Colonoscopy at a tertiary healthcare facility in Southwest Nigeria: Spectrum of indications and colonic abnormalities

Colonoscopy findings in patients with haematochezia in Benin (South-South Nigeria): A 9-year prospective study

Background

Colonoscopy is an important armamentarium in the investigation of haematochezia. Patients with haematochezia are very anxious about the presence of blood in their faeces. They are usually referred for diagnostic colonoscopy based on the presence of blood in stool or anaemia.

Aims/Objectives

To highlight the causes of haematochezia in patients over a 9-year prospective period in the Premier tertiary health centre in the South-South zone of Nigeria.

Materials and Methods

All Consecutive patients seen in our surgical services (June 1, 2009, to May 30, 2018) requiring colonoscopy for haematochezia were entered into a proforma. The demographics, findings at colonoscopy, and outcome of colonoscopy were analysed.

Results

Three hundred and sixty-five colonoscopies were done during the study period; of these, 44% (160 patients) had a colonoscopy for haematochezia. Mean age of patients was 54.7 years. Age range was 16-86 years. Cluster age group was fifth to seventh decade (62.5%). The male-to-female ratio was 2:1. Causes of haematochezia were Haemorrhoids 32.5%, large bowel cancer 23.8%, diverticular disease 10%, inflammatory disease of the bowel 6.3%, polyps 3.8%. About 15% of the patients had more than one colonic site of bleeding. The most common subsites for colon cancer were rectum and sigmoid colon (79.6%), in 11 patients (6.8%) was the tumour within reach of the examining finger. Repeat colonoscopy occurred in 3 patients (0.8%). The most common complication of colonoscopy was bleeding (0.8%). Two patients (0.5%) had colonic perforation.

Conclusion

Forty-four percent (44%) of colonoscopy in Benin, South-South Nigeria has haematochezia as its indication. The cluster age group is the fifth to seventh decade. One in four patients had colon cancer and in 6.8% the tumour was within reach of the examining finger. It is the authors' opinion that colonoscopy should be routinely done in patients with haematochezia in South-South Nigeria.

Histopathological Outcome of Colonoscopic Biopsies in a Tertiary Hospital in Southwestern Nigeria: A 7-Year Retrospective Study

BACKGROUND AND AIM

Colonoscopy with histopathological analysis of mucosal biopsy samples remains the gold standard procedure for diagnosing lower gastrointestinal disorders. This study aimed to determine the pattern of histopathological findings of mucosal biopsies obtained at colonoscopy over a 7-year period and to correlate the histological findings with the clinical profile of the patients.

METHODS

This was a retrospective study conducted in a healthcare facility in southwestern Nigeria. The Histology reports from January 1, 2016, to December 31, 2022, were retrieved from the histopathology department of the institution to obtain the following information for analysis: age, gender, year of the test, presenting complaint, provisional clinical diagnosis, colonoscopy diagnosis, and histological diagnosis.

RESULTS

The data of a total number of 81 patients were analyzed; 51 males (63.0%) and 30 females (37.0%) with a male-to-female ratio of 1.7-1. The age range of the patients was 30-86 years with a mean (±standard deviations) age of 59.87 ± 14.44. The most common indication for colonoscopy was hematochezia (23 (28.4%)) followed by change in bowel habit (16 [19.8%]), constipation (11 [13.6%]), and tenesmus (10 [12.3%]). Large bowel masses suggestive of cancers were the most common colonoscopy finding in the study subjects (36 [44.4%]). Colorectal cancer was the most common histologic abnormality in the study subjects (26 [32.1%]) followed by chronic nonspecific colitis (8 [9.9%]), polyps (7 [8.6%]), adenomas (5 [6.2%]) and acute on chronic colitis (5 [6.2%]). Twenty-two (27.2%) patients had normal histologic findings. Patients aged between 45 and 64 years had the highest prevalence of colorectal cancer (13 [50.0%]).

