Nigerian Journal of Gastroenterology and Hepatology
The NIGERIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, abbreviated as Nig. J. Gastroenterol. Hepatol. is a quarterly publication of the Society for Gastroenterology and Hepatology in Nigeria (SOGHIN) which publishes original research on the biology and diseases of the Gut, Liver, Pancreas, Peritoneum and Spleen both in humans and experimental animal models.
About one year ago, the Nigerian Finance Minister officially admitted that the country’s economy had entered recession. Prior to this declaration, the health sector was notorious in parading some of the worst health indices in the world.
The recession has undoubtedly compounded an already bad situation. The purchasing power of Nigerians has nosedived amidst unpaid workers’ salaries. Qualitative healthcare is beyond the reach of most people, as people no longer patronize hospitals, self-medication is at an all-time high and quacks now take advantage of the situation. Cost of medical equipment, consumables and drugs has increased to incredible levels due in part to scarcity of foreign exchange. Shortage of vaccines is now common place in Nigeria.
The harsh economic climate is taking a huge toll on the digestive health of Nigerians. Hepatitis B virus (HBV) infection is a major public health issue, affecting about 20 million Nigerians, with great morbidity and mortality. This disease is vaccine-preventable but the prevalent disruption in vaccine supplies especially in parts of the country ravaged by insurgency is a cause for great concern. The consequences of not immunizing Nigerian children against HBV in 2017 are unimaginable, considering the fact that infections acquired in childhood tend to run a protracted course with greater chances of eventuating in very serious sequellae. Similarly, the economic realities of the day prevent those who are already infected from accessing proper investigation and treatment. We may be heading towards an era of chronic liver disease epidemic.
Other parts of the gastrointestinal system are not spared. The incidence of colorectal cancer has been reported to be on the increase in Nigeria. The cost of screening, diagnosis and treatment of this dreaded killer is clearly not within the reach of most Nigerians. In fact, there are reports that majority of patients who attend hospitals these days are people with advanced and complicated cases. The examples illustrated above are just two out of numerous diseases of the gastrointestinal system that are ravaging the populace.
I want to seize this opportunity to call on Nigerian Governments (Federal, State and Local) to urgently take definite steps to stem the ugly trend. Health budgets should be increased to a level where basic medical needs of the most vulnerable segments of the society would be reasonably met. Urgent steps should be taken to make necessary vaccines available. Provision of drugs and other medical supplies needs urgent and special intervention. These would help reduce the impending epidemic of serious chronic digestive diseases.
It is with great pleasure that I introduce our respected readers to this issue of NJGH. The editorial board has put together an assortment of thought-provoking papers, including a review article, original articles, a case report and abstracts presented at the 2016 Annual Scientific Conference of SOGHIN in Lagos.
There is a saying that “the more things change, the more they stay the same”. Few months ago, the Rome IV criteria for functional gastrointestinal disorders (FGID)1 was launched to replace Rome III which had been subsisting for ten years. Some of the changes that were made are actually not new, with the result that a see-saw phenomenon seems to be playing out. The review article in this issue of NJGH titled “Concepts and controversies in disorders of upper gastrointestinal tract” highlights some of the unresolved issues in functional and non-functional gastrointestinal disorders.
The discovery of Helicobacter pylori over 3 decades ago2 was a milestone in the understanding of acid-peptic disorders. Contributing to the subject, Abdel, et al used a polymerase chain reaction (PCR) technique to determine the association between various gastrointestinal symptoms and Helicobacter pylori infection of the stomach. Their findings are contained in this issue. In the same vein, Ndububa, et al contributed an article titled: The pattern of gastritis and Helicobacter pylori colonization of the stomach in Nigerian patients with dyspepsia.
Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections are major contributors to morbidity and mortality globally especially in Africa. Also, featured in this issue is a study by Adesina, et al which describes selected laboratory values in pregnant women with HIV-HCV infection.
