Upper Gastrointestinal Endoscopy and Children Digestive Pathology in Abidjan

The aim of our study is to determine the demographic data, indications, performance, and security of gastroscopy in children in Ivory Coast. Patients and Methods: This is a retrospective analytical study based on reports of upper digestive endoscopy per-formed in children (from 1 day to 15 years included) in 2 university hospitals in Abid-jan from March 2009 to March 2016. Results: 276 upper gastrointestinal endoscopies (UGIE) were performed in children during the study period. UGIE was performed with a diagnostic purpose in most cases (99%). The indications of UGIE were abdominal pains (38.95%), ingestion of caustic substances (29.82%), upper gastrointestinal bleeding (10.87%) and vomiting (10.17%). UGIE was normal in 39.49% of cases for all ages. The main anomalies observed in upper gastrointestinal (GI) endoscopy for all ages were gastropathies (29%);caustic lesions (13.02%) and bile reflux (10.45%). Ul-cers were rarely found (2.54%). Histological examination of biopsies revealed chronic H. pylori gastritis in 67% of gastric samples examined. All endoscopic examinations were performed without incident. Conclusion: Gastroscopy is a harmless examination with a great diagnostic and therapeutic utility in digestive pathology of children in Ivory Coast.

Treatment of Chronic Viral Hepatitis with Pegylated Interferon in Ivory Coast

Background: In the Ivory Coast, chronic infection by hepatitis B and C virus is the leading cause of cirrhosis and hepatocellular carcinoma. The absence of universal health coverage makes the treatment inaccessible to all. Objectives: To assess the efficacy of Pegylated Interferon in clinical practice in patients with chronic viral hepatitis B and C and determine the hematologic side effects. Patients and Methods: A descriptive retrospective study from January 2012 to November 2013 on a cohort of patients chronic carriers of hepatitis B virus (n = 11) treated with Pegylated Interferon to 180 mcg per week and hepatitis C virus (n = 30) treated with a combination therapy associating pegylated Interferon to 180 mcg per week and Ribavirin assayed according to the genotype. Results: Out of 1860 patients seen in hepatogastroenterology consultation 422 had viral hepatitis B or C that is a prevalence of 22.7% and 41 patients were treated (9.7%) by Pegylated Interferon. Among these 41 patients mentioned earlier, 30 had HCV (73.17%) with a case of HIV + HVC co-infection, 11 patients had HBV (26.83%) including 3 cases of HBV + HDV co-infection. Patients’ age ranged from 24 - 69 years with an average of 49.2 ± 12.2 years including 46.5 years for HBV and 51.9 years for HCV. The sex ratio was 1.56. The original transaminases were on average 93.37 IU/l for AST and 110.47 for ALT. The average RNA HCV was 1,685,331 IU/ml and the DNA HBV 33,312,767 IU/ml. Patients with HCV were of genotype 1 in 56.66%, genotype 2 in 40% and one case of genotype 4 (3.34%) from Central Africa. Fibrosis score at institution of treatment was significant (≥A2 and/or ≥F2) in 86.9% of cases of Fibrotest®, 100% of cases of Fibrometer®. We observed 48.8% of neutropenia < 750/mm3, 33.3% of anemia and 29.3% of thrombocytopenia < 100,000/mm3. There was no dose reduction of Pegylated Interferon and Ribavirin. For HBV there were 3 partial responses, 3 responders including 1 HBV + HDV co-infected non responder to HDV, 2 non responders including 1 HBV + HDV co-infected to Week 48. For HCV, there was 52.94% of cases of sustained viral response (SVR) including 44.44% of genotype 1, 83.33% of genotype 2 and 100% of genotype 4. Conclusion: The free antiviral treatment program helped treat 10% of chronic viral hepatitis B and C. Our results are not different from those of the literature. Difficulties remain in the performance of non supported diagnostic tests.

Upper Gastrointestinal Endoscopy in Children’s Abdominal Pains in Ivory Coast

Since a longtime considered as functional and psychological, children’s abdominal pains (CAP) is a public health problem. Advances in digestive endoscopy and Helicobacter pylori (H. pylori) discovery have reignited the debate of the organicity of CAP. The aim of this study is to determine the diagnosis rentability of upper gastrointestinal endoscopy (UGIE) in CAP in Ivory Coast. Patients and Methods: This a retrospective analytical study based on reports of UGIE performed in 2 university hospital and 3 private clinics of Abidjan from march 2007 to march 2016. The children (from 1 day to 15 years) in which UGIE were performed for abdominal pains were included in the study. Results: 116 UGIE were performed in children for abdominal pains during the study period. Epigastric pain was the main indication of UGIE (88%). The diagnosis rentability of UGIE was more than 70% in this study. The main anomalies observed in UGIE were gastropathies. Ulcers were rarely found. Conclusion: UGIE play an important diagnosis role in CAP in Ivory Coast. However gastric biopsies for Helicobacter pylori research are not common practice in our country.

