Emerging patterns of inflammatory bowel disease in sub-Saharan Africa: 175 cases from an IBD network.

There is a knowledge gap on the epidemiology of inflammatory bowel disease in Africa. To begin to address this issue we formed a case reporting network of practitioners with an interest in inflammatory bowel disease across sub-Saharan Africa. Here we report a series of 175 cases from 12 countries over 2 years.

Appropriateness and diagnostic yield of open access gastroscopy in two tertiary centers in South-western Nigeria.

Background: There is need for the appropriate use of gastroscopy. Objective: To determine the appropriateness of upper gastrointestinal endoscopy, and its association with significant endoscopy findings in our environment. Methods: This was a prospective study of subjects who underwent gastroscopy at two centers in south-western Nigeria between August 2020 and August 2021. Indications were classified as either appropriate or inappropriate according to the ASGE guidelines, gastroscopic findings as either significant or not significant, patients as either elderly (≥ 60 years) or not, inpatients or outpatients, and referrals as either gastroenterologist referral, or not. Results: There were 227 subjects, 131 (57.7%) females, mean age 45 ± 13.7 years. Fifteen percent were elderly, 65.6% were gastroenterologist referrals, 14.1% were inpatients, while 45.8% had co-morbidities. Endoscopy was appropriately indicated in 81.9%, and significant endoscopy findings were detected in 95.6%. Appropriateness was not associated with significant endoscopy findings. The sensitivity, specificity and AUROC of the ASGE guidelines were 10%, 82%, and 0.46 respectively. Conclusion: According to our study, most procedures are appropriately indicated. However, appropriateness did not determine endoscopy yield. Larger studies are needed to determine the utility of the ASGE guidelines in our environment.

Upper Gastrointestinal Bleeding Secondary to an Incidental, Impacted Foreign Body in the Duodenum.

A 68-year-old woman presented with a three-week history of upper abdominal discomfort, vomiting of coffee ground substance, and passage of tarry stools. There were no typical risk factors for gastroduodenal or liver disease. Gastroscopy done showed a fishbone impacted in the wall of the pyloric opening with its free end abutting on the wall of the duodenum resulting in a duodenal ulcer. Antral erosions were also noted. Retrieval forceps were used to retrieve the fishbone. The patient did not remember eating any fish containing meal, and there was no odynophagia. This case emphasizes the importance of considering foreign bodies as a cause of upper gastrointestinal bleeding as well as the need for an endoscopic review of all patients with upper gastrointestinal bleed.