Pattern of Endoscopic Diagnoses in Patients with Dyspepsia in a tertiary hospital in Nigeria: A Three-Year Hospital based Retrospective Study

Pattern of Endoscopic Diagnoses in Patients with Dyspepsia in a tertiary hospital in Nigeria: A Three-Year Hospital based Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pattern of Endoscopic Diagnoses in Patients with Dyspepsia in a tertiary hospital in Nigeria: A Three-Year Hospital based Retrospective Study Nnennaya Anthony Ajayi, Emmanuel Obasi, Neri Gustavo Picardo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4609582/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 13 You are reading this latest preprint version Abstract Background Dyspepsia refers to a heterogeneous group of symptoms (pain or discomfort) originating from the upper abdomen and may include epigastric pain, postprandial fullness, early satiation, anorexia, belching, nausea, vomiting, upper abdominal bloating, and heartburn and regurgitation. It is very common, and may be associated with serious morbidity and occasionally mortality. It may also adversely affect the socioeconomic status of the sufferer. This study examined patients with dyspepsia and determined their common endoscopic diagnoses, risk factors and comorbidities. Methods This was a hospital-based Retrospective study carried out at the gastroenterology and hepatology unit of Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria. Case notes and endoscopic records of patients who had endoscopy for dyspepsia between October 2018 and October 2020 were reviewed and information relating to demographics, dyspeptic symptoms, risk factors, comorbidities and endoscopic diagnoses were extracted. Results A total of 278 patients were studied with age range between 17 to 98 years. The mean age (SD) of the patients was 48.4 (15.6) years. There were more females than males 148 (53.2%) vs 130 (46.8%). The commonest symptom and associated risk factor in the subjects were epigastric pain 207(74.5%) and Helicobacter pylori infection 113 (40.6%) respectively. Other identified risk factors were use of NSAIDs 50 (18%), Alcohol 37 (13.3%) and herbal remedies 28 (10.1%). The commonest endoscopic diagnosis was gastritis 94 (33.8%) followed by normal findings 42 (15.1%) and GERD 37 (13.3%). Conclusions The commonest endoscopic finding in dyspepsia from this study was gastritis followed by normal findings. Thus, non-ulcer dyspepsias are the commonest cause of dyspepsia in the environment studied. Pattern Endoscopic Diagnosis Dyspepsia Background Dyspepsia was derived from the Greek words “δυς-” (dys-) and “πέψη” (pepse) and literally means “difficult digestion.” 1 Dyspepsia refers to a heterogeneous group of symptoms (pain or discomfort) originating from the upper abdomen. And may include epigastric pain, postprandial fullness, early satiation, anorexia, belching, nausea and vomiting, upper abdominal bloating, heartburn and regurgitation. 1 The Rome II Committee 2 stated that when heartburn is the predominant symptom, the patient should be considered to have GERD, not dyspepsia. The Rome III. 3 Consensus Committee defined dyspepsia as the presence of symptoms that are considered to originate from the gastroduodenal region and created a major restriction in the definition of dyspepsia. The Rome III was confirmed by the Rome IV. 4 criteria which defined dyspepsia as any combination of 4 symptoms considered to be specifically of gastroduodenal origin: postprandial fullness, early satiety, epigastric pain, and epigastric burning that are severe enough to interfere with the usual activities and occur at least 3 days per week over the last 3 months with an onset of at least 6 months in advance. Dyspeptic symptoms are common in the general population, with frequencies ranging from 10–45%. 5,6 The frequency of dyspepsia is slightly higher in women than men, in smokers than non-smokers and also NSAID users. The influence of age varies across studies. 5,6 When heartburn is excluded, the frequency of uninvestigated dyspepsia in the general population ranges from 5–15%. 7 Nwokediuko et al. 8 in Enugu, SE Nigeria studied subjects with functional dyspepsia using endoscopy and histology and found high degree of inflammation in the duodenal mucosa despite normal endoscopic findings. Emuobor et al. 9 in their study at LASUTH, Lagos, SW Nigeria reported dyspepsia as the commonest indication for endoscopy and majority of the dyspeptics had at least one alarm feature. The most frequent dyspeptic symptom was epigastric pain/burning. The most frequent endoscopic findings were gastritis (49%), normal findings (26%), and gastric ulcer (17%). A Study by Ahmed et al. 10 in Egypt revealed dyspepsia as a common indication for endoscopies Major risk factors were smoking, aspirin or NSAID and alcohol. The commonest endoscopic finding in their study was normal findings or miscellaneous irrelevant findings. Khaled et al in their study at Emory University School of Medicine, Atlanta, GA, USA observed low prevalence of clinically significant endoscopic findings in outpatients with dyspepsia Dyspepsia may be a feature of some serious disorders like malignancy with high mortality and morbidity, and even functional dyspepsia can significantly affect the quality of life and may lead to suicide. Enormous amount of money is spent on investigations and treatment of dyspepsia. Dyspepsia is a common reason for absenteeism at work and schooling and also adversely affects productivity. This study examined patients with dyspepsia, determined their endoscopic diagnoses and common risk factors. The data generated from this study will aid in public health planning via creating awareness on the modifiable risk factors for dyspepsia. METHODS Study design This was a hospital based retrospective study of patients who had upper gastrointestinal endoscopies for dyspepsia at the Endoscopy suite of Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State of Nigeria from October 1, 2018 to October 31, 2021. Data collection The case notes and endoscopy records of these patients were retrieved and relevant information extracted from them, including demographics, symptoms, risk factors for dyspepsia, comorbidities and endoscopic diagnosis. Endoscopic diagnoses were made using macroscopic endoscopic features. The presence of helicobacter pylori was determined via urea breath test using Heli probe machine (Carbon-14 and mass spectrometer) made in the USA. The following categories of endoscopic diagnosis were identified: Normal, Antral predominant gastritis, Pangastritis, corpus predominant gastritis, gastric erosions, gastric ulcers, duodenitis, duodenal ulcer, gastric cancer and GERD. The diagnosis of GERD was made via endoscopic evidence (presence of mucosal breaks such as erosions or ulcers at the distal esophagus). Statistical Analysis The data generated from the patients’ records were analyzed using Statistical package for social sciences (SPSS) 20 Software. The data were entered using numerical codes. Frequency distribution tables of variables were generated. Measures of central tendency and dispersion for quantitative variables as well as proportions for qualitative variables were determined. Categorical data were summarized as frequencies and percentages while continuous data were summarized as mean ± standard deviation. Chi-Square was used to compare the relationship between two qualitative variables. Student t- test and Analysis of Variance (ANOVA) were used to assess for significant associations between group means in quantitative (continuous) normally distributed variables and Man Whitney U Test for variables not normally distributed. A P value of ≤ 0.05 at confidence interval of 95% was considered as being statistically significant. Ethical Concerns This study was conducted according to the principles expressed in the Declaration of Helsinki and approved by Alex-Ekwueme Federal University Teaching Hospital Abakaliki Ethics and Research Committee (approval numbers 04/07/2022-02/08/2022). Due to the retrospective study design, the requirement for written informed consent was waived (Alex-Ekwueme Federal University Teaching Hospital Abakaliki Ethics and Research Committee) Results Socio-demographic characteristics of the subjects . The Age range of the patients was between 17 and 98 years with a mean age (SD) of 48.4(15.6) years. Patients in the age groups 51–70 years accounted for the highest frequency with 112(40.35%) of the subjects while those greater than 70 years accounted for the least proportion of the subjects 13(4.7%). A higher proportion of the patients were females 148(53.2%) with a female to male ratio of 1:1.1. Most of the subjects belong to the Igbo ethnic group 260(93.5%), were married 219(78.8%), and Christians 274(98.6%). Their occupational distribution were civil servants 119(44.2%), unemployed/retired 62(22.3%), traders 49(17.6%), farmers 45(16.2%) and Artisans 3(1.1%). A high proportion of subjects had tertiary education 142 (51.1%). This was followed by secondary education 72(25.9%) and primary education 64(23%). (Table 1 ) Table 1: Socio-demographic Characteristics of the subjects. Variable Total N = 278 n (%) Male N = 130 n (%) Female N = 148 n (%) Statistics P-value Age in years (Mean ± SD) 18- 30 31- 50 51-71 >70 48.4±15.6 42(15.1) 111(39.9) 112(40.3) 13(4.7) 48.3±16.4 21(16.2) 52(40) 50(38.5) 7(5.4) 48.5±14.8 21(14.2) 59(39.9) 62(41.9) 7(5.4) T-test X 2 =0.641 0.888 0 .887 Gender 278(100) 130(46.8) 148(53.2) Level of Education Primary Secondary Tertiary 64(23) 72(25.9) 142(51.1) 40(30.8) 35(26.9) 55(42.3) 24(16.2) 37(25) 87(58.8) X 2 =10.14 0.006 Ethnicity Igbo Ogoja Tiv Yoruba Fulani 260(93.5) 13(4.7) 2(0.7) 2(0.7) 1(0.4) 122(93.8) 5(3.8) 1(0.8) 1(0.8) 1(0.8) 138(93.2) 8(5.4) 1(0.7) 1(0.7) 0(0) LR=1.912 