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.

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.

Prognostic Factors for Cirrhosis Hospital in Abidjan (Cote d’Ivoire)

Cirrhosis is the cause of a high rate of death in hospitals. The aim of this research was to estimate the incidence of mortality and identify the risk factors associated with cirrhosis patients in hospital in Cote d’Ivoire. Methodology: It is a retrospective study covering from January 1st, 2002 to December 31st, 2011 at Centre Hospitalier et Universitaire de Yopougon in Abidjan. We concerned the cirrhosis patients that have been followed at the hepatology and gastroenterology department. Survival was estimated by the Kaplan-Meier curve and comparison of survival curves by the log-rank test. The multi-varied analysis of the survivals has been achieved with the Cox proportional Hazard regression. A p value < 0.05 was taken as significant. Results: We recruited, 221 patients (135 men) of whom the medium age was 59 ± 15.12 years. Among those patients, 34.5% were classified as Child Pugh C and 52.94% Child Pugh B, 19.45% suffered from digestive hemorrhage, 26.5% suffered from renal deficiency, 47% suffered from hepatic encephalopathy and 10.7% from hyponatremia. The median overall survival of patients was 0.50 person-months. The variables that were significantly associated to a reduction of survival were hepatic encephalopathy (p = 0.0029), spontaneous ascitesfluid infection (p = 0.0208), hyponatremia (p = 0.0434) and stage Cof Child- Pugh score (p = 0.046). Conclusion: The incidence of mortality in cirrhotic patients hospitalized in Abidjan is high. Pejorative prognostic factors were essentially hepatic encephalopathy, spontaneous ascites fluid infection, hyponatremia and stage C of Child-Pugh score.

Prevalence of hepatitis B infection and factors associated in children of Ivorian HBsAg carrier subjects

Aims of the Study: 1) Determine the Prevalence of Hepatitis B virus (HBV) infection in children (contact subjects) of chronic Hepatitis B surface antigen (HBsAg) carrier subjects (index subjects);2) Search for factors associated with HBV infection in these children. Patients and Methods: Retrospective-crosssectional study (January 5th, 2006 through December 31st, 2012). Studied parameters: biological and clinical characteristics of index subjects;Prevalence of HBsAg and Hepatitis B core antibody (HBcAb) in their children. Search for the HBV infection associated factors in the children (univariate analyses through Chi-square or Fisher’s exact test;multivariate analysis through a backward logistic regression). Results: Our 44 subjects’ median age was 43.1 ± 7.49 years and 88.6% of them lived with a spouse. Average number of children per index subjects was 2.3 ± 1.1. Our 92 children’s median age was 9.3 ± 4.55 (ranging from 1 to 15 years), and 43 (44.8%) were vaccinated against HBV. HBV infection prevalence was 24% (23/96 of which, 4 were HBsAg positive and 19 HBcAb positive subjects without HBsAg). Independent factors associated with HBV infection in children of index subjects were HBV DNA for index subjects >2000 IU/ml (OR = 11.5;p = 0.001), existence of HBV in two parents (OR = 7.9;p = 0.03) and absence of HBV vaccination in the children (OR = 30.9;p = 0.003). Conclusion: Immunization coverage for children of index subjects was insufficient, especially before the introduction of HBV vaccine into the enlarged vaccination program. Outside vertical transmission, those children were more exposed to HBV intrafamilial transmission risk when they were not immunized against HBV, when both parents were infected and when HBV viremia in index subjects was higher than 2000 IU/ml.

Prevalence of Heartburn in Abidjan, a Black African Country, and Associated Factors

