NIGERIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY

CONFERENCE PROCEEDINGS
Year
: 2021  |  Volume : 13  |  Issue : 2  |  Page : 63--66

Abstracts Presented at the 13th Scientific Conference of Society for Gastroenterology and Hepatology in Nigeria Held July 26–30, 2021


 

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How to cite this article:
. Abstracts Presented at the 13th Scientific Conference of Society for Gastroenterology and Hepatology in Nigeria Held July 26–30, 2021.Niger J Gastroenterol Hepatol 2021;13:63-66


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. Abstracts Presented at the 13th Scientific Conference of Society for Gastroenterology and Hepatology in Nigeria Held July 26–30, 2021. Niger J Gastroenterol Hepatol [serial online] 2021 [cited 2022 Jun 30 ];13:63-66
Available from: https://www.njghonweb.org/text.asp?2021/13/2/63/338251


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 Malignant neuroendocrine tumor of the pancreas: A case report



Chukwurah SN, Menkiti FE1, Onyiorah IV1, Onyekwere CA2

Department of Medicine, Nnamdi Azikiwe University Awka, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, 1Department of Pathology, Nnamdi Azikiwe University Awka, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, 2Department of Medicine, Lagos State University, Lagos State University Teaching Hospital, Ikeja, Nigeria

E-mail: [email protected]

Background: Neuroendocrine tumors are rare and when they occur, they frequently involve the gut and may include the pancreas. They may be benign or malignant. They may be slow growing with the patient manifesting with only a swelling, weight loss and tiredness or it may take a rapid clinical course resulting in death. The cause is not known but may have some genetic component. Successful treatment depends on an early detection of the tumor and may involve surgical and/or medical modalities. Case Presentation: We report a 70-year-old woman who presented with a 4-week history of abdominal swelling which was nontender but associated with significant weight loss. She was a known diabetic and hypertensive patient but with good control. There was no other significant history. She performed several investigations including a liver biopsy and had immunohistochemistry, which revealed a diagnosis of well-differentiated malignant neuroendocrine tumor grade 1 likely from the mid-gut including the pancreas. She unfortunately died before treatment could be instituted.Conclusion: Neuroendocrine tumors are rare. There is a dearth of data in the Nigerian literature and hence the need to report this case. There is need for a high index of suspicion.

 Laparoscopic surgeries in a tertiary center in Southern Nigeria: A review



PO Igwe, E Ray-Offor, K Nyengidiki1, NJ Jebbin

Colorectal and Minimal Access, General Surgery Unit, Department of Surgery, University of Port Harcourt Teaching Hospital, 1Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

E-mail: [email protected]

Background: The advent of laparoscopy has resulted in a paradigm shift in surgical practice. This video technology-based practice is widely used in Western countries, but far fewer numbers of cases are treated using the technique in Nigeria yet.Aim: The aim of this study was to highlight the outcome and challenges in establishing laparoscopic surgery service in a tertiary hospital in Southern Nigeria.Materials and Methods: This was a prospective observational cross-sectional study of laparoscopic surgeries performed from April 2017 to March 2021 in the University of Port Harcourt Teaching Hospital Port Harcourt Rivers State Nigeria. Microsoft Excel spreadsheet was used to collect data on patients’ age, sex, types of laparoscopic surgeries, anesthetic technique, primary peritoneal access method, outcome, and challenges encountered. Statistical analysis was performed using SPSS version 23.0.Results: A total number of 50 laparoscopic surgeries were performed during the study period. The age of patients ranged from 17 years to 76 years (mean 42.96 ± 15.3) and a male-to-female ratio of (5:45) 1:9. The common therapeutic laparoscopic surgeries performed were cholecystectomy and appendicectomy, 10 (22.0%) and 8 (8.0%), respectively. Primary peritoneal access was predominantly by open method in 42(84.0%). In all, mean procedure time was 94.6 ± 60.7 min and mean hospital stay was 2 days. There was port site infection in 2 (4.0%) cases, and power outage led to a conversion to open surgery.Conclusion: Laparoscopic surgery is safe in our setting however marred by equipment and peculiar surmountable challenges in the path to establishing it as a routine practice. Keywords: Challenges, laparoscopic surgery, outcome