0.861 Religion Christianity Traditional Religion Islam 274(98.6) 2(O.7) 2(0.7) 126(97) 2(1.5) 2(1.5) 148(100) 0(0) 0(0) LR=6.157 0.104 Marital Status Married Single Widowed 219(78.8) 43(15.5) 16(5.8) 22(16.9) 102(78.5) 6(4.6) 21(14.2) 117(79.1) 10(6.8) X 2 =0.8888 0.641 Occupation Civil servant Trading Unemployed/Retired Farming Artisan 119(44.2) 49(17.6) 62(22.3) 45(16.2) 3(1.1) 48(37) 25(19.2) 30(23.1) 24(18.5) 3(2.3) 72(47.9) 24(16.2) 32(21.6) 21(14.2) 0(0) LR=8.181 0.147 Keys: *=Statistically significant, LR=Likelihood ratio, X 2 =Chi-square test Clinical features of the Subjects The commonest symptom observed in the subjects was epigastric pain 207(74.5%). Other symptoms were retrosternal pain 63(22.7%), abdominal bloating 30(10.8%), belching 23(8.3%), flatulence 23(8.3%), melena 28(10.1%) and hematemesis 36(12.9%). Few patients had waterbrash 13(4.7%), nausea 10(3.6%) and vomiting 14 (5%). Flatulence and belching were significantly commoner in females while melena and haematemesis were significantly commoner in males (p < 0.05). (Table 2 ). Table 2: Clinical features of the Subjects. Variable Total N = 278 n (%) Male N = 130 n (%) Female N = 148 n (%) Statistics p -value Epigastric pain Yes No 207(74.5) 71(25.5) 88(67.7) 42(32.3) 119(80.4) 29(19.6) X 2 = 5.88 df= 1 0.015 Abdominal Bloating Yes No 30(10.8) 248(89.2) 9(6.9) 121(93.1) 21(14.2) 127(85.8) X 2 = 3.79 df= 1 0.051 Flatulence Yes No 23(8.3) 255 (91.7) 6(4.6) 124(95.4) 17(11.5) 131(88.5) X 2 = 4.30 df= 1 0.038 Belching Yes No 23(8.3) 255(91.7) 6(4.6) 124(95.4) 17(11.5) 131(88.5) X 2 = 4.30 df= 1 0.038 Retrosternal pain Yes No 63(22.7) 215(77.3) 27(20.8) 103(79.2) 36(24.3) 112(75.3) X 2 = 0.499 df= 1 0. 480 Water brash Yes No 13(4.7) 265(95.3) 5 (3.8) 125(96.2) 8(5.4) 140(94.6) X 2 = 0.377 df= 1 0. 539 Melena Yes No 28(10.1) 250(89.9) 20(15. 4) 110(84.6) 8(5.4) 140(94.6) X 2 = 7.609 df= 1 0. 006 Hematemesis Yes No 36(12.9) 224 (87.1) 26(20) 104 (80) 10(6.8) 139(93.2) X 2 = 10.992 df= 1 0. 010 Weightloss Yes No 41(14.7) 237(85.3) 16(12.3) 114 (87.7) 25 (16.9) 123(83.1) X 2 = 1.157 df= 1 0. 282 Pallor Yes No 27(9.7) 241(86.6) 7(5.4) 123 (94.6) 10 (6.7) 138 (93.3) X 2 = 0.270 df= 1 0. 603 Easy fullness Yes No 22(7.9) 256(92.1) 8(6.2) 122 (93.8) 14 (9. 5) 134 (90.5) X 2 = 1.038 df= 1 0. 308 Regurgitation Yes No 23(8.3) 255(91.7) 9(6.9) 121 (93.1) 14 (9.5) 134 (90.5) X 2 = 0.587 df= 1 0.444 Nausea Yes No 10(3.6) 268(96.4) 2(1.5) 128(98.5) 8(5.4) 140 (94.6) LR=3.226 df= 1 0. 072 Vomiting Yes No 14 (5) 264(95) 4(3.1) 126 (86.9) 10 (6.8) 138 (93.2) X 2 = 1.960 df= 1 0. 162 Keys: = LR=Likelihood ratio, X 2 =Chi-square test Medical co-morbidities in the subjects The commonest comorbidity was systemic hypertension 207(74.5%) followed by osteoarthritis 27(9.7%) and type 2 diabetes 22(7.9%). Others were liver cirrhosis 11(4%), COPD 9(3.2%), stroke 3(1.1%) and retroviral disease 3(1.1%). Type 2 diabetes mellitus was found to be significantly commoner in males than females in this study (P < 0.005). (Table 3 ) Table 3: Medical co-morbidities in the subjects Variable Total N = 278 n (%) Male N = 130 n (%) Female N = 148 n (%) Statistics p -value Systemic hypertension Yes No 77 (27.7) 201 (72.3) 35 (26.9) 95 (73.1) 42(28.4) 106(71.6) X 2 = 0.073 df= 1 0.787 Diabetes mellitus Yes No 22 (7.9) 256 (92.1) 19 (12.8) 129 (87.2) 3(2.3) 127(97.7) X 2 = 10.531 df= 1 0.001 COPD Yes No 9 (3.2) 269 (96.8) 4 (3.1) 126(96.9) 5 (3.4) 143 (96.6) LR = 0.020 df= 1 0.887 Stroke Yes No 4(1.4) 274(98.6) 3 (2.3) 127(97.7) 1 (0.7) 147 (99.3) LR = 1.341 df= 1 0.247 Retroviral Disease Yes No 3 (1.1) 275 (98.9) 2 (1.5) 128(98.5) 1 (0.7) 147 (99.3) LR =0.847 df= 1 0.485 Osteoarthritis Yes No 27(9.7) 251 (90.3) 15 (11.5) 115 (88.5) 12(8.1) 136 (91.9) X 2 = 0.929 df= 1 0.336 Liver cirrhosis Yes No 11 (4) 267(96) 5 (3.8) 125 (96.2) 6 (4.1) 142 (95.9) X 2 = 0.080 df= 1 0.929 Keys: = LR=Likelihood ratio, X 2 =Chi-square test, COPD: Chronic ob st ru c t i ve pulmonary disease Risk factors for Dyspepsia in the subjects The commonest associated risk factor in the subjects was helicobacter pylori infection 113(40.6%). Others were NSAID use 50(18%), Alcohol 37(13.3%), herbal remedies 28(10.1%) and steroid 21(7.6%). The use of Alcohol and NSAID were significantly commoner in males than females (P < 0.005). (Table 4) Table.4: Risk factors for Dyspepsia in the subjects Table.4: Risk factors for Dyspepsia in the subjects Variable Total N =278 n (%) Male N =130 n (%) Female N = 148 n (%) Statistics p -value NSAID use Yes No 50 (18) 228 (82) 34(26.2) 96 (73.8) 16(10.8) 132(89.2) LR= 11.950 df= 1 0.030 Helicobacter pylori Yes No 113(40.6) 165(59.4) 53 (40.8) 77 (59.2) 60(40.5) 88(59.5) X 2 = 0.969 df= 1 0.002 Alcohol use Yes No 37 (13.3) 241 (86.7) 31 (23.8) 99 (76.2) 6(4.1) 142 (95.9) X 2 = 23.492 df= 1 0.001 Use of Herbal remedies Yes No 28 (10.1) 249 (89.9) 17 (13.1) 113 (86.4) 11(7.4) 136 (91.9) LR=3.643 df= 1 0.162 Steroid use Yes No 21 (7.6) 257 (92.4) 10(7.2) 120 (92.3) 11(7.4) 137 (92.6) X 2 = 0.007 df= 1 0.935 Hiatus Hernia Yes No 3 (1.1) 275 (98.9) 2 (1.5) 128 (98.5) 1(0.7) 147 (99.3) X 2 = 0.87 df= 1 0.910 Keys: = LR=Likelihood ratio, X 2 =Chi-square test, NSAID=Non-steroidal Anti-inflammatory drugs Endoscopic Diagnosis of the subjects There was gastritis in 94(33.8%) of the subjects (Pangastritis 37(13.3%), Antral predominant gastritis 34(12.2%) and Antral-corporal gastritis 23(8.30%)) followed by normal findings 42(15.1%) and GERD 37(13.3%). Other endoscopic findings in the subjects include gastric erosions 26(9.40%), duodenal ulcer 20(7.2%), gastric ulcer 19(6.8%) and gastric cancer 16(5.8%), oesophageal candidiasis 6(2.2%) and oesophageal cancers 3(1.1%). There was no significant difference in the gender distribution of pattern of endoscopic diagnoses (P>0.005) (Table 5) Table 5: Endoscopic Diagnosis of the subjects Variable Total N = 278 n (%) Male N = 130 n (%) Female N = 148 n (%) Statistics p -value Normal 42 (15.1) 18(42.9) 24(57.1) X 2 = 19.206 df= 11 0.057 GERD 37 (13.3) 15 (40.5) 22 (59.5) Pangastritis 37 (13.3) 17 (46.0) 20 (54.0) Antral predominant Gastritis 34 (12.2) 18 (52.9) 16 (47.1) Gastric Erosions 26 (9.40) 13 (50.0) 13 (50.0) Antral + Corporal Gastritis 23 (8.30) 17 (73.9) 6(26.1) Duodenal Ulcer 20 (7.2) 8 (40.0) 12(60.0) Gastric Ulcer 19 (6.8) 8 (42.1) 11 (57.9) Gastric Cancer 16 (5.8) 8 (50.0) 8 (50.0) Esophageal Candidiasis 15 (5.4) 7 (46.7) 8(53.3) Gastric plus Duodenal Ulcer 6 (2.2) 4 (66.6) 2(33.3) Oesophageal Cancer 3 (1.1) 3 (100) - Keys: X 2 =Chi-square test, GERD= Gastroesophageal Reflux Disease Discussion Dyspepsia was most prevalent in the age group 51–70 years, emphasizing its relationship with older age. A similar finding was documented by Nwokediuko et al 8 in Enugu and Kooffreh-Ada et al in Calabar 11 both in Nigeria, Ahmed et al 10 in Egypt and Khaled et al 12 in the USA had similar findings. The relationship between dyspepsia and older age has been attributed to higher prevalence of comorbidities associated with dyspepsia, drug induced dyspepsia due to polypharmacy and higher prevalence of PUD in the older age group 13 . The subjects were predominantly females with a female to male ratio of 1:1.1. This finding is similar to the report by Khaled et al 12 in their retrospective study of outpatients with dyspepsia using endoscopic procedure at Grady Memorial Hospital in Atlanta, Georgia, USA. Kooffreh-Ada et al in Calabar 11 ,Nigeria reported no sex predilection while Ahmed et al 10 in Egypt reported slightly higher prevalence in males. Explanations for the higher prevalence in females in this study may include hormonal differences between males and females, and, higher health seeking behaviors in females as well as higher prevalence of functional gastrointestinal disorders in females. 14,15 The common comorbidities observed in the subjects were, osteoarthritis type 2 diabetes and systemic hypertension. Mari-Ann Wallander et al. 16 in the UK reported angina, osteoarthritis rheumatoid arthritis and sleep disorders as common commodities associated with dyspepsia. Though Mak et al 17 and Solovyova et al 18 (in the USA) found anxiety and depression as major co morbidities in their patients, which were commoner in subjects with functional dyspepsia, these were not seen in our patients.. The increased frequency of osteoarthritis in this population may be because osteoarthritis predisposes to the increased use of NSAIDS and steroids both of which potentially cause dyspepsia. 16 Type 2 diabetes was a common co morbidity in our patients. This is similar to findings elsewhere. A multicenter study in UK and Belgium by Fabien et al 19 reported type 2 diabetes as one of the common comorbidities in dyspeptic patients. This is not surprising as diabetic enteropathy such as gastroparesis may present with dyspepsia. Functional gastrointestinal disorders are also common in diabetics. Some oral hypoglycaemic agents side effect includes dyspepsia e.g Sulphonylureas and DPP-4 inhibitors. 19 Acute or chronic pancreatitis and cholelithiasis associated with diabetes mellitus may also present with abdominal pain which may mimic dyspepsia. 20 A study by Okonkwo et al 21 in Calabar noted high prevalence of dyspeptic symptoms among subjects with hypertension and other cardiovascular risks on low dose Aspirin. The finding of a higher prevalence rate of systemic hypertension in patients with dyspepsia may be because of the existence of mutual risk factors for developing both conditions such as obesity and smoking. 