title: Trends in upper gastrointestinal diagnosis over four decades in Lusaka, Zambia: a retrospective analysis of endoscopic findings.
abstract: OBJECTIVE
  There a shortage of robust information about profiles of gastrointestinal disease in sub-Saharan Africa. The endoscopy unit of the University Teaching Hospital in Lusaka has been running without interruption since 1977 and this 38-year record is largely intact. We report an analysis of endoscopic findings over this period.
  
  
  METHODS
  Written endoscopy records from 29th September 1977 to 16th December 2014 were recovered, computerised, coded by two experienced endoscopists and analysed. Temporal trends were analysed using tables, graphs, and unconditional logistic regression, with age, sex of patient, decade, and endoscopist as independent variables to adjust for inter-observer variation.
  
  
  RESULTS
  Sixteen thousand nine hundred fifty-three records were identified and analysed. Diagnosis of gastric ulcer rose by 22 %, and that of duodenal ulcer fell by 14 % per decade. Endoscopically diagnosed oesophageal cancer increased by 32 % per decade, but gastric cancer rose only in patients under 60 years of age (21 % per decade). Oesophageal varices were the commonest finding in patients presenting with haematemesis, increasing by 14 % per decade in that patient group. Two HIV-related diagnoses, oesophageal candidiasis and Kaposi's sarcoma, rose from almost zero to very high levels in the 1990s but fell substantially after 2005 when anti-retroviral therapy became widely available.
  
  
  CONCLUSIONS
  This useful dataset suggests that there are important trends in some endoscopic findings over four decades. These trends are not explained by inter-observer variation. Reasons for the divergent trends in incidence of peptic ulceration and apparent trends in diagnosis of upper gastrointestinal cancers merit further exploration.
authors.affiliation: TROPGAN, Department of Medicine, University of Zambia School of Medicine, University Teaching Hospital, Nationalist Road, Lusaka, Zambia. viojole@yahoo.com.
authors.forename: Violet
authors.initials: V
authors.lastname: Kayamba
authors.affiliation: TROPGAN, Department of Medicine, University of Zambia School of Medicine, University Teaching Hospital, Nationalist Road, Lusaka, Zambia. sinkalaeddie@yahoo.com.
authors.forename: Edford
authors.initials: E
authors.lastname: Sinkala
authors.affiliation: TROPGAN, Department of Medicine, University of Zambia School of Medicine, University Teaching Hospital, Nationalist Road, Lusaka, Zambia. staynerbanda@yahoo.co.uk.
authors.forename: Stayner
authors.initials: S
authors.lastname: Mwanamakondo
authors.affiliation: TROPGAN, Department of Medicine, University of Zambia School of Medicine, University Teaching Hospital, Nationalist Road, Lusaka, Zambia.
authors.forename: Rose
authors.initials: R
authors.lastname: Soko
authors.affiliation: Copperbelt University School of Medicine, Ndola, Zambia. ninemwamba@hotmail.com.
authors.forename: Boniface
authors.initials: B
authors.lastname: Kawimbe
authors.affiliation: TROPGAN, Department of Medicine, University of Zambia School of Medicine, University Teaching Hospital, Nationalist Road, Lusaka, Zambia. beatriceamadi@ymail.com.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Amadi
authors.affiliation: TROPGAN, Department of Medicine, University of Zambia School of Medicine, University Teaching Hospital, Nationalist Road, Lusaka, Zambia. wxo8@cdc.gov.
authors.forename: Isaac
authors.initials: I
authors.lastname: Zulu
authors.affiliation: Department of Surgery, University Teaching Hospital, Lusaka, Zambia. jebaseng@yahoo.com.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Nzaisenga
authors.affiliation: TROPGAN, Department of Medicine, University of Zambia School of Medicine, University Teaching Hospital, Nationalist Road, Lusaka, Zambia. abmet86@gmail.com.
authors.forename: Themba
authors.initials: T
authors.lastname: Banda
authors.affiliation: TROPGAN, Department of Medicine, University of Zambia School of Medicine, University Teaching Hospital, Nationalist Road, Lusaka, Zambia. dycyjo@gmail.com.
authors.forename: Chipasha
authors.initials: C
authors.lastname: Mumbwe
authors.affiliation: TROPGAN, Department of Medicine, University of Zambia School of Medicine, University Teaching Hospital, Nationalist Road, Lusaka, Zambia. evansmd2016@gmail.com.
authors.forename: Evans
authors.initials: E
authors.lastname: Phiri
authors.affiliation: TROPGAN, Department of Medicine, University of Zambia School of Medicine, University Teaching Hospital, Nationalist Road, Lusaka, Zambia. Phillipmunkonge.k.jnr@gmail.com.
authors.forename: Philip
authors.initials: P
authors.lastname: Munkonge
authors.affiliation: TROPGAN, Department of Medicine, University of Zambia School of Medicine, University Teaching Hospital, Nationalist Road, Lusaka, Zambia. m.p.kelly@qmul.ac.uk.|Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, 4 Newark Street, London, E1 2AD, UK. m.p.kelly@qmul.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D000328:Adult; D002177:Candidiasis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D004381:Duodenal Ulcer / Q000175:diagnosis / Q000453:epidemiology; D016099:Endoscopy, Gastrointestinal / Q000639:trends*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012514:Sarcoma, Kaposi / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D013276:Stomach Ulcer / Q000175:diagnosis / Q000453:epidemiology; D013997:Time Factors; D041742:Upper Gastrointestinal Tract; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology