Prevalence of gastroduodenal lesions in chronic non-steroidal anti-inflammatory drug users presenting with dyspepsia at the Kenyatta national hospital

Abstract

Background. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely prescribed and used classes of drugs worldwide. It is a well known phenomenon that NSAIDs cause gastroduodenal mucosal damage resulting in outcomes ranging from non-specific dyspepsia to ulcerations, upper gastrointestinal bleeding, perforation and even death. However, no data exist to show the prevalence of these lesions in our local setting. Objectives. The aim of the study was to determine the prevalence of gastroduodenal lesions seen at endoscopy and histopathology in chronic NSAID users presenting with dyspepsia at the Kenyatta National Hospital. Study design. This was a hospital-based cross-sectional study. Methods. 72 patients aged 13 years and above, on NSAIDs for 4 weeks or more, and presenting with dyspepsia were recruited into the study. All patients and! or guardians gave informed consent for participation in the study and for endoscopic examination. Six biopsy specimens were taken from each patient (2 from each of the following sites: - " corpus, antrum and duodenum). One specimen from each of the three sites was subjected to the rapid urease test for H pylori detection, while the remaining three were subjected to histopathological evaluation. Results. 47 male and 25 female patients aged between 16-77 years, with a mean age of 43.4 years were studied. At endoscopy, only 10 (13.9%) patients had normal gastroduodenal mucosa Gastritis was the most prevalent lesion occurring in 50% of the patients. Peptic ulcer disease had a point prevalence of 30.5% (duodenal ulcers 22.2%, and gastric ulcers 8.3%). Other lesions at endoscopy were duodenitis 16.7%, gastric erosions 5.6%, duodenal erosions1.4% and hemorrhagic gastritis 1.4%. At histopathology, only 5 (6.9%) patients were found to have normal gastroduodenal mucosa. Chronic active gastritis was the most prevalent lesion at 77.8%. Other lesions were chronic gastritis 12.5%, chemical gastritis 6.9%, duodenitis 41.7% and intestinal metaplasia 4.2%. Prevalence of H pylori in our study population was 50%. There was no association between the gastroduodenal lesions and H pylori infection. Conclusion. There was a high prevalence of gastroduodenal mucosal lesions both at histopathology (93.1 %) and endoscopy (86.1 %) in the chronic NSAID users. The point prevalence of PUD (30.5%) in our study population was much higher than that reported in dyspeptic patients from the general population at Kenyatta National Hospital in whom Lwai-Lume found a point prevalence of 23%. Both H pylori and NSAlDs were independent etiological factors in the pathogenesis of gastroduodenal lesions in chronic NSAID users