22,23 and also similar or overlapping symptomatology 24 . Finally, polypharmacy with drugs used to manage systemic hypertension can cause upper gastrointestinal symptoms 25,26 The common associated risk factors for dyspepsia in the subjects were helicobacter pylori infection, NSAIDs, Alcohol, herbal remedies and steroids. A prevalence rate of 40.6% for H.pylori infection was found in our study. This is similar to the prevalence of H. pylori in a similar study of 42.6% by Mbang et al in Calabar 11 but lower than the reported rates by Adeniyi et al in Ibadan 27 , Ezugwu in Awka 28 , Ishaleku in Keffi 29 , and Bello et al in Kano 30 . Archampong et al also found a higher prevalence rate of 74.5% in a similar study in Ghana 31 whereas Jemikaleja found a much lower prevalence rate of 12. 7% in Warri, Nigeria. The disparity in prevalence rates in the various studies may be linked to the socioeconomic status and hygiene practices of the different patients populations with lower rates associated with improved hygiene standards and wide spread use of antibiotics 32 . Furthermore, urbanization with better access to healthcare facilities and potable water could be another reason for this observation. A low socioeconomic status has been reported to promote the transmission of H. pylori due to poor education, including poor health education and a more likelihood of living in an environment that predisposes to faecal contamination of food and water. 33,34,35 Although H. Pylori commonly causes antral predominant gastritis, it can also cause pangastritis. The patten of gastritis is determined by the immune system of the subjects, genetic factors, the strain of the bacteria 1 . Individuals with antral predominant gastritis are more likely to develop duodenal ulcers while those with pangastritis are more likely to develop gastric ulcer and adenocarcinoma 1,7 . Wallander et al. 16 in the UK reported smoking as the major risk factors which was attributed to cold weather. The second most common risk factor for dyspepsia obtained from this study was NSAID use. Though the prevalence was expected to be higher based on the demographic distribution of the subjects and co-morbidity. This may be related to the oral interview which is limited by forgetfulness and also the respective study design. High prevalence rate of NSAID use in the subjects observed in this study was similar to reports by Okonkwo et al 21 in Calabar, Nigeria and Ahmed Gado et al. 10 in Egypt. A study by Wanjoyi et al. 36 in Kenya reported high incidence of dyspepsia and gastroduodenal lesions in chronic NSAIDS users. Cekin et al 37 in Turkey reported significant association of NSAIDS with duodenal ulcers. Indiscriminate use of NSAIDS and Steroids in our environment is from the handiwork of quacks who usually prescribe both drugs for all forms of body pains and the abuse of these drugs by farmers and artisans after menial jobs. 21,10 NSAIDS causes inhibition of prostaglandins leading to a spectra of GI disorders including gastritis, erosions and PUD which may manifest with dyspepsia. 38 This is compounded by the actions of herbalists who mix all sorts of substances in the name of herbal remedies including different plant roots, leaves and barks of trees the safety of which is not known. 39 Some herbal remedies may be directly cytotoxic to the GI mucosa. 40 Poverty and illiteracy have also contributed to the popularity of these practices in our environment because they are cheap and wrongly believed to treat all types of ailments. 41 The common endoscopic diagnosis in the subjects were gastritis, normal findings and GERD. Others include gastric erosions, duodenal ulcer, gastric ulcer and gastric cancer. The high prevalence of non-specific gastritis (25.5%) in our subjects may be related to the effects of some spices in our diets on the GI tact, helicobacter pylori infection and high consumption rate of herbal mixtures wrongly recommended by herbalist as remedies to all illnesses in our environment. The rate of normal endoscopy in our study was (15.1%) which is high. This is comparable to findings by Ghamar -Chehreh et al in Iran 42 , Sahin et al in Istanbu. 43 , Olokoba et al at FMC, Yola. 44 and Emuobor et al in-Lagos 9 . The clinical implication of this finding is that endoscopic evaluation of dyspeptic patients in our environment is necessary to accurately make a diagnosis. Though some previous studies. 45,46 including a study in the USA by Khaled et al 12 reported high rates of normal endoscopy in most patients with dyspepsia, they did not recommend endoscopic evaluation as an initial step in the management of patients with dyspepsia, however. 47 The normal endoscopic findings in this study may be related to contributions by functional GI disorders, NERD and healthy subjects. In the UK, Mari-Ann Wallander et al. 16 found irritable bowel syndrome, GERD and peptic ulcer disease as common causes of dyspepsia. Conclusions Many patients with dyspepsia have recognisable endoscopic lesions, comorbidities and identifiable predisposing factors. Endoscopic evaluation of dyspeptic patients irrespective of age, absence or presence of alarm symptoms will help to classify them early into organic and functional categories. This will guide appropriate patient management from very early in the doctor patient interaction. Declarations ETHICS DECLARATIONS Human Ethics and consent to participate This study was conducted according to the principle expressed in the declaration of Helsinki and approved by the Alex-Ekwueme Federal University Teaching Hospital Ethics and Research Committee (approval numbers 04/07/2022-02/08/2022). Due to the retrospective study design, the requirement for written consent was waived (Alex-Ekwueme Federal University Teaching Hospital Ethics and Research Committee) Consent for publication Not applicable Competing interests: Authors declare no competing interests Funding None Author Contribution Dr Obasi Emmanuel participated in the study design, data collection, interpretation and drafted the manuscript.Dr Nnnennaya Anthony Ajayi conceived the study and helped to draft the manuscript .Prof Neri G Picardo participated in the interpretation and critical appraisal. Acknowledgements We sincerely thank the hospital Ethics and Research Committee and the Chief Medical Director of Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State for granting us the approval to carry out this study. Special thanks to our study participants for their sacrifices. Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request References Feldman M, Friedman LS, Brandt LJ. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease,10th Edition. 2010. 1432–3 p. Talley NJ, Stanghellini V, Heading RC. Functional gastroduodenal disorders. Gut. 1999;45:1137–42. Ford AC, Bercik P, MorganDG, Bolino C, Pintos-Sanchez MI, Moayyedi P. The Rome III Criteria for the Diagnosis of Functional Dyspepsia in Secondary Care Are Not Superior to Previous Definitions. Gastroenterology. 2014;146(4):932–40. Stanghellini V, Chan FK, Hasler WLM, Suzuki JR, Tack H. 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Dyspepsia is strongly associated with major depression and genealized anxiety disorder- a community study. Aliment Pharmacol Ther. 2012;36:800–10. Solovyova G, Alianova T, Taran A, Aleksieieva VGL. Risk factors and Co-morbidities functional dyspepsia. Retrospective Cohort Analysis. Georgian Med News. 2020;(307):104–8. Wuestenberghs F, Eugenicos MP. PWE-62 Reporting of Comorbidities and Overlap Syndromes in Functional Dyspepsia. review of 15 years of RCTs. Gut jnl. 2021;324. Bharucha AE, Locke GR, Murray JA. Gastrointestinal Manifestations of Diabetes. 3rd Editio. Diabetes Am. 2015. 21–7. Okonkwo UC, Umoh IO, Henshaw E, Victor A. Prevalence of dyspeptic symptoms among patients on low – dose antiplatelet therapy. Nigerian J Cardiol. 2017;14(2):92–6. Shimazu H, Nakaji G, Fukata M, Odashiro K, Maruyama T, Akashi K. on behalf of the Fukuoka F-Scale F Scale Trial Group. Relationship between atrial fibrillation and gastroesophageal reflux disease: a multicenter questionnaire survey. Cardiology. 2011;119(4):217–23. Wormser D, Kaptoge SDAE, Wood AM, Pennells L, Thompson A, Sarwar N, et al. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet. 2011;377(9771):1085–95. Bytzer P, Talley NJ, Hammer J, Young LJ, Jones MP. HM. gastrointestinal symptoms in diabetes mellitus are associated with both poor glycemic control and diabetic complications. Am J Gastroenterol. 2002;97(3):604–11. Bytzer PHJ. Drug-induced symptoms of functional dyspepsia and nausea. A symmetry analysis of one million prescriptions. Aliment Pharmacol Ther. 2000;14(11):1479–84. Sobieraj DM, White CM, Alikhanov S, Winkler S, Mediouni M, Kluger JCC. The impact of antiplatelet and anticoagulant therapies on gastrointestinal symptoms in patients with atrial fibrillation: a systematic review. Ann Pharmacother. 2012;46(9):1220–31. Adeniyi BA, Otegbayo JA, Lawal T, Oluwasola AO, Odaibo G, Okolo C, et al. Prevalence of Helicobacter pylori infection among dyspepsia patients in Ibadan, South West Nigeria. Afr J Microbiol Res. 2012;6(14):3399–402. Ezugwu RICC. Epidemiology of Helicobacter pylori infection among dyspepsia patients in South-East, Nigeria. IOSR J Pharm Biol Sci. 2014;9(6):53–6. Ishaleku DIHA. Sero-prevalence of Helicobacter pylori infection among students of a Nigerian University. Asian Pac J Trop Med. 2010;584–5. Bello AK, Umar ABBM. Prevalence and risk factors for Helicobacter pylori infection in gastroduodenal diseases in Kano, Nigeria. Afr J Med Heal Sci. 2018;17:41–6. Archampong TN, Asmah RH, Wiredu E, K G RK, Nkrumah K, N RK. Epidemiology of Helicobacter pylori infection in dyspeptic Ghanaian patients. Pan Afr Med J. 2015;20:178. Jemikalajah D, J OG. Health point prevalence of helicobacter pylori in Central Hospital Warri, Nigeria. Afr J Cell Pathol. 2014;3:57–60. Mnichi Z, Nibret E, Mekonnem D, Demelash M. Sero and faeco prevalence of Helicobacter pylori infection and its associated risk factors among adult dyspeptic patients visiting the outpatient department of Adet Primary Hospital, Yilmana Densa District, Ethiopia.Can J of Infect Dis Med microbiol. 