 Role of hepatitis B viral load and genotypes in patients with hepatocellular carcinoma at the Lagos University Teaching Hospital, Lagos



Nwude VN, Lesi OA1, Onyekwere CA2

Department of Medicine, Evercare Hospital, Lekki, Lagos, Nigeria, 1World Health Organization, Geneva, Switzerland, 2Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Nigeria

E-mail: [email protected]

Background: Chronic infection with hepatitis B virus (HBV) is the major risk factor for hepatocellular carcinoma (HCC) worldwide. High hepatitis B viral load is an independent risk factor for the occurrence of HCC. Genotypes B and C are endemic in East and Southeast Asia and have been associated with the development of HCC. Aim: The aim of this study was to evaluate the role of HB viral load and genotypes in patients with HCC at the Lagos University Teaching Hospital, Lagos. Materials and Methods: This was a hospital-based analytical case-control study on 184 subjects (92 each for cases and controls) at the Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos. All subjects were hepatitis B surface antigen-positive. Cases had HCC, whereas controls were age and sex matched with no signs of chronic liver disease. A structured interviewer-administered questionnaire was used to obtain relevant data about the subjects. Fifteen milliliters of blood were drawn from all the subjects for determination of their hepatitis B viral load. Hepatitis B genotyping was done for 25, each of randomly selected cases and controls. Real-time polymerase chain reaction was used to quantify HB viral load and type-specific primers for HBV genotyping. Statistical analysis was done using SPSS version 20. Chi-square and Fisher exact test were used for comparisons of categorical variables, whereas the independent samples Student’s t test was used to compare log10-transformed HBV DNA levels between cases and controls. Level of significance was set at 0.05. Results: The mean age ± SD of the cases and controls were, respectively, 41.4 ± 10.5 years (range 21–70 years), 39.9 ± 9.7 years (range 22–69 years). Males predominated in both the cases, 63 (68.5%) and controls, 58 (63.0%) giving a male:female ratio of 2:1. There was no significant difference in age and gender distribution between the cases and controls. Apprximately 75% of the patients with HCC presented in Okuda stages 2 and 3. The mean viral load in the cases 5.32 ± 1.3 copies/mL (range 2.30–7.83) was significantly higher than the controls 2.66 ± 0.5 copies/mL (range 1.28–3.29) (P < 0.05). HBV genotype E was the predominant genotype in the study population and was noted in 60% of controls compared with 20% of cases (P < 0.002). Mixed HBV genotype A/B/E was significantly more common in the cases (36%) than controls (16%) (P < 0.001). Subjects with mixed genotype had significant higher viral loads 5.63 ± 1.1 copies/mL compared with subjects with mono genotype 3.07 ± 0.1 copies/mL (P < 0.001). Eleven (22.0%) subjects had non-typeable infection. Conclusion: This study showed that high hepatitis B viral load and infection with mixed genotypes may predispose to the development of HCC. In addition, genotype E was found to be the predominant genotype among asymptomatic subjects with chronic HBV infection. Keywords: HCC, hepatitis B genotypes, hepatitis B viral load, Lagos

 Screening and surveillance for colorectal cancer by colonoscopy in Port Harcourt, Nigeria: An update



Ray-Offor E1,2, Obiorah CC3, Abdulkareem FB4,5, Jebbin NJ2

1Digestive Disease Unit, Oak Endoscopy Centre, Port Harcourt, Rivers State, 2Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, 3Department of Anatomical Pathology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, 4Department of Anatomic and Molecular Pathology, College of Medicine, University of Lagos, Idi-Araba, Lagos State, 5The Specialist Laboratories Lagos, Surulere, Lagos State, Nigeria

