Showing papers in "Open Journal of Gastroenterology in 2020"

High Prevalence of Hepatitis B Virus Infection Compared to Human Immunodeficiency Virus among Blood Donors in Bangui

Abstract: Introduction: Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) infection is a public health problem worldwide, particularly in sub-Saharan Africa. Objective: to compare the epidemiological, clinical and biological characteristics of chronic HBV and HIV infection in blood donors at the National Center for Blood Transfusion (NCBT) in Bangui. Patients and Methods: This was an 8-month analytical cross-sectional study from August 10, 2011 to April 9, 2012. During this study, we consecutively enrolled consenting blood donors of both sexes in which the search for HBsAg and HIV infection was carried out. Results: During the study period, 850 blood donors were collected. HBsAg was found in 142 donors (16.7%), of whom 55 blood donors (6.5%) were coinfected with HIV. On the other hand, HIV serology was positive in 77 blood donors (9.1%) including 55 co-infected (6.5%) with HBV. In order to better compare the risk factors, we have not included HIV-HBV coinfected patients. Only 795 blood donors were selected for the risk factor study. There were 87 cases of HBsAg positive (10.9%) and 22 cases of HIV positive (2.8%). The average age of HIV and HBV infected patients was 25.7 and 26.2 years, respectively. Twelve blood donors (1.5%) over the age of 20 were HBsAg versus 3 HIV positive blood donors (0.4%). Among blood donors over the age of 20, 75 (9.9%) were HBsAg positive, while 19 (2.4%) were HIV positive. Men were infected with HIV in 20 cases (2.5%), while those infected with HBV were 84 (10.6%). The risk factor found during HIV infection and HBV was unprotected sex with a p of 0.0038 and 0.0017 respectively. Conclusion: The prevalence of HBV infection is higher than that of HIV among blood donors in Bangui. The setting up of a national viral hepatitis control program, which will develop screening, treatment and vaccination actions could make the curve bend.

Impact of Gender Difference on Characteristics and Outcome of Chronic Hepatitis C

Abstract: Gender difference in chronic hepatitis C (CHC) infection is not previously well studied. We aimed to analyze the effect of gender difference on the risk factors of CHC, disease progression, and outcome after oral direct acting antiviral (DAA) therapy. The study was conducted at Tropical Medicine and Gastroenterology Department, Sohag University, Egypt, in the period between 2018 and 2020. 775 patients were evaluated for hepatitis C virus (HCV) risk factors. Laboratory investigations, abdominal ultrasound and liver Shear wave elastography (SWE) were done. The patients were given antiviral therapy and followed up to assess the response and side effects of DAA therapy. 434 (56%) of study patients were males and 341 (44%) were females. Catching infection from blood transfusion and intravenous (IV) injection of tarter emetic was significantly higher in males, while catching infection from surgical operation was significantly higher in females. Hepatic fibrosis was significantly more extensive in males. Side effects were reported more in females. Sustained virological response (SVR) 12 was reported in 98.6%. Females had a slightly better SVR12 than males (99.4% versus 97.9%). In conclusion males were different from females in exposure to HCV risk factors. After introduction of blood screening and stoppage of parenteral anti-bilharzial therapy the risk of HCV infection could be greatly prevented in males, while the exposure of females to obstetric procedure is increasing nowadays which hides a risk of ongoing infection in females. So, HCV surveillance programs in females retain their importance in early detection and management of CHC. Although hepatic fibrosis progression was more in males, females were more liable to adverse events of DAA therapy. So, researchers should consider the gender of their patients in drug design and administration.

