Presentation, distribution pattern, and management of diverticular disease in a Nigerian tertiary hospital

Background: Colonic diverticular disease is one of the most common and costly gastrointestinal disorders among industrialized societies, which have recently been described among Africans. Presentations and distribution pattern of the disease among Africans appeared to be different from that described among the Western population. We embark on this study aimed at evaluating the presentation, distribution pattern, and the management of diverticulosis in our tertiary health facility.Materials and Methods: A prospective descriptive study of the cases of diverticular disease seen between January 2007 and December 2011 at Obafemi Awolowo University Teaching Hospitals Complex, Ile.Ife, Osun State, Nigeria.Results: During the 5.year study period, 40 cases were seen. The patients were aged 41.85 years with a median age of 64 years. There were 29 (72.5%) male and 11 (27.5%) female with an average male to female ratio of 3:1. The most common presentation was bleeding per rectum in 28 (70%) patients, which mostly needed transfusion. Ten (25%) patients presented with recurring abdominal pain, whereas one (2.5%) patient presented with abdominal mass and features of intestinal obstruction. Thirty patients were diagnosed on colonoscopy, eight on barium enema, and two on computerized tomography scan. Thirty.four (85%) patients had a pancolonic disease. All the patients were placed on high fiber diet and antibiotics namely ciprofloxacin and metronidazole. Five patients had recurrence within 6 months of follow up, of which one had emergency colectomy.Conclusion: Diverticular disease is no longer a rare disease in Nigeria. It is a common cause of lower gastrointestinal bleeding in elderly patients. High index of suspicion for diverticular disease of the colon and its  complications should increase in the country.Key words: Distribution pattern, diverticular disease, management, Nigeria, presentatio

Polyp prevalence at colonoscopy among Nigerians: A prospective observational study

Background: This study was aimed at identifying the prevalence, distribution, and clinicopathologic characteristic of colonic polyps among Nigerians undergoing colonoscopy at the Obafemi Awolowo University Teaching Hospitals complex, Ile‑Ife, Nigeria. We also determined the polyp detection rate (PDR), polyps per colonoscopy (PPC) and adenoma detection rate (ADR).Materials and Methods: This is a prospective study of all colonoscopy examinations performed at the endoscopy unit of our hospital from January, 2007 to December 2013. The patient demographics, indications for colonoscopy, colonoscopic findings, number of the polyps, their sizes, possible risk factors in the individual case histories, and histopathological characteristics of the polyps.Results: During the study period, a total of 415 patients met the inclusion criteria and only 67 out of these had colonic polyps. The overall PDR was 16.1%. The age ranged was 2‑87 years with a median of 57 years. Forty‑three (64.2%) patients were 50 years or above and there were 40 (59.7%) males. Thirty‑three (49.3%) patients were referred as a result of lower gastrointestinal bleeding, 14 (20.9%) for colorectal cancer (CRC) and 13 (19.4%) for routine screening. Thirty‑nine (58.2%) patients had the polyps at the rectosigmoid region of the colon, 17 (25.4%) had the polyps located proximal to sigmoid colon and 11 (16.4%) patients had multiple polyps involving both segments. Adenomatous polyps was the most common (28 [47.5%]) histopathological finding of which two patients had adenomatous polyposis. Other findings include inflammatory polyps in 17 (18.8%) patients, 5 (8.5%) patients each had hyperplastic and malignant polyps, while 4 (6.8%) patients had juvenile polyps. The ADR was 6.8 and the PPC was 0.2. Statistically, patients 50 years and older were more likely to have adenomatous and hyperplastic polyps than those younger than this age (P = 0.010).Conclusion: We conclude that polyps are probably not as rare among black Africans especially when they are above 50 years. Our histopathological finding of adenomatous change in a good proportion of the detected polyps show that they are likely to be associated with CRCs in our compatriots and as such we would recommend a routine screening colonoscopy for Nigerians aged 50 and above.Key words: Adenoma, hyperplastic, inflammatory, Nigeria, polyps, prevalenc

Pattern and validity of clinical diagnosis of upper gastrointestinal diseases in south-west Nigeria

BACKGROUND: Diagnosis of upper gastrointestinal (UGI) diseases is often made on clinical grounds alone in Nigeria due to lack of endoscopic facilities. The validity of using such diagnosis is presently unknown. OBJECTIVE: The study aimed to determine: age and sex distribution of patients presenting for UGI endoscopy; pattern of clinical and endoscopic diagnoses in patients with UGI diseases; and, the validity of clinic-based diagnosis. METHODS: Medical records of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria for UGI endoscopy between September 1999 and August 2003 were reviewed. Data was analysed for sensitivity, specificity, positive predictive value, and negative predictive value of clinical diagnosis using endoscopic diagnosis as “gold” standard. RESULTS: Males constituted 53.4% of subjects and mean age was 45 years (± 1.69 SD). Peptic ulcer disease (PUD) constituted 67.6% of referral diagnosis but 33.9% of endoscopic diagnosis. PUD had the highest sensitivity value (0.72) while gastritis had the least (0.04). Specificity ranged from 0.40 for PUD to 1.00 for corrosive oesophagitis. Positive predictive value ranged from 0.29 (oesophageal cancer) to 0.67 (corrosive oesophagitis) and negative predictive value ranged from 0.66 for gastritis to 0.99 for corrosive oesophagitis. CONCLUSION: The validity of clinical diagnosis in UGI conditions varied widely, and in general, there is poor agreement between clinical and endoscopic diagnoses

Pattern and validity of clinical diagnosis of upper gastrointestinal diseases in South-west Nigeria

Background: Diagnosis of upper gastrointestinal (UGI) diseases is often made on clinical grounds alone in Nigeria due to lack of endoscopic facilities. The validity of using such diagnosis is presently unknown. Objective: The study aimed to determine: age and sex distribution of patients presenting for UGI endoscopy; pattern of clinical and endoscopic diagnoses in patients with UGI diseases; and, the validity of clinic-based diagnosis. Methods: Medical records of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria for UGI endoscopy between September 1999 and August 2003 were reviewed. Data was analysed for sensitivity, specificity, positive predictive value, and negative predictive value of clinical diagnosis using endoscopic diagnosis as “gold” standard. Results: Males constituted 53.4% of subjects and mean age was 45 years (+ 1.69 SD). Peptic ulcer disease (PUD) constituted 67.6% of referral diagnosis but 33.9% of endoscopic diagnosis. PUD had the highest sensitivity value (0.72) while gastritis had the least (0.04). Specificity ranged from 0.40 for PUD to 1.00 for corrosive oesophagitis. Positive predictive value ranged from 0.29 (oesophageal cancer) to 0.67 (corrosive oesophagitis) and negative predictive value ranged from 0.66 for gastritis to 0.99 for corrosive oesophagitis. Conclusion: The validity of clinical diagnosis in UGI conditions varied widely, and in general, there is poor agreement between clinical and endoscopic diagnoses. African Health Sciences Vol. 6(2) 2006: 98- 10