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Daouda et al., J Gastroint Dig Syst 2013, S6 DOI: 10.4172/2161-069X.S6-007 Review Article Open Access J Gastroint Dig Syst Clinical Diagnosis and Therapy of Colorectal Cancer: State of the Art ISSN: 2161-069X JGDS, an open access journal Esophageal and Gastric Cancers in Sub-Saharan Africa, Epidemiological and Clinical Review Dia Daouda 1 *, Mbengue Mouhamadou 1 , Bassene Marie Louise 2 and Diouf Mamadou Lamine 2 1 Service de gastroenterologie Hospital General de Grand Yoff, BP 3270, Dakar, Senegal 2 Service de gastroenterologie Hospital Aristide Le Dantec, BP 3001, Dakar, Senegal Abstract The data on esophageal and gastric cancers in sub-Saharan Africa are fragmented and not numerous because of the rarity and of the inaccessibility of the diagnostic means. Esophageal cancer has very variable incidences according to the geographical zones there and nutritional and infectious factors are incriminated in its arisen. It reaches young subjects with a preferential siege the average esophagus with ascendancy of squamous cell carcinomas. For gastric cancer, its incidence there is low despite the strong prevalence of Helicobacter pylori infection. As in Western countries, Helicobacter pylori’s gene Cag A is correlated in its arisen there but the low prevalence of strains with multiple EPIYA-C segments might contribute to its low incidence. It affects young subjects more often male with a big ascendancy of adenocarcinoma. The improvement of the diagnostic conditions and the financing of researches are necessary for a better knowledge of the risk and the protective factors of esophageal and gastric cancers in sub-Saharan Africa. *Corresponding author: Dia Daouda Service General Hospital Gastroenterology Grand Yoff, BP 3270, Dakar, Senegal, e-mail: [email protected] Received March 25, 2013; Accepted April 27, 2013; Published April 29, 2013 Citation: Daouda D, Mouhamadou M, Louise BM, Lamine DM (2013) Esophageal and Gastric Cancers in Sub-Saharan Africa, Epidemiological and Clinical Review. J Gastroint Dig Syst S6: 007. doi:10.4172/2161-069X.S6-007 Copyright: © 2013 Daouda D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Esophageal cancer; Gastric cancer; Sub-Saharan Africa Introduction e cancers of the esophagus and those of the stomach in sub- Saharan Africa are little studied because of the rarity of the diagnostic resources and the absence of functional registers of cancers. We suggest through this short review to characterize them from fragmented data resulting from some countries. Esophageal Cancer Among the digestive cancers, that of the esophagus presents one of the most heterogeneous geographical distributions in touch with the uneven distribution of its risk factors [1]. Contrary to the western countries where prevail as risk factors alcoholism, smoking and Barret’s esophagus with gastro-esophageal reflux disease and obesity, in sub-Saharan Africa nutritional and infectious factors are more incriminated [2]. e infectious factors could be the infection to the Human Papilloma Virus as already suggested in the certain Chinese regions [1]. e food factors are a high consumption of corn by means of its contamination by fumonisine which is a mycotoxin [3] but also the nutritional deficiencies which contribute to the installation of Plummer-Vinson’s syndrome which constitutes a pre-neoplastic ground [4]. is Plummer-Vinson’s syndrome which disappeared in the western countries is found in 1 % prevalence in our digestive endoscopic center in Dakar, Senegal [5,6]. In endoscopic middle, prevalence of esophagus cancer is low in West Africa (0.97 % in Senegal [7]) and very high in East and South Africa (27 % in Malawi [8]). e average age of the patients is young at about 50 years and more than 70% of them are of less than 60 years old [7]. e ascendancy is male with approximately 2 men for a woman. e diagnosis is late at the stage of mechanical dysphagia with even an aphagia in 42 % of cases. e preferential siege is the middle third of the esophagus and squamous cell carcinoma prevail with more than 92 % of cases [7]. Gastric Cancer It is one of the most frequent worldwide cancers with annual 755000 new cases, it’s considered rare in Africa more particularly in its sub-Saharan party [9]. e average age of the patients is young between the fiſth and the sixth decade of life [10]. e big youth of the general population could explain partially this report as in the majority of the countries of the South. Intervention of other factors in particular environmental and genetic could be also evoked. Indeed, Helicobacter pylori infection is found to almost all of the subjects living in these zones and it arises very prematurely [11-13] there while this bacterium is incriminated in an indisputable way in the arisen of the gastric distal adenocarcinoma [14]. e unknown data on the slightest virulence of the genes of Helicobacter pylori in Africa make speak until now about the African enigma [15]. We have found in Senegal that the Cag A-positive strains were significantly associated with gastric cancer as in western countries [14] but we think that the low prevalence of strains with multiple EPIYA-C segments might contribute to the low incidence of this cancer in our country and by extension in Africa [16], although further studies are needed to evaluate their prevalence in other African countries. e ascendancy is male with a sex-ratio around 1.5 to 3 and it would be probably explained by the role of the other incriminated toxic factors (alcohol, tobacco, etc.) more found in men than in women [9,17]. e circumstances of discovery of the gastric cancer are represented by clinical signs evolved in type of pyloric stenosis, loss of weight, digestive bleeding or anemia and they translate the long delay of consultation [18]. Few patients are seen at an early stage or at a fall of the surveillance of pre-neoplastic pathologies as gastric ulcers or a Biermer’s disease. e endoscopic features ensue from this long diagnostic delay with an ascendancy of ulcerative and/or bourgeoning forms with oſten stenosis and bleeding [19]. e concentration of the means of exploration diagnostic as the digestive endoscopy in big cities and especially their difficult financial accessibility for the populations explain largely the delay of the diagnosis. As an example, the cost of a high digestive endoscopy with biopsies and histological reading in Senegal is at least equivalent to the monthly guaranteed minimum wage (50000 FCFA = 75 Euros). e highest frequencies are located in the anthral and cardia regions which accounted for 79% of all the tumors [9,18]. e histological aspects are dominated as somewhere else by adenocarcinoma [18,20]. e MALT lymphoma is rarely reported to it J o u r n a l o f G a s t r o i n t e s t i n a l & D i g e s t i v e S y s t e m ISSN: 2161-069X Journal of Gastrointestinal & Digestive System

