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*Corresponding Author: Enow orock g, Service d’Anatomie et de Cytologie Pathologiques, Hôpital Régional de Bafoussam
Citation: Enow orock g, enow orock a, Ngounou e, konang n jl, noubom m, nzeukou e1, tabeu nm, luma h. Pathologies Gastro-Intestinales dans un centre à ressources limitées : Etude Pilote à l’Hôpital Régional de Bafoussam, Cameroun.. J Clinical Research and Reports, 5(2); DOI:10.31579/2690-1919/112
Copyright: © 2020 Enow orock g. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 23 July 2020 | Accepted: 29 July 2020 | Published: 06 August 2020
Keywords: pathology; digestive; gastrointestinal pathology; Cameroon
Rationale: The pathology of the digestive tract is frequent in Cameroon. Despite this situation, studies of gastrointestinal pathology are rare. The pathological anatomy service is almost non-existent in the Cameroonian suburbs. Bafoussam in the west of the country is a semi-urban area and one of the rare ones to have a pathological anatomy department. This is why we decided to present the epidemiological data of the pathologies of the digestive tract of this locality.
Methods: We carried out a prospective study over three months (October 2019 - January 2020), in the pathological anatomy department of the Bafoussam Regional Hospital in Cameroon with the aim of presenting the structural pathologies of the digestive tract listed in this institution. .
Results: the pathology of the digestive tract has an incidence of approximately 400 in this locality, and represents 45.24% of all the pathologies identified in the pathological anatomy department of the Bafoussam Regional Hospital The age of our patients varies between 17 and 98 years old, with an average of 52.8. Women are slightly more represented (sex ratio M: F of 1: 1.3). Samples from the digestive tract represent 45% of all histological samples recorded in this department. The most common location, in decreasing order, is the stomach (84%), followed by the esophagus (5%), the colon and the rectum (4% each). On the other hand, other sites including the duodenum are rather rare. Of 100 samples of the digestive tract examined, 98 were pathological with a preponderance of inflammatory lesions (80.61%) against 19.39% of neoplastic nature. The inflammatory pathology was distributed uniformly in all age groups while the malignant pathologies were not observed until after 50 years. Malignant pathologies were more common in men (sex ratio M: F of 3: 1). Gastritis was the most common diagnosis (76.53%) and 94.66% of these gastritis were associated with Helicobacter pylori.
Conclusion: The pathology of the digestive tract is important in our community and dominated by the inflammatory type. The most common site is the stomach, most of the lesions of which are linked to Helicobacter pylori. It would be desirable to actively seek out and eradicate Helicobacter pylori infection to decrease the incidence of digestive pathology. Further studies are recommended to establish the true epidemiological trend of gastrointestinal pathology in our community.
Le tractus gastro-intestinal (TGI) est l'un des appareils les plus complexes du corps car il doit remplir plusieurs fonctions, y compris la digestion et l'absorption des nutriments. Exposé à une insulte continue du macrobiote local, l'épithélium de ce dernier est constamment renouvelé [1]. Plusieurs conditions pathologiques peuvent ainsi affecter le TGI.
Les maladies digestives touchent des millions de patients à travers le monde avec un impact économique important y compris cout élevé du système sanitaire, absentéisme au travail, et une qualité de vie médiocre chez les patients [2, 3, 4].
Les études rapportent que la pathologie gastro intestinale est fréquente au Cameroun. [5]. Une autre indique que ces pathologies constituent 10% des problèmes des patient en consultation dans l’hôpital régional de Limbe et à l’hôpital régional de Buea, dans la région du sud-ouest au Cameroun [6]. Les études sur la pathologie gastro-intestinale structurale histologiquement confirmée sont rares au Cameroun et peu effectuées en milieu tropical [7, 8]. Cette rareté est attribuée à un manque de services d’anatomie-pathologique au Cameroun. Ce travail présente un aperçu des pathologies structurales du tractus gastro-intestinal dans notre communauté.
Nous avons mené une étude prospective sur une période de 03 mois (octobre 2019 - janvier 2020). L’étude a concerné les pièces opératoires adressées au laboratoire d’anatomie pathologique, intéressant le tractus gastro-intestinal. Nous avons utilisé la technique histologique de routine : les échantillons fixés au formol 10%, les coupes effectuées au microtome en section de 0,5mm puis colorées à l’hématéine éosine. Enfin les lames sont interprétées sur microscope à lumière simple par un anatomopathologiste. Toutes les biopsies du TGI reçus durant la période d’études sont répertoriées, assemblées et analysées. Les résultats sont présentés en forme de tableau et graphes.
Sur 221 échantillons histologiques reçus dans la période d’étude 100 intéressent le système digestif (45,24%).
L’âge moyen des patients est de 52,8 ans (17-98 ans). Les patients les plus représentés étaient ceux de 60 ans et plus (43,0%).
On note une légère prédominance de femmes dans notre série, avec sexe ratio M:F de 1:1,3.
