Upper gastrointestinal tract bleeding in Ilorin, Nigeria - a report of 30 cases

Background: Upper gastrointestinal tract bleeding refers to blood loss within the intraluminal gastrointestinal tract from any location between the upper oesophagus to the duodenum at the ligament of Treitz. The onset and severity of blood loss varies widely.Acute gastrointestinal bleeding is a potentially life-threatening abdominal emergency that remains a common cause of hospitalization. There is no local data on the clinical presentation, endoscopic findings and the risk factors for upper gastrointestinal tract bleeding in Ilorin. This study was therefore to review the cases of upper gastrointestinal tract bleed in Ilorin. Aim: To reviewthe cases of upper gastrointestinal tract bleeding seen in Ilorin. Methodology: A retrospective review of the cases of upper gastrointestinal tract bleeding who had upper gastrointestinal tract endoscopy as part of their workup was undertaken to cover a eighteen month period from June 2006 to November 2007. Their clinical presentation, endoscopic findings, and the risk factors which predisposed themto bleedingwere evaluated.The endoscopy register and the request formswere reviewed. Results: Atotal of thirty patients had upper gastrointestinal tract bleeding for which upper gastrointestinal tract endoscopy was performed during the period under review. Twenty-three of the patients were males (76.7%) while seven were females (23.3%). Sixteen patients (53.3%) presented with malaena only; eleven patients (36.7%) with malaena and haematemesis only; while three patients (10.0%) presented with malaena, haematemesis and haematochexia. However all the patients presented with malaena, haematemesis or haematochexia. The commonest clinical presentation of patients with upper gastrointestinal tract bleeding passage of malaena (53.3%). The commonest endoscopic finding was multiple sources of bleeding (66.7%)while the commonest risk factor for upper gastrointestinal tract  bleeding was NSAIDuse (36.7%). Conclusion: The passage of malaena, multiple source of bleeding, and NSAID use are the commonest clinical presentation, endoscopic findings and risk factors respectively in patients with upper gastrointestinal tract bleeding in Ilorin. The spectrum of clinical presentation, endoscopic findings and risk factors for upper gastrointestinal tract bleed found in this study is similar to that found by other workers.Keywords: Upper, gastrointestinal tract, bleeding, Ilori

Indications for Oesophagogastroduodenoscopy in Ilorin, Nigeria- A 30 month Review

Background:Oesophagogastroduodenoscopy is one of the most commonly performed endoscopic procedures. Properly performed, it provides valuable information in patients with upper gastrointestinal conditions. Oesophagogastroduodenoscopy is a visual examination of the upper intestinal tract using a lighted, flexible fibreoptic endoscope or videoscope. Oesophagogastroduodenoscopy is generally indicated for evaluating upper abdominal symptoms such as dysphagia or odynophagia, oesophageal reflux symptoms, gastroduodenal or oesophageal ulcer, upper tract stricture or obstruction, gastrointestinal bleeding, persistent vomiting of unknown cause etc. This study is therefore to review the indications for oesophagogastroduodenoscopy in Ilorin, Nigeria. Aim: To review the indications for oesophagogastroduodenoscopy in Ilorin, Nigeria. Methodology: A review of the indications for  oesophagogastroduodenoscopy was undertaken to cover a thirty-month period from June 2006 to November 2008. The endoscopy register of the operating theatre was examined over this period. The biodata of the patients who underwent the procedure over this period was reviewed. Results: A total of 206 patients had oesophagogastroduodenoscopy done on them during the period under review. 124 of the patients were males (60.2%) while 82 were females (39.8%). The indications for oesophagogastroduodenoscopy were dyspepsia, 94 patients (45.6%); upper gastrointestinal tract bleed, 54 patients (26.2%); gastric outlet obstruction, 12 patients (5.8%); gastric cancer, 11 patients (5.3%); dysphagia, 9 patients (4.3%); acute exacerbation of peptic ulcer disease, 8 patients (3.8%); gastro-oesophageal reflux disease, 7 patients (3.4%); recurrent vomiting, 3 patients (1.5%); bloody stool, 2 patients (1.0%); epigastric mass, 2 patients(1.0%); 1 patient (0.5% ) each on account of excessive salivation, foreign body ingestion, ingestion of corrosive, and recurrent anaemia. Conclusion: The commonest indication for oesophagogastroduodenoscopy in Ilorin is dyspepsia.Key Words: Indications, Oesophagogastroduodenoscopy, Ilori

