Indications and findings of patients undergoing upper gastrointestinal endoscopy at Muhimbili National Hospital, Dar es salaam, Tanzania.

Abstract

Background. OGD is a safe, widely available technique for which demand continues to grow, resulting in an increase in costs and waiting lists for endoscopic procedures 3, 4. So, the appropriateness of indications for OGD is critical in assessing quality in endoscopy units, improving cost-effectiveness and providing better patient care.7, 8 The rationale of the study was to obtain information that will assist in formulating guidelines for upper GI endoscopy examination in Muhimbili National Hospital and probably Tanzania; so that a better quality of care is provided within such a financially constrained environment. The therapeutic services provided at the National Hospital’s endoscopy unit are also worth documenting and hence be in a position to suggest some solutions in order to improve or assist patient care. Objectives. The aim of this study was to profile by documenting the pattern of demographic characteristics, indications, and endoscopic findings of patients undergoing upper GI endoscopy at MNH. Methodology. A descriptive, prospective, cross-sectional study to establish the profile including indications and the endoscopic findings of all the subjects who attended and did upper gastro-intestinal endoscopy at the MNH endoscopy unit from March 2011 to December 2011 was conducted. The data were analyzed using SPSS to obtain frequencies, mean, and percentage of variables. Results. A total of 159 subjects aged between 12 and 93years were enrolled in the study whereby 94 (59.1%) were males. Most of the study population was from Dar es Salaam that comprised of 54.1%. The indications for endoscopy procedure were mainly for diagnosis and none was for therapeutic reasons. These included isolated dyspepsia (44.7%) followed by dysphagia (26.4%) and UGI bleeding (9.4%) and others. Combined symptoms comprised of 15.7%. The causes of these symptoms, all diagnosed endoscopically, included Gastritis in 39.0% of cases, malignancy in 20.7% and PUD in 12.6%; Most of the isolated dyspeptic patients had gastritis. Significant endoscopic findings were detected in those with dyspepsia complicated by alarm symptoms or isolated alarm symptom in those aged 40 yrs and above. There were no therapeutic endoscopic interventions performed during the study period. Conclusion. OGD plays a pivotal role in diagnosis and management of a number of upper GI diseases. At MNH, it is being utilized mostly by subjects aged 45.3 yrs on average who came mainly from Dar es Salaam and coastal regions of the country. Dyspepsia remained the leading indication for the procedure and the commonest upper GI endoscopic finding was gastritis. 25% of the upper GI malignancies were found between 40 to 50yrs of age. No therapeutic interventions were done during the study period. Recommendations.  Guidelines to do Upper GI endoscopy at MNH should be established pending a further evaluation by a larger prospective study, involving a number of endoscopy units in different regions where duration of symptoms and Histopathological results may be included.  The demand for therapeutic/interventional endoscopy at MNH is high. The Hospital should acquire accessories required for these services, in order to improve quality of health care at the MNH endoscopy unit.  Surveillance protocols and programme need to be strengthened so that significant people with potential risk for Upper GI malignancy may be picked earlier.