Abstract
IntroductionSevere chronic hepatic schistosomiasis is a common cause of episodes upper gastrointestinal bleeding (UGIB) in sub-Saharan Africa (SSA). However, there is paucity of data on clinical epidemiology of episodes of UGIB from rural Africa despite on going public health interventions to control and eliminate schistosomiasis.MethodsThrough a cross sectional study we profiled lifetime episodes of upper gastrointestinal bleeding and associated factors at a rural primary health facility in sub-Saharan Africa were schistosomiasis is endemic. The main outcome was number of lifetime episodes of UGIB analyzed as count data.ResultsFrom 107 enrolled participants, 323 lifetime episodes of UGIB were reported. Fifty-seven percent experienced ≥ 2 lifetime episodes of UGIB. Ninety-four percent had severe chronic hepatic schistosomiasis and 80% esophageal varices. Alcohol use and viral hepatitis was infrequent. Eighty-eight percent were previously treated with praziquantel and 70% had a history of blood transfusion. No patient had ever had an endoscopy or treatment for prevention of recurrent variceal bleeding. Multivariable analysis identified a cluster of eight clinical factor variables (age ≥ 40, female sex, history of blood transfusion, abdominal collaterals, esophageal varices, pattern x periportal fibrosis, anemia, and thrombocytopenia) significantly associated (P-value < 0.05) with increased probability of experiencing two or more lifetime episodes of UGIB in our study.ConclusionUpper gastrointestinal bleeding is a common health problem in this part of rural SSA where schistosomiasis is endemic. The clinical profile described is unique and is important for improved case management, and for future research.
Highlights
Severe chronic hepatic schistosomiasis is a common cause of episodes upper gastrointestinal bleeding (UGIB) in sub-Saharan Africa (SSA)
In the absence of treatment up to 50% with severe chronic hepatic schistosomiasis of Mansoni type and/or chronic viral hepatitis will develop esophageal varices and more than half will experience upper gastrointestinal bleeding during their lifetime
We studied patients with one or more episodes of UGIB and determined the factors associated with number of lifetime events among patients presenting at a rural primary health facility in sub Saharan Africa
Summary
Severe chronic hepatic schistosomiasis is a common cause of episodes upper gastrointestinal bleeding (UGIB) in sub-Saharan Africa (SSA). Methods: Through a cross sectional study we profiled lifetime episodes of upper gastrointestinal bleeding and associated factors at a rural primary health facility in sub-Saharan Africa were schistosomiasis is endemic. In the absence of treatment up to 50% with severe chronic hepatic schistosomiasis of Mansoni type and/or chronic viral hepatitis will develop esophageal varices and more than half will experience upper gastrointestinal bleeding during their lifetime. There is paucity of data on clinical epidemiology of lifetime episodes of upper gastrointestinal bleeding from rural Africa where schistosomiasis is endemic. We studied patients with one or more episodes of UGIB and determined the factors associated with number of lifetime events among patients presenting at a rural primary health facility in sub Saharan Africa. Our specific study objective was to determine the clinical, laboratory and ultrasound findings associated with increased probability of experiencing two or more episodes of UGIB is this part of rural SSA
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