Nigerian Journal of Gastroenterology and Hepatology

Zenker’s diverticulum co-existing with a duodenal ulcer: A case report

Matthew Olumuyiwa Bojuwoye — 2024-07-14

Oesophageal diverticula are relatively rare, with Zenker’s diverticulum (ZD) being the most common type. ZD is a relatively rare disease in the pharyngoesophageal area. It is a pulsion diverticulum, or false diverticulum, located dorsally at the wall between the pharynx and esophagus. We present a case of an incidental finding of a ZD in an elderly woman who presented with upper gastrointestinal bleeding from a co-existing duodenal ulcer.

Management of 52 small bowel perforations following gunshot injury: A case report

Oluwole Olayemi Olaomi — 2024-07-14

Small bowel injury is one of the most common abdominal injuries following penetrating injuries and is usually secondary to gunshot, stab, or impalement injuries to the abdomen. We report a case of shotgun injury to the abdomen in a hemodynamically stable man. He had an emergency exploratory laparotomy, during which 52 small bowel perforations and 1 transverse colon perforation were found. He was managed by damage control surgery involving a temporary nonclosure of the anterior abdominal wall with resuscitation and a second look laparotomy after 48h.

Hepatitis B virus serology in first-degree relatives and spouses of patients with hepatocellular carcinoma at a Nigerian hospital

Olutoyin Iretiola Asaolu — 2024-07-14

Background: The link between hepatitis B virus (HBV) infection and hepatocellular carcinoma (HCC) has been well established. There is a dearth of scientific data on the important phenomenon of familial clustering of these diseases in sub-Saharan Africa. This study evaluated the prevalence and risk of HBV infection in first-degree relatives and spouses of patients with HCC.
Materials and Methods: This case–control study was conducted in a Nigerian hospital. A total of 211 first-degree relatives and spouses of confirmed 110 patients with HCC and 212 matched controls were consecutively recruited. All participants were screened for the HBV serological markers using the Aria lateral immunoassay kits. Logistic regression was used to determine the odds ratio while bivariate analysis was used to calculate χ2.
Results: The prevalence of HBsAg was higher in the first-degree relatives and spouses of patients with HCC than in the controls (17.1% versus 3.3%, P < 0.001, odds ratio 5.9, 95% confidence interval (CI): 2.6–13.7). Among the relatives, the prevalence of HBsAg positivity was highest in the parents and siblings of HCC patients compared with the children and spouses (P < 0.0001). Furthermore, the relatives of female index patients had a higher prevalence of HBV than the relatives of the male HCC patients (75.0% versus 27.0%, p = 0.012). Significant risks for HBV infection included lower vaccination rate, low educational status and tattoo acquisition (p = 0.006, 0.010 and 0.023 respectively).
Conclusion: This study provides important local-based population data (perhaps the first of its kind) supporting the scientific postulation of familial clustering of HBV infection and HCC. It also underscores the importance of targeting first-degree relatives and spouses of patients with HCC for HBV screening to reduce the infection and its sequelae.

Hepatic fibrosis among chronic hepatitis B virus-infected patients: North-Western Nigeria experience

Yusuf Musa — 2024-07-14

Background: Chronic hepatitis B (CHB) virus infection is a global health problem, affecting two billion individuals worldwide, with 257 million suffering from chronic infection. This condition can lead to severe complications, including fulminant hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Fibrosis serves as the common pathway through which CHB infection progresses to cirrhosis and HCC. Liver biopsy is considered the gold standard assessment method, although it is a procedure that is often avoided. However, the feared complications associated with it can be averted with preventive measures. In this study, we aim to assess the fibrosis pattern among CHB patients using liver biopsy, as well as its tolerability and histological outcome within our locality.
Materials and Methods: This was a cross-sectional descriptive study conducted at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Sixty-eight patients with CHB infection were consecutively recruited over a period of 7 months. Following a focused history and physical examination, various tests including complete blood count, liver enzymes, serum proteins, prothrombin time, and international normalized ratio were conducted. A liver biopsy was performed on all eligible consenting subjects without contraindications. The histological findings and results of investigations were recorded and analyzed accordingly.
Results: The mean age of the study subjects was 32.43 ± 10.50 years with a male-to-female ratio of 2:1. More than 80% of the patients were negative for HBe antigen (envelope antigen). Out of the 68 patients successfully biopsied, 42 (61.7%) had histological evidence of necroinflammation, with 22% exhibiting significant inflammation. Additionally, 35 patients (56.5%) displayed evidence of fibrosis, with 46.5% of them having significant fibrosis.
Conclusion: More than half of the CHB patients examined exhibited evidence of fibrosis and necroinflammation.

