Comparison of Prognostic Scores for Upper Gastrointestinal Bleeding in the Hepato-Gastro-Enterology Department of Campus Teaching Hospital of Lome

Objective: To evaluate and compare the prognostic contribution of different UGIB prognostic scores. Patients and Method: Descriptive cross-sectional study with retrospective collection conducted from January 2014 to December 2019. Patients hospitalized in the Gastroenterology Department of Campus Teaching Hospital of Lome for upper gastrointestinal hemorrhage were included. The analytical component of this study had consisted of an evaluation of the sensitivity and specificity of different prognostic scores (GBS, mGBS, FRS, CRS, AIMS65) in predicting the occurrence of death and/or re-bleeding within 42 days. These different scores were compared using ROC (Receiver Operating Characteristic) curves. Results: We included 314 patients in our study. The male to female sex ratio was 2.48. Fibroscopy found non-related portal hypertension UGIB in 70.94% of the cases. The “FRS” was the most accurate score in predicting death or re-bleeding in all patients. The “FRS” was the most precise score in predicting the occurrence of spotting in all patients. The “FRS” was the most accurate score in predicting death among all patients. The mortality of patients at low risk of death (below the threshold value) was 2.2% for the “FRS”, 9.3% for the “CRS”, 0% for the “GBS” (p = 0.565), 50% for the “mGBS” and 11.4% for the “AIMS65”. Scores were more accurate for non-related portal hypertension UGIB. Conclusion: The “FRS” and the “CRS” are two precise scores in predicting the occurrence of an incident in the event of upper gastrointestinal hemorrhage. However, these scores were less effective in related portal hypertension UGIB.

Patients’ Lived Experience and Injuries Observed during Upper Digestive Endoscopy at KARA Teaching Hospital (Togo)

Background: Endoscopy remains the most performant medical exam exploring the upper digestive tract;but depending on patients, its tolerance is variable. Objective: This study aimed at describing the experience and evaluating the tolerance, acceptability and injuries observed during upper gastrointestinal endoscopy. Methods: This is a prospective and descriptive study carried out from April to July 2017 in the digestive endoscopy unit of the Kara teaching hospital (Togo). The gastroscopy was performed by the same operator (Hepatogastroenteroloogist). The premedication was done with direct intravenous injection of 10 mg of Metoclopramide hydrochloride and viscous Lidocaine oral gel. Previously, essential information about the examination course was given to patients after obtaining their verbal consent. Patients’ impressions of the experience, tolerance and acceptability were collected on a survey sheet, before and after the examination. Results: One hundred and eleven patients were included, 62 women and 49 men. The average age was 45.9 years (15 - 88 years), and the sex ratio (F/M) was 1.2. Most of the patients (89.2%) were experiencing the gastroscopy for the first time, and the main reason was epigastralgia in 55%. The examination duration was good at 88.3% and tolerance was good at 72.1%. Tingling, irritation, pain or sore throat feelings were noted in 13.5%. Patients agreeing to make an ulterior UDE if necessary were up to 92.8%. Observed injuries were dominated by antral erythematous gastropathy (28.8%). Conclusion: UDE is well tolerated among our patients and its acceptability is high. Injuries are dominated by inflammatory pathologies of the stomach in our population.

Quality of Life of the Patients Suffering from Chronic Liver Diseases at the University Health Center Campus of Lome

Objective: Assess the quality of life (QOL) of the patients suffering from chronic liver diseases in our service. Patients and Method: A transversal prospective study conducted at the service of hepatology and gastroenterology at the University health center Campus of Lomé from August 1, 2013 to August 31, 2014. We have used the short form 36 health survey questionnaire (SF-36). Patients of cirrhosis and hepatocellular carcinoma admitted during the said period were selected. Patients suffering from any other chronic diseases such as psychiatric or emotional troubles;linguistic or cognitive deficiencies that could hamper the dependability of the questionnaire were excluded. Results: The average age of the patients was 46 ± 12 years old with a male predominance (sex-ratio: 2.9). Our patients were distributed into 47.4% of cirrhosis and 52.6% of CHC. Those chronic liver diseases etiologies were alcoholic (57%), B viral (66%) and C viral (12.3%). The assessment of QOL showed an overall average score of 76.34 ± 21.1;a mean score of 30.4 ± 86.8 for the physical dimension and 36.5 ± 10.3 for the mental dimension. Patients with viral liver disease had poorer physical summary score (p = 0.000) and poorer mental summary score (p = 0.014) compared to alcoholic patients. Alcohol influenced the physical dimension of the patients (p = 0.000) while the mental dimension was more affected by the age of patients (p = 0.0035). Conclusion: The quality of life is altered by the patients suffering from chronic liver diseases (p = 0035) with regard to our context. This is so in particular with those identified to be viral infected.

Effectiveness of Treatment of Chronic Viral Hepatitis C by Direct-Acting Antivirals in Togo

Background: Viral hepatitis C is the second leading cause of hepatocellular carcinoma after hepatitis B in Africa and Togo in particular. The advent of direct acting antivirals has revolutionized the care and prognosis of patients infected with hepatitis C virus (HCV). Objective: To evaluate the sustained virological response (SVR) 12 weeks after oral treatment without interferon in HCV infected patients with genotypes 1 and 2. Patients and Method: Descriptive and analytical study based on the retrospective collection of data in the hepatogastroenterology unit of the University Hospital Campus of Lome (Togo) from July 11, 2016 to April 22, 2018. All patients who had a chronic viral hepatitis C with viral replication, naive, regardless of the genotype, regardless of the degree of liver fibrosis, and who had completed their treatment with direct-acting antivirals were included. Results: We recruited 84 patients, 60 of whom were infected with HCV genotype 2 (71.43%) and 24 with HCV genotype 1 (28.57%). There were 58 men and 26 women (sex ratio: 0.45). In HCV genotype 1 patients, the median age was 54.29 years and Sofosbuvir/Ledipasvir was the most used combination (62.50%). In HCV genotype 2 patients, the median age was 54.5 years and Sofosbuvir associated with Ribavirin was the most used treatment (81.66%). The virological response at the end of treatment was 100% (genotype 1) and 93.30% (genotype 2). The SVR 12 was 100% (genotype 1) and 91.70% (genotype 2). Five patients were in treatment failure (genotype 2). Conclusion: Direct-acting antivirals were effective in our patients. The rate of sustained virological response was above 90%.

