Epidemiological and Diagnostic Profile of Patients with Chronic Hepatitis B Virus from 2017 to 2021 in Parakou, Republic of Benin

Introduction: Viral hepatitis B is a public health problem worldwide. The objective of this study was to determine the epidemiological and diagnostic profile of chronic carriers of hepatitis B virus seen for gastroenterology consultations in Parakou, Republic of Benin. Patients and Methods: This was a cross-sectional and descriptive study with retrospective data collection. Patients seen for gastroenterology consultations from January 1, 2017 to June 30, 2021 at the Regional Teaching Hospital of Borgou/Alibori (CHUD-B/A) and having been diagnosed as chronic carriers of hepatitis B virus were included. A minimum initial assessment was required to be included. The minimum sample size was calculated with Schwartz formula. The variable of interest was the detection of HBsAg twice and at least 6 months apart. The other variables studied were sociodemographic, clinical and paraclinical data. The data collected were analyzed using SPSS 17 software. Results: A total of 2786 patients were seen for gastroenterology consultations, including 1126 (40.4%) HBsAg-positive patients. Among them, 417 patients met the inclusion criteria and were the subject of the present study. The average age of the patients was 34.8 ± 10.5 years. Two hundred and forty-seven patients (65.7%) were male, representing a sex ratio of 1.9. The discovery of positive HBsAg status was made during systematic screening in 231 patients (55.4%). Scarifications were noted in 373 patients (89.4%). Asthenia was reported in 184 patients (44.1%). Co-infections with human immunodeficiency virus, hepatitis C and D viruses were 0% (0 in 92), 2.8% (4 in 146) and 14.3% (2 in 146), respectively. During the initial assessment, 274 patients (65.7%) were sero-negative for chronic HBeAg infection, 21 (5%) had clinically significant fibrosis including 16 (3.8%) at the stage of cirrhosis and 7 patients (5.4%) had hepatocellular carcinoma. Conclusion: In Parakou, chronic hepatitis B virus infection is common and affects young people with a male predominance. Asthenia is a non-specific symptom and the most reported by the patients. Around 5 out of 100 patients are seen for consultations at the stage of complication. Emphasis must be placed on early detection and subsidy for pre-therapeutic assessment.

Updated Review on the Panorama of Liver Diseases in Benin

Introduction: The aim of this work was to take stock of the epidemiological aspects of liver diseases in Benin. Methods: Two methods were used: documentary research and collection of the position of gastroenterologists on the subject. For the literature search, the sources interviewed were Medline, African Journal On Line (AJOL), Google and Google scholar. Additional searches were made on the websites of European gastroenterology societies (AFEF, EASL). A collection of the opinions of gastroenterologists, most of them members of the Beninese Society of Hepato-gastroenterology was made. Results: From a nosological point of view, the most frequent and serious liver diseases in Benin are mainly infectious: viral hepatitis B and C (9.9% and 4.12% of the general population in 2013). Bacterial liver diseases (ascites fluid infections and tuberculosis of the liver) come in 3rd position after cirrhosis and hepatocellular carcinoma. Amoebic abscesses of the liver tend to regress. The toxic causes are dominated, in addition to alcoholic liver diseases (steatosis, cirrhosis), by drug lesions: two fatal cases of hepatotoxicity by artesunate-amodiaquine combination and asymptomatic and transient cytolysis in 23.8% of 63 children less than 5 years old treated with arthemether-lumefantrine combination have been described. Phytotherapy, alone or in combination with modern drugs, can in some cases be hepatotoxic. Plants with recognized medicinal virtues (may be harmful to the liver (Senna, Moringa oleifera, tamarind). Chronic aflatoxicoses secondary to the consumption of contaminated food (maize, cassava or peanuts) are relatively under-documented. Overload diseases (in particular alcoholic or non-alcoholic fatty liver) are on the increase (3.19% of 662 ultrasounds in 1995 against 14.5% of 411 in 2011 in Cotonou) partly due to the demographic and nutritional transition underway in Benin. These diseases, often blamed on spells cast, lead to hospital deaths from cirrhosis or hepatocellular carcinoma in young economically active subjects. Conclusion: Despite anti-infectious therapeutic advances, the prevention of toxic and metabolic hepatopathies is essential. Clinical research is crucial.

