Patterns of Upper Gastro Intestinal Disease Among Patients Referred For Upper Gi Endoscopic Evaluation at Endoscopy Unity of Jumc, Jimma, South West of Ethiopia

Abstract

Back ground. Upper gastro intestinal (GI) symptoms are common health problem in communities at different parts of the world; responsible for 15-20% of general practitioner visits, hospital admissions and drug use. They considerably affect the quality of life and psychological wellbeing of patient, result in high healthcare resource utilization and significant costs due to lost work productivity, with symptomatic patients having an increased odd of work absenteeism. In developing countries like Ethiopia, upper gastrointestinal endoscopy remains the investigation of choice in making diagnosis upper gastrointestinal pathologies. All upper gastrointestinal symptoms are presumably prevalent in Ethiopia. However, the prevalence and impact are not clearly identified. Most data are obtained from selected samples derived from patients presenting to health care institutions with clinical symptoms. Hence, the study aims to analyze the upper gastrointestinal endoscopic examinations carried out in the endoscopy unit at JUMC from May 1, 2016 to May 1, 2017 and to identify common manifestation, indication as well as the prevalence of upper gastrointestinal diseases in the examined patients. Objective To assess the patterns of upper gastro intestinal disease among patients referred for upper GI endoscopic evaluation at the endoscopy unit of JUMC, Jimma, south west of Ethiopia. METHODS

A descriptive retrospective study was conducted by reviewing the report form and charts available at the endoscopy unit of JUMC. All patients who underwent endoscopic evaluation at endoscopy unit, from May l, 2016 to May 1, 2017 was included during study. All Endoscopic procedures were conducted by Gastro-enter ology fellow. Olympus flexible fiber-optic endoscope model GIF-E 300 was used for the procedure during the study period. Informed consent was obtained from all patients before the procedure. The examination was performed using local anesthetic lidocaine or xylocaine sprays Oro pharyngeal region in all cases. A procedure was conducted on empty stomach in the morning. The Gastroenterologist was document endoscopic findings of each patient in a prepared format. Data registration forms, prepared to include the variables documented in the registration books and patients’ charts was used for data collection. A pretested structured questionnaire which contains socio-demographic data, indications for upper gastrointestinal endoscopy and endoscopic findings was taken from upper gastro intestinal endoscopic examination report form. Data was collected by trained nurses, residents and intern s at respective wards. Data collectors were oriented on how to access and retrieve information from the records. The collected data was edited, entered and analyzed by SPSS version 16.0 statistical package for windows (SPSS Inc., Chicago). ii Chi square test was conducted to compare proportions and a p-value < 0.05 was taken as statistically significant. The study was conducted after obtaining ethical approval from the Institutional Review Board of the JUMC .A prior written permission was also obtain from Hospital Medical Director’s office. All record reviews of the patients’ records will be kept confidential. A total budget of 15,978.00 birr was used to conduct this study.

Results A total of 304 upper gastrointestinal endoscopies were performed over one year period of the study. Patients age ranged from 18 to 75 years, with a mean of 39.82 years (SD +/- 14.705).Majority of patients (56.6 %) were aged between 18 - 45 years. The leading indication for upper gastro intestinal endoscopic examination was dyspepsia 38.1%, followed by Epigastric pain and difficulty of swallowing 20 %, 15.3 % respectively while from the total population underwent endoscopic evaluation 13 (4.3%) were found to be macroscopically normal. Of those who had positive endoscopic findings; duodenal ulcer seen in 40.5, gastritis in 24.4 % (hemorrhagic gastritis 10.2%, erosive gastritis 8.9% and atrophic gastritis 5.3%) followed by gastric ulcer and GERD each constitutes 15.1%.

Conclusion Dyspepsia followed by Epigastric pain constitutes 58% of indication for UGIE and common manifestation of duodenal ulcer. There was significant association between difficult of swallowing and esophageal mass (p-value-0.002) and also there was positive correlation between increased age and both esophageal and gastric cancer (p-0.001).Chest pain is the common presentation GERD. There was significant association between age <45 years and duodenal ulcer (p-0.003) and strong male predominance of duodenal ulcer, Gastric ulcer, duodenitis, achalasia and GOO.