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  • Daouda et al., J Gastroint Dig Syst 2013, S6

    DOI: 10.4172/2161-069X.S6-007

    Review Article Open Access

    J Gastroint Dig Syst Clinical Diagnosis and Therapy of Colorectal Cancer: State of the Art ISSN: 2161-069X JGDS, an open access journal

    Esophageal and Gastric Cancers in Sub-Saharan Africa, Epidemiological and Clinical ReviewDia Daouda1*, Mbengue Mouhamadou1, Bassene Marie Louise2 and Diouf Mamadou Lamine2 1Service de gastroenterologie Hospital General de Grand Yoff, BP 3270, Dakar, Senegal2Service de gastroenterologie Hospital Aristide Le Dantec, BP 3001, Dakar, Senegal

    AbstractThe data on esophageal and gastric cancers in sub-Saharan Africa are fragmented and not numerous because of

    the rarity and of the inaccessibility of the diagnostic means. Esophageal cancer has very variable incidences according to the geographical zones there and nutritional and infectious factors are incriminated in its arisen. It reaches young subjects with a preferential siege the average esophagus with ascendancy of squamous cell carcinomas. For gastric cancer, its incidence there is low despite the strong prevalence of Helicobacter pylori infection. As in Western countries, Helicobacter pylori’s gene Cag A is correlated in its arisen there but the low prevalence of strains with multiple EPIYA-C segments might contribute to its low incidence. It affects young subjects more often male with a big ascendancy of adenocarcinoma. The improvement of the diagnostic conditions and the financing of researches are necessary for a better knowledge of the risk and the protective factors of esophageal and gastric cancers in sub-Saharan Africa.