Indications and Findings of Upper Gastrointestinal Endoscopy in Elderly Patients in Parakou, Republic of Benin

Introduction: Elderly people are considered fragile and at greater risk of having malignant gastrointestinal tumors. The objective of this work was to report the reasons for performing gastrointestinal endoscopy and the lesions found during the endoscopy of this target population in Parakou. Patients and Study Methods: This was a descriptive and cross-sectional study with a retrospective collection of data from January 2016 to December 2017, then from January 2020 to December 2021. It took place in the Regional Teaching Hospital of Borgou-Alibori in Parakou and in the private gastrointestinal endoscopy center of Parakou (Northern Gastrointestinal Exploration Center). All patients aged at least 60 years who had undergone an upper gastrointestinal endoscopy during the study period were included. The variables studied were: the sex, age, indications for the examination, endoscopic lesions and data from the anatomo-pathological examination. Results: In total, out of 1540 upper gastrointestinal endoscopies performed during the study period, 249 (16.17%) involved patients aged 60 years and over. The sex ratio was 1.26. The main indication for the examination was epigastric pain (123 cases, i.e. 49.40%) followed by vomiting (53 cases, i.e. 21.29%). In terms of lesions, non-tumorous gastropathy came first in the stomach (206 cases, i.e. 82.73%) while esophageal lesions were dominated by esophageal candidiasis and cardial incompetence (39 cases, i.e. 15.66% in each of the two situations). In the duodenum, ulcer was noted in 30 patients (12.05%). In 38 patients, 12 (31.58%) were tested positive for Helicobacter pylori infection. Cancers of the gastrointestinal tract were confirmed in 11 patients (4.42%). Conclusion: Upper gastrointestinal endoscopy remains an excellent examination for the exploration of the upper gastrointestinal tract. In Parakou, epigastric pain represents the main indication for this examination in subjects over 60 years of age. Inflammatory or ulcerated non-tumorous gastropathy is the most commonly endoscopic lesion. Esophageal and gastric cancers are less common in this population group according to our study.

Seroprevalence, Importance of Rapid Testing and Factors Associated with HBsAg Carriage in Pregnancy in Three Referral Maternity Hospitals in Mono (Benin), in 2020

Introduction Difficulties in accessing the screening test for viral hepatitis B in maternity wards could be a factor in underestimating the prevalence of anti-HBV antibodies. The rapid diagnostic orientation test (RDOT) could improve seroprevalence and obstetrical prognosis. The aim of this study was to use the rapid diagnostic orientation test (RDOT) to determine the seroprevalence of HBs antigen carriage in pregnant women while highlighting the associated factors. Methods This was a cross-sectional and descriptive study that took place from October to December 2020 (three months) in three (03) reference maternities in western Benin (Mono). Consenting pregnant women received in prenatal consultation had been screened by RDOT. Positive cases were confirmed by ELISA test. The follow-up of these cases made it possible to establish the obstetrical prognosis. Results Of 201 women studied, 11 (5.5%) were positive for RDOT HBV and confirmed by the ELISA test. The factors associated with HBsAg carriage during pregnancy were multiple sexual partnerships (p = 0.01), female circumcision (p = 0.0001), and ignorance of prior HBV serological status (p = 0.0001). No influence of hepatitis B on pregnancy was noted. Conclusion The seroprevalence of hepatitis B in pregnancy was intermediate in the reference maternities of western Benin. The associated factors were multiple sexual partnerships, female circumcision and unawareness of prior HBV status. Free RDOT in maternity wards would improve early detection and management of viral hepatitis B in pregnancy.

Functional Constipation in the General Population in Cotonou:Prevalence and Associated Socio-Demographic Factors

Background: Constipation is considered rare in sub-Saharan Africa because of the high fiber content of the local diet. However, certain factors could intervene in this pathology. The purpose of this study was to assess the prevalence of constipation in the general population in Cotonou and to determine the associated socio-demographic factors. Methods: This was a cross-sectional descriptive and analytical study conducted from July to August 2017 in 7 districts of the township of Cotonou, according to a cluster sampling. We included anyone over the age of 15 living in the city of Cotonou for at least 6 months. Constipation was either self-reported or functional (meeting the Rome IV criteria). Results: A total of 1058 participants were included: 574 men (sex ratio of 1.2), mean age of 29 years [range 15 - 92]. Self-reported constipation was noted in 512 patients (48.5%). It was functional in 256 cases (24.2%). In the latter category, there was a predominance of women (138, 53.9%), of secondary education (46.5%), of self-employed professionals (50.4%), from the Ouémé-Plateau (41.8%). Were associated with the occurrence of functional constipation (univariate analysis), age ≥ 60 years (p = 0.049), female gender (p = 0.003), and subjects living alone (166, 64.8%) vs. those living in a relationship (90, 35.2%, p = 0.001). Conclusion: Constipation was not as rare in Cotonou. It was more common in women, subjects over 60 years old or living alone.

