Upper Gastrointestinal Bleeding In A Nigerian Diagnostic Center:A Retrospective Study Of Endoscopic Records

Emuobor Aghoghor Odeghe (1), Oluwafunmilayo Funke Adeniyi (2), Aderemi Omololu Oluyemi (3), Vivian Ngozi Nwude (4), and Samuel Olalekan Keshinro (5)

1Department of Medicine, College of Medicine/Lagos University Teaching Hospital, Lagos, Nigeria

 2Department of Paediatrics, College of Medicine/Lagos University Teaching Hospital, Lagos, Nigeria

 3ReMay Consultancy and Medical Services, Ikeja, Lagos, Nigeria

 4Evercare Hospital, Lekki, Lagos, Nigeria

 5Police Hospital, Falomo, Ikoyi, Lagos, Nigeria

Correspondences to: Emuobor A. Odeghe; email: eaodeghe@yahoo.com

Received: 12 Jun 2021; Revised: 21 Oct 2021; Accepted: 26 Oct 2021; Available online: 5 Dec 2021

Abstract

Background: Upper gastrointestinal bleeding (UGIB) is a common indication for endoscopy. We aimed to describe the endoscopic findings in patients referred to our center with UGIB. Methods: This was a single-center retrospective study of the endoscopic findings in patients with UGIB between August 1, 2017, and April 30, 2019, in Lagos, Nigeria. Data were analyzed using Statistical Package for Social Sciences version 23.0. Results: Eight hundred thirty-two patients underwent endoscopy, of which 129 (16%) were for UGIB, which occurred twice as frequently in males. Melena was the most frequent presentation. Endoscopic abnormalities including gastric/duodenal peptic ulcers (39%),

gastroduodenal erosions (36%), and varices (12%), were identified in 83% of the participants. Most ulcers were low risk. Conclusion: Patients presenting to our center with UGIB commonly have gastric/duodenal peptic ulcers or gastroduodenal erosions.

 

Keywords: Upper gastrointestinal bleeding, Endoscopy, Nigeria.

 Ann Afr Surg. 2022; 19(1): 28-32 

DOI: http://dx.doi.org/10.4314/aas.v19i1.6 

Conflict of interest: None

 Funding: None.

 

© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License

Introduction 

Upper gastrointestinal bleeding (UGIB) is defined as bleeding above the ligament of Treitz, and it includes bleeding from the esophagus, stomach, and duodenum (1). It can be classified as either variceal or non-variceal, and its treatment depends on this classification (1). Endoscopy has become a most essential tool in the definitive evaluation of the causes of upper gastrointestinal diseases in general, and UGIB in particular; indeed, the condition is a common indication for the procedure (2-4). Clinical presentation in UGIB is varied, and may include hematemesis, melena, hematochezia, syncope, or shock (2, 5, 6). It is more common in males and older adults (5, 6). The most common endoscopic findings include peptic ulcer disease (PUD), gastroduodenal erosions, and esophageal varices (2, 3, 6). This is hardly surprising, as these are also the most common findings in patients undergoing endoscopy for the evaluation of upper gastrointestinal symptoms (4). Risk factors include use of non-steroidal anti-inflammatory drugs (NSAIDs), alcohol consumption, smoking, or previous PUD or UGIB (2, 7). Mortality from an episode of UGIB from African studies is up to 15% and is higher in patients with diastolic blood pressures >90 mmHg, those who did not receive blood transfusion, those at least 60 years old, those who were hospitalized at the time they developed UGIB, and those with major comorbidities such as liver cirrhosis, renal failure, and ischemic heart failure (3, 5, 6). There are few local studies on this topic, with most being carried out in public institutions (3, 5, 8). The aim of this study, therefore, was to describe the endoscopic findings in patients presenting with UGIB to a private diagnostic center in Lagos, Nigeria.

 

Materials and Methods

This was a retrospective study of the endoscopic records of all patients aged at least 16 years who had endoscopy for UGIB between August 2017 and April 2019 at the endoscopy suite of a private diagnostic center in Lagos. This center is located in the mainland area of the state, offers both diagnostic and therapeutic gastrointestinal endoscopy services to adults and children who are referred from within and outside the state, and performs an average of 100 procedures monthly. The procedures are performed by both adult and pediatric gastrointestinal endoscopists. Ethical approval was obtained before commencement of the study.

 The following data were retrieved and entered into a proforma designed for this study: basic demographics, the indication for the procedure, use of NSAID, presence of comorbidities (such as liver cirrhosis and chronic kidney disease), and endoscopic findings. The endoscopic procedures were performed after an overnight fast by three gastrointestinal endoscopists, and endoscopic diagnoses were based on visual examination. The Forrest classification was used to describe ulcers as follows (9):