E-mail: [email protected]

Background: Colorectal cancer (CRC) constitutes a significant health problem in both developed and developing countries. Thus, it is deserving of an effective control policy. Aim: This study aimed to highlight the need to improve the rate of use of endoscopic screening as an effective health policy tool in CRC control in a sub-Saharan African population. Materials and Methods: It was a retrospective cross-sectional observational study on patients that underwent colonoscopy in a referral endoscopy facility in Port Harcourt, Rivers State, Nigeria from March 2014 to March 2021. The variables collated were demographics, endoscopic, and histologic findings. Statistical analysis was done using IBM SPSS, version 20 (Armonk, New York). Results: A total of 590 colonoscopies were performed during the study period with the indications of screening and surveillance for colorectal cancer in 91 (16.4%) and 13 (1.9%) cases, respectively. The patients’ mean age was 55.3 ± 7.2 years with 92 males and 12 females. Polyp detection rate (PDR) of 36.5% (38/104) was recorded. Adenoma detection rate (ADR) at screening colonoscopy was 20.9% (19/91); tubular adenoma with low-grade dysplasia was predominant-17 (94.4%). Of the cases for surveillance, two cancer recurrence cases were recorded, and no case of adenoma detected. Conclusion: Despite the necessity for and increasing availability of colonoscopy in our setting, the scale of its use for screening and surveillance for CRC remain low. Keywords: Colonoscopy, colorectal cancer, screening, surveillance

 Hepatopulmonary syndrome in a Nigerian male with decompensated alcoholic liver cirrhosis



Onyia CP, Obienu O, Asogwa P, Adiri W, Ijoma U, Nwokediuko SC

Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria

Background: Hepatopulmonary syndrome is a rare complication of chronic liver disease and or portal hypertension. It has not been previously described in medical literature in Nigeria and West Africa. Case Report: A 64-year-old Nigerian man presented to the University of Nigeria Teaching Hospital (UNTH) Enugu Medical Outpatient Department in August 2020 with a 3 months’ history of recurrent breathlessness, platypnea and bilateral leg swelling. He had been diagnosed with decompensated liver cirrhosis and had variceal band ligation done in India in 2018. He had also been managed for hepatic encephalopathy in two private hospitals prior to referral to UNTH. On examination, he was in respiratory distress, centrally cyanosed with dusky palms, grade 4 digital clubbing, and no leg edema. There was tachypnea, platypnea, orthodeoxia, and bi-basal coarse crepitations. Other important examination findings were a bounding regular pulse, a distended and heaving apex beat, an apical pansystolic murmur radiating to the axilla, non-tender hepatomegaly, splenomegaly, and ascites but a normal blood pressure. Investigations done showed negative screening for hepatitis B and C, elevated AST and GGT, conjugated hyperbilirubinemia, hypoalbuminemia, negative COVID-19 test, polycythemia, thrombocytopenia, prolonged INR, coarsely nodular, and enlarged liver with irregular margins on ultrasound. Upper GI endoscopy showed Grade 3 esophageal varices, Forrest-3 pre-pyloric ulcer, and portal hypertensive gastropathy. Chest X-ray showed cardiomegaly, perihilar/mid/lower lung zone patchy linear and cystic shadows, spirometry showed a restrictive pattern of airflow limitation, whereas the chest CT scan showed engorged pulmonary vessels. Echocardiography showed features of degenerative aortic valve disease with regurgitation, whereas contrast echocardiography showed intrapulmonary shunt. Alpha-1-anti-trypsin was not deficient. The initial arterial blood gas estimation suggested he had mild hepatopulmonary syndrome, but a repeat test done 4 months later showed he had severe hepatopulmonary syndrome.

The peripheral cyanosis was resolved with oxygen therapy. He was initially commenced on pentoxyfylline but terminated therapy about 8 days later due to side effects. Upon a review of relevant literature, we found that this is perhaps the first reported case in Nigeria and in the West African sub-region. Liver transplant is the only effective therapy for HPS and prompt recognition and referral for transplant is key.

