Endoscopic Outcome of non complicated Gastric Ulcer following Standard Medical Treatment in sub-Saharan African Population


Endoscopic Outcome of non complicated Gastric Ulcer following Standard Medical Treatment in sub-Saharan African Population


Kowo MP1, Essouma M1, Ndjitoyap Ndam AW1, Wembe Sop BD2, Kenfack GU1, Guekam Ouamba P2, Ndjitoyap Ndam EC1, Njoya O1, Ankouane Andoulo F1

1Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon; 2Université des Montagnes Banganté Cameroon


Open Journal of Gastroenterology and Hepatology

Background.The endoscopic outcome of gastric ulcers is not well described in sub-Saharan Africa. This study was therefore conducted in order to track the endoscopic outcome of non complicated gastric ulcers following standard medical treatment in  sub-Saharan African population.

Methods.This was a prospective cohort study conducted from January to July 2018 in three tertiary healthcare centers in Yaounde (Cameroon).Gastric ulcers and gastric H. pylori infection were diagnosed and monitored by upper digestive endoscopy performed before and at least four weeks following treatment with proton pump inhibitors alone or combined with antibiotics depending on H. pylori status.  A complete case analysis was done using the SPSS software, version 21.0. p-values ≤0.05 were considered as significant.

Results. Ninety-six patients (54.2% males) with a mean age of 55.3 ± 14.9 years were initially enrolled. In most patients, the ulcer frequently was unique (76%) and the antrum was the commonest localization 76 (79.2%). Among patients with H. pylori infection, the quadruple therapy was the most prescribed treatment 41 (87.2%) patients. There were 60 (62.5%) subjects lost to follow-up. Of the 36 (37.5%) patients who underwent repeat endoscopy, 26 (72.2%) had ulcer healing and 8/13 patients had successful H. pylori eradication. A delay of repeat endoscopy >8 weeks was the only predictor of non-healing of the ulcer: relative risk 0.6[95% CI: 0.3-1.08], p = 0.05.

Conclusion.Ulcer healing was found in nearly 2/3 of patients and H. pylori eradication in almost ¾ of patients. This study should be repeated in a large sample.


Keywords: Gastric ulcer, endoscopic outcome, standard medical treatment, sub-Saharan Africa.

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How to cite this article:
Kowo MP, Essouma M, Ndjitoyap Ndam AW, Wembe Sop BD, Kenfack GU, Guekam Ouamba P, Ndjitoyap Ndam EC, Njoya O, Ankouane Andoulo F. Endoscopic Outcome of non complicated Gastric Ulcer following Standard Medical Treatment in sub-Saharan African Population. Open Journal of Gastroenterology and Hepatology, 2020, 3:39. DOI: 10.28933/ojgh-2020-06-1505


References:

1. GBD 2017 Disease and Injury incidence and prevalence Collaborators. Global, regional, and national incidence, prevalence and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet.2018 ;392 :1789-858.
2. Kavitt RT, Lipowska AM, Anyane-Yeboa A, Gral-nek Ian M. Diagnosis and Treatment of Peptic Ulcer Disease. The American Journal of Medicine. 2019 ; doi: https://doi.org/10.1016/j.amjmed.2018.12.009.
3. Asali AM, Alghamdi MA, Fallatah SA, Alholaily WA, Adandan RG, Alnosair AH, et al. Risk factors leading to peptic ulcer disease: systematic review in literature. Int J Community Med Public Health. 2018;5(10):4617-4624.
4. Scally B, Emberson JR, Spata E, Reith C, Davies K, Halls H, et al. Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications:a meta-analysis of randomized trials. Lancet Gastroenterol Hepatol 2018; 3: 231–41.
5. Lanas A, Chan FKL. Peptic ulcer disease. Lancet 2017 ;390 : 613–24.
6. Archampong TN, Asmah RH, Richards CJ, Martin VJ, Bayliss CD, Botao E, et al. Gastro-duodenal disease in Africa: Literature review and clinical data from Accra, Ghana. World J Gastroenterol. 2019; 25(26): 3344-3358.
7. Ndjitoyap Ndam EC, Tzeuton C, Mbakop A, Pouepene J, Guemne TA, Njoya O, et al. Endoscopie digestive haute au Cameroun Etude analytique de 4100 examens. Médecine d’Afrique Noire. 1990;37 (9) : 454-456.
8. Gyedu A, Yorke J. Upper gastrointestinal endoscopy in the patient population of Kumasi, Ghana: Indications and findings. Pan African Medical Journal. 2014 ;18 :327.doi :10.11604/pamj.2014.18.327.4806.
9. Smith S, Fowora M, Pellicano R. Infections with Helicobacter pylori and challenges encountered in Africa. World J Gastroenterol. 2019 ; 25(25): 3183-3195.
10. Jaka H, Rhee JA, Östlundh L, Smart L, Peck R, Mueller A, Kasang C, Mshana SE. The magnitude of antibiotic resistance to Helicobacter pylori in Africa and identified mutations which con-fer resistance to antibiotics: Systematic review and meta-analysis. BMC Infect Dis 2018 ;18 : 193.
11. Rickard J. Surgery for Peptic Ulcer Disease in sub-Saharan Africa: Systematic Review of Published Data. J Gastrointest Surg. 2015 ; doi : 10.1007/s11605-015-3025-7.
12. Chey WD, Leontiadis GI, owden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol 2017; 112:212–238.
13. Touloumi G, Pocock SJ, Babicker AG, Darbyshire JH. Impact of Missing Data Due to Selective Dropouts in Cohort Studies and Clinical Trials. Epidemiol. 2002 ; 13(3): 347-355.
14. Okada M, Yao T, Fuchigami T, Imamura K, Omae T. Factors influencing the healing rate of gastric ulcer in hospitalized subjects. Gut. 1984 ;25 : 881-885.
15. Wang S-Y, Wang H-Y, Wang T-E, Wang H-H, Chang W-H, Chu C-H, et al. Delayed healing of gastric ulcer is associated with downregulation of connexin 32 in the gastric mucosa. Advances in Digestive Medicine. 2015 ;2 : 67e73.
16. Ndip RN, Takang AEM, Ojongokpoko JEA, Lu-ma HN, Malongue A, Akoachere JFTK, et al. Helicobacter pylori isolates recovered from gastric biopsies of patients with gastro-duodenal pathologies in Cameroon: current status of antibiogram. Trop Med Int Health. 2008;13 (6): 848-854.
17. Buta N, Tanih NF, Ndip RN. Increasing trend of metronidazole resistance in the treatment of Helicobacter pylori infection: A global challenge. African Journal of Biotechnology. 2010 ;9(8) :1115-1121.
18. Kristman V, Manno M, Côté P. Loss to follow-up in cohort studies: how much is too much? European Journal of Epidemiology. 2004 ;19 : 751–760.