Changing trends in upper gastrointestinal endoscopic findings in Ethiopia: A comparison of eighteen thousand exams across two periods.

Abstract

Background: Relative changes in the prevalence of gastrointestinal (GI) diseases have been reported worldwide over the past decades. However, data on changing trends of upper GI diseases remain scarce in sub-Saharan Africa. This study examines the shifting patterns of upper GI endoscopic findings over 35 years in Ethiopia.

Aim: To analyze trends in upper GI endoscopic findings over two distinct time periods, 35 years apart, in Ethiopia.

Methods: We extracted findings from 8412 upper GI endoscopies performed between 2016 and 2024 at a tertiary referral center in Addis Ababa, Ethiopia. Patient characteristics, indications, and endoscopic findings were analyzed using descriptive statistics and presented in tables, map and graphs. These findings were compared to 10000 procedures conducted between 1979 and 1994. Key endoscopic findings were identified, and percentage changes in disease prevalence were calculated.

Results: Between the two study periods, the male-to-female ratio of patients undergoing upper GI endoscopy shifted from 2:1 to 1.4:1, while the median patient age increased from 36 to 40 years. The proportion of patients older than 50 years doubled (14.6% to 30.2%), and referrals from outside Addis Ababa increased from 33% to 57%. The prevalence of peptic ulcer disease and its complications decreased from 46.2% to 9.5%. Conversely, gastroesophageal varices increased from 9.5% to 21.8%, and upper GI malignancies rose from 3.6% to 18.8%.

Conclusion: This study sheds light on critical epidemiological shifts in upper GI diseases in Ethiopia, with a decline in peptic ulcer disease and a rise in portal hypertensive lesions and malignancies which have important public health implications. These findings underscore the need for increased awareness, improved clinical practices, enhanced resource allocation, and expanded access to early diagnosis and treatment of prevailing conditions. Preventive strategies targeting immunization and treatment of viral hepatitis, schistosomiasis, and Helicobacter pylori infection are urgently needed.