 Fibrosis among chronic hepatitis B virus-infected patients, North-Western Nigeria experience



Musa Y, A Yakubu1, AS Maiyaki1, I Yusuf2, AA Samaila3, MM Borodo3

Department of Internal Medicine, Federal Medical Centre Katsina, Katsina, 1Department of Internal Medicine, Usman Danfodio University Teaching Hospital, Sokoto, 2Department of Histopathology, Aminu Kano Teaching Hospital, Kano, 3Department of Internal Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria

E-mail: [email protected]

Background: Chronic hepatitis B (CHB) virus infection is a global health problem with about 2 billion infected persons worldwide. It results in a variety of serious complications ranging from fulminant hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Liver fibrosis is a common complication of chronic hepatitis B virus infection. With limited data on pattern of fibrosis in our setting, we set out to evaluate the fibrosis pattern of CHB patients in our locality. Materials and Methods: It was a cross-sectional study in which 68 patients with chronic hepatitis B virus infection were consecutively recruited within a period of 7 months. After a focused clinical history and physical examination, complete blood count, liver enzymes, serum proteins, prothrombin time, and international normalized ratio (INR) were assayed. Liver biopsy was carried out in all eligible consented subjects. The histological findings and results of laboratory investigations were recorded and analyzed accordingly. Results: The mean age of study subjects was 32.43 ± 10.50 years with male:female ratio of 2:1. More than 80% of the patients were HBeAg negative with evidence of antibody to the HBe. Of 68 patients biopsied, 42 (61.7%) had histological evidence of necroinflammation of which 22% had significant inflammation, whereas 35 (56.5%) had evidence of fibrosis among which 46.5% had significant fibrosis. Conclusion: More than half of the patients CHB patients examined had evidence of fibrosis and necroinflammation.

 Health-related quality of life of patients with dyspepsia presenting in a tertiary health institution in Benin, Nigeria



Egbo O, Egbo HO1, Omuemu CE, Okeke EN2, N Mokogwu

Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, 1Department of Morbid Anatomy, Edo State University Uzaure, Okpella, 2Department of Internal Medicine, University of Jos Teaching Hospital, Katon Rikkos, Nigeria E-mail: [email protected]

Background: The symptoms of dyspepsia are usually chronic and lead to increased health-seeking behavior among patients all over the world. We investigated the effects of dyspepsia on the health-related quality of life (HRQoL) indices in patients with dyspepsia in Benin, Nigeria. Materials and Methods: This was a hospital-based cross-sectional study involving 324 dyspeptic patients who were referred for upper gastrointestinal endoscopy from different peripheral hospitals into the University of Benin Teaching Hospitals. The ROME IV criteria were used to recruit patients with dyspepsia. The Short-Form Nepean Dyspepsia index (SF NDI) was used to assess HRQoL in all participants. Upper gastrointestinal endoscopy was performed on all 324 dyspeptic patients. Results: Of the 324 dyspeptic patients who had upper gastrointestinal endoscopy, 127 (39.2%) were males and 197 (60.8%) were females. Age range of patients was 18 to 97 years with a mean (SD) of 47.6 ± 15.6 years. Among the patients with dyspepsia, 300 (92.6%) had a significantly impaired HRQoL with SF NDI mean score of 31.3 ± 9.1. Interference with daily activities (IDA) and eating and drinking subdomains of HRQoL were more impaired than other subdomains (P < 0.001). There was no statistical difference between the impaired HRQoL in patients with functional dyspepsia (FD) and organic dyspepsia (OD) (P = 0.694). Among patients with OD, those with upper GI cancers had significantly worse HRQoL SF-NDI mean (SD) scores (39.7 ± 5.9) compared with patients with gastritis, PUD and GERD with SF-NDI scores 30.3 ± 9.2, 31.5 ± 9.7 and 32.9 ± 7.1, respectively (P = 0.01). Conclusion: HRQoL is significantly impaired in all forms of dyspepsia among patients visiting UBTH, Benin in Nigeria. Awareness on the association of dyspepsia on HRQoL needs to be created and clinicians need to properly investigate and manage persons with dyspepsia. Keywords: Dyspepsia, gastrointestinal endoscopy South-South Nigeria, health related quality of life