2023; 2023(1)2 305681. Ozbey G, Hanafia A, Epidemiology. Diagnosis, and Risk Factors of Helicobacterpylori Infection in Children. Euroasian J Hepato- Gastroenterol. 2017;7(1):34–9. Oling M, Odongo J, Kituuka OGM. Prevalence of Helicobacter pyloriin dyspeptic patients at a tertiary hospital in a low resource setting. BMC Res Notes. 2015;8:256. Wanjohi W, Ogutu E, Oyoo, Kioko HM, Radia KMT. prevalence of gastrodoudenal leisions in chronic NSAIDS users pesening with dyspepsia at the Kenyaa National Hospial. Afr J rheumathology. 2014;2(1):2307–482. Cekin AH, Taskoparan M, Duman A, Sezer C, Cekin Y, Yolcular BO et al. The Role of Helicobacter pylori and NSAIDs in the Pathogenesis of Uncomplicated Duodenal Ulcer. Gastroenterology Research and Practice . 2012; 2012.1-6. Butt JH, Barthel JS, Moore RA. Clinical spectrum of upper gastrointestinal effects of non-steroidal anti-inflammatory drugs. Natural history, symptomatology and significance. Am J Med. 1988;22(2A):84. Smith S, Oyedeji KS, Opere, Iwalokun AOE. The effects of some Nigerian Local herbs on Helicobacter pylori. Afr J Clin Exp Microbiol. 2003;4(2):29–35. Adeunji JS, Funmilayo GF, Ayodeji OO, Oguntimehin SA. Cytotoxic Activity of selected Nigerian Medicinal plants. J Herbs spices Med plants. 2019;26(2). Kate L, Mandeville. Justus Krabshuis SAK. gastroenterology in developing countries: Issues and advances. World J Gastroenterol. 2009;15(23):2839–54. Me G, Shahverdi E, Khedmat H, Ghafoorian A, Amini M. Endoscopic Findings in Patients with Dyspepsia in Iran. iMedPub Journals: 2016;1–5. Sahin M, Akbulut C, Dolapcioglu C, Ozpolat E, Dabak R, et al. Endoscopic findings of dyspeptic patients unresponsive to proton pump inhibitors. North Clin Istanbul 1. 2014;1:158–65. Olokoba AB, Salawu FK, Ja V. Functional dyspepsia in Yola, Nigeria La dyspepsie fonctionnelle à Yola au Nigeria. Res J Health Sci. 2015;3(1):38–44. Tack J, Talley NJ, Camilleri M, Holtmann G, Hu P, et al. Functional gastroduodenal disorders. Gastroenterology. 2006;130:1466–79. Spiller RC. Anorexia, nausea, vomiting, and pain. Br Med J. 2001;323(7325):1354–7. Naji S, Brunt P, Hagen S, Mowat N, Russell I, et al. Improving the selection of patients for upper gastrointestinal endoscopy. Gut. 1993;34:187–91. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 28 Aug, 2024 Reviews received at journal 22 Aug, 2024 Reviewers agreed at journal 14 Aug, 2024 Reviewers agreed at journal 12 Aug, 2024 Reviewers agreed at journal 10 Aug, 2024 Reviews received at journal 29 Jul, 2024 Reviewers agreed at journal 29 Jul, 2024 Reviewers agreed at journal 28 Jul, 2024 Reviewers invited by journal 25 Jul, 2024 Editor invited by journal 21 Jun, 2024 Editor assigned by journal 21 Jun, 2024 Submission checks completed at journal 21 Jun, 2024 First submitted to journal 20 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4609582","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":318835895,"identity":"37526114-0029-426f-b4da-de1aee42e6d1","order_by":0,"name":"Nnennaya Anthony Ajayi","email":"","orcid":"","institution":"Alex-Ekwueme Federal University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nnennaya","middleName":"Anthony","lastName":"Ajayi","suffix":""},{"id":318835896,"identity":"dbcb8f60-cfcc-40f0-a13c-f78bbb9a0d18","order_by":1,"name":"Emmanuel Obasi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYBADGQYJIJlQYQMkGRsPEKOFB6LlTBpISwMJWhjbDoN5eLXwi51O/FzYZsPDL938+MODM+ft1rYfBtpSYxONS4vk7NzN0jPb0ngk5xwzk0iouJ287UwiUMuxtNwGHFoMbudukOZtO8xjcCPBDOiX28lmB4BaGBsO49Rifzt382/etv9ALemfPyS2nUs2O/8QvxYD6dxtQFsOALXkGEgkth2wM7tBwBaJ27nbrHnOJQP9cqZMIuFMcoLZDaAtCXj8wg/0/m2eMjs5fun2zR9/VNjZm51Pf/jgQ40NTi0YIBGsMoFY5SBgT4riUTAKRsEoGBkAAMauZQps7kf/AAAAAElFTkSuQmCC","orcid":"","institution":"Alex-Ekwueme Federal University Teaching Hospital","correspondingAuthor":true,"prefix":"","firstName":"Emmanuel","middleName":"","lastName":"Obasi","suffix":""},{"id":318835897,"identity":"a99827d8-9f96-4b5b-a1b3-08ecaa21cee9","order_by":2,"name":"Neri Gustavo Picardo","email":"","orcid":"","institution":"Alex-Ekwueme Federal University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Neri","middleName":"Gustavo","lastName":"Picardo","suffix":""}],"badges":[],"createdAt":"2024-06-20 06:32:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4609582/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4609582/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60049478,"identity":"97b01d3b-2a4d-4ce8-a28d-44cbbfe212ec","added_by":"auto","created_at":"2024-07-11 05:45:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1092635,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4609582/v1/a05e1b65-fcae-461d-be08-0ac0172d4d25.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pattern of Endoscopic Diagnoses in Patients with Dyspepsia in a tertiary hospital in Nigeria: A Three-Year Hospital based Retrospective Study","fulltext":[{"header":"Background","content":"\u003cp\u003eDyspepsia was derived from the Greek words \u0026ldquo;δυς-\u0026rdquo; (dys-) and \u0026ldquo;πέψη\u0026rdquo; (pepse) and literally means \u0026ldquo;difficult digestion.\u0026rdquo;\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDyspepsia refers to a heterogeneous group of symptoms (pain or discomfort) originating from the upper abdomen. And may include epigastric pain, postprandial fullness, early satiation, anorexia, belching, nausea and vomiting, upper abdominal bloating, heartburn and regurgitation.\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe Rome II Committee\u003csup\u003e2\u003c/sup\u003e stated that when heartburn is the predominant symptom, the patient should be considered to have GERD, not dyspepsia.\u003c/p\u003e \u003cp\u003eThe Rome III.\u003csup\u003e3\u003c/sup\u003e Consensus Committee defined dyspepsia as the presence of symptoms that are considered to originate from the gastroduodenal region and created a major restriction in the definition of dyspepsia.\u003c/p\u003e \u003cp\u003eThe Rome III was confirmed by the Rome IV.\u003csup\u003e4\u003c/sup\u003e criteria which defined dyspepsia as any combination of 4 symptoms considered to be specifically of gastroduodenal origin: postprandial fullness, early satiety, epigastric pain, and epigastric burning that are severe enough to interfere with the usual activities and occur at least 3 days per week over the last 3 months with an onset of at least 6 months in advance.\u003c/p\u003e \u003cp\u003eDyspeptic symptoms are common in the general population, with frequencies ranging from 10\u0026ndash;45%.\u003csup\u003e5,6\u003c/sup\u003e The frequency of dyspepsia is slightly higher in women than men, in smokers than non-smokers and also NSAID users. The influence of age varies across studies. \u003csup\u003e5,6\u003c/sup\u003e When heartburn is excluded, the frequency of uninvestigated dyspepsia in the general population ranges from 5\u0026ndash;15%.\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNwokediuko et al.\u003csup\u003e8\u003c/sup\u003e in Enugu, SE Nigeria studied subjects with functional dyspepsia using endoscopy and histology and found high degree of inflammation in the duodenal mucosa despite normal endoscopic findings.\u003c/p\u003e \u003cp\u003eEmuobor et al.\u003csup\u003e9\u003c/sup\u003e in their study at LASUTH, Lagos, SW Nigeria reported dyspepsia as the commonest indication for endoscopy and majority of the dyspeptics had at least one alarm feature. The most frequent dyspeptic symptom was epigastric pain/burning. The most frequent endoscopic findings were gastritis (49%), normal findings (26%), and gastric ulcer (17%).\u003c/p\u003e \u003cp\u003eA Study by Ahmed et al.\u003csup\u003e10\u003c/sup\u003e in Egypt revealed dyspepsia as a common indication for endoscopies Major risk factors were smoking, aspirin or NSAID and alcohol. The commonest endoscopic finding in their study was normal findings or miscellaneous irrelevant findings.\u003c/p\u003e \u003cp\u003eKhaled et al in their study at Emory University School of Medicine, Atlanta, GA, USA observed low prevalence of clinically significant endoscopic findings in outpatients with dyspepsia\u003c/p\u003e \u003cp\u003eDyspepsia may be a feature of some serious disorders like malignancy with high mortality and morbidity, and even functional dyspepsia can significantly affect the quality of life and may lead to suicide.\u003c/p\u003e \u003cp\u003eEnormous amount of money is spent on investigations and treatment of dyspepsia. Dyspepsia is a common reason for absenteeism at work and schooling and also adversely affects productivity. This study examined patients with dyspepsia, determined their endoscopic diagnoses and common risk factors. The data generated from this study will aid in public health planning via creating awareness on the modifiable risk factors for dyspepsia.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis was a hospital based retrospective study of patients who had upper gastrointestinal endoscopies for dyspepsia at the Endoscopy suite of Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State of Nigeria from October 1, 2018 to October 31, 2021.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eThe case notes and endoscopy records of these patients were retrieved and relevant information extracted from them, including demographics, symptoms, risk factors for dyspepsia, comorbidities and endoscopic diagnosis. Endoscopic diagnoses were made using macroscopic endoscopic features. The presence of helicobacter pylori was determined via urea breath test using Heli probe machine (Carbon-14 and mass spectrometer) made in the USA.