Mortality Factors for Cirrhotics in an Ivorian University Hospital (Ivory Coast)

Abstract: Background: Cirrhosis, an ineluctable development of chronic liver disease, still has high mortality throughout the world despite many advances in physiopathology and therapy. This high mortality is closely related to the unpredictable course of cirrhosis with numerous complications. Objective: To evaluate the predictive factors of death during cirrhosis. Materials and methods: This is an observational, descriptive study on cirrhotic patients hospitalized in the hepatology unit of the Center Hospitalier Universitaire in Bouake (Ivory Coast) during the period from January 01, 2018 to December 31, 2019. The study focused on the data collected in the medical files (paper format) of hospitalized cirrhotics and the death register of the service. The diagnosis of cirrhosis and the death of the cirrhotic were the main criteria for judgment. The secondary criteria defined were: history of cirrhosis, reasons for consultation, clinical signs, biological signs, complications of cirrhosis and the treatment received. The relationship between the parameters was expressed as an odds ratio (OR) with a 95% confidence interval (CI) and the significance threshold fixed at p 0.05. Results: The study retained 206 files of cirrhotics including 146 men and 60 women. The hospital prevalence of cirrhosis was 44.17% and the mortality rate was 42.23%. The deceased patients were mainly men with an average age of 49 years. The etiologies of cirrhosis were dominated by viral hepatitis B, chronic alcohol poisoning and viral hepatitis C, respectively 46.95%, 37.35% and 10.84%. The predictors of death were: the presence of icterus (OR = 1.89, 95%CI [1.08 - 3.30], p = 0.036), hepatic encephalopathy (OR = 8.75, 95%CI [4.51 - 16.94], p = 2.23, 95%CI [1.25 - 3.98], p = 0.010); the presence in the biology of hepatic cytolysis (OR = 2.57, 95%CI [1.35 - 4.89], p = 0.006), severe hepatocellular insufficiency (OR = 2.57, 95%CI [1.38 - 4.77], p = 0.004), severe renal insufficiency (OR = 2.41, 95%CI [1.09 - 5.32], p = 0.044) and hyperleukocytosis (OR = 2.28, 95%CI [1.29 - 4.04], p = 0.007); Child-Pugh stage C (OR = 19.64, 95%CI [9.02 - 42.74], p 0.001); the presence on ultrasound of large liver and variable nodules (OR = 4.16, 95%CI [2.02 - 8.58], p Conclusion: Cirrhosis is a public health problem at the Bouake university hospiler center. Decompensated and complicated old cirrhosis, hepatic cytolysis, severe hepatocellular insufficiency, severe renal insufficiency and hyperleukocytosis, heterogeneous nodular large liver are the detrimental factors.

Hepatic Steatosis in Patients with Metabolic Syndrome at the Brazzaville University Hospital Center

Abstract: Objective: To study the epidemiological, clinical and paraclinical particularities of fatty liver disease in patients with metabolic syndrome. Patients and Method: This was a cross-sectional and analytical study carried out over a period of seven months, from February 1 to September 30, 2019, in the outpatient services of Gastroenterology and Metabolic and Endocrine Diseases of the Brazzaville University Hospital. It interested all patients with metabolic syndrome, according to the criteria of the FID harmonized in 2009, namely known diabetic and hypertensive patients, having abdominal obesity. Results: The variables studied were socio-demographic, clinical, morphological and biological. The search for fatty liver was done using an abdominal ultrasound. Results: During the study period, 124 patients with metabolic syndrome were included. The average age of the population was 52.8 ± 12 years with extremes ranging from 30 and 84 years. The population was mainly female with a Sex-Ratio of 2.54 (F/M). The frequency of fatty liver disease was 38.7%. The frequency of dyslipidemia was high in the study. Conclusion: The prevalence of hepatic steatosis is high in patients with metabolic syndrome at Brazzaville University Hospital. The gender, lack of occupation and high level of education were the factors associated with fatty liver disease.

Epidemiological, Clinical and Biological Characteristics of Patients with Chronic Hepatitis B Infection Followed-Up at the University Hospital of Conakry, Guinea