    *Corresponding author: Dia Daouda Service General Hospital Gastroenterology Grand Yoff, BP 3270, Dakar, Senegal, e-mail: [email protected]

    Received March 25, 2013; Accepted April 27, 2013; Published April 29, 2013

    Citation: Daouda D, Mouhamadou M, Louise BM, Lamine DM (2013) Esophageal and Gastric Cancers in Sub-Saharan Africa, Epidemiological and Clinical Review. J Gastroint Dig Syst S6: 007. doi:10.4172/2161-069X.S6-007

    Copyright: © 2013 Daouda D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Keywords: Esophageal cancer; Gastric cancer; Sub-Saharan Africa

    IntroductionThe cancers of the esophagus and those of the stomach in sub-

    Saharan Africa are little studied because of the rarity of the diagnostic resources and the absence of functional registers of cancers. We suggest through this short review to characterize them from fragmented data resulting from some countries.

    Esophageal CancerAmong the digestive cancers, that of the esophagus presents one

    of the most heterogeneous geographical distributions in touch with the uneven distribution of its risk factors [1]. Contrary to the western countries where prevail as risk factors alcoholism, smoking and Barret’s esophagus with gastro-esophageal reflux disease and obesity, in sub-Saharan Africa nutritional and infectious factors are more incriminated [2]. The infectious factors could be the infection to the Human Papilloma Virus as already suggested in the certain Chinese regions [1]. The food factors are a high consumption of corn by means of its contamination by fumonisine which is a mycotoxin [3] but also the nutritional deficiencies which contribute to the installation of Plummer-Vinson’s syndrome which constitutes a pre-neoplastic ground [4]. This Plummer-Vinson’s syndrome which disappeared in the western countries is found in 1 % prevalence in our digestive endoscopic center in Dakar, Senegal [5,6]. In endoscopic middle, prevalence of esophagus cancer is low in West Africa (0.97 % in Senegal [7]) and very high in East and South Africa (27 % in Malawi [8]). The average age of the patients is young at about 50 years and more than 70% of them are of less than 60 years old [7]. The ascendancy is male with approximately 2 men for a woman. The diagnosis is late at the stage of mechanical dysphagia with even an aphagia in 42 % of cases. The preferential siege is the middle third of the esophagus and squamous cell carcinoma prevail with more than 92 % of cases [7].

    Gastric CancerIt is one of the most frequent worldwide cancers with annual

    755000 new cases, it’s considered rare in Africa more particularly in its sub-Saharan party [9]. The average age of the patients is young between the fifth and the sixth decade of life [10]. The big youth of the general population could explain partially this report as in the majority of the countries of the South. Intervention of other factors in particular environmental and genetic could be also evoked. Indeed, Helicobacter

    pylori infection is found to almost all of the subjects living in these zones and it arises very prematurely [11-13] there while this bacterium is incriminated in an indisputable way in the arisen of the gastric distal adenocarcinoma [14]. The unknown data on the slightest virulence of the genes of Helicobacter pylori in Africa make speak until now about the African enigma [15]. We have found in Senegal that the Cag A-positive strains were significantly associated with gastric cancer as inwestern countries [14] but we think that the low prevalence of strainswith multiple EPIYA-C segments might contribute to the low incidenceof this cancer in our country and by extension in Africa [16], althoughfurther studies are needed to evaluate their prevalence in other Africancountries. The ascendancy is male with a sex-ratio around 1.5 to 3 andit would be probably explained by the role of the other incriminatedtoxic factors (alcohol, tobacco, etc.) more found in men than inwomen [9,17]. The circumstances of discovery of the gastric cancerare represented by clinical signs evolved in type of pyloric stenosis,loss of weight, digestive bleeding or anemia and they translate the longdelay of consultation [18]. Few patients are seen at an early stage or ata fall of the surveillance of pre-neoplastic pathologies as gastric ulcersor a Biermer’s disease. The endoscopic features ensue from this longdiagnostic delay with an ascendancy of ulcerative and/or bourgeoningforms with often stenosis and bleeding [19]. The concentration of themeans of exploration diagnostic as the digestive endoscopy in big citiesand especially their difficult financial accessibility for the populationsexplain largely the delay of the diagnosis. As an example, the cost ofa high digestive endoscopy with biopsies and histological reading inSenegal is at least equivalent to the monthly guaranteed minimum wage(50000 FCFA = 75 Euros). The highest frequencies are located in theanthral and cardia regions which accounted for 79% of all the tumors[9,18]. The histological aspects are dominated as somewhere else byadenocarcinoma [18,20]. The MALT lymphoma is rarely reported to it

