UPPER GASTROINTESTINAL MUCOSAL LESIONS IN DYSPEPTIC PATIENTS WITH HOMOZYGOUS SICKLE-CELL DISEASE IN KENYA

A case controlled study comprising 51 patients with homozygous sickle cell (HbSS) disease who complained of dyspepsia and 41 age and sex mat ched non-HbSS control dyspeptic patients was carried out, to look at u pper gastrointestinal mucosal lesions associated with dyspepsia. Upper gastrointestinal tract (UGIT) endoscopy was performed with gastric co ntrol biopsy taken for histology. Thirty two (62.3%) of the HbSS or si ckle cell anaemia (SCA) patients had upper gastrointestinal pathology at endoscopy as compared to 17 (41.5%) of controls. The difference was significant at p = 0.042. Bile reflux (47%) was the predominant abnor mal morphological finding in SCA patients while duodenal ulcer was the most common morphological finding in dyspeptic controls. The prevalen ce of duodenal ulcer in controls (22%) though higher than in SCA patie nts (9.8%), was not statistically significant p = 0.18, Gastric ulcer was not found in SCA patients. Duodenal ulcer was commoner in males th an females in both cases and controls with a ratio of 4 : 1 and 3.5 : 1 respectively. Only four (7.8%) SCA patients and one (2.4%) of contro ls had normal mucosa at histology, the rest had evidence of histologic al gastritis. We could not draw any correlation between non-steroidal anti-inflamatory drugs (NSAIDS) use and UGIT findings. Since the propo rtion of SCA cases with UGIT abnormalities was significantly high, we recommend that dyspeptic SCA patients undergo UGIT investigations incl uding endoscopy to maximise their clinical care.