The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
African health sciences
Abstract
Variceal upper gastrointestinal bleeding (UGIB) is common in sub-Saharan Africa (SSA). However, poor access
to endoscopy services precludes the diagnosis of varices.
Objectives: We determined the diagnostic accuracy of routine clinical findings for detection of esophageal varices among patients
with UGIB in rural SSA where schistosomiasis is endemic.
Methods: We studied patients with a history of UGIB. The index tests included routine clinical findings and the reference test
was diagnostic endoscopy. Multivariable regression with post-estimation provided measures of association and diagnostic accuracy.
Results: We studied 107 participants with UGIB and 21% had active bleeding. One hundred and three (96%) had liver disease
and 86(80%) varices. Factors associated with varices (p-value <0.05) were ≥ 4 lifetime episodes of UGIB, prior blood transfusion,
splenomegaly, liver fibrosis, thrombocytopenia, platelet count spleen diameter ratio <909, and a dilated portal vein.
Two models showed an overall diagnostic accuracy of > 90% in detection of varices with a number needed to misdiagnose of
13(number of patients who needed to be tested in order for one to be misdiagnosed by the test).
Conclusion: Where access to endoscopy is limited, routine clinical findings could improve the diagnosis of patients with UGIB
in Africa.
Description
Keywords
Diagnostic accuracy, Clinical findings, Esophageal varices, Rural sub-Saharan Africa
Citation
Opio CK, Rejani L, Kazibwe F, Ocama P. The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic. Afri Health Sci.2019;19(4):3225-3234.https://dx.doi.org/10.4314/ahs. v19i4.46