    Jou

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    of G

    astro

    intestinal & Digestive

    System

    ISSN: 2161-069X

    Journal of Gastrointestinal & Digestive System

  • Citation: Daouda D, Mouhamadou M, Louise BM, Lamine DM (2013) Esophageal and Gastric Cancers in Sub-Saharan Africa, Epidemiological and Clinical Review. J Gastroint Dig Syst S6: 007. doi:10.4172/2161-069X.S6-007

    Page 2 of 2

    J Gastroint Dig Syst Clinical Diagnosis and Therapy of Colorectal Cancer: State of the Art ISSN: 2161-069X JGDS, an open access journal

    [21], the gastric Kaposi in touch with the HIV occupies 0.3 to 4 % of all cases [22]; other histological types as GIST are found there in a trivial way and in contrast with the reported cases from western countries the African patients are younger, their tumors are larger and often present late with non-specific symptoms [23,24].

    ConclusionThe cancers of the esophagus and the stomach in sub-Saharan

    Africa, the part their relative rarity and their arisen at a young age, constitute a riddle with the likely intervention of nutritional and infectious factors. A certain interest lies in the improvement of the diagnostic technical tray and the continuation of research for the exact determination of their risk factors and their possible protective factors.

    References

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    2. Hongo M, Nagasaki Y, Shoji T (2009) Epidemiology of esophageal cancer: Orient to Occident. Effects of chronology, geography and ethnicity. J Gastroenterol Hepatol 24: 729-735.

    3. Williams JH, Grubb JA, Davis JW, Wang JS, Jolly PE, et al. (2010) HIV and hepatocellular and esophageal carcinomas related to consumption of mycotoxin-prone foods in sub-Saharan Africa. Am J Clin Nutr 92: 154-160.

    4. Jessner W, Vogelsang H, Püspök A, Ferenci P, Gangl A, et al. (2003) Plummer-Vinson syndrome associated with celiac disease and complicated by postcricoid carcinoma and carcinoma of the tongue. Am J Gastroenterol 98: 1208-1209.

    5. Novacec G (2006) Plummer-Vinson syndrome. Orphnet J Rare Dis 1: 36.

    6. Dia D, Diouf ML, Diouf G, Mbengue M, Bassene ML, et al. (2009) Le syndrome de Plummer-Vinson : aspects cliniques, paracliniques et thérapeutiques. A propos de 19 cas à Dakar. Médecine d’Afrique Noire 57: 189-192.

    7. Dia D, Bassene ML, Ndiaye-Bâ N, Halim A, Diallo S, et al. (2011) Endoscopic features of esophageal cancer in Dakar, Senegal: study of 76 observations. Med Trop (Mars) 71: 286-288.

    8. Wolf LL, Ibrahim R, Miao C, Muyco A, Hosseinipour MC, et al. (2012) Esophagogastroduodenoscopy in a public referral hospital in Lilongwe, Malawi: spectrum of disease and associated risk factors. World J Surg 36: 1074-1082.

    9. Mandong BM, Manasseh AN, Tanko MN, Echejoh GO, Madaki AJ (2010) Epidemiology of gastric cancer in Jos University Teaching Hospital Jos a 20 year review of cases. Niger J Med 19: 451-454.