Awareness of diabetic retinopathy among patients with diabetes mellitus in Ilorin, Nigeria

Background: Diabetic retinopathy is a major cause of blindness worldwide. The associated loss of productivity and quality of life of the patients with diabetic retinopathy will lead to additional socioeconomic burden. This study aims to determine the level of awareness of diabetic retinopathy among diabetic patients.Materials and Methods: This hospital-based cross sectional study, was carried out at the Diabetic and Ophthalmology clinics of University of Ilorin Teaching Hospital, Nigeria from November 2011 to July 2012. A total of 365 patients had validated, semi-structured, and interviewer-administered questionnaires to obtain information on socio-demographic characteristics, clinical information and awareness of diabetic retinopathy.Results: A total of 365 patients were enrolled, with age between 19 and 90 years, and a mean of 45.8 ± 16.3 years. The male to female ratio was 1: 2.2. Ninety-nine respondents (27.1%) had no education. The majority (30.4%) had only primary education; 21.1% had tertiary; 14.5% had secondary while 6.8% had Quranic education. The mean duration of diabetes mellitus was 14.1 ± 13.09 years. Of the 365 patients with diabetes mellitus, 279(76.4%) had heard that diabetes mellitus affects the eyes, while 86 (23.6%) had not. Of those who had heard, 221(79.2%) heard it from health personnel, 45 (16.1%) from radio/television, 25(9.0%) from internet, 23 (8.2%) from books/newspapers, while 16 (5.7%) heard from other sources.Conclusion: There was a high level of awareness of diabetic retinopathy amongst the patients. However, the high level of awareness of the blinding complication of diabetes mellitus did not translate to a correspondingly high level of ocular examination for diabetic retinopathy.Keywords: Awareness, Diabetic retinopathy, Diabetes mellitus, Eye examinatio

Massive rectal bleeding from colonic diverticulosis

Objectives: This is to describe a case of colonic diverticulosis causing massive rectal bleeding in an elderly Nigerian man.Case report: We highlight a case of a 79 year old man who presented with massive rectal bleeding due to colonic diverticulosis from our centre. Colonoscopy identified multiple diverticula in the proximal rectum, sigmoid, descending and transverse colon. The diverticula were more in the descending colon and also oozing blood. He was worked up, and had surgery for hemicolectomy due to massive blood loss following failure of initial conservative management.Conclusion: Colonic divericulosis may cause massive rectal bleeding severe enough to require hemicolectomy. Only few similar cases have been reported in this part of the continent.Keywords: Colon, rectal bleeding, diverticulosis, colonoscop

Functional dyspepsia in Yola, Nigeria

Objective: Dyspepsia is a common disorder originating from the upper gastrointestinal tract, and is the most common indication for gastrointestinal endoscopy. Even though, functional dyspepsia (non-ulcer dyspepsia) is not life –threatening, it has profound clinical and economic effects, and influences the quality of life of sufferers. Data is scanty on functional dyspepsia from Nigeria. This study aims to determine the prevalence of functional dyspepsia in Yola, Nigeria.Methods: This was a cross-sectional study carried out at the Gastroenterology unit of Federal Medical Centre, Yola from December, 2006 to October, 2010. Patients with dyspepsia who had upper gastrointestinal endoscopy as part of their work-up were recruited. Their biodata, history and duration of dyspepsia were noted on a proforma. The spectrum of endoscopic findings was also noted.Results: A total of 441 patients underwent upper gastrointestinal endoscopy out of which 299 patients had dyspepsia. One hundred and thirteen (37.8%) were males while 186 (62.2%) were females, giving a male to female ratio of 1:1.6. The age range was from 18 to 97 years with a mean of 47.6 ± 9.4 years. Clinically significant endoscopic findings were seen in 94.0% while functional dyspepsia was seen in 18 patients (6.0%).Conclusions: Functional dyspepsia was seen in only a minority of patients with dyspepsia.Keywords: Functional dyspepsia, endoscopic, Nigerian