\u003c/p\u003e \u003cp\u003eThe following categories of endoscopic diagnosis were identified: Normal, Antral predominant gastritis, Pangastritis, corpus predominant gastritis, gastric erosions, gastric ulcers, duodenitis, duodenal ulcer, gastric cancer and GERD. The diagnosis of GERD was made via endoscopic evidence (presence of mucosal breaks such as erosions or ulcers at the distal esophagus).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe data generated from the patients\u0026rsquo; records were analyzed using Statistical package for social sciences (SPSS) 20 Software. The data were entered using numerical codes. Frequency distribution tables of variables were generated. Measures of central tendency and dispersion for quantitative variables as well as proportions for qualitative variables were determined. Categorical data were summarized as frequencies and percentages while continuous data were summarized as mean\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;standard deviation. Chi-Square was used to compare the relationship between two qualitative variables. Student t- test and Analysis of Variance (ANOVA) were used to assess for significant associations between group means in quantitative (continuous) normally distributed variables and Man Whitney U Test for variables not normally distributed.\u003c/p\u003e \u003cp\u003eA P value of \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.05 at confidence interval of 95% was considered as being statistically significant. \u003c/p\u003e \u003cp\u003e\u003cb\u003eEthical Concerns\u003c/b\u003e\u003c/p\u003e \u003cp\u003e This study was conducted according to the principles expressed in the Declaration of Helsinki and approved by Alex-Ekwueme Federal University Teaching Hospital Abakaliki Ethics and Research Committee (approval numbers 04/07/2022-02/08/2022). Due to the retrospective study design, the requirement for written informed consent was waived (Alex-Ekwueme Federal University Teaching Hospital Abakaliki Ethics and Research Committee)\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eSocio-demographic characteristics of the subjects\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eThe Age range of the patients was between 17 and 98 years with a mean age (SD) of 48.4(15.6) years. Patients in the age groups 51\u0026ndash;70 years accounted for the highest frequency with 112(40.35%) of the subjects while those greater than 70 years accounted for the least proportion of the subjects 13(4.7%). A higher proportion of the patients were females 148(53.2%) with a female to male ratio of 1:1.1. Most of the subjects belong to the Igbo ethnic group 260(93.5%), were married 219(78.8%), and Christians 274(98.6%). Their occupational distribution were civil servants 119(44.2%), unemployed/retired 62(22.3%), traders 49(17.6%), farmers 45(16.2%) and Artisans 3(1.1%). A high proportion of subjects had tertiary education 142 (51.1%). This was followed by secondary education 72(25.9%) and primary education 64(23%). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e\u003cstrong\u003eTable 1: \u0026nbsp;Socio-demographic Characteristics of the subjects.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" style=\"width: 100%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN = 278 \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN = 130 \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN = 148 \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\" style=\"width: 33.6831%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Mean \u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e18- 30\u003c/p\u003e\n \u003cp\u003e31- 50\u003c/p\u003e\n \u003cp\u003e51-71\u003c/p\u003e\n \u003cp\u003e\u0026gt;70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48.4\u0026plusmn;15.6\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42(15.1)\u003c/p\u003e\n \u003cp\u003e111(39.9)\u003c/p\u003e\n \u003cp\u003e112(40.3)\u003c/p\u003e\n \u003cp\u003e13(4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e48.3\u0026plusmn;16.4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21(16.2)\u003c/p\u003e\n \u003cp\u003e52(40)\u003c/p\u003e\n \u003cp\u003e50(38.5)\u003c/p\u003e\n \u003cp\u003e7(5.4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48.5\u0026plusmn;14.8\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21(14.2)\u003c/p\u003e\n \u003cp\u003e59(39.9)\u003c/p\u003e\n \u003cp\u003e62(41.9)\u003c/p\u003e\n \u003cp\u003e7(5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eT-test\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e=0.641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\" style=\"width: 33.6831%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.888\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e.887\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e278(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e130(46.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e148(53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\" style=\"width: 33.6831%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of Education\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePrimary\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSecondary\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e64(23)\u003c/p\u003e\n \u003cp\u003e72(25.9)\u003c/p\u003e\n \u003cp\u003e142(51.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40(30.8)\u003c/p\u003e\n \u003cp\u003e35(26.9)\u003c/p\u003e\n \u003cp\u003e55(42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24(16.2)\u003c/p\u003e\n \u003cp\u003e37(25)\u003c/p\u003e\n \u003cp\u003e87(58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e=10.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\" style=\"width: 33.6831%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eIgbo\u003c/p\u003e\n \u003cp\u003eOgoja\u003c/p\u003e\n \u003cp\u003eTiv\u003c/p\u003e\n \u003cp\u003eYoruba\u003c/p\u003e\n \u003cp\u003eFulani\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e260(93.5)\u003c/p\u003e\n \u003cp\u003e13(4.7)\u003c/p\u003e\n \u003cp\u003e2(0.7)\u003c/p\u003e\n \u003cp\u003e2(0.7)\u003c/p\u003e\n \u003cp\u003e1(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e122(93.8)\u003c/p\u003e\n \u003cp\u003e5(3.8)\u003c/p\u003e\n \u003cp\u003e1(0.8)\u003c/p\u003e\n \u003cp\u003e1(0.8)\u003c/p\u003e\n \u003cp\u003e1(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e138(93.2)\u003c/p\u003e\n \u003cp\u003e8(5.4)\u003c/p\u003e\n \u003cp\u003e1(0.7)\u003c/p\u003e\n \u003cp\u003e1(0.7)\u003c/p\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLR=1.912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\" style=\"width: 33.6831%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.861\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eChristianity\u003c/p\u003e\n \u003cp\u003eTraditional Religion\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Islam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e274(98.6)\u003c/p\u003e\n \u003cp\u003e2(O.7)\u003c/p\u003e\n \u003cp\u003e2(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e126(97)\u003c/p\u003e\n \u003cp\u003e2(1.5)\u003c/p\u003e\n \u003cp\u003e2(1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e148(100)\u003c/p\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLR=6.157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\" style=\"width: 33.6831%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eWidowed\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e219(78.8)\u003c/p\u003e\n \u003cp\u003e43(15.5)\u003c/p\u003e\n \u003cp\u003e16(5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22(16.9)\u003c/p\u003e\n \u003cp\u003e102(78.5)\u003c/p\u003e\n \u003cp\u003e6(4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21(14.2)\u003c/p\u003e\n \u003cp\u003e117(79.1)\u003c/p\u003e\n \u003cp\u003e10(6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e=0.8888\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\" style=\"width: 33.6831%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.641\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCivil servant\u003c/p\u003e\n \u003cp\u003eTrading\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eUnemployed/Retired\u003c/p\u003e\n \u003cp\u003eFarming\u003c/p\u003e\n \u003cp\u003eArtisan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e119(44.2)\u003c/p\u003e\n \u003cp\u003e49(17.6)\u003c/p\u003e\n \u003cp\u003e62(22.3)\u003c/p\u003e\n \u003cp\u003e45(16.2)\u003c/p\u003e\n \u003cp\u003e3(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48(37)\u003c/p\u003e\n \u003cp\u003e25(19.2)\u003c/p\u003e\n \u003cp\u003e30(23.1)\u003c/p\u003e\n \u003cp\u003e24(18.5)\u003c/p\u003e\n \u003cp\u003e3(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e72(47.9)\u003c/p\u003e\n \u003cp\u003e24(16.2)\u003c/p\u003e\n \u003cp\u003e32(21.6)\u003c/p\u003e\n \u003cp\u003e21(14.2)\u003c/p\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLR=8.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\" style=\"width: 33.6831%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eKeys:\u003c/strong\u003e *=Statistically significant, LR=Likelihood ratio, X\u003csup\u003e2\u003c/sup\u003e=Chi-square test\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eClinical features of the Subjects\u003c/h2\u003e \u003cp\u003eThe commonest symptom observed in the subjects was epigastric pain 207(74.5%). Other symptoms were retrosternal pain 63(22.7%), abdominal bloating 30(10.8%), belching 23(8.3%), flatulence 23(8.3%), melena 28(10.1%) and hematemesis 36(12.9%). Few patients had waterbrash 13(4.7%), nausea 10(3.6%) and vomiting 14 (5%). Flatulence and belching were significantly commoner in females while melena and haematemesis were significantly commoner in males (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e\u003cstrong\u003eTable 2: Clinical features of the Subjects.