Prevalence, patterns, and risk factors for endoscopy-related musculoskeletal injuries among endoscopists in Nigeria

Chinwe Philomena Onyia — 2024-07-14

Introduction: Musculoskeletal issues are quite common among endoscopists especially considering the complexity of GI endoscopy with prolonged examination time. In particular, the combination of repetitive movements, long procedure time, high volume and setup of the endoscopy suite provide the basis for these health issues. Considering the increasing number of new endoscopic interventional and diagnostic procedures, ergonomics in gastrointestinal endoscopy has not been addressed to the same extent. There has been no study on musculoskeletal injuries among practicing endoscopists in Nigeria. This study was designed to study the prevalence, patterns and risk factors for endoscopy-related musculoskeletal injuries among endoscopists in Nigeria.
Methods: This was a nationwide cross-sectional questionnaire-based study in which practicing endoscopists in Nigeria were administered an online Google form. The questions on the questionnaire were adapted from the Nordic Musculoskeletal Questionnaire (NMQ). The questionnaire also included social demographic variables. There were 66 respondents which included gastroenterology physicians and surgeons. Data was analyzed with IBM-SPSS version 25. Inferential statistics was done using chi-square with p-value set at 0.05.
Results: The Prevalence of endoscopy-related musculoskeletal injuries among endoscopists in Nigeria is very high. The commonest sites affected were the wrist/hands, lower back, neck and shoulders. These injuries prevented about one-third of the endoscopists from carrying out their normal activities while the injuries were severe enough to necessitate therapy in more than two-thirds of the respondents. The only statistically significant risk factor for endoscopy-related musculoskeletal injury was female sex.
Conclusion: Most of the endoscopists in Nigeria have not had any form of training on ergonomics. While most of the endoscopists adopted the correct posture while performing endoscopies, a significant number did not practice ergonomic timeout nor use the finger grip technique. Thus there was a knowledge gap as well as a practice gap. A proper ergonomic education is a key step in preventing endoscopy-related musculoskeletal injury.

Evaluation of liver fibrosis by non-invasive markers (transient elastography vs. APRI, FIB-4, and FORNS) in chronic hepatitis C virus carriers in a low-income country

Eloumou Bagnaka Servais Albert Fiacre — 2024-07-14

Background: The interest in evaluating hepatic fibrosis stems from the fact that the risk of developing cirrhosis following hepatitis C virus (HCV) infection is estimated at 10%–20%. The aim of this study was to identify feasible, accessible, and affordable non-invasive methods other than transient elastography (TE) in the evaluation of liver fibrosis in a resource-limited country.
Materials and Methods: This was a cross-sectional analytical study conducted over 24 months in two health facilities in Douala, Cameroon. All chronically infected HCV patients who had undergone a TE were enrolled. In this study, TE was considered the gold standard for evaluating hepatic fibrosis. Other non-invasive markers considered were the aspartate transaminase to platelet ratio (APRI) index, fibrosis-4 (FIB-4), and FORNS scores. The sensitivity (Se), specificity (Sp), positive predictive value, and negative predictive value of each marker to determine significant fibrosis and cirrhosis were calculated for different thresholds, and the best Se/Sp ratio evaluated by the area under the receiving operating characteristic curve.
Results: One hundred eighty-four patients were enrolled. The mean age was 56.2 ± 10.6 years with a female predominance. There was a positive correlation between TE and the FIB-4 score, the APRI score, and the FORNS score. The threshold values to predict significant fibrosis for the FIB-4, APRI, and FORNS score were 2, 0.5, and 7.6, respectively. The threshold values to predict cirrhosis for the FIB-4, APRI, and FORNS scores were 3.2, 1.3, and 9.6, respectively.
Conclusion: The FIB-4 score is the best at predicting significant fibrosis, while the APRI and FIB-4 scores are the best at predicting cirrhosis in hepatitis C patients when compared to TE as the gold standard.

Investigation on self-medication among outpatients consulting in the Hepato-Gastroenterology Department at the Campus University Hospital of Lome-Togo

Laté Mawuli Lawson-Ananissoh — 2024-07-14

Aim: To evaluate knowledge regarding self-medication and describe hepatic and renal biological disturbances observed in patients practicing self-medication.
Materials and Methods: This descriptive cross-sectional study with prospective data collection was conducted from February 1, 2022, to July 31, 2022, in the Hepato-Gastroenterology Department of the Lome Campus Teaching Hospital (Togo). It included outpatients who provided written, voluntary, and informed consent to participate in the study.
Results: A total of 419 patients participated in the study. The mean age of the patients was 39.80 ± 14.93 years. The frequency of self-medication was estimated at 91.65%. The main reasons mentioned were the lack of funds to visit the hospital (45.25%), perceived non-gravity of the condition (30.73%), and time constraints (28.77%). The top three reasons for self-medication were headache (32.56%), flu-like illness (29.5%), and abdominal pain (26.82%). Analgesics (73.31%), antimalarials (28.93%), and anti-inflammatories (24.71%) were the most commonly used therapeutic classes. epatic cytolysis syndrome was found in 19.27% of patients, and kidney failure was noted in 5.46% of patients.
Conclusion: Self-medication poses significant dangers when undertaken recklessly, given the inherent risks associated with drugs and the consequences that such risks entail.