    10. Amegbor K, Napo-Koura GA, Songne-Gnamkoulamba B, Redah D, Tekou A

    (2008) Epidemiological and pathological aspects of gastrointestinal tumors in Togo. Gastroenterol Clin Biol 32: 430-434.

    11. Aduful H, Naaeder S, Darko R, Baako B, Clegg-Lamptey J, et al. (2007) Upper gastrointestinal endoscopy at the korle bu teaching hospital, accra, ghana. Ghana Med J 41: 12-16.

    12. Kalebi A, Rana F, Mwanda W, Lule G, Hale M (2007) Histopathological profile of gastritis in adult patients seen at a referral hospital in Kenya. World J Gastroenterol 13: 4117-4121.

    13. Ibara JR, Mbou VA, Gatsélé-Yala C, Ngoma-Mambouana P, Ngounga B, et al. (2005) Infection à Helicobacter pylori chez l’enfant de 6 mois à 16 ans à Brazzaville (Congo). Gastroenterol Clin Biol 29: 752-753.

    14. Blaser MJ, Perez-Perez GI, Kleanthous H, Cover TL, Peek RM, et al. (1995) Infection with Helicobacter pylori strains possessing cagA is associated with an increased risk of developing adenocarcinoma of the stomach. Cancer Res 55: 2111-2115.

    15. Campbell DI, Warren BF, Thomas JE, Figura N, Telford JL, et al. (2001) The African enigma: low prevalence of gastric atrophy, high prevalence of chronic inflammation in West African adults and children. Helicobacter 6: 263-267.

    16. Breurec S, Michel R, Seck A, Brisse S, Côme D, et al. (2012) Clinical relevance of cagA and vacA gene polymorphisms in Helicobacter pylori isolates from Senegalese patients. Clin Microbiol Infect 18: 153-159.

    17. Walker AR, Halse J (1999) Pattern of cancer in Indian patients hospitalized in Durban, South Africa. Eur J Cancer Prev 8: 247-254.

    18. Osime OC, Momoh MI, Irowa OO, Obumse A (2010) Gastric carcinoma--a big challenge in a poor economy. J Gastrointest Cancer 41: 101-106.

    19. Afuwape OO, Irabor DO, Ladipo JK, Ayandipo B (2012) A review of the current profile of gastric cancer presentation in the university college hospital Ibadan, a tertiary health care institution in the tropics. J Gastrointest Cancer 43: 177-180.

    20. Abdulkareem FB, Faduyile FA, Daramola AO, Rotimi O, Banjo AA, et al. (2009) Malignant gastrointestinal tumours in south western Nigeria: a histopathologic analysis of 713 cases. West Afr J Med 28: 173-176.

    21. Dia D, Seck A, Mbengue M, Bassène ML, Breurec S, et al. (2010) Helicobacter pylori and gastroduodenal lesions in Dakar, Senegal. Med Trop (Mars) 70: 367-370.

    22. Soukho-Kaya A, Minta DK, Diarra MT, Konate A, Diallo B, et al. (2012) Upper gastrointestinal endoscopy during Kaposi’s sarcoma to the Point G Hospital, Bamako (Mali): case study 20. Mali Med 27: 62-65.

    23. Tesfay W, Komminoth P, Schneider J (2011) Gastrointestinal stromal tumors in Addis Ababa, Ethiopia. Ethiop Med J 49: 43-50.

    24. Hartley RJ, Becker JH, Van der Walt H, Luvhengo T (2011) Gastro-intestinal stromal tumours (GISTs) - the Pretoria experience and a literature review. S Afr J Surg 49: 128-131.

    This article was originally published in a special issue, Clinical Diagnosis and Therapy of Colorectal Cancer: State of the Art handled by Editor. Dr. Ralph Schneider, Philipps University Marburg, Germany

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    TitleCorresponding authorAbstractKeywordsIntroductionEsophageal Cancer Gastric Cancer ConclusionReferences


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