Interest of Serum-Ascites Albumin Concentration Gradient in the Diagnosis of Portal Hypertension in Cirrhotic Patients

Objective: To find a more accessible and less restrictive mean such as serum-ascites albumin gradient (SAAG) to predict esophageal varices (EV) in cirrhotics with ascit. Patients and methods: Descriptive and analytical studies based on the retrospective collection of data on 125 patients’ records in the hepatogastroenterology unit of the University Hospital Campus of Lome (Togo) from January 1, 2008 to March 31, 2018 were included. Cirrhotic patients aged 15 years and older had performed cytochemical analysis of ascites fluid and upper gastrointestinal fibroscopy and had a protidogram. Statistical analysis was done by R Studio Software 3.4.2. Results: The mean age was 48.70 years;there was a male predominance (70.40%) with a sex ratio of 2.38. Protein levels in ascitic fluid was Conclusion: Our study noted that at an upper threshold of 1.10 g/dl, the SAAG significantly predicted the presence of EV.

Characteristics and Prognosis of Patients with Hepatocellular Carcinoma at Campus Teaching Hospital of Lome

Background: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world, as well as in Togo, where it is a major public health problem. HCC is the third most common cause of death from cancer. Chronic infection with HBV and HCV is the most important cause of HCC. Objective: To determine the epidemiological, diagnostic and evolutionary aspects of HCC in the hepatology and gastroenterology department of Campus Teaching Hospital of Lomé. Patients and method: Descriptive and analytical study, conducted from January 1, 2013 to December 31, 2017, on all patients admitted in the hepatology and gastroenterology department of Campus Teaching Hospital of Lome for hepatocellular carcinoma. The statistical analysis was done using Stata 13 software. The significance threshold was used for p Findings: A total of 250 patients were retained. Hospital prevalence was 6.1%. There was a male predominance with a sex ratio of 2.84. The average age was 47.15 ± 13.85 (extreme: 20 - 85 years). The average duration of symptoms was 67.08 ± 82.59 days. Pain in the right hypochondrium was the most common reason for consultation (64.6%). The average AFP value was 24,062 ± 33,318 ng/ml. Ultrasound found more than two nodules in 74.75% of cases and a portal thrombosis in 64.97% of cases. The main etiologies found were chronic hepatitis B (55%) and C (8%) virus infections. The majority (89.20%) of patients were in the BCLC D stage. Survival at 6 months was 45%. Factors associated with death were: chronic ethylism (OR = 16.87, p = 0.002), jaundice (OR = 341.57, p = 0.004), rupture of esophageal varices (OR = 42.45, p = 0.008) and a BCLC D score (OR = 9.82, p = 0.041). Conclusion: Young adults were the most affected by HCC, whose etiologies are dominated in our context by hepatitis B and C viruses. The majority of our patients consulted late and was found at the terminal stage of the disease, limiting any therapeutic possibility. In this situation, the best attitude remains prevention.

Hematological Profile of Anemia in Hospitalized Cirrhotics in the Hepato-Gastroenterology Unit of the University Hospital Campus of Lome (Togo)

Background: Anemia is multifactorial and very frequently observed in the evolution of cirrhosis. Only biological investigations can clarify its mechanisms. Objective: To determine the frequency of anemia in cirrhosis patients and to identify the different types of anemia encountered. Patients and Methods: Descriptive and analytical study based on the retrospective collection of data was carried out over 12 months in the hepato-gastroenterology unit of the University Hospital Campus of Lome (Togo). This study included hospitalized cirrhotic patients with a complete medical file including a blood count and presenting anemia. Results: During the study period, we collected 253 cases of cirrhosis, of which 153 patients had anemia (60.5%);there was a male predominance of 73.2%. The mean age was 51 ± 13 years. The B viral origin of cirrhosis was the most common (60.1%). Oedemato-ascitic decompensation (82.4%) and hepatocellular carcinoma (34%) were the main complications. The Child-Pugh B score was the most represented (74.5%). Hypochromic microcytic anemia was noted (48.4%) followed by normochromic normocytic anemia (46.4%);82 patients (53.6%) had thrombocytopenia;pancytopenia was noted in 17 patients (11.1%). Hepatitis B virus was most commonly found with 50% hypochromic microcytic anemia followed by 46.7% normochromic normocytic anemia (p = 0.311). Hepatic encephalopathy was significantly more frequent in patients with hypochromic microcytic anemia (45.5%) (p = 0.025);hepatocellular carcinoma was significantly noted with 63.5% hypochromic microcytic anemia (p = 0.016). Child-Pugh C score with 47.4% hypochromic microcytic anemia was more frequent (p = 0.673). Conclusion: Hypochromic microcytic anemia was the most common type of anemia noted in our study. Hepatic encephalopathy and hepatocellular carcinoma were the major complications of cirrhosis significantly associated with the hypochromic microcytic anemia.