Prevalence, short term outcome and factors associated with survival in patients suffering from upper gastrointestinal bleeding in a resource limited-setting, the case of Mulago hospital in Kampala, Uganda

Factors associated with severity and length of hospital stay in patients with acute upper gastrointestinal bleeding: insights from two Ethiopian hospitals

BACKGROUND

Upper gastrointestinal bleeding (UGIB) is a critical emergency with substantial morbidity and mortality. Outcomes depend on bleeding severity, patient risk factors, and comorbidities. This study evaluated clinical patterns and factors influencing disease severity and hospital stay among patients present with UGIB symptoms at two major Ethiopian hospitals.

METHODS

A retrospective, cross-sectional review was conducted on 199 UGIB patients admitted to Yekatit 12 Hospital Medical College (Y12HMC) and Tikur Anbesa Specialized Hospital (TASH) from September 2022 to September 2023. Data on demographics, clinical presentations, endoscopic findings, and outcomes were analyzed using SPSS version 26. Binary logistic regression assessed associations, with statistical significance set at P < 0.05.

RESULTS

Of 199 patients, 70.9% were male, predominantly aged 18-40. Hematemesis (63.8%) and hematemesis with melena (27.6%) were common presentations. Endoscopy was not performed on more than half of the participants, with 116 patients (58.3%) not undergoing this procedure. Among the 83 cases who did have endoscopy, esophageal varices emerged as the most common condition, observed in 43.3% (36 cases. Smoking (AOR = 1.77), alcohol intake (AOR = 1.89), and drug use (AOR = 1.34) were linked to higher severity scores. Alcohol use, comorbidities, liver disease, and previous drug use correlated with prolonged hospital stays.

CONCLUSION

UGIB predominantly affects younger males, with hematemesis as the primary presentation. Key factors like smoking, alcohol intake, and drug use were associated with greater disease severity and longer hospital stays. These findings suggest the importance of lifestyle interventions, particularly in resource-limited settings.

Helicobacter pylori Management in Africa: A Survey of Diagnostic, Treatment, and Related Resources

BACKGROUND

Although Helicobacter pylori infection (H. pylori) prevalence in Africa has declined in the last decade, it remains concerningly high. H. pylori is asymptomatic in the majority of patients but is associated with significant morbidity and mortality in 10%-20%.

MATERIALS AND METHODS

We conducted an online survey of 21 African countries, with the link distributed to members of the African Helicobacter Microbiota Study Group. The survey was completed by 562 respondents; the majority were from Nigeria (27.2%), South Africa (18.1%), Tanzania (17.6%), Egypt (16.9%), and Cameroon (14.2%).

RESULTS

The most common reason for H. pylori testing was dyspepsia in 83.9% of the cases. Abnormal findings at gastroscopy (62.3%) and heartburn (61.7%) were also common indications. Stool antigen testing and histological examination of gastric biopsies using Giemsa were the two most used methods for H. pylori testing at 62.3% and 50.3%, respectively. Most respondents reported the use of standard clarithromycin-based triple therapy as first-line treatment for H. pylori infection.

CONCLUSION

This survey has demonstrated the diversity of practice and resource availability within the African continent. Several international guidelines exist on the management of H. pylori, but little data is available in Africa on how this condition is managed in every day clinical practice. There is an urgent need to formulate evidence-based and locally relevant practice guidelines on the African continent. In this context, the African Helicobacter and Microbiota study group was formed to coordinate efforts across the continent on H. pylori research to provide guidance on its management. This paper, therefore, aimed to evaluate the practice of H. pylori diagnostics and management, as well as related resources in representative countries in Africa, to facilitate the development of such guidelines.

The diagnostic accuracy of triphasic abdominal CT in detecting esophageal varices

BACKGROUND

In Tanzania, triphasic abdominal Computed Tomography (CT) is a more accessible and non-invasive alternative for diagnosing esophageal varices, though its accuracy has not been thoroughly evaluated, therefore this study aimed to determine the diagnostic accuracy of triphasic abdominal CT in detecting esophageal varices using esophagogastroduodenoscopy (OGD) as the gold standard among patients with upper gastrointestinal bleeding at Muhimbili National Hospital (MNH).

METHODS

This cross-sectional study was conducted at MNH from January 2021 to May 2023. We sampled upper gastrointestinal bleeding patients who underwent both OGD and triphasic abdominal CT using non-probability consecutive sampling. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of triphasic abdominal CT were assessed against OGD findings.

RESULTS

In a study of 200 participants, esophageal varices were detected in 54% by OGD and 53.5% by CT. We observed 105 true positives, 2 false positives, 90 true negatives, and 3 false negatives. Triphasic abdominal CT demonstrated a sensitivity of 97.2%, specificity of 97.8%, PPV of 98.1%, NPV of 96.8%, and an accuracy of 97.5%. Extraluminal findings included portal venous thrombosis in (22%), splenic collateral (51.5%), ascites (32%), hepatocellular carcinoma (13%), and periportal fibrosis (32%).

CONCLUSION

Triphasic abdominal Computed Tomography can be used as a reliable and non-invasive alternative modality for diagnosing and screening esophageal varices in resource-limited settings.

Reproductive health issues, infections and non-communicable diseases

NIL