 Upper gastrointestinal endoscopic (UGIE) findings of patients presenting with dyspepsia in a tertiary institution in Benin, Nigeria



Egbo O, Egbo HO1, Omuemu CE , Sefia U

Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, 1Department of Morbid Anatomy, Edo State University Uzaure, Iyamho, Nigeria E-mail: [email protected]

Background: Dyspepsia is responsible for 2%–5% of primary care visits and 30% of consultation to gastroenterology clinics worldwide. It is one of the most common reasons for referral for UGIE in Nigeria. Materials and Methods: In this hospital-based cross-sectional study, 324 dyspeptic patients who were referred for upper gastrointestinal endoscopy at the University of Benin Teaching Hospital were enrolled, using the ROME IV criteria. Upper GI endoscopy, with biopsy, was performed on all the 324 dyspeptic patients. Results: Three hundred and twenty-four patients with dyspepsia had upper GI endoscopy 127 (39.2%) males and 197(60.8%) females. 283 (87.35%) of the patients had Organic dyspepsia (OD), whereas 41 (12.65%) had functional dyspepsia (FD). Gastritis was the most prevalent lesion on endoscopy accounting for 182 (56.2%) cases alone and in combination with other lesions. A total of 12 tumors were seen on endoscopy 3.7% of total dyspeptic patients, 8 gastric and 4 esophageal, which made up 2.5% and 1.2% of the total 324 patients with dyspepsia, respectively. Among patients with FD 29 (70.7%) had EPS, 4 (9.8%) had PDS, whereas 8 (19.5%) had EPS–PDS overlapConclusion: Organic dyspepsia is more prevalent in this cohort of patients from Benin City and gastritis is the most common finding on upper gastrointestinal endoscopy.

 Severity of dyspepsia and its effect on health-related quality of life in patients with dyspepsia in a tertiary institution in South-South Nigeria



Egbo O, Egbo HO1, CE Omuemu, EN Okeke2

Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, 1Department of Morbid Anatomy, Edo State University Uzaure, Iyamho, 2Department of Internal Medicine, University of Jos Teaching Hospital, Katon Rikkos, Nigeria E-mail: [email protected]

Background: Health-related quality of life has been found to be impaired in majority of patients with dyspepsia. This study investigated the effect of severity of dyspepsia on HRQoL in dyspeptic patients in a tertiary hospital in Benin, Nigeria. Materials and Methods: In this hospital-based cross-sectional study, 324 patients who presented for upper GI endoscopy were recruited using the ROME IV classification for dyspepsia, whereas severity was assessed using Short-Form Leed Dyspepsia Questionnaire (SF-LDQ). HRQoL was assessed using the Short-Form Nepean Dyspepsia Index (SF-NDI). Data was analyzed with IBM SPSS statistics software, version 21.0. A value of P < 0.05 was considered significant. Results: Using the SF-LDQ 31 (9.6%) of the patients had very mild dyspepsia, 81 (25.0%) had mild dyspepsia, 123 (38.0%) had moderate dyspepsia, and 89 (27.4%) had severe dyspepsia.

There was no significant difference in the severity of dyspepsia between patients with organic and functional dyspepsia (P = 0.174). In comparing the association between severity of dyspepsia and HRQoL, increasing severity of dyspepsia was associated with higher (and worsened) HRQoL. A weak positive statistically significant correlation between SF-NDI scores for HRQoL and severity of dyspepsia (r = 0.465; P < 0.001). Conclusion: Among patients with dyspepsia, irrespective of the type, increased severity of dyspepsia correlated with a worsening of the HRQoL of patients.