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" style=\"width: 93%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN = 278 \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN = 130 \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN = 148\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003eStatistics\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEpigastric pain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;207(74.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 71(25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;88(67.7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;42(32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e119(80.4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 29(19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 5.88\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbdominal Bloating\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;30(10.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;248(89.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;9(6.9)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;121(93.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 21(14.2)\u003c/p\u003e\n \u003cp\u003e127(85.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 3.79\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFlatulence\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;23(8.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;255 (91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 6(4.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;124(95.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 17(11.5)\u003c/p\u003e\n \u003cp\u003e131(88.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 4.30\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBelching\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;23(8.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;255(91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;6(4.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;124(95.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 17(11.5)\u003c/p\u003e\n \u003cp\u003e131(88.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 4.30\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetrosternal pain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;63(22.7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;215(77.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;27(20.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;103(79.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;36(24.3)\u003c/p\u003e\n \u003cp\u003e112(75.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.499\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.\u0026nbsp;480\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWater brash\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;13(4.7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 265(95.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;5 (3.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;125(96.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;8(5.4)\u003c/p\u003e\n \u003cp\u003e140(94.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.377\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.\u0026nbsp;539\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMelena\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;28(10.1)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;250(89.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;20(15. 4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;110(84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;8(5.4)\u003c/p\u003e\n \u003cp\u003e140(94.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 7.609\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.\u0026nbsp;006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHematemesis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;36(12.9)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;224 (87.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;26(20)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;104 (80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 10(6.8)\u003c/p\u003e\n \u003cp\u003e139(93.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 10.992\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.\u0026nbsp;010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeightloss\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41(14.7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;237(85.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 16(12.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;114 (87.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;25 (16.9)\u003c/p\u003e\n \u003cp\u003e123(83.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 1.157\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.\u0026nbsp;282\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePallor\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27(9.7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;241(86.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;7(5.4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;123 (94.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 10 (6.7)\u003c/p\u003e\n \u003cp\u003e138 (93.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.270\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.\u0026nbsp;603\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEasy fullness\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22(7.9)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;256(92.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;8(6.2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;122 (93.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 14 (9. 5)\u003c/p\u003e\n \u003cp\u003e134 (90.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 1.038\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.\u0026nbsp;308\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegurgitation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23(8.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 255(91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 9(6.9)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;121 (93.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 14 (9.5)\u003c/p\u003e\n \u003cp\u003e134 (90.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.587\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.444\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNausea\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10(3.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 268(96.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;2(1.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;128(98.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;8(5.4)\u003c/p\u003e\n \u003cp\u003e140 (94.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e LR=3.226\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; df= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.\u0026nbsp;072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVomiting\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;264(95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 4(3.1)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;126 (86.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 10 (6.8)\u003c/p\u003e\n \u003cp\u003e138 (93.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 1.960\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.\u0026nbsp;162\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eKeys:\u003c/strong\u003e = LR=Likelihood ratio, X\u003csup\u003e2\u003c/sup\u003e=Chi-square test\u0026nbsp;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMedical co-morbidities in the subjects\u003c/h2\u003e \u003cp\u003eThe commonest comorbidity was systemic hypertension 207(74.5%) followed by osteoarthritis 27(9.7%) and type 2 diabetes 22(7.9%). Others were liver cirrhosis 11(4%), COPD 9(3.2%), stroke 3(1.1%) and retroviral disease 3(1.1%). Type 2 diabetes mellitus was found to be significantly commoner in males than females in this study (P\u0026thinsp;\u0026lt;\u0026thinsp;0.005). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 3: Medical co-morbidities in the subjects\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" style=\"width: 100%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eN \u003cstrong\u003e= 278\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eN = 130 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eN = 148 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistics\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSystemic hypertension\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;77 (27.7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;201 (72.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;35 (26.9)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;95 (73.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 42(28.4)\u003c/p\u003e\n \u003cp\u003e106(71.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.073\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.787\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes mellitus\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;22 (7.9)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;256 (92.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 19 (12.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 129 (87.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 3(2.3)\u003c/p\u003e\n \u003cp\u003e127(97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 10.531\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCOPD\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 9 (3.2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;269 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;4 (3.1)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;126(96.