Abstract: Introduction: Very little information is available in Guinea on chronic hepatitis B infections. The objective of this study was to describe the epidemiological, clinical and biological features of patients who are chronic carriers of the hepatitis B virus. Patients and Methods: This is a retrospective study carried out from January 2017 to May 2020, based on the medical records of patients seen via consultation or hospitalized with a record of positive HBs antigen for more than 6 months. Clinical and paraclinical data were collected and analyzed. Results: Seven hundred and sixteen patients with a mean age of 35.6 ± 12.2 (sex ratio 2.05), were included. The HBs antigen was discovered incidentally in 36% of cases (n = 258). A history of dental care and surgical procedures was found in 46.3% (n = 290) and 21.1% (n = 138) of cases, respectively. The median value of ALAT enzymes was 34 (21 - 47) IU/L. HBeAg was positive in 20.8% (n = 55/265) of cases. The median B viral load was 458.5 (87 - 3827) IU/ml and 29% (n = 94) of patients had a viral load over 2000 IU/ml. Anti-HCV antibody was present in 10.4 % of cases (n = 39/374). HIV serology was positive in 2.7% (n = 8/298). A total of 19.4% (n = 139) of the patients had cirrhosis and 4.5% (n = 32) had hepatocellular carcinoma. Conclusion: The discovery of chronic HBs antigen was mostly fortuitous in young sexually active men, some of whom were already at the stage of cirrhosis and hepatocellular carcinoma. The best prevention strategy against this infection remains early detection and vaccination.

Predictive Factors Differ between Hepatocellular Carcinoma Occurrence and Recurrence after Sustained Virological Responses by Direct-Acting Antivirals in Patients with Hepatitis C

Abstract: Background: Interferon-free direct-acting antivirals (DAA) have markedly increased the sustained virological response (SVR) rate among patients with hepatitis C. Although DAA inhibit the development of hepatocellular carcinoma (HCC), predictive factors remain unclear. The aims of the present study were to investigate predictive factors for HCC occurrence and recurrence after SVR by DAA in prospectively followed patients with hepatitis C (HCV). Methods: One hundred and eighty-three HCV-infected patients treated with DAA and achieving SVR were prospectively followed up for more than one year. Among these patients, 166 had no history of HCC before DAA therapy, while 17 had a history of being treated for HCC by radiofrequency ablation or resection before the initiation of DAA. Liver stiffness (LS) measurements were conducted using transient elastography, and LS was assessed at the initiation of DAA (LS0), 24 weeks after the initiation of DAA (LS24), 48 weeks after (LS48), and every year after that. Results: HCC occurred in 7 out of 166 patients without a history of HCC (4.2%), and recurred in 9 out of 17 with a history of HCC (52.9%). Patients with a history of HCC were significantly older, mainly males, had higher alpha-fetoprotein (AFP) levels before DAA and at SVR24, higher Fib-4 levels, and higher LS0, 24, and 48 than those without a history of HCC. Age (p = 0.013) and AFP at SVR24 (p = 0.036) correlated with occurrence. LS48 (p = 0.043) correlated with recurrence. Conclusions: Predictive factors differed between HCC occurrence and recurrence after SVR by DAA in HCV patients. High recurrence rates were due to fibrosis in the liver being more advanced in patients with than in those without a history of HCC. Age and AFP at SVR24 were identified as predictive factors of HCC occurrence and LS48 of HCC recurrence.

Evolutionary and Pronostic Aspects of Cirrhosis at the University Hospital of Brazzaville (Congo)

Abstract: Introduction: cirrhosis is a serious pathology that leads to complications whose management remains difficult in our country. This study aimed to evaluate the evolutionary aspects of cirrhosis at the Brazzaville University Hospital. Patients and methods: this was a retrospective study over a period of 18 months (from January 2015 to July 2016), performed in the Gastroenterology Department of the Brazzaville University Hospital. All patients regularly followed for decompensated cirrhosis were included. The studied variables were the epidemiological, clinical and paraclinical characteristics, the occurrence of complications, the survival, and the causes of death. Univariate analysis was used to determine prognostic factors based on the Child Pugh score. Results: There were 43 patients, including 32 men and 11 women, with a mean age of 52 ± 9.5 years. Viral hepatitis B was the most common etiology (39.5%). Child Pugh stage C was found in 60.5%. Oesophageal varices were present in 93% of cases. Survival at 18 months was 72%. In univariate analysis, two variables were significantly associated with decreased survival, including Child Pugh stage C and esophageal varices (grade II and III). Conclusion: cirrhosis remains a worrying pathology because the diagnosis is often made at the stage of often serious complications putting at risk of vital prognosis.

