Article

Factors associated with carcinoma of the oesophagus at Mulago Hospital, Uganda.

Department of Medicine, Makerere University, Uganda.
African health sciences (Impact Factor: 0.66). 07/2008; 8(2):80-4.
Source: PubMed

ABSTRACT In Uganda, as in many other parts of the world cancer of the oesophagus (CAE) is on the rise. Squamous cell carcinoma and adenocarcinoma are the common subtypes. Risk factors for this cancer have been identified but not studied systematically in Uganda. Identification of these factors would enable establishment of preventive measures.
To determine the prevalence, histological features and associated factors for CAE among patients referred to the endoscopic unit of Mulago hospital, Kampala, Uganda.
We performed a 1-year cross-sectional study in 2004 and 2005 of all patients presenting for oesophageal-gastro-duodenoscopy (EGD) at Mulago Hospital. Demographic characteristics, behavioural practices, endoscopy findings and histology results where biopsies were performed were collected using a study tool. Data analysis was done using STATA 8 statistical package.
Two hundred nineteen patients were enrolled in the study, three were excluded because they could not tolerate the endoscopy procedure. Fifty five (19%) of the 287 had histologically proven CAE. Squamous cell carcinoma was found in 100% of tumours of the upper third, 91% middle third, and 73% lower third of the oesophagus. Four patients had a histological diagnosis of adenocarcinoma of the oesophagus. Factors that were associated with CAE included age (OR 1.63, CI 1.34-1.98, p value <0.001), smoking (OR 3.63, CI 1.82-7.23, p value <0.001) and gender (OR 2.17, CI 1.07-4.41, p value 0.032).
Many patients referred for EGD in Uganda had esophageal cancer most of which were.squamous cell type. Smoking, male gender and older age were risk factors. Preventive measures should target stopping smoking.

Full-text

Available from: Robert Colebunders, Apr 28, 2015
0 Followers
 · 
94 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: There is emerging evidence that esophageal cancer occurs in younger adults in sub-Saharan Africa than in Europe or North America. The burden of human immunodeficiency virus (HIV) is also high in this region. We postulated that HIV and human papillomavirus (HPV) infections might contribute to esophageal squamous cell carcinoma (OSCC) risk. This was a case–control study based at the University Teaching Hospital in Lusaka, Zambia. Cases were patients with confirmed OSCC and controls had completely normal upper endoscopic evaluations. A total of 222 patients were included to analyze the influence of HIV infection; of these, 100 patients were used to analyze the influence of HPV infection, alcohol, smoking, and exposure to wood smoke. The presence of HIV infection was determined using antibody kits, and HPV infection was detected by polymerase chain reaction. HIV infection on its own conferred increased risk of developing OSCC (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.0–5.1; P = 0.03). The OR was stronger when only people under 60 years were included (OR 4.3; 95% CI 1.5–13.2; P = 0.003). Cooking with charcoal or firewood, and cigarette smoking, both increased the odds of developing OSCC ([OR 3.5; 95% CI 1.4–9.3; P = 0.004] and [OR 9.1; 95% CI 3.0–30.4; P < 0.001], respectively). There was no significant difference in HPV detection or alcohol intake between cases and controls. We conclude that HIV infection and exposure to domestic and cigarette smoke are risk factors for OSCC, and HPV immunization unlikely to reduce OSCC incidence in Zambia.
    Cancer Medicine 01/2015; 4(4). DOI:10.1002/cam4.434
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Esophageal cancer at Moi Teaching and Referral Hospital (MTRH) is the leading cancer in men with a poor prognosis. A case control study (n = 159) aimed at the histology type, gender, and risk indicators was carried out at MTRH. Mantel Haenszel chi-square and logistic regression were employed for analysis. Squamous-cell carcinoma was the common histological type occurring in the middle third portion of the oesophagus. The occurrence of the cancer in males was 1.4 times that of females. The mean age was 56.1 yrs. Low socioeconomic, smoking, snuff use, alcohol, tooth loss, cooking with charcoal and firewood, hot beverage, and use of mursik were independently associated with esophageal cancer (P < 0.05). Using logistic regression adjusted for various factors, alcohol consumption was associated with the increased risk of esophageal cancer. AHR was 0.45 and 95% CI: 0.205-0.985, P = 0.046. A societal component of low socioeconomic conditions, a lifestyle component with specific practices such as the consumption of mursik, chang'aa, busaa, snuff, smoking, hot tea, poor oral hygiene, and an environmental component with potential exposure to high levels of nitrosamines, passive smoking, and cooking with coal, could be involved. The increase in experts at MTRH capable of diagnosing could be responsible for the increase in reporting this neoplasm.
    12/2013; 2013:503249. DOI:10.1155/2013/503249
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Characteristics of patients undergoing Upper GI endoscopy (UGIE) in Kumasi, Ghana are largely unknown. This paper reviews the work of three endoscopy units in Kumasi. A review of the records of patients undergoing diagnostic UGIE in the three centers from October 2006 to December 2011 was undertaken. 3110 completed UGIE were performed over the period. In 80% of the patients the primary indication for UGIE was dyspepsia occurring without any other symptom. In 50% of patients UGIE findings were normal. Peptic ulcer disease, the most common positive finding, was diagnosed in 27.4% of patients. The odds ratio (O.R) of yielding a positive endoscopic finding for patients presenting with recurrent vomiting, dyspepsia associated with weight loss and UGI bleeding were 3.87 (95% C.I: 2.23-6.69), 1.72 (95% C.I: 1.03-2.87) and 1.81 (95% C.I: 1.03-3.16) respectively. Dyspepsia without any other symptom, on the other hand, yielded a positive endoscopic finding with O.R of 0.67 (95% CI: 0.57-0.80). Alarm symptoms (UGI bleeding, recurrent vomiting, dysphagia or weight loss associated with dyspepsia) yielded a positive endoscopic finding with an O.R of 2.34 (95% C.I: 1.74-3.13). Most patients in Kumasi underwent UGIE because of dyspepsia in the absence of any other symptom. These patients were more likely to have normal endoscopic findings. The opposite was true for those presenting with alarm symptoms. Our results suggest that initial UGIE may be preferentially offered to patients presenting with alarm symptoms especially in resource-poor settings such as ours.
    08/2014; 18:327. DOI:10.11604/pamj.2014.18.327.4806