Colorectal polyps risk factors: A case–control study in Abidjan (Côte d’Ivoire)

Henriette Ya Kissi Anzouan-Kacou — 2024-07-14

Background and Objectives: Adenomas and certain serrated polyps have the potential to develop into colorectal cancer (CRC). Despite barriers limiting routine screening for CRCs in Côte d’Ivoire, it is important to focus on the risk factors for colorectal (CR) polyps. To facilitate the identification of individuals to prioritize for CRC screening, this study aimed to determine the risk factors of CR polyps in a hospital setting in Abidjan.
Materials and Methods: From January 1st, 2023, to July 31st, 2023, a prospective analytical multicenter case–control study was conducted in four hospitals in Abidjan. Patients diagnosed with CR polyps (cases) were compared to those without polyps (controls), matched for age and gender at a 1:1 ratio. Logistic regression was employed to determine factors associated with the discovery of CR polyps.
Results: Thirty-three cases were matched to 33 controls [age (P = 0.97), gender (P = 0.80), recruitment site (P = 1.00), indication for colonoscopy (P = 0.93)]. Adenomatous polyps represented 68.3% (n = 28) of cases. In univariate analysis, factors associated with CR polyps were body mass index (P = 0.004), personal or family history of CRC (P = 0.004) and/or CR polyps (P = 0.007), and consumption of red meat (P < 0.001). After multivariate analysis, only red meat consumption was statistically associated with CR polyps (P = 0.02) [odds ratio (OR) = 17.0 (1.5–189.3)]. Alcohol and tobacco were not statistically associated with the presence of CR polyps either in univariate analysis [alcohol (OR= 0.14) and tobacco (OR= 1.00)] or in multivariate analysis [alcohol (OR= 0.99) and tobacco (OR= 0.99)].
Conclusion: Our study found that increased consumption of red meat is associated with the presence of CR polyps. However, tobacco and alcohol did not show an association with CR polyps in our study. Larger studies are necessary to validate or challenge our findings.

Nonalcoholic fatty liver disease in Sub-Saharan Africa: A descriptive study of the range of histopathological findings in the South-West zone of Nigeria

Olusegun Sylvester Ojo — 2024-07-14

Background: Nonalcoholic fatty liver disease (NAFLD) is increasingly becoming a public health problem worldwide. It has been shown that a very strong link exists between NAFLD and the risk of other systemic diseases. Currently, data on the incidence of NAFLD are limited in much of sub-Saharan, whereas hepatitis B virus (HBV) infections are also endemic. Thus, there is an impelling need to assess if NAFLD makes any significant contribution to the severity of HBV-associated chronic liver disease (CLD) in patients who develop NAFLD simultaneously.
Aim: This study described the range of histopathological findings in NAFLD and assessed the impact of NAFLD on the severity of HBV-associated chronic hepatitis.
Materials and Methods: We retrospectively studied 120 cases of histologically diagnosed NAFLD within a 4-year study period from May 31, 2018 to April 30, 2022. Brunt Scoring System was used to grade and stage NAFLD cases with or without chronic hepatitis B (CHB) infection in each case. Data were analyzed using descriptive and Chi-t tests.
Results: The results revealed that the mean age was 45.78 ± 12.29 years with a female predominance. HBV-associated CLD patients with histological diagnosis of NAFLD were present in 55 (45.83%), and NAFLD in patients without CHB was 54.16%. There was a statistically significant association between the older age group with the cohort cases with NAFLD without associated CHB infection (P < 0.001). The grading and fibrosis stage was found not to be related to the age group or gender among any of the cohorts of cases.
Conclusion: This study concludes that the histological range primarily includes steatosis with or without lobular and portal inflammation or fibrosis as well as ballooned hepatocytes. There is no statistically significant difference in the grade and stage between NAFLD patients without CHB and HBV-associated CLD patients with histological features of NAFLD. However, the grade tends to be higher in NAFLD patients without CHB, whereas the fibrosis level tends to be higher in cases of HBV-associated CLD patients with histological NAFLD.