Clinical features of upper gastrointestinal endoscopy in 3146 patients: a 9-year retrospective cohort study in Zanzibar Archipelago, Tanzania

Prevalence and patterns of peptic ulcer disease in Africa: a systematic review and meta-analysis

BACKGROUND

Peptic ulcer disease (PUD) remains a significant yet poorly understood public health issue in Africa, despite its declining prevalence in Western countries. Studies from Africa report a highly variable burden, with the highest prevalence observed in West Africa and the lowest in Southern Africa. However, the overall burden of PUD in Africa, its patterns (duodenal ulcers, gastric ulcers, and coexisting ulcers), and its association with H. pylori infection remain unclear.

OBJECTIVE

This review aims to systematically analyze the pooled prevalence and patterns of PUD in Africa through a systematic review and meta-analysis.

DESIGN

A systematic review and meta-analysis was conducted following the PRISMA checklist. We searched PubMed, Hinari, and Google Scholar, supplemented by Google and Yahoo search engines. Observational studies reporting the prevalence and patterns of PUD among the African population were included. Two independent reviewers extracted data and assessed study quality. Pooled prevalence estimates were calculated using a random-effects model, with heterogeneity assessed via the Cochrane Q test and I2 statistic.

RESULTS

A comprehensive analysis of 58 studies revealed a pooled prevalence of PUD in Africa at 15.2%. The most common ulcer pattern was DU at 10.2%, followed by GU at 5.8%, while 0.6% of cases had both types. Regional variations were observed, with West Africa having the highest prevalence (19%), followed by East Africa (15%), North Africa (12%), and Southern Africa (8%). Among individual countries, Ghana reported the highest prevalence (27%), followed by Ethiopia (19%) and Tanzania (16%). Furthermore, the pooled prevalence of PUD was 14% before 2010 and 15% in 2011 and later. Additionally, 57.1% of patients tested positive for Helicobacter pylori infection, with its prevalence reaching 76.4% among those diagnosed with PUD. Substantial heterogeneity was observed across most analyses, with I2 values exceeding 95% and p-values < 0.001.

CONCLUSION

The analysis revealed a significant burden of PUD in Africa, with DU being more common than GU. Regional disparities were observed, with the highest prevalence in West and East Africa. Over the past two decades, the burden has remained relatively stable, reflecting a concerning trend. H. pylori infection was also frequently diagnosed in individuals undergoing endoscopic examination. However, substantial heterogeneity was noted across studies, highlighting variability in reported prevalence.

Indications and endoscopic findings of upper gastrointestinal diseases in Africa: A systematic review & meta-analysis

BACKGROUND

Upper gastrointestinal endoscopy (UGIE) plays a crucial role in diagnosis of gastrointestinal pathology. Therefore, this systematic review and meta-analysis aimed to assess the indications and findings UGIE, while exploring their regional distribution and temporal trend across Africa.

METHODS

Systematic Reviews and Meta-Analysis of pooled prevalence for various indications and endoscopic findings were analyzed from multiple studies in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

RESULTS

Seventeen common indication were identified. Of these dyspepsia was the most prevalent indication 52.4%, followed by abdominal pain 17.4%, hematemesis 13.9%, and GERD symptoms 11.2%. Other indications included dysphagia 9.2%, vomiting 9.2, odynophagia 3.5%, and melena 6.2% were identified. Rare indications such as anemia 2.3%, weight loss 2.6% were also reported. Regarding endoscopic findings, thirty-one common findings were identified by UGIE. Gastritis (33.3%) was the most common findings followed by normal findings 21.8%, the third most common was PUD 15.1%, particularly duodenal ulcer (10%), gastric cancer 3.3% were also prevalent in stomach. Related to esophageal findings, GERD 9.6%, esophagitis 8.3%, esophageal varices 7.2% and esophageal cancer 6.1% were identified. Regional difference were apparent, with esophageal cancer prevalent in Eastern (10%) and Southern Africa (10%). Gastritis (45%) and GERD (18%) were more apparent and common in Northern Africa. Even though it is not significant, temporal trends showed an increase in prevalence of gastritis (26 to 36%) and esophagitis (6 to 10%) from 2000-2010 to 2011-2024.

CONCLUSION

Most UGIE indications resulted significant UGIT pathology. However, this analysis did not assess age, sex based indications and findings and their relationship among specific indications and UGIE findings. So, future analysis should focus on age and sex based difference in indications and findings, and explore their relationship among specific indication and corresponding UGIE findings.

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.

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