NIGERIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY

Export selected to

Endnote

Reference Manager

Procite

Medlars Format

RefWorks Format

BibTex Format

Colorectal cancer (CRC) is a major public health issue in Nigeria. The incidence is rising, and majority of the patients diagnosed with CRC, die of the disease burden. CRC is an ideal cancer for screening and early detection. It has been well documented that screening for CRC, by a variety of methods, leads to a sustained reduction in mortality from the disease in two ways: increased detection of early stage with more curable cancer and detection and removal of adenomas, which are known precursors to CRC. Screening has also been shown to be cost-effective in terms of quality-adjusted life-years gained compared to nonscreening. CRC screening can be approached as an organized program or on an opportunistic basis. Opportunistic screening is the only option in systems that lack the resources, infrastructure, and framework needed for an organized approach. A myriad of CRC screening tests exist, which can be divided into two main categories namely biological sample-based tests, which include fecal, blood, and urine tests, and colonic structure-based tests, which include flexible sigmoidoscopy, colonoscopy, and imaging studies such as computed tomography colonography, magnetic resonance imaging colonography, and double-contrast barium enema. The recommendation for CRC screening includes offering patients the opportunity to select test, based on their preference, affordability, and test availability. This decision-making process is personalized and requires an understanding between the patient and doctor. This guideline reviews the available evidence and makes recommendation on the screening method for CRC in Nigeria.

Background: Achalasia is a rare disease. The present standard treatment is laparoscopic Heller's myotomy. Some centers still use thoracoscopy, thoracotomy, or laparotomy. Newer approaches such as the per-oral endoscopic esophagomyotomy are being evaluated. Objectives: The objective of the study was to review the diagnostic procedures for achalasia cardia and the therapeutic approaches being used in the study centers and to evaluate the dysphagia and reflux esophagitis outcomes and the occurrence of operative complications. Methods: This is a retrospective study over 10 years (2008–2017) from three centers in Nigeria. The clinical and operative records were reviewed. The route and outcome of modified Heller's myotomy for achalasia cardia were reviewed. Results: The total number of cases was 16. The male-to-female ratio was 1:1, and age ranged from 3 to 55 years. Diagnosis was done by clinical features and barium swallow test. Two of the 16 cases were done via the laparotomy approach, while the remaining 14 were achieved via a left thoracotomy. Only in one case was fundoplication done. Perioperative mortality was zero. Overall long-term dysphagia and reflux outcomes were satisfactory. Conclusion: Clinical and radiological features are predominantly used to diagnose achalasia; esophageal manometry was not available. Surgery was predominantly done by the thoracotomy approach, with occasional fundoplication.

Background: Evaluation of patients who present with diarrhea and constipation requires a good knowledge of what constitutes normal defecation frequency and stool form. This study was designed to determine the normal defecation frequency and normal stool form in adult rural and urban dwellers in Southeast Nigeria. Materials and Methods: This was an observational, descriptive, cross-sectional, questionnaire-based study of adults in rural and urban settings in Southeast Nigeria. Defecation frequency was recorded as number of bowel motions per week, while stool form was determined with the use of the Bristol stool scale. Variables included in the questionnaire were age, sex, occupation, level of education, use of alcohol, cigarette smoking, use of kolanut, use of coffee, and body mass index. Data were analyzed with SPSS v 23. Results: There were 670 participants (61.6% females and 56.7% rural dwellers). The 25 and 75 percentiles of the stool form were Bristol types 3 and 4, while the 25 and 75 percentiles of defecation frequency were 7 and 14. Defecation frequency was higher in males than females (P = 0.006), while stool form was significantly affected by age (P = 0.001), sex (P = 0.041), and place of abode (P = 0.001). Conclusion: In Southeast Nigeria, normal defecation frequency is between 7 and 14 bowel motions per week, while normal stool forms are Bristol types 3 and 4. Age, sex, and place of abode significantly affect defecation frequency and stool form.

Background and Aim: Colorectal cancer (CRC) is known to be a major cause of morbidity and mortality worldwide. It is believed that CRC develops from adenomas or benign adenomatous polyps. Information concerning this premalignant condition in Nigeria is still relatively scarce. The aim of this study was to describe the clinicopathologic features of colorectal polyps seen in patients who had colonoscopy at the University College Hospital, Ibadan, Nigeria. Patients and Methods: This was a descriptive cross-sectional study carried out at the Endoscopy Unit of the University College Hospital, Ibadan, Nigeria. Colonoscopy was performed on the patients after bowel preparation. Polyps were characterized by their colonic location, size in millimeter, and histopathological diagnosis. The data were analyzed using SPSS version 17.0. Results: The patients comprised 65 (58.0%) males and 47 (42.0%) females. The mean age was 60 ± 12.5 years, with majority being in the age range of 51–60 years. The most common indication for colonoscopy was hematochezia. The location of the polyps was as follows: 41 (36.6%) in the rectum, 30 (26.8%) in the sigmoid colon, and 22 (19.6%) each in the transverse and descending colon. In 51 (45.5%) patients, polyps were <5 mm in size; 5–10 mm in 48 (42.9%) patients; and >10 mm in 13 (11.6%) patients. The most frequent histological diagnosis was adenomatous polyp. Conclusion: Polyps were found more commonly in males and in individuals aged 50 years and above. The most common location is the rectosigmoid colon, and the polyps are majorly adenomatous. Our findings suggest the need for colonoscopy service to be made more widely available across the country so as to contribute to reduction in CRC incidence among Nigerians.

Online since 20^th November 2019