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;5 (3.4)\u003c/p\u003e\n \u003cp\u003e143 (96.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLR = 0.020\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.887\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eStroke\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;4(1.4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;274(98.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;3 (2.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;127(97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1 (0.7)\u003c/p\u003e\n \u003cp\u003e147 (99.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLR = 1.341\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRetroviral Disease\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;3 (1.1)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;275 (98.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;2 (1.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;128(98.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1 (0.7)\u003c/p\u003e\n \u003cp\u003e147 (99.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLR =0.847\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOsteoarthritis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 27(9.7)\u003c/p\u003e\n \u003cp\u003e251 (90.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;15 (11.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;115 (88.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;12(8.1)\u003c/p\u003e\n \u003cp\u003e136 (91.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;X\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e = 0.929\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.336\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLiver cirrhosis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;11 (4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 267(96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;5 (3.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;125 (96.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 6 (4.1)\u003c/p\u003e\n \u003cp\u003e142 (95.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e = 0.080\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.929\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eKeys:\u003c/strong\u003e = LR=Likelihood ratio, X\u003csup\u003e2\u003c/sup\u003e=Chi-square test,\u0026nbsp;COPD: Chronic ob\u003cstrong\u003est\u003c/strong\u003eru\u003cstrong\u003ec\u003c/strong\u003et\u003cstrong\u003ei\u003c/strong\u003eve pulmonary disease\u003c/p\u003e\u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eRisk factors for Dyspepsia in the subjects\u003c/h2\u003e \u003cp\u003eThe commonest associated risk factor in the subjects was helicobacter pylori infection 113(40.6%). Others were NSAID use 50(18%), Alcohol 37(13.3%), herbal remedies 28(10.1%) and steroid 21(7.6%). The use of Alcohol and NSAID were significantly commoner in males than females (P\u0026thinsp;\u0026lt;\u0026thinsp;0.005). (Table\u0026nbsp;4)\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable.4: Risk factors for Dyspepsia in the subjects\u003c/b\u003e \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable.4: \u0026nbsp;Risk factors for Dyspepsia in the subjects\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" style=\"width: 100%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN =278 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN =130 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN = 148 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003eStatistics\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNSAID use\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50 (18)\u003c/p\u003e\n \u003cp\u003e228 (82)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;34(26.2)\u003c/p\u003e\n \u003cp\u003e96 (73.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;16(10.8)\u003c/p\u003e\n \u003cp\u003e132(89.2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLR= 11.950\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHelicobacter pylori\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;113(40.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;165(59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;53 (40.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 77 (59.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 60(40.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 88(59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.969\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol use\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;37 (13.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;241 (86.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;31 (23.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;99 (76.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 6(4.1)\u003c/p\u003e\n \u003cp\u003e142 (95.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 23.492\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of Herbal remedies\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;28 (10.1)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;249 (89.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 17 (13.1)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;113 (86.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 11(7.4)\u003c/p\u003e\n \u003cp\u003e136 (91.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003eLR=3.643\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSteroid use\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;21 (7.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;257 (92.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 10(7.2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;120 (92.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 11(7.4)\u003c/p\u003e\n \u003cp\u003e137 (92.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.007\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHiatus Hernia\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;3 (1.1)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;275 (98.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2 (1.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;128 (98.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1(0.7)\u003c/p\u003e\n \u003cp\u003e147 (99.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.903846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.87\u003c/p\u003e\n \u003cp\u003edf= 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.910\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eKeys:\u003c/strong\u003e = LR=Likelihood ratio, X\u003csup\u003e2\u003c/sup\u003e=Chi-square test, NSAID=Non-steroidal Anti-inflammatory drugs\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEndoscopic Diagnosis of the subjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was gastritis in 94(33.8%) of the subjects (Pangastritis 37(13.3%), Antral predominant gastritis 34(12.2%) and Antral-corporal gastritis 23(8.30%)) followed by normal findings 42(15.1%) and GERD 37(13.3%).\u0026nbsp;Other endoscopic findings in the subjects include gastric erosions 26(9.40%), duodenal ulcer 20(7.2%), gastric ulcer 19(6.8%) and gastric cancer 16(5.8%), oesophageal candidiasis 6(2.2%) and oesophageal cancers\u0026nbsp;3(1.1%). There was no significant difference in the gender distribution of pattern of endoscopic diagnoses (P\u0026gt;0.005)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e(Table 5)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Endoscopic Diagnosis of the subjects\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"654\" style=\"width: 100%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.596330275229358%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eN \u003cstrong\u003e= 278\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.761467889908257%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eN = 130 \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.596330275229358%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eN = 148 \u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.761467889908257%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistics\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.009174311926605%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.596330275229358%\" valign=\"top\"\u003e\n \u003cp\u003e42 (15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.761467889908257%\" valign=\"top\"\u003e\n \u003cp\u003e18(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.596330275229358%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;24(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.761467889908257%\" rowspan=\"12\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e = 19.206\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003edf= 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.009174311926605%\" rowspan=\"12\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.24390243902439%\" valign=\"top\"\u003e\n \u003cp\u003eGERD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e37 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e15 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;22 (59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.24390243902439%\" valign=\"top\"\u003e\n \u003cp\u003ePangastritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e37 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e17 (46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;20 (54.