Tags

Type your tag names separated by a space and hit enter

Oesophageal varices, schistosomiasis, and mortality among patients admitted with haematemesis in Mwanza, Tanzania: a prospective cohort study.
BMC Infect Dis. 2014 Jun 03; 14:303.BI

Abstract

BACKGROUND

Upper gastrointestinal bleeding (UGIB) is a common cause of hospital admissions worldwide. Aetiologies vary by sociodemographics and geography. Retrospective studies of endoscopies in much of Africa have documented oesophageal varices as a leading cause of UGIB. Prospective studies describing outcomes and associations with clinical factors are lacking.

METHODS

We conducted a prospective cohort study at a referral hospital in Mwanza, Tanzania where schistosomiasis is endemic. Adults admitted with haematemesis underwent laboratory workup, schistosomiasis antigen testing and elective endoscopy, and were followed for two months for death or re-bleeding. We assessed predictors of endoscopic findings using logistic regression models, and determined prediction rules that maximised sensitivity and positive predictive value (PPV).

RESULTS

Of 124 enrolled patients, 13 died within two months (10%); active schistosomiasis prevalence was 48%. 64/91(70%) patients had oesophageal varices. We found strong associations between varices and numerous demographic or clinical findings, permitting construction of simple, high-fidelity prediction rules for oesophageal varices applicable even in rural settings. Portal vein diameter ≥ 13 mm or water sourced from the lake yielded sensitivity, specificity, PPV and NPV >90% for oesophageal varices; presence of splenomegaly or water sourced from the lake maintained sensitivity and PPV >90%.

CONCLUSIONS

Our results guide identification of patients, via ultrasound and clinical examination, likely to have varices for whom referral for endoscopy may be life-saving. Furthermore, they support empiric anti-schistosome treatment for patients with UGIB in schistosome-endemic regions. These interventions have potential to reduce UGIB-related morbidity and mortality in Africa.

Authors+Show Affiliations

Department of Internal Medicine, Bugando Medical Centre, Box 1370, Mwanza, Tanzania. awilchofle12@gmail.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24894393

Citation

Chofle, Awilly A., et al. "Oesophageal Varices, Schistosomiasis, and Mortality Among Patients Admitted With Haematemesis in Mwanza, Tanzania: a Prospective Cohort Study." BMC Infectious Diseases, vol. 14, 2014, p. 303.
Chofle AA, Jaka H, Koy M, et al. Oesophageal varices, schistosomiasis, and mortality among patients admitted with haematemesis in Mwanza, Tanzania: a prospective cohort study. BMC Infect Dis. 2014;14:303.
Chofle, A. A., Jaka, H., Koy, M., Smart, L. R., Kabangila, R., Ewings, F. M., Mazigo, H. D., Johnson, W. D., Fitzgerald, D. W., Peck, R. N., & Downs, J. A. (2014). Oesophageal varices, schistosomiasis, and mortality among patients admitted with haematemesis in Mwanza, Tanzania: a prospective cohort study. BMC Infectious Diseases, 14, 303. https://doi.org/10.1186/1471-2334-14-303
Chofle AA, et al. Oesophageal Varices, Schistosomiasis, and Mortality Among Patients Admitted With Haematemesis in Mwanza, Tanzania: a Prospective Cohort Study. BMC Infect Dis. 2014 Jun 3;14:303. PubMed PMID: 24894393.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oesophageal varices, schistosomiasis, and mortality among patients admitted with haematemesis in Mwanza, Tanzania: a prospective cohort study. AU - Chofle,Awilly A, AU - Jaka,Hyasinta, AU - Koy,Mheta, AU - Smart,Luke R, AU - Kabangila,Rodrick, AU - Ewings,Fiona M, AU - Mazigo,Humphrey D, AU - Johnson,Warren D,Jr AU - Fitzgerald,Daniel W, AU - Peck,Robert N, AU - Downs,Jennifer A, Y1 - 2014/06/03/ PY - 2013/08/09/received PY - 2014/05/13/accepted PY - 2014/6/5/entrez PY - 2014/6/5/pubmed PY - 2015/6/19/medline SP - 303 EP - 303 JF - BMC infectious diseases JO - BMC Infect. Dis. VL - 14 N2 - BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common cause of hospital admissions worldwide. Aetiologies vary by sociodemographics and geography. Retrospective studies of endoscopies in much of Africa have documented oesophageal varices as a leading cause of UGIB. Prospective studies describing outcomes and associations with clinical factors are lacking. METHODS: We conducted a prospective cohort study at a referral hospital in Mwanza, Tanzania where schistosomiasis is endemic. Adults admitted with haematemesis underwent laboratory workup, schistosomiasis antigen testing and elective endoscopy, and were followed for two months for death or re-bleeding. We assessed predictors of endoscopic findings using logistic regression models, and determined prediction rules that maximised sensitivity and positive predictive value (PPV). RESULTS: Of 124 enrolled patients, 13 died within two months (10%); active schistosomiasis prevalence was 48%. 64/91(70%) patients had oesophageal varices. We found strong associations between varices and numerous demographic or clinical findings, permitting construction of simple, high-fidelity prediction rules for oesophageal varices applicable even in rural settings. Portal vein diameter ≥ 13 mm or water sourced from the lake yielded sensitivity, specificity, PPV and NPV >90% for oesophageal varices; presence of splenomegaly or water sourced from the lake maintained sensitivity and PPV >90%. CONCLUSIONS: Our results guide identification of patients, via ultrasound and clinical examination, likely to have varices for whom referral for endoscopy may be life-saving. Furthermore, they support empiric anti-schistosome treatment for patients with UGIB in schistosome-endemic regions. These interventions have potential to reduce UGIB-related morbidity and mortality in Africa. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/24894393/Oesophageal_varices_schistosomiasis_and_mortality_among_patients_admitted_with_haematemesis_in_Mwanza_Tanzania:_a_prospective_cohort_study_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-14-303 DB - PRIME DP - Unbound Medicine ER -