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

The contribution of alcohol to chronic liver disease in patients from South-West Nigeria

Objective: This study aimed at determining the level and type of alcohol consumed by patients diagnosed with chronic liver disease (CLD) and, hence, the extent to which alcohol may have contributed to the development of the condition.Study Design: Patients with diagnosis ofCLDwere consecutively recruited and a structured questionnaire was administered on each of them. Diagnosis of CLD was made based on liver histology and/or typical clinical and laboratory features.Alcohol consumption was considered significant if a patient took 50g/day for 10 years.Results: A total of 145 patients were studied consisting of 102 males and 43 females. Their ages ranged from 20- 80 years with a mean of 46.8 ± 15.7 years. Fifty-one (35.2%) patients, all males, drank significant alcoholwhile consumption was not significant in 43 (29.6%) patients. Alcohol was not consumed at all by 51 (35.2%) patients made up of 18 males (35.3%) and 33 females (64.7%). Beer was the commonest form of alcohol consumed (70.2%) followed by palm wine (50%) and locally-brewed gin (20.2%).The diagnoses made were liver cirrhosis [LC] (60, 41.38%), chronic hepatitis [CH] (54, 37.20%), hepatocellular carcinoma [HCC] (23, 15.86%), alcoholic liver disease [ALD] (6, 4.14%) and non-alcoholicfatty liver disease [NAFLD] (2, 1.38%). The liver disease spectrum did not differ between the patients who drank significant alcohol and those who did not. However, the proportion of LC/HCC cases increased relativetoCHwith increasing age and consumption of alcohol.Conclusions: The proportion of CLD directly attributable to alcohol (i.e. ALD) is low among the patients studied. However, the burden of LC andHCCis directly related to age and the amount of alcohol consumed andthe determinants of alcohol abuse are gender and affluence

Peptic Ulcer Disease in Nigeria

Peptic ulcer disease is due to the circumscribed, complete loss of gut epithelium in parts of the digestive tract exposed to hydrochloric acid and pepsin secretion. It can be acute or chronic and occurs as a result of an imbalance between the defensive and aggressive forces at play in the mucosal lining of the stomach, combined with superimposed environmental or immunological injury. NSAIDs contribute to peptic ulcer formation by undermining a vital part of the mucosal defensive forces. The greatest impact of the understanding of the role of H. pylori in PUD has been the ability to obtain a cure and prevent recurrence of what was once a recurrent disease. The true prevalence rate of PUD in the Nigerian populace is not certain although over three decades ago Nigeria was listed as an area of high PUD prevalence8 with perforation being the most frequent indication for surgery. More recent studies begin to show similar prevalence rates for DU and GU in both southern and northern Nigeria12-14 and this is attributed to improved diagnostic facilities12. IFEMED Journal Vol. 14 (1) 2008: pp. 62-6

Hepatocellular carcinoma in Nigeria: a Review

No Abstract. IFEMED Vol. 13 (1) 2007 pp. 37-4

Diagnostic Utility of Alpha‑fetoprotein and Des‑gamma‑carboxyprothrombin in Nigerians with Hepatocellular Carcinoma

Background: Alpha-fetoprotein (AFP) and Des-gamma-carboxyprothrombin (DCP) have been extensively studied as biomarkers for the diagnosis of and prognostication in hepatocellular carcinoma (HCC). However there are only few reports on the clinical characteristics of hepatocellular carcinoma in relation to the combination of the two tumor markers in hepatitis B virus-related HCC. Aim: The aim of this study was to investigate the clinical characteristics of HBVrelated HCC in relation to different sets of AFP and DCP values. Methods: Sixtytwo patients with untreated HCC were studied. The positive value of AFP was set at 20 1U/L while DCP positive value was set at 150 mAU/ml. Patients were divided into three groups: Group 1(n=36) with AFP ≥ 20 IU/L and DCP ≥ 150 mAU/ml. Group 2(n=24) with AFP <20 1U/L and DCP ≥ 150 mAU/ml. Group 3 (n=2) with AFP < 20 1U/L and DCP < 150 mAU/ml. There were no patients in group 4 meant for those with AFP ≥ 20 1U/L and DCP < 150 mAU/ml. Clinical and laboratory variables were compared among the groups. Results: Clinical and laboratory variables were comparable among the groups with the exception of gender and values of serum alanine aminotransferase (ALT). Males were significantly more than females among the groups (p<0.03). ALT values were significantly different among the groups (p<0.006). Paired comparisons between the groups showed the mean values of serum ALT were significantly higher in group 2 than in group 1(p<0.003). The mean serum ALT values were also higher in group 2 than in group 3 (p <0.014). There was no significant difference between group 1 and group 3 (P = 0.124). Conclusion: HCC patients who are sero-positive for DCP and seronegative for AFP have significantly higher levels of serum ALT; serum ALT levels may be of diagnostic importance in AFP-negative, HBV-related HCC patients.Keywords: Alanine aminotransferase, alpha‑fetoprotein, des‑gamma‑carboxyprothrombin, hepatitis B virus, hepatocellular carcinom

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

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

Case Report: Hepatocelluar Carcinoma In Pregnancy And Postpartum Period: A Study Of 6 Cases In Nigerian Women.

Six Nigerians women with hepatcocelluar carcinoma (HCC) in pregnancy and the postpartum period were studied. Their ages ranged from 22 to 37 year with a mean of 28.2 years. Five (83.3%) of the women presented in the postpartum while 1 (16.7 %) presented during pregnancy.There was co – existing cirrhosis in 5 (83.3%) of them. All the 4 women tested for HBsAg were positive. Rapid tumour growth was observed in 2 women who were breastfeeding their babies while on admission. One of the 6 women had a fresh stillbirth at 32 weeks gestation but the other 5 had normal deliveries. Five out of 6 patients died on admission (after an average of 20 weeks of illness) while 1 patient discharged herself against medical advice. The major causes of death were hepatic failure and intra – peritoneal haemorrhage. This study shows that the pregnant Nigeria with women with HCC may carry her pregnancy to term and have normal delivery. Those women who do not present pregnancy may do so in the postpartum period. It is suggested that breastfeeding may ad rapid HCC growth and rupture. Key Words: Hepatocellular Carcinoma, pregnancy, postpartum period, Breastfeeding Nigerian Journal of Clinical Practice Vol.7(1) 2004: 46-4