Ulcerative Colitis in Sub-Saharan Africa: Analysis of 24 Cases in Dakar (Senegal)

Introduction: The aim of our study was to determine the socio-demographic, diagnostic and therapeutic aspects of ulcerative colitis (UC) in one of the largest gastroenterology departments in Senegal. Patients and Method: This was a retrospective and descriptive study based on the analysis of the records of patients hospitalized in the Hepato-Gastroenterology Department of the Grand Yoff General Hospital (Dakar, Senegal) between January 2013 and December 2019. All cases of UC were collected. Clinical, biological, endoscopic and histological data were collected, as well as treatment options. Results: We observed 24 cases, representing a prevalence of 0.87% of inpatients. The mean age of patients was 36 (ranged 18 to 73) and sex ratio 0.9 (13 females). The mean diagnostic delay was 1.6 years (ranged 4 months to 5 years). The clinical symptomatology was dominated by diarrhea with blood and mucus (18 cases). The Litchiger score on admission averaged 8 and 5 patients (20.8%) had severe acute colitis. Colonoscopy showed pancolonic involvement (Montreal E3) in 11 cases (45.8%) and severe endoscopic lesions (stage 3 of the Mayo endoscopic subscore) in 10 cases (41.6%). Therapeutically, 17 patients (70.8%) were initially treated with corticosteroids. Background therapy was 5-ASA in 17 patients (70.8%) and azathioprine in 7 patients (29.2%). Two cases of death (8.3%) were observed following colectasia with colonic perforations before emergency surgery could be performed. Conclusion: UC in our study was primarily among young adults with a slight female predominance. Diagnosis is often late. The lack of biotherapy requires close collaboration with surgeons for the management of severe forms.

Benign Stenosis of Oesophagus: About 101 Cases in the Digestive Endoscopy Department of the General Idrissa Pouye Hospital (Dakar, Senegal)

Introduction: Benign oesophageal strictures are defined as narrowing of the oesophageal lumen not related to neoplastic pathology. They are frequently encountered during endoscopic practice and are often responsible for a reduction in the quality of life of patients due to the appearance of dysphagia. In sub-Saharan Africa, little data are available on these benign esophageal strictures. The objective of our study was to determine the sociodemographic, diagnostic and therapeutic aspects of benign oesophageal strictures in a digestive endoscopy centre in Senegal. Patients and Methods: This was a retrospective, descriptive study analysing reports of upper GI endoscopies performed between January 2015 and December 2017 in a hospital in Senegal. Reports that concluded to have non-neoplastic oesophageal stenosis were collated. Sociodemographic data, indications for and results of endoscopy, and therapeutic modalities were collected. These data were analysed using the Sphinx version 5 software. Results: We collected 101 cases of benign oesophageal stenosis, representing a prevalence of 2.1% in the endoscopy centre. The mean age of the patients was 34 years (range 2 and 83 years) with a median of 37.9 years. There was a female predominance with a sex ratio of 0.38 (73 females). Dysphagia, the main symptom, was present in 87 patients (86.1% of cases) with a Dysphagia score greater than or equal to 2 in 51 patients (50.5%). The average duration of this dysphagia, excluding caustic stenosis, was 4 years (extremes 1 and 15 years). Endoscopy revealed simple stenosis in 76 cases (75.2% of cases). A membranous ring of the cervical oesophagus, suggestive of the Plummer-Vinson syndrome ring, was found in 60 patients (59.4% of cases) and was the primary cause;other aetiologies were dominated by caustic stenosis (19 cases), Schatzki rings (8 cases) and peptic stenosis (4 cases). Endoscopic dilatation was performed in 90 patients (89.1% of cases) with Savary Gilliard bougies (87 cases) and hydrostatic balloons (3 cases). The average number of dilatation sessions was 1.69. In 10 patients (11.1%), refractory stenosis was observed. This stenosis could be resolved after further dilatation in 8 cases before the 8th session. In 2 patients, dilatation failed. Conclusion: Benign oesophageal strictures in our digestive endoscopy centre in Senegal mainly affect young adults, with a predominance of women. Diagnosis is often late. Cervical oesophageal rings in the context of Plummer-Vinson syndrome are the main cause. Oesophageal dilatation with bougies is of great therapeutic value.

Upper Digestive Lesions Not Linked to Portal Hypertension during Cirrhosis: About 82 Cases in the Hepato-Gastroenterology Department of Aristide Le Dantec Hospital

Introduction: The aim of this study was to determine the frequency of digestive lesions unrelated to portal hypertension during cirrhosis and to look for a possible correlation between these lesions and the severity of chronic liver disease. Material and method: Over a period of 15 months (April 1, 2014 to June 30, 2015), all the records of cirrhotic patients who followed up on an outpatient or inpatient basis in the hepato-gastroenterology department of the Aristide Le Dantec Hospital were collected. The data collected were as follows: age, sex, Child-Pugh severity score, etiology of cirrhosis, indication for endoscopy and endoscopic lesions observed. Results: Data were analyzed from 82 patient records with a mean age of 43 years (range 16 and 79 years) and a sex ratio of 1.4 (54 males). Cirrhosis was classified as Child-Pugh B in 47% of cases and Child-Pugh C in 35% of cases. The etiology was viral B in 75 patients (91.5%), B-D co-infection in 2 cases, and alcoholic in 1 case. The indication for oeso-gastroduodenal endoscopy was a systematic search for signs of portal hypertension in 66 cases (80.4%), upper gastrointestinal haemorrhage in 11 cases (13.4%) and epigastralgia in 6.2% of cases. Endoscopic lesions unrelated to portal hypertension were observed in 61 patients (74.4%). Peptic ulcer was present in 26 patients (31.7%), and congestive gastrobulbitis was observed in 38 patients (46.3%) and erosive gastrobulbitis in 32 patients (39%). Of the 43 upper GI endoscopies with biopsies, Helicobacter pylori was found at histology in 17 cases (39.5%). Eighteen patients (21.9%) had esophageal candidiasis. In multivariate analysis, there was no association between no portal hypertension lesions and the severity of cirrhosis. Conclusion:Upper gastro intestinal lesions unrelated to hypertension were present in 3/4 of cirrhotic patients. Peptic ulcer disease and congestive and erosive gastrobulbitis were the most frequently observed lesions. There was no significant association between non-PTH-related lesions and the severity of cirrhosis.