Seroprevalence of Hepatitis E Virus Infection and Factors Associated in HIV Infected Patients in Yaoundé (Cameroon)

Abstract: The Hepatitis E Virus (HEV) infection is one of the main causes of acute viral hepatitis. This affection is generally asymptomatic and benign. Its incidence is elevated in sub Saharan Africa. In Human Immunodeficiency Virus (HIV) infected patients, the HEV can cause chronic hepatitis with risks of cirrhosis and cancer. Assessing the prevalence and risk factors of an HEV infection in people living with HIV can help to prevent the transmission and the onset of their complications. The aim of this study was to evaluate the seroprevalence of HEV markers and associated factors among HIV infected patients in Yaounde (Cameroon). Ninety HIV infected patients were included in this study, with 29 men (32.2%) and 61 women (67.8%). The mean age was 46 ± 11.4 years old (21 - 74). The prevalence of HEV serological markers was 6.7% and 12.2% for immunoglobulins (IgG) and IgM respectively. Both IgG and IgM were positive for 2 patients (2.2%), while 15 patients (16.7%) had at least one immunoglobin positive. The consumption of well water and porcine foods was found to be associated with the presence of IgM HEV antibodies. There was no association between CD4 count, viral load and the presence of HEV serological markers.

What Is the Role of Endoscopic Retrograde Cholangio-Pancreato-Grahy in the Management of Hepatic Hydatid Disease Complications?

Abstract: Liver hydatid cyst is a parasitic disease that is endemic in Morocco. Its gravity is essentially due to its complications, such as Intrabiliary rupture. The aim of our study was to evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy in the management of intrabiliary rupture of hydatid disease of the liver. Materials and Methods: This is a retrospective study in the department of Gastroenterology in the University Hospital Hassan II of Fez over a period of 12 years from March 2005 to October 2017. All patients admitted for hepatic hydatid disease and who received ERCP were included. We analyzed the success rate of catheterization of the common bile duct (CBD), the successful clearance of the bile duct and the complications. Results: 2860 patients had received therapeutic ERCP, 151 patients (5.3%) had hepatic hydatid disease, 112 of which had intrabiliary disruption of hepatic hydatid and 39 patients were admitted for sphincteromy for reversal of the flow after surgery of hydatid cyst. The average age of our patients was 41 years old [12 - 85]. The sex ratio F/H = was 1.12. 74% (N = 112) patients were admitted to a table cholangitis and 26% of cases were operated for KHF fistulized in the bile ducts with persistence of a large biliary flow in post-operative (39 cases). The success of initial catheterization of the commun bile duct was achieved for 138 patients (91%) or obtained secondarily after precut for 13 patients. The evacuation of hydatid membranes was carried out in 51% of them (N = 78); twenty two (14.5%) patients had one or more calculations with or without hydatid membranes. A case of gastrointestinal bleeding post ERCP was observed. All the patients followed evolved well in the long term except for two patients who presented in few months after the first ERCP severe cholangitis which required the use of a second ERCP with successful evacuation of membranes. Conclusion: In our study, endoscopic management of hydatid cyst remains a dominant position, with a very satisfactory success rate and an acceptable rate of morbidity and mortality.

Predictors of Recurrence of Hepatocellular Carcinoma after Transarterial Chemoembolization: Role of Hepatocyte Growth Factor

Abstract: Background: Hepatocellular carcinoma is the third leading cause of tumor related mortality and develops mostly in patients with chronic liver disease and liver cirrhosis. Human hepatocyte growth factor (HGF) is produced in various organs of the body and is characterized as a multifunctional factor with various biologic activities. Aim: Our aim was to investigate the predictive factors of recurrence specially the role of HGF in patients with HCC treated with TACE. Patients and Methods: one hundred HCC patients treated by TACE who achieved complete response were included and divided into two groups according to disease free survival (DFS) status at 1 year: the non-early recurrence (NER) group (1) and the early recurrence (ER) group (2). Univariate binary logistic regression analysis for the possible risk factors of recurrence showed that AFP, multinodularity and HGF level were significant. Conclusion: high AFP, multinodularity and high HGF were inter-related possible risk factors for 1-year recurrence of HCC in patients with initial remission following TACE.

Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract in Yaoundé (Cameroon)

Abstract: Background/Aims: Foreign body (FB) ingestion is a common clinical situation. In some cases, it could be life-threatening, requiring interventional digestive endoscopy. Knowing the main FBs observed could help to prevent their ingestion or to improve management. The aim of this study is to report the results of upper digestive endoscopies performed for ingestion of FBs in Yaounde (Cameroon). Methods: We recorded all patients who did a gastroscopy for FB ingestion from January 2000 to April 2020 in three medical centers of Yaounde. We collected data concerning the socio-demographic characteristics of patients, foreign body type, endoscopic management and outcome. Results: A total of 9380 upper digestive endoscopies were performed, with 51 FBs ingestion (0.54%). Male were 27 (52.9%). The mean age was 25.8 ± 22.3 years (8 months to 75 years). Coins were the most frequent FB (23.5%), only observed in children, followed by fishbones (17.6%), only observed in adults. We also observed dental wears (11.8%), metallic objects (11.8%), non-metallic objects (3.9%), batteries (3.9%), toothpick (2%), packet of tablets (2%), and bezoars (2%). The FB was unknown at 21.6%. The most frequent localization was the esophagus in 29/36 patients (80.5%). Endoscopic removal was a success in 35/36 patients (97.2%). A surgery has been performed on one patient. We didn’t register any death. Conclusion: Most common FBs ingested in Yaounde are coins and fishbones. The upper digestive endoscopy has a high success rate.

A Simultaneous Multidisciplinary Evaluation of Irritable Bowel Syndrome in Egyptian Patients: Dietary, Psychiatric, Microbiologic and Autonomic Aspects

Abstract: Background and Aim: Irritable bowel syndrome (IBS) is a common medical disorder that may be severe enough to impair the quality of life. This study aimed to assess the role of each of dietary, psychiatric, autonomic, and microbiology background and their interactions in Egyptian patients with IBS. Patients and Methods: Forty adult patients diagnosed with IBS, equally divided into 2 groups the diarrhea predominant and the constipation predominant, were recruited from the Endoscopy Unit. Dietary assessment was done by monthly food frequency questionnaire. Psychiatric assessment was done by both the Eysenck Personality Questionnaire (EPQ) and Hopkins Symptom Checklist (HSCL-90). Microbiologic evaluation was done by faecal cultures and neurophysiologic autonomic evaluation was done via the sympathetic skin response and the parasympathetic R-R interval variation. Another 20 healthy subjects were included as control group. Results: All IBS patients were young, with significant female predominance (P = 0.007), particularly in IBS-C group (20/20; 100%, P = 0.003). Psychologically, abnormal scores of neuroticism, extraversion and criminality, and depression, obsessive compulsion, somatization, sensitivity and anxiety in both IBS groups with particularly extraversion, criminality and depression were significantly higher in constipation subtype. Microbiologically, Bacteroids were significantly related to IBS, while Klebsiella was significantly deficient without significant difference between its groups. On the contrary, neither diet nor autonomic activity showed any significant relation. Conclusions: IBS is a disorder induced by many factors and affected by several interacting agents, thus revealing controversial results when studied simultaneously.

Real World Evidence of Safety and Effectiveness of Combination of Vitamin E and Fraxinus excelsior in Treatment of Indian Patients with Nonalcoholic Fatty Liver Disease

