|Year : 2013 | Volume
| Issue : 1 | Page : 6-9
Non-ulcer dyspepsia: An endoscopic review
Rose Ashinedu Ugiagbe, Casmir Erhunmun Omuemu
Department of Medicine, Gastroenterology Unit, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
|Date of Web Publication||19-Apr-2014|
Rose Ashinedu Ugiagbe
Department of Medicine, Gastroenterology Unit, University of Benin Teaching Hospital, Benin City, Edo State
Source of Support: None, Conflict of Interest: None
Background: Non-ulcer dyspepsia refers to dyspepsia with no organic cause. Upper gastrointestinal (GI) endoscopy provides superior diagnostic accuracy in detecting organic causes of dyspepsia than radiography. Objective: The objective of this study is to determine the prevalence of non-ulcer dyspepsia in the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. Patients and Methods: A review of the upper GI endoscopy register of the endoscopy unit of the UBTH was undertaken to cover a 7 year period from February 2006 to January 2013. All consecutive adult patients who had dyspepsia as the indication for endoscopy were included in the study. The bio-data and findings from the procedure were obtained from the endoscopy register. Results: A total of 1075 patients had diagnostic upper GI endoscopy during the study period. Of these patients, 597 (55.5%) had dyspepsia as the indication for endoscopy and were studied. The ages ranged from 16 to 90 years with a mean age of 48.6 ± 15.7 years. Those in the 6 th decade of life constituted the largest cohort. Patients consisted of 201 (33.7%) males and 396 (66.3%) females giving a male to female ratio of 1:2. Non-ulcer dyspepsia constituted 15.4% (92/597) of the patients undergoing endoscopy for dyspepsia while the remaining 84.6% (505/597) was accounted for by organic dyspepsia. Conclusion: This study shows that the prevalence of non-ulcer dyspepsia in UBTH is low as compared with findings from other centers in the country. This finding needs to be explored further in alarger cohort study in Nigeria.
Keywords: Endoscopy, non-ulcer dyspepsia, a review
|How to cite this article:|
Ugiagbe RA, Omuemu CE. Non-ulcer dyspepsia: An endoscopic review. Afr J Med Health Sci 2013;12:6-9
| Introduction|| |
Dyspepsia is a symptom complex often related to eating that includes epigastric pain or discomfort, bloating and fullness. Some may choose to call their symptoms indigestion.  Similarly, non-ulcer dyspepsia refers to dyspepsia with no organic cause. , It may also be referred to as functional, essential or idiopathic dyspepsia. ,,
Symptoms, physical findings and Helicobacter pylori testing are unreliable in differentiating non-ulcer dyspepsia from organic dyspepsias. , One investigation that is in valuable in this regard is an upper gastrointestinal (GI) endoscopy. Upper GI endoscopy has consistently been shown to provide superior diagnostic accuracy in detecting organic causes of dyspepsia compared with radiography, in addition endoscopy allows mucosal biopsy specimens to be taken. ,
The prevalence rates of dyspepsia vary considerably with the community studied. An earlier study from London reported a prevalence rate of 38%.  Two other researchers from Montreal, Canada and the United States reported prevalence rates of 45% and 25% respectively. , An epidemiological survey in Jos, Nigeria reported a prevalence rate of dyspepsia of 45%.  For non-ulcer dyspepsia, the reported prevalence rates range from 14% to 67%.  Previous studies from Nigeria,  Tanzania  and Sudan  reported prevalence rates of non-ulcer dyspepsia of 35.5%, 30%, and 42% respectively. In the western world, non-ulcer dyspepsia accounts for about 60% of cases of dyspepsia. ,,
This study was therefore a review to generate preliminary data on the prevalence of non-ulcer dyspepsia in the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria.
Information derived will provide a baseline for research and help in formulating policies that will improve the care and management of patients with this disease.
| Patients and Methods|| |
This was a retrospective study. A review of the upper GI endoscopy register of the endoscopy unit of the UBTH was undertaken to cover a seven-year period from February 2006 to January 2013. The records of all consecutive adult patients with dyspepsia as the indication for endoscopy were included in the study. The bio-data as well as the findings from the procedure were obtained from the endoscopy register of the endoscopy unit of the UBTH.
Excluded from the study were patients with previous known endoscopic or contrast study findings of an organic disease in the upper GI tract, pregnant patients, patients with upper GI bleeding, patients taking non-steroidal anti-inflammatory drugs, those who had other indications for endoscopy other than dyspepsia as well as those with therapeutic indications. These informations were retrieved from the endoscopy records of the hospital.
UBTH is located in the South-South region of Nigeria and is one of the tertiary health institutions that cater for the health needs of patients in this geographical zone with a population of over 10 million people. The upper GI endoscopes in use at the endoscopy unit during the period of study included a forward viewing Pentax video gastroscope and Olympus fiber gastroscope.
For the procedure, patients were fasted overnight, informed consent was obtained and counseling was done. A pharyngeal spray was then applied using 2% xylocaine and occasional premedication with 20-40 mg of intravenous hyoscine but ylbromide and 5 or 10 mg of diazepam in the very anxious patients. A systematic examination of the oesophagus, stomach, first and second parts of the duodenum was carried out using the gastroscope.
The data obtained was analyzed using the Statistical Package for Social Sciences version 15.0 Incoporated, Chicago, Illinois, USA. Chi-square test was used to compare the relationship between dyspepsia and age as well as dyspepsia and sex. The level of significance was set at P value <0.05.