SITE | Nombre échantillons | Pourcentage (%) |
Œsophage | 5 | 5,0 |
Estomac | 84 | 84,0 |
Duodénum | 2 | 2,0 |
Côlon | 4 | 4,0 |
Rectum | 4 | 4,0 |
Pancréas | 1 | 1,0 |
Total | 100 | 100,00% |
Tableau I : Répartition des échantillons selon le site anatomique
Dans notre série, la localisation la plus fréquente des affections du TGI est gastrique à 84%, et le reste répartie comme suit : Œsophage (5%), Rectum (4%), Colon (4%), Duodénum (2%) et Pancréas (1%).
Diagnostic pathologique | Effectifs | Pourcentage |
Adénocarcinome | 8 | 8,0% |
Carcinome | 2 | 2,0% |
Duodénite | 1 | 1,0% |
Gastrite | 75 | 75,0% |
Lymphome | 2 | 2,0% |
Œsophagite | 1 | 1,0% |
Polype bénin | 7 | 7,0% |
RCUH* | 2 | 2,00% |
Sans lésion | 2 | 2,00% |
Total | 100 | 100,00% |
* RCUH : recto-colite ulcéro hémorragique
Tableau II : Répartition des échantillons en fonction du diagnostic pathologique
Sur 98 lésions enregistrées, 80,61% des lésions sont de natures inflammatoires contre 19,39% de lésions néoplasiques. La gastrite est le diagnostic le plus fréquent (76,53%).
Tranche âge Dg pathologique | 0 - 19 | 20 - 29 | 30 - 39 | 40 - 49 | 50 - 59 | 60 - 69 | ≥70 | Total |
Adénocarcinome | 3 | 5 | 8 | |||||
Carcinome | 1 | 1 | 2 | |||||
Duodénite | 1 | 1 | ||||||
Gastrite | 3 | 10 | 12 | 11 | 10 | 13 | 16 | 75 |
Lymphome | 2 | 2 | ||||||
Œsophagite | 1 | 1 | ||||||
Polype bénin | 1 | 1 | 4 | 1 | 7 | |||
RCUH | 2 | 2 | ||||||
Sans lésion | 1 | 1 | 2 | |||||
Total | 3 | 12 | 13 | 14 | 15 | 24 | 19 | 100 |
Tableau III : Diagnostic pathologique par tranche d’âge
La pathologie gastro-intestinale inflammatoire est repartie uniformément dans toutes les tranches d’âge tandis que les pathologies malignes apparaissent après 50 ans.
Diagnostic pathologique | F | M | Total |
Adénocarcinome | 1 | 7 | 8 |
Carcinome | 1 | 1 | 2 |
Duodénite | 1 | 1 | |
Gastrite | 48 | 27 | 75 |
Lymphome | 1 | 1 | 2 |
Œsophagite | 1 | 1 | |
Polype bénin | 3 | 4 | 7 |
Rectocolite | 2 | 2 | |
Sans lésion | 2 | 2 | |
Total | 55 | 45 | 100 |
Tableau IV : Diagnostic pathologique par Sexe
Les lésions gastro-intestinales malignes sont plus fréquentes chez les hommes (20,93%) que chez les femmes (3,63%), avec un sexe ratio M:F de 3:1.
Site/Dg pathologique | Effectifs | Pourcentage |
Colon | 4 | 4,00% |
Adénocarcinome | 1 | 1,00% |
Polype bénin | 1 | 1,00% |
RCUH | 1 | 1,00% |
Sans lésion | 1 | 1,00% |
Duodénum | 2 | 2,00% |
Duodénite | 1 | 1,00% |
Polype bénin | 1 | 1,00% |
Estomac | 84 | 84,00% |
Adénocarcinome | 5 | 5,00% |
Gastrite | 75 | 75,00% |
Lymphome | 2 | 2,00% |
Polype bénin | 1 | 1,00% |
Sans lésion | 1 | 1,00% |
Œsophage | 5 | 5,00% |
Carcinome | 2 | 2,00% |
Œsophagite | 1 | 1,00% |
Polype bénin | 2 | 2,00% |
Pancréas | 1 | 1,00% |
Adénocarcinome | 1 | 1,00% |
Rectum | 4 | 4,00% |
Adénocarcinome | 1 | 1,00% |
Polype bénin | 2 | 2,00% |
RCUH | 1 | 1,00% |
Total | 100 | 100,00% |
Tableau V : Diagnostic pathologique selon les sites anatomiques
L’Estomac est le site le plus représenté, il enregistre 84% des échantillons du tractus gastro-intestinal, et enregistre 84,6% de l’ensemble des lésions de notre étude.
Diagnostic pathologique | Effectifs | Pourcentage |
Adénocarcinome | 5 | 5,95% |
Gastrite | 75 | 89,29% |
Sans atrophie | 43 | 51,19% |
Sans H.p | 3 | 3,57% |
Avec H.p | 40 | 47,62% |
Avec atrophie | 32 | 38,10% |
Sans H.p | 1 | 1,19% |
Avec H.p | 31 | 36,90% |
Lymphome | 2 | 2,38% |
Polype bénin | 1 | 1,19% |
Sans lésion | 1 | 1,19% |
Total | 84 | 100% |
Tableau VI : Les lésions de l’estomac
Les lésions de l’estomac sont des gastrites à 89,29% ; associées à une atrophie (42,66%) et très souvent associées à Helicobacter pylori (94,66% de cas).
