Epidemiological and Diagnostic Profile of Peptic Ulcer Disease in Upper Gastrointestinal Endoscopy in Libreville

Abstract

Introduction: Peptic ulcer disease (PUD) results from an imbalance between aggressive and protective factors of the gastric and duodenal mucosa. Helicobacter pylori ( H. pylori ) is a common etiology. However, the African paradox exists, where the WHO-estimated 80% prevalence of H. pylori is not statistically associated with a high frequency of PUD. This study aimed to investigate the relationship between H. pylori and PUD in Libreville. Methodology: We conducted a 3-year prospective study (2017-2019) at the Libreville University Teaching Hospital (CHUL), including 167 patients with PUD confirmed by endoscopy and biopsies. Epidemiological, clinical, therapeutic, and histological data were analyzed using Epi Info 7.2, with statistical tests (Chi-square, Fisher). Result: H. pylori was present in 79.3% of patients. PUD predominantly occurred in patients with low socioeconomic status (66.5%). Regarding patients with negative H. pylori , there was a significant association with NSAID use (p = 0.0001), stress (p = 0.0108), and alcohol consumption (p = 0.0242). Gastric ulcers (61.1%) were most frequent, with chronic gastritis (89.2%) as the predominant histological lesion. Conclusion: While H. pylori remains a major factor in peptic ulcer in Libreville, our study highlights the important role of NSAIDs, stress, and alcohol. These findings underscore an epidemiological shift and call for integrated management strategies addressing both infectious and non-infectious risk factors.