C. Dally1, J. Valenzuela2, A. Merchant2, O. Gunter3 1Komfo Anokye Teaching Hospital,Surgery,Kumasi, ASHANTI, Ghana 2University Of Cincinnati,Surgery,Cincinnati, OHIO, USA 3Vanderbilt University Medical Center,Surgery,Nashville, TN, USA
Introduction:
Abdominal pain remains a large proportion of presenting complaints when seeking medical assistance. Comprehensive patient information is scarce in Africa to follow these patients and characterize epidemiology, pathology, and treatment. Endoscopy remains vital to the diagnosis and treatment of upper gastrointestinal diseases including peptic ulcer disease (PUD), gastrointestinal reflux disease (GERD), gastrointestinal tumors and causes of bleeding. Direct visualization along with photography and biopsy can lead to definitive diagnosis and collaborative efforts for treatment. This study looks at presenting complaints of patients who underwent endoscopy in Kumasi, Ghana and correlates them with endoscopic findings, CLO test, and need for biopsy.
Methods:
Between 2012 and 2015, 1077 endoscopies were performed by a single-operator at three institutions in Kumasi, Ghana. No image-capturing ability was available. A retrospective review was completed that evaluated age, sex, presenting complaint, endoscopic findings, CLO test for H. Pylori, and pathology reports when available.
Results:
The average patient age for endoscopy was 44.5 years. Sixty percent of endoscopies were performed on woman and 40% on men. Forty percent of the clinical complaints leading to endoscopy were abdominal/epigastric pain. Another 37% of patients were thought to have gastritis, peptic ulcer disease, or gastrointestinal reflux disease. Eighty-nine percent of patients underwent CLO test; 56% of those patients had a positive CLO test indicating H. Pylori infection. The remaining 11% could not undergo CLO testing due to lack of testing strips. Thirty-eight percent of endoscopic findings included gastritis. Of 1065 patient records, 12.4% had lesions or ulcers biopsied.
Conclusion:
The overwhelming findings show gastritis from endoscopy. The incidence of H. Pylori remains high. Current patient data does not indicate whether patients received a proton-pump inhibitor trial prior to endoscopy and complete biopsy results are not available, sometimes due to affordability. Improved documentation and a database can further characterize epidemiology of abdominal pain in developing countries. One major limitation in endoscopy reports is the lack of pictures to accompany the descriptive report. Image-capturing ability can confirm endoscopic findings, assist the referring physician with treatment plan and patient education, as well as lead to multi-disciplinary efforts in treatment.