Prevalence of intestinal parasites in newly diagnosed HIV/AIDS patients in Ilorin, Nigeria

AbstractBackgroundHuman immune-deficiency virus/acquired immune-deficiency syndrome predisposes to opportunistic parasitic infestations of the gastrointestinal tract. This study aimed to determine the prevalence of intestinal parasites in newly diagnosed treatment naïve HIV/AIDS patients.MethodsThis hospital-based cross-sectional study was carried out from December 2010 to June 2011. Questionnaires were administered to 238 HIV/AIDS subjects, and 238 age and sex-matched controls. CD4+ T cell count was carried out on HIV-positive subjects. Stool samples were examined using direct microscopic and modified Ziehl-Neelsen methods. Positivity of intestinal parasites was taken as the presence of worms, oocyst, cyst, ova or larvae in the stool samples.ResultsNinety males and 148 females were studied for the HIV-positive and HIV-negative controls respectively. Intestinal parasitic infestation in HIV-positive subjects was 68.5%, and was significantly higher than in the HIV-negative controls 49.2% (P<0.05). In HIV-positive subjects, Cryptosporidium spp. was the commonest (55.0%) parasite isolated. Others were Cyclospora cayetanensis (41.2%), Isospora belli (3.0%), Entamoeba histolytica (8.4%), Giardia lamblia (3.7%), Ascaris lumbricoides (2.5%), Strongyloides stercoralis (1.7%), Trichuris trichiura (0.8%) and Schistosoma mansoni (0.4%). HIV-positive patients with CD4+ T cell count of less than 200 cells/ul were more at risk of opportunistic parasites compared to the HIV-negative controls.ConclusionThe prevalence of intestinal parasites in newly diagnosed HIV/AIDS individuals was high, and its association with CD4+ T cell count was demonstrated. Routine screening for parasitic infestations at diagnosis is indicated to reduce the burden of the disease

Self-reported symptoms of uninvestigated dypepsia among University staff in Ilorin, Nigeria

Objectives: Dyspepsia is a common gastrointestinal (GI) symptom which impacts negatively on quality of life, workplace efficiency and overall productivity. Many studies on dyspepsia in our environment are hospital based, but being a complaint frequently treated first by self-medication before presentation to the hospital, such studies may underestimate its prevalence. The objective of the study was to determine the prevalence of the dyspepsia and its associated factors among administrative staff of the College of Health Sciences, University of Ilorin, Nigeria.Methods: This was a cross-sectional study. Pretested structured, close-ended, interviewer-administered questionnaires were administered to 53 administrative staff selected across the different units by stratified random sampling. The questionnaire obtained information about subject's experiences of dyspeptic symptoms and presence of associated factors such as family history, non-steroidal anti-inflammatory drugs (NSAIDS), tobacco and alcohol use, and presence of diabetes mellitus (DM).Results: The prevalence of uninvestigated dyspepsia among the respondents was 37.5%. Age was significantly predictive of the occurrence of dyspepsia among the subjects Odds Ratio- 1.46, 95% Confidence Interval (1.042-2.045) P=0.03. Use of NSAIDS, presence of DM, family history and tobacco use were not predictive of occurrence of dyspepsia.Conclusion: The prevalence of dyspepsia is high among respondents in the study.Keywords: Dyspepsia, prevalence, university, Nigeri

