An epidemic of malignancies of the upper digestive system

1) SHORT CASE REPORT

A 35 year-old patient has been admitted in our hospital for epigastric pains and vomiting in the end of July 2011.

I had seen him before as out patient in November 2010 and I had done an OGD on him diagnosing a prepyloric ulcer.

I have given him treatment with PPI and I have advised him to come back in case of no improvement. I would have liked to perform a biopsy on that ulcer but I did not do, because of financial problems of the patient. To send a biopsy to Nairobi in fact costs 1700 Ksh. 

Unfortunately, in spite of my advice, I have not seen him again before the above admission, when I have repeated another OGD and I have found a completely different situation.

The ulcer had now become a huge, ulcerated mass around the pylorus. The mass was heavily covered with fibrin and easily bleeding at the touch of the gastroscope.

I have this time taken multiple biopsies and sent them for histopathology. The problem is that my biopsy is very late: actually I believe the ulcer I had seen in November 2010 was already a cancer and, maybe, it would have been easier to treat this patient in an earlier stage of the disease.

The biopsy report will take about a month to come back to me; therefore I have decided not to waste any more time and to try to save the young patient, referring him to the Nairobi University for any possible surgical, and/or chemotherapeutic option.

2) GENERAL CONSIDERATIONS

With the advent of digestive endoscopy in Chaaria, we find ourselves in front of a huge and silent epidemic of malignancies of the upper digestive system.

The most frequent type of malignancy is for sure the carcinoma of the lower part of the oesophagus: for some ethnic group, the above CA accounts for 80% of the gastroscopies we do.

But also the carcinoma of the stomach (mainly at the oesophago-gastric junction and at the pyloric area) is becoming very rampant.

The CA oesophagus mainly affects elderly people in their sixties and above, while for the CA stomach we see an alarming trend to affect younger people more and more.

The reason of this high number of malignancies remains unclear and I have found no help in the few studies published on the particular situation of Kenya. The articles in fact present contradicting data which do not allow us to come to any conclusion.

It is therefore an area of medicine where more studies are urgently needed.

GLOSSARY

OGD= oesophago-gastro-duodenoscopy

PPI= protein pump inhinitors

CA= carcinoma

Dr. Giuseppe Gaido