Abstract: Introduction: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease ranging from liver steatosis to nonalcoholic steatohepatitis (NASH). Besides lifestyle modifications, Vitamin E (800 IU/day) is generally recommended for NASH. Vitamin E monotherapy is not sufficient for the multifaceted disease like NALFD. The combination of Vitamin E 400IU and Fraxinus excelsior 500 mg twice daily was found to be better than vitamin E 400 IU twice daily in improving the lipid profile and liver function parameters in patients with NAFLD. We conducted a study to assess safety and effectiveness of Vitamin E plus Fraxinus excelsior in Indian patients with NAFLD in real-world settings. Patients and Methods: This was a non-interventional study in NAFLD patients with varying grades of steatosis conducted by 234 physicians across India from January 2018 to August 2018. Patients received combination of Vitamin E (400 IU) and Fraxinus excelsior (500 mg) soft gelatin capsules twice daily after meals for 12 weeks. Effectiveness of the treatment was assessed at visit 2 (6 weeks) and visit 3 (12 weeks, end of study) from baseline. The parameters for assessment included severity of liver steatosis, liver function parameters and the global assessment of safety and effectiveness. Results: A total of 1114 patients were included in the study. At baseline, majority of the patients (71.18%) had Grade II liver steatosis followed by 21.01% and 7.81% patients who had Grade III and Grade I liver steatosis, respectively. After 12 weeks of treatment with vitamin E and Fraxinus excelsior combination, 21% patients had no steatosis, 58.79% patients were in Grade 1 steatosis, 19.57% in grade II steatosis and only 0.63% patients in Grade III steatosis. The mean percentage reduction in aspartate aminotransferase (AST) level at week 6 and week 12 from baseline was 24.92% and 43.79%, respectively. Similarly, the mean percentage reduction in alanine aminotransferase (ALT) level at week 6 and week 12 from baseline was 24.37% and 44.05% respectively. The mean reductions in AST and ALT were significant at week 6 and week 12. More than 50% of the investigators rated treatment as excellent for the safety and effectiveness. Conclusion: Evidence from this Indian real-life study suggests that Vitamin E (400 IU) and Fraxinus excelsior (500 mg) is safe and effective for the treatment of NAFLD in routine clinical practice. Its consumption is associated with improvement in hepatic steatosis and liver function parameters (AST and ALT). Given the limited therapeutic options in NAFLD, this combination has the potential to bridge the therapeutic gap in management of NAFLD.

A Critical Review of Post Endoscopic Sub-Mucosal Dissection (ESD) Delayed Bleeding Risk Factors

Abstract: Endoscopic sub-mucosal dismemberment (ESD) has become a settled strategy for treatment of shallow neoplasms in the gastrointestinal tract In three local areas, ESD was introduced to overcome traditional endoscopic mucous resection (EMR) and inadequate resection of the EMR, combining mouth, stomach, and the colon, for early disruptive sores ESD was grown first in Japan since that nation has the highest predominance of gastric malignant growth on the planet Endoscopic sub-mucosal analyzation causes enormous fake ulcers with more severe dangers of intra-usable and deferred postoperative draining However, there is no agreement in regards to the ideal peri-usable administration for the anticipation of free draining and the advancement of ulcer mending The hugeness of this investigation is to locate a superior procedure to bring down the hazard post ESD draining and to plan to defeat the confinements of regular EMR (endoscopic mucosal resection) and fragmented resection for early malignant injuries in the three districts which incorporate throat, stomach, and colon However, it has considered a standard in Eastern Asian nations and Japan because of the incredible importance of ESD The EMR and ESD approaches are discussed in this report Thus, the warning factors for early gastric neoplasms of PPB after ESD were established, and a superior technique was created to mitigate the danger of ESD dying EMR was already widely used for treating early neoplastic sores in the gastrointestinal tract; colon adenoma and colorectal tumors are widely acknowledged

Fusion Navigation Technique for Management of Difficult to Access Hepatocellular Carcinoma: A Single Center Experience

Abstract: Introduction: Sonography is the most universally used imaging technique for planning and performing thermal ablation in Hepatocellular carcinoma patients due to its efficiency and safety. However, the presence of HCC nodules that are hardly visible on traditional sonography is a major drawback to its use during thermal ablation. Real-time image fusion (fusion imaging) or real-time virtual sonography is a new technology that has been developed. Aim: To determine the value of fusion/navigation guided percutaneous thermal ablation in the management of hepatocellular carcinoma that has poor conspicuity at conventional sonography. Subjects and Methods: This study included 70 HCC patients (BCLC A and B). Percutaneous radiofrequency ablation was done via real-time image fusion for 14 patients with poorly visible HCC nodules (study group), while Percutaneous radiofrequency ablation was done via traditional sonography for 56 patients with HCC nodules (control group). Results: The median time to reach the tumor was significantly shorter by using fusion navigation technique (P = 0.034). By using fusion navigation technique 92% of the lesions were completely ablated while 55% only were completely ablated by using ultrasonography (P = 0.014). One year after the procedure , by using fusion navigation technique 92% of the patients had complete response and only 55% of the patients had complete response by using conventional ultrasonography (P = 0.011). The survival distributions for both interventions were statistically significantly different, χ2 = 10.12, P = 0.001. Conclusion: Fusion imaging-guided percutaneous RFA is a reasonable and efficient treatment of patients with HCC undetectable by traditional ultrasonography.