Hepatocellular Carcinoma - A synopsis of current developments

This review highlights the burden associated with hepatocellular carcinoma and the progress made so far in the diagnosis, management, and treatment of the disease. It is based on a search of Medline, the Cochrane database of Systemic Reviews, and citation lists of relevant and current publications. Subject headings and key words used included "hepatocellular carcinoma", "pathogenesis", "liver transplantation", "local ablative therapy”, and “novel drug therapies”. Additional information was obtained by a manual search of the references from the key articles, current advances in treatment. Only articles in English were included.  Currently, surgical resection and liver transplantation are the treatment strategies offering the best long-term outcomes in patients with hepatocellular carcinoma. Non-transplant treatment as a bridge to transplantation also helps in lessening the risk of tumour progression or death during the waiting period. Targeted multi-cellular therapy with Sorafenib, is the first systemic agent to have yielded survival benefits in patients with advanced disease. Other agents: Brivanib, Erlotinib, monoclonal antibodies, Bevacizumab and Cetuximab, are currently being studied to determine their use in hepatocellular carcinoma.  Radionuclide Yttrium-90 microspheres, or combined subcutaneous interferon alpha and intra-arterial infusion chemotherapy, seem to be more promising strategies than Sorafenib treatment to downstage advanced hepatocellular carcinoma, including cases with macroscopic portal venous invasion.Although numerous modalities of diagnosis and treatment of hepatocellular carcinoma have been studied, there is still need for further evaluation of newer adjuvant treatment to provide more effective and tolerable methods for the patients with hepatocellular carcinoma.Keywords: Hepatocellular carcinoma, Hepato-carcinogenesis, Current diagnostic methods and techniques, Advances in treatmen

Oesophageal Carcinoma - A Report of Two Cases and Review of Literature

Background: Oesophageal carcinoma is a malignant epithelial tumour of the oesophagus that arises from the mucosa. It mostly comprises of squamous cell carcinoma and adenocarcinoma of the oesophagus and oesophagogastric junction. It is a relatively uncommon finding.Objective: The objective of this case report is to demonstrate two cases of oesophageal carcinoma seen at the gastroenterology unit of the University of Ilorin Teaching Hospital, Ilorin. Case report: Two cases of oesophageal carcinoma were seen in the last three years. Two Nigerian males of ages 60 and 69 years respectively presented at our centre with a history of progressive dysphagia initially for solids but later involved liquids, and odynophagia. There was associated history of recurrent regurgitation and weight loss. However there was no heartburn, epigastric pain, abdominal swelling, haematemesis or malena. There was significant history of cigarette smoking and intake of alcohol. Barium swallow done, showed shouldering and distal rat tail appearance of the oesophagus. Upper gastrointestinal endoscopy revealed a mass in the oesophagus with evidence of malignant tumour, occluding the lumen of the oesophagus making it impossible to intubate the stomach. Histological examination of the biopsy specimen taken at endoscopy showed adenocarcinoma of the oesophagus. Conclusion: Oesophageal carcinomas are rare findings in Ilorin, Nigeria.Key Words: Oesophageal Carcinoma, Rare, Endoscopy, Nigeria

Multiple antibiotic resistance iIndex of EscherichiaColi isolates in a tertiary hospital in south-west Nigeria

Background: The effectiveness of available antibiotics is reducing as  microorganisms device means of evading its effects, resulting in the development of superbugs. Pathogens previously susceptible are becoming resistant, and spreading beyond the hospital environment. This change is a major concern for infection control and prevention and a huge economic burden for health care. This study aims to determine the drug sensitivity pattern of E. coli isolated in a tertiary hospital labMethodology: Gram negative bacilli, lactose fermenter, motile, indole positive,  glucose fermenter, gas producing isolate were identified as E.coli. Antimicrobial susceptibility testing to commonly prescribed antibiotics was carried out using the modified Kirby Bauer method and reported with the Clinical and Laboratory Standard Institute Interpretative chart. Mulitiple Antibiotic Resistance index was calculated as number of antibiotics to which isolate is resistant divided by the total number of antibiotics against which isolate was tested.Result: Five hundred and twenty–seven isolates were identified, among which a high rate of resistance to cefuroxime (407), high rate of intermediate susceptibility to nalidixic acid (264) and high rate of sensitivity to ceftriaxone (388) was noted. Sixty percent of the isolates had an index 0.2. Of the 40% with Multiple Antibiotic Resistance index &gt; 0.2, 61 % were from inpatient samples.Conclusion: The high Multiple Antibiotic Resistance index of the E. coli isolates indicates previous exposure to antibiotics and development of resistance to commonly prescribed antibiotics, hence, antimicrobial susceptibility testing is imperative in selecting therapeutic options. Attention also needs be paid to effective infection control and prevention to curb its spread among individuals