Upper Gastrointestinal Bleeding in Nigeria: A Systematic Review of Aetiology, Demographic Patterns, and Regional Variations
Ofodile Francis Uchechukwu *
University of Nigeria Teaching Hospital, Enugu State, Nigeria.
Orie Desmond Emeke
Delta State University Teaching Hospital, Oghara, Delta State, Nigeria.
Arinze Queen Uchechi
University of Nigeria Teaching Hospital, Enugu State, Nigeria.
Ezeh, Chidiebere Joel
University of Nigeria Teaching Hospital, Enugu State, Nigeria.
Agba Somkenechukwu Obiora
Federal Medical Centre, Jabi, Abuja, Nigeria.
Ekekwe, Nwabunwannne Emmanuel
University of Nigeria Teaching Hospital, Enugu State, Nigeria.
Azuaru Chukwuka Peter
University of Nigeria Teaching Hospital, Enugu State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: In Nigeria, upper gastrointestinal bleeding (UGIB) is a life-threatening medical emergency with an estimated death rate of 30%. There is limited comprehensive data on its epidemiology and regional distribution, which impedes efficient healthcare strategies. This is a systematic review that combines existing evidence regarding the prevalence, aetiology, and demographic trends of UGIB in Nigeria.
Methods: We searched PubMed, Google Scholar, AJOL, Scopus, and WHO Global Health Library (2000-2024) using PRISMA guidelines to locate studies that reported UGIB prevalence, incidence, or aetiology in Nigeria. Inclusion demanded primary data from Nigerian observational studies (English language). The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of studies. Data were narratively synthesised owing to expected heterogeneity.
Results: Six studies involving a total of 1,047 study participants met the inclusion criteria. No studies reported national prevalence or incidence rates. A striking male predominance was consistent (pooled average: 69.6%; M:F ratio ~2.3:1), with a mean age range of 43.5-52.4 years. Significant regional variations in aetiology were found:
- North-West Nigeria: Oesophageal varices were the leading cause (46.5%).
- South-West, South-South & North-Central Nigeria: Peptic ulcer disease (PUD) was predominant (prevalence: 32.8%-53%), followed by varices (12.4%-25.6%). Gastritis/erosions (5.1%-35.7%) and malignancies (4.2%-8.5%) were also significant. A notable proportion (7.6%-26.2%) had no identifiable lesions. Studies were absent from the South-East and North-East regions.
Conclusion/Recommendation: UGIB in Nigeria typically occurs in middle-aged males and shows significant etiological regional variation, with varices being preponderant in the North-West and PUD prevailing elsewhere. A key evidence gap is the critical absence of population-based prevalence/incidence estimates and a comprehensive assessment of risk factors. Results highlight the necessity of region-specific prevention efforts (e.g., varices in the North, NSAID abuse/PUD in the South), improved endoscopic access, and strong multi-regional research to define accurate disease burden and shape national policy.
Keywords: Upper gastrointestinal bleeding, Newcastle-Ottawa Scale, PUD, endoscopic