Gastro-duodenal disease in Africa: Literature review and clinical data from Accra, Ghana

Table 1 Patterns of incidence of peptic ulcer disease in hospital-based endoscopic studies of dyspeptic patients

Country	Year(s) of study	Mean age (yr)	Males	Females	n	Incidence rate (%)
			n (%)	n (%)		DU	GU	Total
Ibadan, Nigeria[19]	2008-2009	49.2 ± 13.8	39 (45.3)	47 (54.7)	86	2.3	9.3	11.6
Northern Nigeria[17]	2012	49.5 ± 15	68 (46)	80 (54)	148	6.8	2.7	9.5
Mbarara, Uganda[39]	2014-2015	53.5 ± 17.8	110 (59.8)	74 (40.2)	184	3.8	7.6	11.4
Accra, Ghana[75]	1995-2002	43.7 ± 10.6	3777 (54.1)	3200 (45.9)	6977	19.6	5.0	24.6
Kumasi, Ghana[18]	2006-2011	-	1337 (43)	1773 (57)	3110	3.0	4.7	7.7
Nairobi, Kenya[21]	2011-2013	47.0	1368 (43.5)	1779 (56.5)	3147	9.8	8.5	18.3
Nakuru, Kenya[21]	2011-2013	42.0	1372 (46.7)	1564 (53.3)	2936	9.5	1.9	11.4
Kilimanjaro, Tanzania[76]	2009-2010	Median: 48.0	99 (47.6)	109 (52.4)	208	18.3	5.8	24.1
Lusaka, Zambia[27]	1999-2002	-	79 (35.7)	142 (64.3)	221	3.1	0.5	3.6
Rotterdam, Netherlands[24]	1996-2005	55.6 ± 17.9	9222 (46.1)	10,784 (53.9)	20006	3.5	2.4	5.9
Rome, Italy[25]	2005-2007	Median: 62.5	-	-	11148	1.8	0.9	2.7
United States[23]	1996-2005	-	-	-	6438	-	-	1.5-3.0

DU: Duodenal ulcer; GU: Gastric ulcer.

Table 2 Hospital-based endoscopic studies of pre-malignant lesions

Country	Study population	n	Gastric atrophy frequency (%)	Intestinal metaplasia frequency (%)
Cote d’Ivoire, Attia et al[77], 2001	Dyspeptic patients	137	-	19
Sudan, El-Mahdi et al[78], 1998	Dyspeptic H. pylori infected patients	78	37	4
Egypt, Abdel-Wahab et al[79], 1996	DU patients	43	-	26
Gambia, Campbell et al[80], 2001	Dyspeptic patients	45	10	12
Uganda, Wabinga et al[81], 2005	Dyspeptic patients	114	17	7
Kenya, Kalebi et al[82], 2007	Dyspeptic patients	71	57	11
Nigeria, Ndububa et al[83], 2007	DU and GC patients	115	-	32 GC
				16 DU
Jos, Nigeria, Tanko et al[52], 2008	Dyspeptic patients	100	38	28
Nigeria, Badmos et al[84], 2009	Dyspeptic patients	1047	5	9
Tunisia, Jmaa et al[85], 2010	Dyspeptic patients	352	35	11
Ilorin, Nigeria, Badmos et al[86], 2010	Dyspeptic patients	57	32	9
Maputo, Mozambique Carrilho et al[46], 2009	Dyspeptic patients	109	8.3	8.3
United States, Almouradi et al[87], 2013	Symptomatic individuals	437	-	15.01
Finland, Eriksson et al[88], 2008	Symptomatic individuals	505	-	18.8 (antrum)
				7.1 (body)
Sweden, Borch et al[89], 2000	Symptomatic individuals	501	9.41
Korea, Kim et al[90], 2008.	Symptomatic individuals	713	42.7 (antrum)	42.5 (antrum)
			38.1 (body)	32.7 (body)
China, Zou et al[91], 2011	Symptomatic individuals	1,022	63.81
Japan, Sakitani et al[47], 2011	Symptomatic individuals	1395	-	17.2 (antrum)
				10.8 (body)

¹Prevalence of gastric atrophy or intestinal metaplasia in the antrum and/or body. DU: Duodenal ulcer; GU: Gastric ulcer; H. pylori: Helicobater pylori.