Diagnostic accuracy of biochemical markers of fibrosis in black African patients with chronic hepatitis B

Contradictory results of the accuracy of bio-chemical markers to predict the stage of fibrosis in black African patients with chronic hepatitis B (CHB) were previously published. We con-ducted a prospective cohort study to determine the diagnostic accuracy of aspartate ami-notransferase to platelet ratio (APRI), aspartate aminotransferase to alanine aminotransferase ratio (AAR), platelet count, age-platelet (AP) in-dex, and FIB-4 index for the prediction of sig-nificant fibrosis or cirrhosis in 117 black African patients (median age: 38 years, males: 73 %) with CHB not previously treated. Among them, 45 had significant fibrosis and 18 had cirrhosis using the METAVIR score system. Factors as-sociated either with significant fibrosis or cir-rhosis were determined in logistic multivariate analysis. Areas under receiver operating curve were assessed and compared for APRI, AAR, AP index, FIB-4 index and platelet count. Sensitivity, specificity, positive and negative predictive values were determined for each biochemical markers. Multivariate analysis showed that as-partate aminotransferase (p 1.1) and FIB-4 index (cut-off > 2.1) ruled out significant fibrosis with high specific-ity of 84.7 % and 86.1 % respectively and nega-tive predictive values of 78.2 % and 72.9 % re-spectively. More accurately, APRI (cut-off > 0.63) or FIB-4 index (cut-off > 1.26) ruled out cirrhosis with high sensitivity of 94.4% and 88.9% and high negative predictive values of 98.1% and 96.3% respectively. In conclusion, APRI and FIB-4 index are simple readily available markers to exclude significant fibrosis or more accu-rately cirrhosis in black African patients with CHB.

Predictors of Direct-Acting Antivirals Failure in Patients with Chronic Hepatitis C Virus in Ivory Coast: About 5 Cases

Context and Aim: Direct-acting antivirals are the therapeutic revolution in the management of viral hepatitis C, but often with a few cases of failure. The aim of this study was to identify factors that may be implicated in the failure of direct-acting antiviral therapy in patients with hepatitis C virus in Ivory Coast. Methodology: This was a cross-sectional and descriptive study with a retrospective compendium of data from the year 2016 to the year 2018. This study included all patients with chronic viral hepatitis C, patients naive to antiviral treatment, or pre-treated patients in whom a failure to treatment with direct-acting antiviral has been diagnosed. Results: During the study period, 5 patients out of 14 cases of therapeutic failure were included, i.e. 35.71%. Most of the patients were over 50 years (4 out of 5) and predominantly female (3 out of 5). High blood pressure was the most common comorbidity (3 out of 5 patients). Genotype 1 was found in 4 patients versus 1 case of genotype 2. None of the patients had hepatitis B or HIV coinfection. A viral load > 6log was found in 4 patients at baseline. All our patients had hepatic cytolysis. Two of them were cirrhotic. All 4 cases of genotype 1 benefited from the combination sofosbuvir + ledipasvir for 12 weeks and the case of genotype 2 from the combination sofosbuvir + ribavirin for 24 weeks. The resistance mutations were observed mainly on the sequencing of NS5A at the Y93H, L31M, 28L, 30T, 31V, 58S and 93H genes and a case of mutation on the N3 gene sequencing. Conclusion: Age > 50 years, comorbidities (high blood pressure), polymedication, female gender, genotype 1b, viremia > 6log, and cytolysis were the profile of patients with treatment of HCV by direct-acting antiviral failure.

Risks of Viral Hepatitis B Transmission in Mother-to-Infant of Pregnant Women Carriers of Chronic Viral Hepatitis B in Cote d’Ivoire

The aim of this study was to identify the risk factors of mother-to-child transmission of HBV in positive Ag Hbs pregnant women in Cote d’Ivoire. Methods: This was a transversal prospective study that took place over a period of 7 months (from February 2016 to August 2016) in 2 university hospital and 2 private clinics. We consecutively recruited 91 pregnant women who were positive for HBs Ag in prenatal consultations. For each pregnant woman record included in the study, we provided Socio-demographic (Age, marital status, education level, social rank, gravidity, parity) and biological data (HBs Ag, Anti-HBc Total Ac, Hbe Ag, Ac anti-Hbe Ac, DNA-VHB, Ac anti-HCV Ac, retroviral serology, transaminases). All of these data were collected using a survey sheet developed for the study. Results: The age of our pregnant women HBs positive ranged from 18 years to 44 years with a mean age of 30.10 years. The age group from 20 to 39 years was the most represented with a frequency of 92.31%. Almost of all positive HBs Ag pregnant women was HBe Ag negative, only 3.3% was HBe Ag positive. The viral load above 2000 IU/ml was found in 21 (23.03%) patients. There were 4 co-infected patients, which 3 HBV-HIV and 1 HBV-HCV. Only 19 (20.88%) pregnant HBs Ag positive women were able to bring back the supplementary virological assessment within a period less than one month. Conclusion: According to our work the virologic profile of positive HBs Ag in pregnant women in Cote d’Ivoire is characterized by an important viral replication objectified by a high viral load in about 23% pregnant women, a negativity of HBe antigen in 96.6% of them.