Sero-Prevalence of H. pylori Antibodies among Asymptomatic Rural Population in Bauchi State, Nigeria—A Preliminary Study

Abstract: Helicobacter pylori infection is a major public health problem globally, with high prevalence in developing countries associated with poor sanitation, low standard of living, urban-rural disparity and increased gastrointestinal pathologies. This preliminary study determined the seroprevalence of H. pylori infection among asymptomatic rural population and association of sociodemographic variables on the result outcome. A total of 250 asymptomatic volunteered participants were screened for H. pylori antibodies, using rapid immunochromatographic strips. 44.8% (112/250) were seropositive, and showed increased prevalence with the age group, years (8.0%), 18 - 39 years (23.5%) and 40 - 65 years (12.0%) with no significant difference. High prevalence among males, 88 (35.2) compared to 24 (9.6) females (p 0.228). Significant association was observed with marital status, high prevalence among married participants 63 (25.0) followed by singles, 41 (16.4) (p 0.010). Similarly, significant prevalence was observed among participants with non-formal education, 60 (24.0) followed by primary education, 21 (8.4) (p 0.51). While non-salary earners accounted for 79 (31.6) (p 0.244). The H. pylori seropositivity of 44.8% is relatively low in region with previous reports of high prevalence and predisposing risk factors. Further studies are needed to evaluate the effect of environmental and occupational risk factors for better epidemiological understanding of H. pylori infection and a template for intervention measures.

Predictive Values of Platelets Count and Spleen Diameter in the Diagnosis of Esophageal Varices in Black African Cirrhotic Patients

Abstract: Background: Gastrointestinal hemorrhage from ruptured esophageal varices is of concern in Africa where gastrointestinal fibroscopy for diagnosis is lacking. Purpose: To determine the performance of the length of the spleen, of the platelet count in the diagnosis of esophageal varices (OVs) by specifying the diagnostic thresholds in order to facilitate the prophylaxis of varicose hemorrhages in black African cirrhotic patients. Material and Method: This was a prospective study with a descriptive and analytical aim on cirrhotic patients hospitalized at the university hospital of Bouake (Ivory Coast) from 2017 to 2019. The patients included in the study were the cirrhotic of black race hospitalized having carried out an abdominal ultrasound with measurement of the spleen diameter (SD), an eso-gastro-duodenal endoscopy, and a blood count with platelet count (PC). The first primary endpoint was the diagnosis of esophageal varices in cirrhosis. Cirrhosis was retained by the combination of clinical, biological, ultrasound and endoscopic arguments. The OVs were distributed according to size and the presence of red signs. The platelet count, and the measurement of the spleen to calculate the PC/SD ratio were the second endpoint. The secondary endpoints studied were, the viral and ethyl etiologies of the cirrhosis, the Chlid-Pugh prognostic score. Performance was assessed using the ROC curve. The difference was significant for p less than 0.05. Results: The study included 101 patients; they were 79 men (78.2%) and 22 women (21.8%). The mean age of the cirrhotic patients was 48 ± 14. Esophageal varices were present in (n = 93; 92%) of cases. The different etiologies were hepatitis B virus (HBV) (n = 65; 78.3%), hepatitis C virus (HCV) (n = 21; 25, 3%), and alcohol (n = 6; 7.2%). Platelet count (PC) 130 mm) and PC/SD ratio 102 mm predicted 75% of OVs (AUROC = 0.797). CP with a cutoff 129 mm predicted large OVs. Conclusion: Platelet count, spleen diamater, and PC/SD ratio were all performant for the diagnosis of OVs in our setting with better diagnostic performance for PC/SD. This report could help initiate prophylactic treatment for OVs rupture in cirrhotic patients in health centers where gastrointestinal endoscopy is lacking.