L’âge moyen de nos patients est de 52,8 ans (17-98 ans). Les patients les plus représentés étaient ceux de 60 ans et plus (43,0%) ; voir figure I. Notre série se rapproche de la littérature rapportée par Nezha et al [9], dont l'âge moyen des patients était de 55 ans (23-80 ans) avec une fréquence plus élevée pour la tranche 40-60ans, contrairement à celle de certains auteurs [10] dont l’âge moyen était de 38,5 ans (7-85 ans), et 57% des patients avec un âge compris entre 20 et 39 ans. On note une légère prédominance de femmes dans notre série, avec un sexe ratio M:F de 9:11 (figure II) tout comme dans une littérature antérieure [11] dont le sexe ratio M:F était de 107:113, contrairement à une autre [10] qui avait une prédominance masculine (sexe ratio M:F de 707:514).
Notre étude montre que l’estomac est le site le plus représenté, il enregistre 84% des échantillons du système digestif (voir tableau I). Cette tendance corrobore avec l’étude de Nezha qui avait une prédominance d’échantillon de localisation gastrique à 40,74% [9]. Par contre, certaines littératures rapportent que les affections digestives sont très fréquentes en Afrique avec une forte prédominance de la pathologie colique [12, 13].
80,61% de lésions dans notre série sont de natures inflammatoires (voir tableau II). Ce pourcentage est très élevé par rapport à celui retrouvé par Ndjitoyap et al qui était de 54,65 % [14]. Cette fréquence élevée de la pathologie inflammatoire dans notre contexte pourrait être en rapport avec les multiples facteurs agressifs pour la muqueuse gastrique qui font partie du régime alimentaire locale de cette population [15]. En effet dans l’ensemble de lésions observées dans notre étude, la gastrite est le diagnostic le plus fréquent (76,53%). Cette fréquence est plus élevée que celle rapporté par J.FAIVR et al, avec une prédominance de gastrite à 27,79%. Cependant une étude d’ATTIA en côte d’Ivoire nous rapporte deux fois plus de duodénites que de gastrites [12].
Un rapport antécédent trouve les maladies digestives malignes comme principale cause de pathologies de ce système avec une mortalité élevée parmi tous les néoplasmes, contribuant à environ 3 millions de décès en 2012 dans le monde entier. Ce rapport présente comme principales tumeurs maligne digestives par ordre décroissant, le carcinome hépatocellulaire (CHC), le cancer colorectal, le cancer gastrique (CG), le cancer du pancréas, le cancer de l'œsophage et le cancer buccal [18].
Dans notre étude on trouve une prédominance de lésions malignes du tube digestif chez les patients du sexe masculin avec un rapport M:F de 3:1 (voir tableau IV). Cette opinion a été reportée par Daniyal et al [19]. Cependant son incidence est caractérisée par une importante disparité géographique [20].
La pathologie gastro-intestinale inflammatoire est repartie uniformément dans toutes les tranches d’âges tandis que les pathologies malignes apparaissent après 50 ans (voir tableau III). Les lésions gastro-intestinales malignes sont plus fréquentes chez les hommes (20,93%), avec un sexe ratio M:F de 3:1 (voir tableau IV). Il nous semble évident que l’âge est un facteur de risque des cancers du tractus gastro-intestinal [16]. En effet notre résultat corrobore avec certaines littératures qui rapportent que les cancers du tractus gastro-intestinal sont rares avant 50 ans avec une prédominance masculine (sex-ratio de 5:2), et leur incidence augmente avec l’âge [16].
L’estomac est le site le plus affecté du TGI, il enregistre 84,6% de l’ensemble des lésions de notre étude (voir tableau V). Ce pourcentage est très élevé par rapport à celui de Djibril et al [10], qui avait une prédominance de lésions gastrique à 44%.
Dans les lésions de l’estomac sont des gastrites à 89,29% (voir tableau VI) et associées souvent à une atrophie (42,66%) et très souvent associé à Helicobacter pylori (94,66% de cas), Helicobacter pylori étant un facteur de risque majeur du cancer gastrique selon plusieurs auteurs [21, 22, 23, 24].
Environs 45,24% des échantillons histologiques adressés au service d’anatomie pathologique intéressent le système digestif. Les lésions inflammatoires de ce système représentent 80,61% dont 19,39% sont des lésions néoplasiques. La cause de la prédominance de lésions inflammatoire reste à déterminer. Le diagnostic le plus fréquent est une gastrite, le plus souvent associé à Helicobacter pylori (94,66%). L’éradication de Helicobacter pylori est très capitale dans la stratégie de lutte contre la pathologie digestive.
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My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
