Firmin Ankouane

Helicobacter pylori and precancerous conditions of the stomach: the frequency of infection in a cross-sectional study of 79 consecutive patients with chronic antral gastritis in Yaoundé, Cameroon

Introduction The study aimed at determining the different types of precancerous conditions of the stomach and searches the frequency of Helicobacter pylori in these lesions in patients with chronic antral gastritis in Yaounde, Cameroon. Methods Five gastric biopsies were performed during upper gastrointestinal endoscopy for pathology and fixed in formol 10% before being coated in paraffin. Both the modified Giemsa and Periodic acid of Shift – Alkaline blue stains were used for the histological diagnosis of Helicobacter pylori infection. Hematoxylyn and eosin stain was used to determine the activity of gastritis, atrophic gastritis and intestinal metaplasia in accordance to the Sydneys classification of gastritis. Data were analysed using both the Epi info 6.04 and Excel 2007 softwares. Means and their standard deviations, medians and their interquartiles (IQR) were calculated. Proportions were established for qualitative variables and chi square analysis done in this study with a p value set at 0.05. Results Seventy-nine patients with chronic antral gastritis were enrolled, of which 43 (54.4%) were male, median age: 43 years (range from 21 to 70 years). The rate of atrophic gastritis was 74.7% (59/79). The activity of atrophic gastritis was mild in 47.5% (28/59) of cases, moderate in 47.5% (28/59) and severe in 5% (5/59). Intestinal metaplasia and follicular gastritis were present in 6.3% (5/79), and 10.1% (8/79), respectively. Concerning Helicobacter pylori infection, 71.2% (42/59) of patients with atrophic gastritis tested positive against 28.8% (17/59) who tested negative (p = 0.00003). Helicobacter pylori infection was related to the severity of gastric atrophy (p = 0.0001). Among patients with intestinal metaplasia and follicular gastritis, the proportion of those who tested positive for Helicobacter pylori infection was 80% (4/5), and 75% (6/8), respectively. There were no significant differences in the occurrence of atrophic gastritis according to age groups (p = 0.908). Conclusion This study concludes that atrophic gastritis, which is most often caused by Helicobacter pylori, is the most frequent precancerous condition of stomach in Cameroon. Routine gastric sampling for pathologic analysis is mandatory for effective diagnosis and surveillance of Helicobacter pylori infection and precancerous conditions of the stomach.

Résection endoscopique de polypes coliques et rectaux : expérience du centre médical La Cathédrale de Yaoundé. À propos d’une série de 112 exérèses entre 2010 et 2015

RésuméObjectifRapporter l’expérience du traitement endoscopique des polypes coliques et rectaux au centre médical La Cathédrale à Yaoundé (Cameroun).Patients et méthodesEntre janvier 2010 et avril 2015, les données de 112 résections de polypes coliques ou rectaux consécutives, ont été colligées rétrospectivement chez 71 patients (âge médian de 49 ans- extrêmes : 3–75 ans). Ont été étudiés : a) l’âge et le sexe des patients ; b) la localisation, l’aspect et la taille des polypes ; c) la technique endoscopique ; et d) les complications. La résection a été effectuée avec des anses diathermiques tressées de 25 mm en endocoupe (ERBE-ICC 200) avec une puissance de coupe de 75–150 Wet une coagulation de 35–55 W, associée à l’injection de sérum physiologique à la base du polype dans deux cas.RésultatsLe sex ratio H/F était de 1,96/1. Deux pics de fréquence de résection étaient retrouvés à <20 ans (25,5 %) et à ≥ 60ans (28,6 %). Les polypes étaient principalement localisés au rectum (42,9 %), suivi du sigmoïde (24,1 %) et du côlon gauche (13,4 %). Selon l’aspect : 46,4 % des polypes étaient pédiculés et 53,6 % sessiles. Le diamètre des polypes était < 5 mm dans 44,6 % des cas, de 5 à 10 mm dans 18,8 %, de 10 à 20 mm dans 25,0 %, >20 mm dans 11,6 %. Soixante-deux (55,4 %) polypes ont été réséqués à l’anse diathermique. Parmi les cinq mucosectomies, quatre polypes <20 mm ont été réséqués en un seul fragment et 1 de >20 mm par fragmentation. Tous les polypes de <5 mm (50 cas) ont été enlevés à la pince à biopsie avec réalisation d’un traitement complémentaire à la pince coagulante. Chez quatre patients (5,6 %), on a relevé une hémorragie immédiate post-polypectomie, contrôlée par hémostase endoscopique dans trois cas. Un cas a récidivé au 3e jour et a été pris en charge chirurgicalement. La pièce opératoire a montré une perforation. Aucun décès n’a été enregistré.ConclusionCette expérience montre que la polypectomie est une méthode efficace et sûre. Nos limites sont dues à une expertise insuffisante et à un plateau technique inadéquat.AbstractObjectiveTo report the experience of the endoscopic treatment of colonic and rectal polyps at the medical center La Cathédrale in Yaounde (Cameroon).Patients and MethodsBetween January, 2010 and April, 2015, data on 112 consecutive colonic or rectal polyps, for which endoscopic resection was performed, were collected retrospectively in 71 patients (median age: 49 years, range: 3–75 years). The following parameters were analyzed: a) age and sex of patients; b) location, morphology and size of polyps; c) endoscopic resection technics; and d) complications. Snare (25 mm) polypectomy and endoscopic mucosal resection (EMR) were conducted with a 75–150 W cutting power and 35–55 W for coagulation (ERBE ICC-200), with saline injection at the base of the polyp in two cases.ResultsThe sex ratio (M/F) was 1.96/1. Two frequency peaks of endoscopic resection were found in <20 years (25.5%) and ≥60 (28.6%). The polyp’s main locations were: rectum: 42.9%, sigmoid colon: 24.1%, and left colon: 13.4%. There were 60 (53.6%) sessile polyps, and 52 (46.4%) pedunculated polyps. The diameter of the polyps was <5 mm in 44.6% of cases, 5 to 10 mm in 18.8%, 10 to 20 mm in 25.0%, and >20 mm in 11.6%. In 55.4% of cases, polypectomy using diathermic snare was performed. Among five EMR, 4 polyps of <20 mm were resected in one fragment and 1 of >20 mm was treated by piecemeal polypectomy. Biopsy technique was employed for removing all small polyps of <5 mm with completion of a complementary treatment with heater probe. As for complications: in 4(5.6%) patients immediate bleeding occurred. In three of them, endoscopic treatment of bleeding proved sufficient. One patient underwent surgery on day 3, because of recurrence of the bleeding. The specimen showed a colonic perforation. There was no associated mortality.ConclusionThe present study shows that polypectomy is safe and effective treatment. Our limits are due to insufficient expertise and to inadequate technical platform.

