Histopathological patterns and helicobacter pylori status of gastric lesions at Muhimbili National Hospital, Dar es Salaam, Tanzania

Abstract

Background:Gastric cancer is the second leading cause of cancer-related deaths and the fourth most common cancer worldwide. Its frequency in different geographical areas is markedly variable. Etiologically, the majority (>90%) of malignant gastric lesions are the sporadic type mostly caused by long-standing inflammatory premalignant conditions. The more differentiated variant, the intestinal-type adenocarcinoma, is closely linked with Helicobacter pylori (H. pylori) infection and is associated with well-characterized dysplastic precursor premalignant lesions. There is a scarcity of data regarding gastric lesions at Muhimbili National Hospital and Tanzania in general. This study was carried out to describe the histomorphological patterns of gastric lesions, their relationship with the age of patients, sex, anatomical tumour locations and to determine the frequency of H. pylori infection. Methods: This was a prospective hospital-based cross-sectional study of gastric lesions received at Histopathology unit of Muhimbili National hospital between July 2018 and February 2019. Gastric tissue biopsies were stained for routine H&E and Modified Giemsa stain for H. Pylori detection. A designed data collecting sheet collected data and analyzed by using SPSS computer software version 23.0. Results: A total of 189 cases of gastric lesions were registered in the study with a male to female ratio of 1.5:1. The mean age of patients was 53(SD±15.881) years, with age ranging from 17 to 85 years and the majority were >40 years (76.2%). Majority of cases had inflammatory lesions (56.6%) with chronic gastritis dominating. Gastric adenocarcinoma was the most common gastric malignancy (86.6%) with its Intestinal type the most common in patients with < 40 years of age (p=0.019). The antrum was the most frequent anatomical site for both inflammatory, benign and malignant lesions (42.3%). The frequency of H. Pylori was 24.9% of all cases, and among the positive cases, 91.5% were inflammatory lesions. Conclusion: Gastric lesions are common conditions in Tanzania, affecting persons from childhood to late adulthood. They are represented by chronic gastritis for inflammatory lesions and adenocarcinoma for malignant tumours, respectively. Males are moreaffected than females. Gastric cancer occurs mostly in adults of more than 40 years of age; however, intestinal-type adenocarcinoma shows a tendency towards relatively young age at diagnosis. H. pylori infection is more common in patients with chronic gastritis.A significant proportion of Tanzanian population with gastric cancer has precursor inflammatory and benign lesions, which can be discovered and treated earlier before giving rise to cancer.