CONCLUSION

Colorectal cancer was the most common histopathological finding in this study and the patients were mostly within the middle-age group. Early screening colonoscopy is therefore recommended and histopathological analysis of the mucosal specimens obtained is essential for early detection of premalignant lesions.

Challenges in the diagnosis and management of IBD: a sub-Saharan African perspective

With the exception of South Africa, inflammatory bowel disease (IBD) has long been considered uncommon in sub-Saharan Africa (SSA) with a dearth of peer-reviewed publications from the subcontinent. This most likely reflects underreporting as some cases may be missed due to the high burden of infectious diseases which may closely mimic IBD. In addition, many countries in SSA have limited endoscopic capacity, inadequate access to diagnostic imaging and a notable scarcity of histopathologists, radiologists and gastroenterologists. Beyond these obstacles, which significantly impact patient care, there are many other challenges in SSA, particularly the unavailability of key IBD therapies. In this review, we discuss barriers in diagnosing and managing IBD in SSA, as well as some of the initiatives currently in place to address these short comings.

Colorectal Surgery Practice, Training, and Research in Low-Resource Settings

Colorectal surgery (CRS) practice, training, and research differ between low- and middle-income countries (LMICs) and high-income countries due to disparity in resources. LMIC CRS is primarily done by general surgeons due to the paucity of fully trained colorectal surgeons. The majority of colon and rectal resections are done using open techniques, and laparoscopy and robotic platforms are only available in select private or academic centers. Multi-disciplinary teams are not available in most hospitals, so surgeons must have a broad knowledge base, and learn to adapt their practice. Formal CRS training opportunities through accredited post-residency fellowships and professional colorectal surgical associations are limited in LMICs. CRS is less established as an academic field, and less data are generated in LMICs. There are fewer staff and less dedicated funding for CRS research. However, LMIC colorectal surgeons and researchers can contribute valuable clinical findings especially on conditions of higher prevalence in their settings such as anal squamous cell carcinoma and obstetric fistulas. Effective surgical care for colorectal conditions requires significant investment in infrastructure, training, and governance in LMICs. This is critical to improve access to safe surgical care for all.

Examining the Factors That Affect the Diagnosis of Patients with Positive Fecal Occult Blood Test Results

Due to the threat of colorectal cancer (CRC) to health, Taiwan included the fecal occult blood test (FOBT) under preventive health services in 2010. We examined the factors that affect the diagnosis of people with positive FOBT results. Data were retrospectively collected from the CRC screening database. In the model predicting factors that affect the diagnosis of 89,046 people with positive FOBT results, the risks of disease in the CRC group were lower in medical institutions that conducted follow-up examinations in regions such as Northern Taiwan compared to that in Eastern Taiwan (p = 0.013); they were lower in the age group of 50 to 65 years than those in the age group of 71 to 75 years (p < 0.001, p = 0.016), and lower in the outpatient medical units that conducted follow-up examinations than those in the inpatient medical units by 0.565 times (p < 0.001, 95% CI: 0.493−0.647). Factors affecting the diagnosis of patients with positive FOBT results were gender, the region of the medical institution, medical unit for follow-up examinations, age, screening site, family history, type of follow-up examinations, and follow-up time. Therefore, the identification of characteristics of patients with positive FOBT results and the promotion of follow-up examination are important prevention strategies for CRC.

