Nathalie Colas, MD, Richard McGlaughlin, MD, Maria Gambirasio, MD, Marc Edson Augustin, MD, Susan Baker, MD, L. Richard Freschette, CRP, DO
From the Departments of Gastroenterology and Internal Medicine, L’opital Saint Luc, Tabarre, the Department of Infectious Diseases, University of Milan, and the Department of Pathology, St Vincent’s Hospital, Birmingham, AL.
After the earthquake and cholera epidemic in Port au Prince, St Damien’s Pediatric Hospital in Tabarre was quickly expanded to include an acute care adult hospital, St Luc’s.
A review of the first six months’ admissions at St Luc’s revealed pyrosis and or dyspepsia as a primary or secondary diagnosis in 48% of patients.
Discharge diagnoses were not refined further- pyrosis and dyspepsia were listed 45% of the time.
A gastroenterology lab was created to better define the issues, and this report describes the findings of the first 150 endoscopies performed in that lab, which runs one week each month.
90 women and 60 men between the ages of 17 and 88 were evaluated endoscopically, including 55 inpatients and 95 outpatients.
Indications for endoscopy included pyrosis and dyspepsia unresponsive to outpatient therapy, gastrointestinal bleeding, unexplained anemia, and weight loss.
Patients were biopsied for RUT tests to assess for Helicobacter activity, and by routine histologic biopsy.
The concordance rate of RUT and histologic biopsy was 95%.
Findings included a substantial number of normal endoscopies- 30%.
There was a significant number of Helicobacter pylori cases, 68%, with (36%) or without (64%) gastric or duodenal ulcers.
There were three gastric cancers, all in patients over the age of 70, and all of these were Helicobacter positive.
Four patients had esophageal varicies, and these were treated with esophageal banding, without complication.
Four patients had achalasia, one of these in a familial setting, and all were treated with a combination of Botox and pneumatic dilation without complication. One patient ( the familial) required retreatment with a larger balloon before he gained weight.
One patient (#38) dropped his Oxygen saturations and required naloxone and romazicon to reverse his sedation.
RUT and Histology are concordant.
The number of Helicobacter positive patients among this symptomatic naive population was in line with expectations, and they appeared to respond well to antibiotic treatment (MOA- pepto). Repeat endoscopy was not performed, and breath testing was not available.
There were a few cancers, in an older age group. Treatment options for those were limited.
The achalasic patients were a surprise.
Chaga’s disease, which appears clinically similar to achalasia, has not been described in Haiti. Chaga’s often causes cardiac arrhythmias and cardiomegaly, and in the three patents we evaluated with echocardiography, no abnormalities were found.
Treatment regimens changed for about 65%, based on the endoscopic findings.
A substantial number of endoscopies were normal.
There is a benefit to evaluating gastrointestinal complaints in this setting, where internists are unaccustomed to gastroenterological support. The number of normals could be decreased with rigorous adherence to more restrictive indications, but in the early going, an open stance was preferred.
In the future, combining bedside sonography should result in a greater diagnostic yield.
Helicobacter breath testing would be an inexpensive way to follow the treated HP patients, and we will institute this as time and money allow.
The surprising number of achalasics will require further study. Most of these occurred in the early days, so perhaps this is just a statistical anomaly.
This lab was assembled from used equipment bought cheap or donated. Repair costs for this equipment are prohibitive, and the expertise required for repair is not available in Port au Prince. This may be rate limiting.
Submitted to the American College of Gastroenterology, 2/13/12.