This issue highlights the many challenges to controlling the scourge of Viral Hepatitis in Africa: poor public and political awareness, lack of accurate data for action, vaccination coverage, diagnosis and treatment; proffers approaches to address the challenges, including the dire need to increase the awareness and training of health care workers on hepatitis B and C.
Nwabuaku, et al. demonstrated a high prevalence of minimal hepatic encephalopathy (HE) in subjects with chronic liver disease. Infection and occult GI bleeding were significant risk factors for HE in this cohort. Adoption of cognitive evaluation may allow early identification of this liver de-compensation thus enabling a more aggressive preventative strategy.
In patients with Sickle cell anaemia, intrahepatic sickling and iron overload may be responsible for liver enzyme derangements, irrespective of hepatitis status as documented by Odeghe, et al. Other interesting articles in this edition include the experience of a Hepato-biliary Surgical Unit and their laudable efforts to establish laparoscopic cholecystectomy for the management of acute cholecystitis and a case report describing the rare gastro-duodenal Crohn’s disease in a young man with upper GI bleeding.
This landmark edition of the Nigerian Journal of Gastroenterology and Hepatology bears three practice guidelines. This is the culmination of a long process where a decision was made to review the pre existing guideline for Hepatitis B and C management and to develop three additional practice guidelines for management of GERD and Dyspepsia, Hepatocellular carcinoma and Colorectal cancer screening. Four committees comprising the nations foremost authorities in these areas were constituted during the Annual General Meeting of the Society for Gastroenterology and Hepatology in Nigeria (SOGHIN) held in Lagos in July 2013.
In this edition, more clinical evidence is emerging in the area of Gastroenterology with the wider availability of endoscopic techniques in Nigeria. Akere, et. al identified gastric erosions as the commonest cause of acute upper gastrointestinal bleeding in Ibadan. Akintayo and Bojuwoye also report the finding of multiple angiodysplasia in the distal colon in a patient with the rare Osler- Weber-Rendu syndrome.
Other exciting highlights include identifying pregnant women with hepatitis B virus infection who may be at risk for mother-to-child HBV transmission. This article by Ogunlana et.al is particularly important and highlights the need for routine antenatal HBV testing.Obaseki et.al demonstrates convincingly that the use of pro-forma reporting ensures standardization and optimizes quality reporting in histopathology. The dissociation between the high prevalence of helicobacter infection and low incidence of gastric cancer- the African paradox is the subject of the review by Abdul Kareem and colleagues. The scientific abstracts presented at the recently concluded 8th SOGHIN AGM in Ilorin continue to showcase the rapidly expanding frontiers and the exciting growth of GI in the past year.
In this edition, the importance of multi-disciplinary team (MDT) approach for cancer management is featured. Oguntunde et. al, highlight the need to set up and sustain MDTs as an essential cancer- management protocol and discuss the opportunities for and challenges against its use in Nigeria. Drug induced hepatotoxicity of anti-tuberculosis therapy in subjects with HIV infection is a real clinical challenge and is evaluated by Nnabuchi et al. The role of various commonly used local herbs in the development of hepatotoxicity has always been a moot point but unproven phenomenon. Odigwe et al, convincingly highlight the role of hepatotoxicity of Pausinystalia yohimbe bark extract (Burantashi), a local herb commonly used as an aphrodisiac.
In the newly established SOGHIN News Corner, we showcase the occasion of 2014 World Hepatitis Day Events, which took place in more than 28 locations in Nigeria. Community hepatitis testing was carried out in volunteers in 27 centers nationwide and over 7,500 people were screened for Hepatitis B and C. This opened up a previously unexplored opportunity for SOGHIN to carry out nationwide hepatitis data capture as part of a nationwide prevalence study.
The Nigerian Journal of Gastroenterology and Hepatology, is a quarterly publication of the Society for Gastroenterology and Hepatology in Nigeria (SOGHIN), which publishes original research on the biology and diseases of the Gut, Liver, Pancreas, Peritoneum and Spleen both in humans and experimental animal models.