Clinical Outcome of a Portosplenomesenteric Venous Thrombosis in Necrotizing Acute Pancreatitis with Protein C and S Deficiency Treated by Anticoagulation Therapy Alone

Cases of splanchnic venous thrombosis have not been described in Cameroon. Their prevalence in acute pancreatitis is variable. With the emergence of acute intra-abdominal infections including typhoid fever and peritoneal tuberculosis in situations of acquired immunodeficiency syndrome, these cases will become frequent. We report the case of a portosplenomesenteric venous thrombosis related to necrotizing acute pancreatitis associated with proteins C and S deficiency, in a 46-year-old Cameroonian man, without particular past medical history. He was admitted for abdominal pain which had been evolving for 3 weeks and accompanied by vomiting. In the absence of hemorrhagic risk factor, the patient received low molecular weight heparin followed by oral warfarin. The abdominal ultrasound check on the 12th day showed a partial recanalization of venous thrombosis. The abdominal contrast-enhanced CT scanner at day 30 on oral anticoagulation therapy showed collateral vessels and small bowel edema. At the same time the upper gastrointestinal endoscopy showed grade II esophageal varices. We have maintained oral anticoagulation therapy. This case highlights that an early effective anticoagulation heparin therapy is needed for a clear benefit in case of suspected PSMVT. It is certain that the sooner the treatment is given, the better outcome will be.

Hémorragie gastro-intestinale sévère sur ulcères de Cameron chez un patient alcoolique : à propos d’un cas

RésuméLes lésions de Cameron sont une entité rare et mal connue. Il s’agit d’érosions et des ulcères linéaires des plis de la muqueuse gastrique au niveau du collet des volumineuses hernies hiatales diaphragmatiques. Elles sont responsable à la fois d’anémies aiguës et de carences martiales sur des pertes occultes. Très rarement, elles sont la cause d’hémorragie gastro-intestinale aiguë sévère.Nous rapportons le cas d’un homme camerounais de 56 ans, alcoolotabagique avec une histoire de douleur épigastrique d’allure ulcéreuse et de prise d’anti-inflammatoires non stéroïdiens depuis une dizaine d’années et une hypertension artérielle, admis au centre hospitalier et universitaire de Yaoundé pour hématémèse et méléna ayant entraîné un état de choc hypovolémique. L’endoscopie digestive haute a montré deux larges ulcérations linéaires œsogastriques au sein d’une volumineuse hernie hiatale, non connue préalablement, associées à un ulcère duodénal. Les lésions ont été assimilées aux ulcères de Cameron. Le patient a bénéficié de mesures de réanimation, de la transfusion de sept unités de concentrés globulaires et des inhibiteurs de la pompe à protons en double dose.Après une récidive hémorragique au 5e jour, on n’a plus noté de complication et le patient a été autorisé à quitter l’hôpital au 15e jour. Le suivi pendant un mois est sans particularité.AbstractCameron lesions are uncommon. They can be found as an incidental finding during esogastroduodenoscopy. Cameron lesions are linear gastric ulcers or erosions on the mucosal folds at the diaphragmatic impression found in 5.2% of patients with large hiatal hernias. They are clinically presented with chronic gastrointestinal bleeding and associated iron deficiency anemia. The rate of acute gastrointestinal bleeding is found to be variable.We are reporting the case of a 56-year-old Cameroonian male, whose past-medical history is relevant for hypertension, alcohol and tobacco abuse, and a ten year use of nonsteroidal anti-inflammatory drugs. He was admitted to the Yaounde Teaching Hospital for hypovolemic shock in the setting of hematemesis and melena associated with epigastric pain. The patient underwent esogastroduodenoscopy, which showed two Cameron ulcers in the hiatal hernia at the level of the diaphragmatic junction, and a duodenal ulcer. No active bleeding was found. The patient had a drop in hemoglobin level, which required blood transfusion. He was discharged on proton pump inhibitors.After one episode of rebleeding on the 5th day, we no longer noticed any complications and the patient was allowed to leave the hospital on the 15th day. The follow-up atone month was unremarkable.