09/2014] [Indexed: 11/11/2022] Open
Abstract
Introduction Méthodes Résultats Conclusion
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Affiliation(s)
| | | | - Aklesso Bagny
- Service d'Hépato-gastro-entérologie du CHU Campus de Lomé, Togo
| | - Laconi Kaaga
- Service d'Hépato-gastro-entérologie du CHU Campus de Lomé, Togo
| | - Datouda Redah
- Service d'Hépato-gastro-entérologie du CHU Campus de Lomé, Togo
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