Risk factors for hemorrhoidal disease among healthy young and middle-aged Korean adults

Hemorrhoidal disease is a highly prevalent anorectal condition causing substantial discomfort, disability, and decreased quality of life. Evidence on preventable risk factors for hemorrhoidal disease is limited. We conducted a cross-sectional study of 194,620 healthy men and women who completed a health screening exam including colonoscopy in 2011–2017. We evaluated potential risk factors of hemorrhoidal disease, including lifestyle factors, medical history, birth history, gastrointestinal symptoms, and anthropometric measurements. The prevalence of hemorrhoidal disease was 16.6%, and it was higher in females than in males (17.2 vs. 16.3%; P < 0.001). Compared to men, the prevalence of hemorrhoidal disease was higher in parous women (adjusted odds ratio [OR] 1.06; 95% confidence interval [CI] 1.02–1.10), and lower in nulliparous women (adjusted OR 0.92; 95% CI 0.86–0.98). In the adjusted analyses, older age, female sex, smoking, overweight, and being hypertensive were independently associated with the presence of hemorrhoidal disease. The prevalence of hemorrhoidal disease was positively associated with body mass index and waist circumference in parous women. The prevalence of hemorrhoidal disease was higher in older age, females, ever-smokers, and hypertensive participants. The association of excess adiposity with the prevalence of hemorrhoidal disease differed by sex and parity.

Inflammatory bowel disease in Africa: what is the current state of knowledge?

Inflammatory bowel disease (IBD) is increasingly recognized as a global disease in the twenty-first century; however, little is known about its epidemiology in Africa. We conducted a literature review in order to assess what is currently known on this subject, the results of which are reported here. Based on available observational studies, it appears that the incidence of IBD in Africa is rising, although comprehensive epidemiological data are lacking. This is likely due to multiple factors, including shifting trends in diet and exposure to environmental pathogens. Many challenges relating to IBD exist for healthcare systems in Africa, including the need for improved access to diagnostic facilities such as endoscopy and histopathology, and the potential economic burden of treatment. Intestinal TB also represents a significant confounding factor in the diagnosis of IBD in Africa.

Genetic Risk Factors for Diverticular Disease-Emerging Evidence

Diverticular disease is traditionally understood as an environmental disease caused by diet and constipation. However, genes are increasing understood to play a role in pathogenesis. Twin studies suggest a substantial component of individual risk is due to heritable factors. Association of diverticular disease with other traits suggests an underlying biological mechanism and recently genome-wide association studies have described the genetic architecture underlying this complex phenotype. These studies suggest a new paradigm for understanding this common surgical disease.

Inflammatory bowel diseases: time of diagnosis, environmental factors, clinical course, and management - a follow-up study in a private inflammatory bowel disease center (2003-2017)

BACKGROUND

The governmental program of Brazilian Unified National Health System has already published studies on the incidence of inflammatory bowel diseases (IBD), but up until now, there have been no epidemiological studies in private centers in Brazil. However, these diseases tend to affect people from a higher socioeconomic class, mainly in the capital of MS state that has the third highest GDP in Brazil.

OBJECTIVES

The aim was to analyze an observational, descriptive study of an IBD database in a private center including: the side, behavior of the disease and medical management, the association of extra-intestinal manifestations, and the main clinical symptoms which led to the investigation and diagnosis of IBD.

PATIENTS AND METHODS

A cohort study was developed in which data of all patients with IBD were analyzed with SPSS software in a constructed electronic database.

RESULTS

Of 329 patients, 212 (64.4%) had Crohn's disease (CD) and 117 (35.6%) had ulcerative colitis (UC). Average age at diagnosis of CD was 36.19 (±14.33) and of UC was 41.61 (±15.37). An amount of 50.05% of the patients with CD and 72.7% (P<0.001) with UC were female. We have observed that concerning the first symptoms, diahrrea and blood feces corresponded to 70% in UC while in CD 50% of the patients presented diahrrea with blood feces, loss of weight corresponded to 50% and only diahrrea 25%. (P<0.001). Anti-TNFs corresponded to 56.2% being more frequent in CD 0.001%. CD patients used biologic therapy and antibiotics more frequently than those with UC. In conclusion, IBD is also frequent in private health care centers in Brazil; women are most affected. Symptoms such as diarrhea and bleeding, as well as diarrhea and weight loss, must be taken as warning signs to investigate for inflammatory disease. The use of biologic therapies is frequent in referral centers when patients have severe disease.