Ethical approval was obtained from the Hospital Ethical Committee.
| Results|| |
A total of 1,075 patients had diagnostic upper GI endoscopy during the study period.
Of these patients, 597 (55.5%) had dyspepsia as the indication for endoscopy and were studied.
The ages ranged from 16 to 90 years with a mean age of 48.6 ± 15.7 years. Those in the 6 th decade of life constituted the largest cohort, followed by those in the 5 th and 7 th decades of life respectively [Figure1].
The patients consisted of 201 (33.7%) males and 396 (66.3%) females giving a male to female ratio of 1:2 [Figure1].
Endoscopic findings among dyspeptic patients in UBTH, Benin City, Nigeria
As shown in [Table 1], non-ulcer dyspepsia (normal findings) constituted 15.4% (92/597) of the patients undergoing endoscopy for dyspepsia while the remaining 84.6% (505/597) was accounted for by organic dyspepsia; 272 (45.6%) had gastritis, 82 (13.7%) showed esophagitis, 51 (8.5%) had gastric ulcer, 42 (7%) showed duodenitis, 35 (5.9%) had duodenal ulcer and 10 (1.7%) had gastric cancer. Six (1%), 4 (0.7%) and 3 (0.5%) accounted for esophageal candidiasis, gastric polyp and esophageal cancer respectively.
| Discussion|| |
In this study, about one-half (55.5%) of patients who had upper GI endoscopy did so because of dyspepsia. Dyspepsia has previously been reported from this same center (UBTH, Benin City, Nigeria) as the most common diagnostic indication for endoscopy.  Although dyspepsia accounted for 33% of diagnostic upper endoscopy in that study, patients with peptic ulcer disease and gastroesophageal reflux disease were excluded from dyspepsia, some of these patients may have presented mainly with dyspepsia increasing the number in this review.
This study shows that non-ulcer dyspepsia occurred in 15.4% of patients with dyspepsia who had upper GI endoscopy. The finding of 15.4% falls within the reported prevalence rates of 14-67%.  The prevalence of non-ulcer dyspepsia in this study is however low compared with two previous reports from Jos, Nigeria were findings of 39.9% and 69.4% respectively , were reported. Another study in Enugu, Nigeria reported a prevalence rate of 49.3% for non-ulcer dyspepsia.  Our finding is also lower than findings from other African countries, such as Tazania, Sudan and Kenya where non-ulcer dyspepsia rates were reported as 30%, 42% and 34% respectively. ,, In the western world, higher prevalence rates of about 60% of cases of dyspepsia have been reported by some authors. ,, The reason for the differences in prevalence rates of non-ulcer dyspepsia is not obvious, but may be due to inherent differences in the studied population.
On the other hand, the finding from the study is similar to an earlier report from England, where the prevalence of non-ulcer dyspepsia was 14%.  An earlier study in this center (UBTH, Benin City, Nigeria) showed a normal endoscopic finding in 12.4% of patients undergoing upper GI endoscopy. 
The relatively lower prevalence of non-ulcer dyspepsia found in the study may be explained by improved ability of endoscopy to diagnose subtle mucosal lesions such as gastritis and duodenitis, which occurred frequently in this review and which otherwise, may have been reported as normal. A previous report from Iceland has shown an improvement in the diagnosis of organic causes of dyspepsia by endoscopy.  Furthermore our center being a tertiary referral center, many patients with dyspepsia presenting for endoscopy may be at the tail end of the natural history of their disease if we consider non-ulcer dyspepsia, gastritis and peptic ulcer disease as a continuum as has been previously reported.  Moreover, improved awareness of endoscopy among doctors and appropriate referral may explain why many of the patients will have abnormal findings with only a few showing normal endoscopic findings. Furthermore, the high cost of the procedure might discourage patients with mild disease who ordinarily might have normal endoscopic findings.
The pathophysiology of non-ulcer dyspepsia is not fully understood. Putative mechanisms include; motility disorders, altered visceral sensation, altered intestino-gastric reflexes, psychological factors as well as H. pylori infection. ,,,,
This study shows an association between non-ulcer dyspepsia and the age and sex of the patients. The younger the patients were, the higher the proportion with non-ulcer dyspepsia, the older the patients, the lower the proportion with non-ulcer dyspepsia. The converse is also true for organic dyspepsia. This finding is similar to previous report from England  and Jos, Nigeria  but contrasts with a report from Kenya.  The association between non-ulcer dyspepsia and age of the patient however was not statistically significant (P = 0.063). From this study out of a total of, as shown in [Table 2]. 92 patients with non-ulcer dyspepsia, 71.7% (66) were females while 28.3% (26) were males. This is consistent with previous reports from Jos, Nigeria  and Sudan  where non-ulcer dyspepsia was reported more in females than males. One explanation for this may be as a result of a possible lower pain threshold among females. Another explanation would be a better health seeking behavior among females. The association between non-ulcer dyspepsia and sex however was not statistically significant (P = 0.233), as shown in [Table 3].
| Conclusion|| |
This study shows that the prevalence of non-ulcer dyspepsia in UBTH is low compared with findings from other centers in the country. This suggests that there is a relatively high prevalence of organic dyspepsia in our environment. This finding needs to be explored further in a larger cohort study in Nigeria.
| Acknowledgments|| |
We are grateful to other consultants and staff of Endoscopy/Gastroenterology unit, UBTH for their contributions to this work.
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[Table 1], [Table 2], [Table 3]