Aims: To determine the prevalence and risk factors of heartburn in Abidjan, a black African city. Patients and Methods: cross-sectional study from June 15 to September 30, 2003. One thousand nine hundred forty (1940) persons from five health zones of the city Abidjan were included after their informed consent. Socio demographic and clinical parameters were collected using a questionnaire in an interview format. Heartburn was defined as a discomfort or burning sensation extending from the sternal manubrium to the base of the neck. Factors related to the complaint were asked such as predisposing factors, habits (tobacco, alcohol and coffee intake) and body mass index. Stepwise multiple logistic regression analyses were used to examine associations between these factors and heartburn. Results: Among 1940 respondents (mean age 28 ± 9 years;sex ratio (M:F) 0.86), heartburn occurred in 433 persons (once a week in 9.2% of case (178 persons)). Five factors were statistically associated with heartburn: male sex (p = 0.025, OR = 0.555 [CI95% 0.331 - 0.930]), heartburn in a family member (p = 0.010, OR = 1.765 [95%CI 1.143 - 2.725]), constipation (p = 0.011, OR = 2.182 [95%CI 11,953,983]), right lateral decubitus (p = 0.001, OR = 6.247 [95%CI 2.079 - 18.775]) and after a meal (p = 0.000, OR = 2.643 [95%CI 1.594 4.383]). Conclusion: Heartburn is common in this black African population. Male sex appears to be less associated. Constipation, right lateral decubitus and after a meal are trigger factors for heartburn. Heartburn in a family member is a risk factor.

Appropriateness of colonoscopy in Cocody teaching hospital center in 2010: A prospective study using criteria established by the European panel on the appropriateness of gastrointestinal endoscopy (EPAGE)

Aims: 1) To assess the feasibility of EPAGE criteria in clinical practice;2) To assess appropriateness colonoscopy using EPAGE criteria;3) To compare colonoscopy appropriateness and endoscopic lesions. Method: Hundred thirtynine consecutive patients explored by colonoscopy were included. The appropriateness of colonoscopy was evaluated by EPAGE criteria. Results: EPAGE criteria were applicable among 127 patients (91% of the cases). Colonoscopies were appropriate, uncertain and inappropriate in respectively 40%;27% and 24% of the cases. Rate of abnormal colonoscopies was significantly different between the 3 groups (p = 0.03). Cancers were diagnosed exclusively in the groups with appropriate and uncertain colonoscopies (11% and 5%). Colonic adenomas were observed in the three groups (appropriate (7%), uncertain (5%) and inappropriate (6%)). Subjects with uncertain indication were older (58.25 years;p = 0.035). Conclusion: EPAGE criteria are feasible in clinical practice in Cocody’s teaching hospital center. Colonoscopies are generally appropriate in our hospital. However, within sight of the significant number of normal colonoscopies and discovered lesions in uncertain indication, colonoscopy cannot concern exclusively calculation of a score of appropriateness.

Virological profile of hepatitis B infection in Black African HBsAg chronic carriers

Aims: 1) Describe virological profile of patients followed-up for chronic Hepatitis B virus (HBV);2) Search for a correlation between cirrhosis and virological profile of patients. Patients and Methods: Retrospective study about 75 HBsAg positive patients followed-up for at least one year in two medical structures of Abidjan. Studied parameters: clinical signs, biological check-up (serum transaminases every 3 months for at least one year, platelets count and prothrombin rate), abdominal echography, virological check-up (HBsAg, HBeAg, anti-HBe, total anti-HBc, anti-VHC and anti- HIV Ab, HBV DNA biannual quantification during at least one year). Histological or biochemical evaluation of hepatic activity and fibrosis were realized in case of transaminases elevation or HBV DNA > 2000 IU/ml. Results: The mean age of our 75 patients (54 men) was 42.1 ± 11.54 years. HBV was fortuitously discovered in most of our patients (74.7% of the cases). The HBV inactive chronic carriage was 50.7%;HBeAg-positive and HBeAg-negative chronic hepatitis represented respectively 9.3% and 40% of the cases. Mean B viral load was 327.5 IU/ml in HBV inactive chronic carriers, 44,047,663 IU/ml in HBeAg-positive chronic HBV and 20,231,822 IU/ml in HBeAg-negative chronic HBV. Cirrhosis prevalence was significantly high- er in positive or negative HBeAg chronic HBV than in HBV inactive chronic carriers (32.4% vs. 5.3%, p = 0.008;OR = 8.6). Conclusion: Our patients’ virological profile was dominated by HBeAg-negative chronic HBV and HBV inactive chronic carriage. The risk of having cirrhosis was multiplied by 8.6 in case of active chronic hepatitis compared with HBV inactive chronic carriage.