Effectiveness and Safety of Tenofovir Disoproxil Fumarate in Patients Treated for Hepatitis B in the National University Hospital of Cotonou

Introduction: Viral hepatitis B (VHB) is a serious and global public health issue, particularly in sub-Saharan Africa where it is endemic. The objective of this work was to evaluate the effectiveness and safety of tenofovir disoproxil fumarate (TDF) in the treatment of chronic VHB in Cotonou. Methods: This was a descriptive cross-sectional study with a retrospective collection of data from January 1st, 2015 to December 31st, 2016 (24 months) and prospective from May to August 2017 (4 months). Chronic VHB patients treated with TDF for at least 6 months were included. The non-detectability of HBV DNA and the normalization of aminotransferases defined the virological and biochemical responses, respectively. The evaluation of the treatment response on liver fibrosis was done by using APRI score. Renal impairment was assessed by a reduction in glomerular filtration rate according to MDRD (Modifications of the Diet in Renal Disease) formula below 90 mL/min/1.73 m2. Results: In all, 42 patients treated with TDF were included. The average age was 46.7 ± 13.8 years. The study population was predominantly male with a sex ratio of 2.5. Among the 42 patients treated with TDF for an average of 60 weeks (24 to 96 weeks), 36 patients (85.7%) had a virological response;21 patients (50%) had a biochemical response. Virologic response was 70% at week 24 (W24), 92.6% at W48, 87.5% at W72 and 100% at W96 without significant difference between W24 and W48;between W48 and W72 then between W72 and W96. There was a regression of fibrosis and cirrhosis but not significantly. Renal involvement occurred in 3 out of 19 cases (15.8%) including a case of chronic end stage renal failure and 2 cases of mild chronic renal failure. Conclusion: The treatment with TDF is effective and globally safe in our patients with chronic viral hepatitis B in Cotonou.

Contribution to the Study of Irritable Bowel Syndrome in Medical Students at the University of Parakou in Republic of Benin

Introduction: Irritable bowel syndrome is the most common functional gastrointestinal disorder. The objective of this work is to contribute to improving the medical follow-up of medical students at the University of Parakou through a study of irritable bowel syndrome. Study Methods: This was a descriptive and analytical cross-sectional study with prospective data collection. Data were collected from medical students from May 2018 to July 2018 using a pre-established questionnaire. Sampling was probabilistic using a two-stage survey. The diagnostic tools were: Rome IV criteria, Bristol scale and HAD (hospital anxiety and depression) scale. Data analysis was performed using Epi Info 7.1.3.14 software. CDC. Results: Thirty-two (7.55%) of the 424 students included had irritable bowel syndrome. Out of the 32 students with IBS, 24 (75%) were female. Their average age was 21.38 ± 2.39 years. For 24 students (75%), the symptoms occurred at the same time as exam preparation or the intense course period. Of the 32 students with IBS, 1 (3.12%) was regularly physically active. In this series, 8 students (28%) consulted a doctor for their symptoms. The factors associated with this syndrome were female sex (p = 0.022), sleep disorders (p = 0.008) and the presence of a doubtful depression (p = 0.021). Absenteeism due to irritable bowel syndrome was noted in 18 (56.25%) students. Conclusion: Irritable bowel syndrome is a common condition among medical students in Parakou. Support for better management of psychological disorders could improve the quality of life of these students.

