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    EVALUATION OF UPPER GASTROINTESTINAL ENDOSCOPIC FINDINGS IN PATIENTS WITH LIVER CIRRHOSIS AT THE KOMFO ANOKYE TEACHING HOSPITAL, GHANA
    (OPPONG, BRIGHT, 2022-09-01) OPPONG, BRIGHT
    Introduction: Liver cirrhosis remains an important cause of hospitalization, morbidity, and mortality in sub-Saharan Africa. A common complication of liver cirrhosis is acute upper gastrointestinal bleeding. The objective of this study was to assess the prevalence of upper gastrointestinal endoscopic findings and to correlate the presence of these findings with the severity of liver cirrhosis in patients at the Medicine Directorate, Komfo Anokye Teaching Hospital (KATH). Methods: This was a descriptive cross-sectional study of patients accessing care at the KATH. Consecutive sampling was used to recruit patients with cirrhosis of the liver, diagnosed by transabdominal ultrasound scan. A structured questionnaire was administered to assess socio-demographic characteristics and clinical information. Liver chemistry, full blood count, HBsAg, anti-HCV antibodies and INR tests were done for all the patients. An upper gastrointestinal tract endoscopy was performed for all patients and the severity of the cirrhosis was assessed using the Child-Turcotte-Pugh score. Data was collected with the REDcap tool and exported to STATA statistical software for analysis. Descriptive analysis was performed by using frequencies, percentages and means. Chi-square and Fisher exact tests were used to determine the association between severity of cirrhosis and other predictor variables. Logistic regression and partial proportional odds assumption model were used to determine the odds ratio and possible factors that influenced the severity of cirrhosis. Results: The study included 145 participants. The mean age (standard deviation) of participants was 46.5 ± 12.0. the ratio of males to females was 3:1. Seventy percent had oesophageal varices and 46.2% and 47.6% had portal hypertensive gastropathy and gastritis respectively. Other lesions were gastric ulcer (23.5%) and duodenal ulcer (10.3%). Seventy five percent had hepatitis B infection. Majority of the participants (76.5%) had class C disease and Helicobacter. Pylori (H. pylori) was detected in 87.6%. The presence of oesophageal varices and lax Lower Oesophageal Sphincter (LES) correlated positively with severity of the liver cirrhosis. Oesophageal varices was strongly associated with patients who had finger clubbing (p-value, <0.001), leukonychia (p-value, <0.001), silky hair(p-value, <0.001),, ascites(p-value, <0.036),, palmar erythema(p-value, <0.001),, and spider naevi(p-value, <0.003), Conclusion: Hepatitis B infection is the leading cause of liver cirrhosis at KATH. The most prevalent endoscopic finding was oesophageal varices (mostly medium and large varices) but a significant number of participants had non-variceal lesions. H. pylori infection is common in this population. Screening endoscopy is recommended in cirrhosis to detect lesions which can predispose to upper GIT bleeding.