Table 3 Gastric histopathological lesions at the Korle Bu Teaching Hospital, Accra, Ghana and Maputo Central Hospital, Mozambique

	Accra, Ghana	Maputo, Mozambique
Total	136	109
Median age (yr)	52	37
Sex	n (%)	n (%)
Female	61 (44.9)	74 (67.9)
Male	75 (55.1)	35 (32.1)
H. pylori prevalence:
Histology	54.4%	62.4%
H. pylori prevalence:
PCR	93.3%	92.6%
Active inflammation	n (%)	n (%)
Antrum	47 (34.6)	57 (53.8)
Incisura	45 (37.2)	58 (54.2)
Body	40 (29.9)	21 (31.3)
Chronic inflammation	n (%)	n (%)
Antrum	115 (84.6)	100 (94.4)
Incisura	97 (80.2)	99 (92.5)
Body	97 (72.4)	57 (85.1)
Pattern of gastritis	n (%)	n (%)
antral-predominant	51 (37.5)	54 (49.5)
Pangastritis (antrum and body)	70 (51.5)	45 (41.3)
Gastric atrophy	n (%)	n (%)
Antrum	5 (3.7)	2 (2.5)
Incisura	7 (5.8)	6 (6.2)
Body	3 (2.2)	1 (1.5)
Intestinal metaplasia	n (%)	n (%)
Antrum	10 (7.3)	4 (3.8)
Incisura	6 (5.0)	7 (6.5)
Body	1 (0.7)	0 (0.0)
Pre-malignant lesions	n (%)	n (%)
Gastric atrophy and/or intestinal metaplasia	20 (14.7)	15 (13.8)

H. pylori: Helicobater pylori.

Table 4 Severity of atrophic gastritis and intestinal metaplasia at the Korle Bu Teaching Hospital, Accra, Ghana (n = 136), as per updated Sydney system

Atrophy (n = 9)		Metaplasia (n = 16)
Grade	n (%)	Grade	n (%)
T1	6 (66.7)	M1	10 (62.5)
T2	2 (22.2)	M2	5 (31.3)
T3	1 (11.1)	M3	1 (6.2)

Table 5 Age-Standardized Incidence rates of gastric cancer in sub-Saharan Africa[60]

Region	Years of study	Age-standardized incidence rate (per 100000 person-years)			Total
		Males		Females
Central Africa
Congo, Brazzaville	2009-2013	2.0	1.5		3.5
East Africa, Mainland
Ethiopia, Addis Ababa	2012-2013	3.0	2.2		5.2
Kenya, Eldoret	2008-2011	9.8	7.9		17.7
Kenya, Nairobi	2007-2011	9.2	9.7		18.9
Malawi, Blantyre	2009-2010	4.4	3.5		7.9
Mozambique, Beira	2009-2013	0.8	0.4		1.2
Uganda, Kampala	2008-2012	6.4	3.3		9.7
Zimbabwe, Bulawayo	2011-2013	4.8	5.7		10.5
Zimbabwe, Harare	2010-2012	18.7	16.3		35.0
East Africa, Islands
France Reunion	2011	16.8	6.3		23.1
Mauritius	2010-2012	7.0	3.2		10.2
Seychelles	2009-2012	3.7	3.2		6.9
Southern Africa
Botswana	2005-2008	1.1	0.4		1.5
Namibia	2009	5.0	2.0		7.0
South Africa, National	2007	4.0	1.8		5.8
South Africa, East Cape	2008-2012	1.4	0.8		2.2
Western Africa
Benin, Cotonou	2013-2015	11.3	2.4		13.7
Cote D’Ivoire, Abidjan	2012-2013	2.8	2.8		5.6
The Gambia	2007-2011	2.2	0.8		3.0
Guinea, Conakry	2001-2010	4.7	2.8		7.5
Mali, Bamako	2010-2014	19.1	15.3		34.4
Niger, Niamey	2006-2009	2.2	1.6		3.8
Nigeria, Abuja	2013	4.4	2.2		6.6
Nigeria, Calabar	2009-2013	0.7	1.4		2.1
Nigeria, Ibadan	2006-2009	2.8	1.3		4.1