Ultrasound Diameter of the Portal Vein to Healthy Adult in Parakou (Benin)

Introduction: The portal vein (PVD) diameter is one of the predictive variables of portal hypertension. This diameter can differ according to the population. The objective of this study was to determine the PVD in a healthy adult population in Parakou using ultrasonography. Methods: A cross-sectional descriptive study was conducted in the medical imaging department of the Borgou and Alibori University-affiliated Hospitals in Parakou from July 1st to October 1st, 2019. The study population consisted of 201 healthy adults. The ultrasound diameter of the portal vein was measured at the level of the hepatic hilum on a cross-sectional epigastric view and on an oblique intercostal view. An association was sought between the PVD and sociodemographic and anthropometric factors. Results: The mean age was 28.97 ± 10.56 years and the sex ratio (M/F) was 0.79. The mean PVD in regular breathing (FB) was 9.83 ± 0.95 mm with a 95% confidence interval of [9.70;9.97], a 95th percentile of 11.49 mm with extremes of 7.50 mm and 12.23 mm. PVD was correlated with age, sex, weight, height and abdominal girth. After multiple linear regressions (r = 0.19), there was correlation between the PVD in normal breathing with age (p = 0.0090), weight (p = 0.0026), body mass index (p = 0.0171) and body surface (p = 0.004). Conclusion: A PVD greater in normal adults is less than 12 mm and seems to be correlated to the subject age, weight, body mass index and body surface. A more than 13 mm PVD should lead to the suspicion of portal vein hypertension in adults in our populations.

Clinical and Etiological Profile of Ascites in the Departmental University Hospital of Porto-Novo

Aim: To determine the frequency, the clinical and etiological aspects of ascites in the Internal Medicine Division of the University Hospital of Porto-Novo. Methods: It was a cross-sectional study with a descriptive focus covering the period from January 16 to August 31, 2015. It covered patients hospitalized for ascites in Internal Medicine Department at the Departmental University Hospital of Porto-Novo during the study period. Data were collected on a survey sheet and entered by Excel and analyzed with SPSS. The Chisquare test was used for statistical analysis and a significance threshold of 5% was retained. Results: Of the 511 hospitalized patients during the study period, 61 (11.9%) had ascites. The mean age was 49.6 ± 13.6 years with extremes of 19 years and 80 years. There was a male predominance with a sex ratio of 2.05. Ascites were often type III (34 patients, 55.7%), or type II (22 patients, 36.1%). The frequent signs were hepatomegaly (65.6%), splenomegaly (45.9%), pelvic limb edema (44.3%), and abdominal collateral venous circulation (39.3%). The macroscopic appearance of the ascites fluid was dominated by citrin yellow (82%), followed by hazy (11.5%). The hematic appearance was found in 6.5% of the cases. Hepatic cirrhosis was the most frequent etiology (34.4%) followed by overall heart failure (21.0%). Hepatocellular carcinoma was found in 16% of cases and nephrotic syndrome in 10% of cases. Conclusion: The etiological diversity of ascites, found in our study, imposes a careful clinical and paraclinical approach.

Primary Duodenal Adenocarcinoma Revealed by Chronic Iron Deficiency Anemia:Diagnostic Difficulties in a Case Report in Internal Medicine CNHU HKM-COTONOU

The location of a primary duodenal adenocarcinoma is exceptional. Only few cases have been reported in the literature. We hereby report a case of primary adenocarcinoma of the duodenum with a 60 years old patient admitted because of chronic iron deficiency anemia. Endoscopic examination revealed a budding and ulcerated process in the second duodenum. The biopsy analysis showed primary adenocarcinoma. No other primary tumor was found. The staging directed showed cephalic pancreatic invasion. The patient died in the aftermath of a surgical management.

Haemorrhoidal Disease in Cotonou: Epidemiological, Clinical and Anuscopic Aspects

The haemorrhoidal disease is a very common disorder in proctology. It is favoured by many factors. Although benign, its treatment is difficult. Our aim is to study the epidemiological, clinical and anuscopic of haemorrhoidal disease. This was a cross sectional, descriptive and prospective study covering a three-month period from 06 January 2014 to 10 April 2014. It involved patients seen in gastroenterology consultation in internal medicine of the National Teaching Hospital of Cotonou and in the digestive diseases Unit of the Hospital of Menontin. We recorded 182 patients including 57 cases of haemorrhoidal disease, a prevalence of 31.3%. The sex ratio was 1.10. The average age was 43 years with extremes of 18 and 88 years. Anal events were dominated by rectal bleeding (54.4%) with a predominance of internal haemorrhoidal disease (87.7%). Stage 2 evolution of the disease was the most represented (65.4%). Haemorrhoidal disease is a common disorder seen mainly in actively producing people (young adult) with a male predominance.