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.24390243902439%\" valign=\"top\"\u003e\n \u003cp\u003eAntral predominant Gastritis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e34 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e18 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 16 (47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.24390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGastric Erosions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e26 (9.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 13 (50.0)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 13 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.24390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAntral + Corporal Gastritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23 (8.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 17 (73.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 6(26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.24390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDuodenal\u0026nbsp;Ulcer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20 (7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;8 (40.0)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 12(60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.24390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGastric Ulcer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;8 (42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 11 (57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.24390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGastric Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;16 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;8 (50.0)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 8 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.24390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEsophageal Candidiasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;7 (46.7)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 8(53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.24390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGastric plus\u0026nbsp;Duodenal\u0026nbsp;Ulcer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;4 (66.6)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 2(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.24390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOesophageal Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;3 (100)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.73170731707317%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; -\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eKeys:\u0026nbsp;\u003c/strong\u003eX\u003csup\u003e2\u003c/sup\u003e=Chi-square test, GERD= Gastroesophageal Reflux Disease\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDyspepsia was most prevalent in the age group 51–70 years, emphasizing its relationship with older age. A similar finding was documented by Nwokediuko et al\u003csup\u003e8\u003c/sup\u003e in Enugu and Kooffreh-Ada et al in Calabar\u003csup\u003e11\u003c/sup\u003e both in Nigeria, Ahmed et al\u003csup\u003e10\u003c/sup\u003e in Egypt and Khaled et al\u003csup\u003e12\u003c/sup\u003e in the USA had similar findings. The relationship between dyspepsia and older age has been attributed to higher prevalence of comorbidities associated with dyspepsia, drug induced dyspepsia due to polypharmacy and higher prevalence of PUD in the older age group\u003csup\u003e13\u003c/sup\u003e. The subjects were predominantly females with a female to male ratio of 1:1.1. This finding is similar to the report by Khaled et al\u003csup\u003e12\u003c/sup\u003e in their retrospective study of outpatients with dyspepsia using endoscopic procedure at Grady Memorial Hospital in Atlanta, Georgia, USA. Kooffreh-Ada et al in Calabar\u003csup\u003e11\u003c/sup\u003e,Nigeria reported no sex predilection while Ahmed et al\u003csup\u003e10\u003c/sup\u003e in Egypt reported slightly higher prevalence in males. Explanations for the higher prevalence in females in this study may include hormonal differences between males and females, and, higher health seeking behaviors in females as well as higher prevalence of functional gastrointestinal disorders in females.\u003csup\u003e14,15\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe common comorbidities observed in the subjects were, osteoarthritis type 2 diabetes and systemic hypertension. Mari-Ann Wallander et al.\u003csup\u003e16\u003c/sup\u003e in the UK reported angina, osteoarthritis rheumatoid arthritis and sleep disorders as common commodities associated with dyspepsia. Though Mak et al\u003csup\u003e17\u003c/sup\u003e and Solovyova et al\u003csup\u003e18\u003c/sup\u003e (in the USA) found anxiety and depression as major co morbidities in their patients, which were commoner in subjects with functional dyspepsia, these were not seen in our patients.. The increased frequency of osteoarthritis in this population may be because osteoarthritis predisposes to the increased use of NSAIDS and steroids both of which potentially cause dyspepsia. \u003csup\u003e16\u003c/sup\u003e Type 2 diabetes was a common co morbidity in our patients. This is similar to findings elsewhere. A multicenter study in UK and Belgium by Fabien et al\u003csup\u003e19\u003c/sup\u003e reported type 2 diabetes as one of the common comorbidities in dyspeptic patients. This is not surprising as diabetic enteropathy such as gastroparesis may present with dyspepsia. Functional gastrointestinal disorders are also common in diabetics. Some oral hypoglycaemic agents side effect includes dyspepsia e.g Sulphonylureas and DPP-4 inhibitors.\u003csup\u003e19\u003c/sup\u003e Acute or chronic pancreatitis and cholelithiasis associated with diabetes mellitus may also present with abdominal pain which may mimic dyspepsia.\u003csup\u003e20\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA study by Okonkwo et al\u003csup\u003e21\u003c/sup\u003e in Calabar noted high prevalence of dyspeptic symptoms among subjects with hypertension and other cardiovascular risks on low dose Aspirin. The finding of a higher prevalence rate of systemic hypertension in patients with dyspepsia may be because of the existence of mutual risk factors for developing both conditions such as obesity and smoking.\u003csup\u003e22,23\u003c/sup\u003e and also similar or overlapping symptomatology\u003csup\u003e24\u003c/sup\u003e. Finally, polypharmacy with drugs used to manage systemic hypertension can cause upper gastrointestinal symptoms\u003csup\u003e25,26\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe common associated risk factors for dyspepsia in the subjects were helicobacter pylori infection, NSAIDs, Alcohol, herbal remedies and steroids. A prevalence rate of 40.6% for H.pylori infection was found in our study. This is similar to the prevalence of H. pylori in a similar study of 42.6% by Mbang et al in Calabar\u003csup\u003e11\u003c/sup\u003e but lower than the reported rates by Adeniyi et al in Ibadan\u003csup\u003e27\u003c/sup\u003e, Ezugwu in Awka\u003csup\u003e28\u003c/sup\u003e, Ishaleku in Keffi\u003csup\u003e29\u003c/sup\u003e, and Bello et al in Kano\u003csup\u003e30\u003c/sup\u003e. Archampong et al also found a higher prevalence rate of 74.5% in a similar study in Ghana\u003csup\u003e31\u003c/sup\u003e whereas Jemikaleja found a much lower prevalence rate of 12. 7% in Warri, Nigeria. The disparity in prevalence rates in the various studies may be linked to the socioeconomic status and hygiene practices of the different patients populations with lower rates associated with improved hygiene standards and wide spread use of antibiotics\u003csup\u003e32\u003c/sup\u003e. Furthermore, urbanization with better access to healthcare facilities and potable water could be another reason for this observation. A low socioeconomic status has been reported to promote the transmission of H. pylori due to poor education, including poor health education and a more likelihood of living in an environment that predisposes to faecal contamination of food and water.\u003csup\u003e33,34,35\u003c/sup\u003e Although H. Pylori commonly causes antral predominant gastritis, it can also cause pangastritis. The patten of gastritis is determined by the immune system of the subjects, genetic factors, the strain of the bacteria\u003csup\u003e1\u003c/sup\u003e. Individuals with antral predominant gastritis are more likely to develop duodenal ulcers while those with pangastritis are more likely to develop gastric ulcer and adenocarcinoma\u003csup\u003e1,7\u003c/sup\u003e. Wallander et al.\u003csup\u003e16\u003c/sup\u003e in the UK reported smoking as the major risk factors which was attributed to cold weather. The second most common risk factor for dyspepsia obtained from this study was NSAID use. Though the prevalence was expected to be higher based on the demographic distribution of the subjects and co-morbidity. This may be related to the oral interview which is limited by forgetfulness and also the respective study design. High prevalence rate of NSAID use in the subjects observed in this study was similar to reports by Okonkwo et al\u003csup\u003e21\u003c/sup\u003e in Calabar, Nigeria and Ahmed Gado et al.\u003csup\u003e10\u003c/sup\u003e in Egypt. A study by Wanjoyi et al.\u003csup\u003e36\u003c/sup\u003e in Kenya reported high incidence of dyspepsia and gastroduodenal lesions in chronic NSAIDS users. Cekin et al\u003csup\u003e37\u003c/sup\u003e in Turkey reported significant association of NSAIDS with duodenal ulcers. Indiscriminate use of NSAIDS and Steroids in our environment is from the handiwork of quacks who usually prescribe both drugs for all forms of body pains and the abuse of these drugs by farmers and artisans after menial jobs.\u003csup\u003e21,10\u003c/sup\u003e NSAIDS causes inhibition of prostaglandins leading to a spectra of GI disorders including gastritis, erosions and PUD which may manifest with dyspepsia.\u003csup\u003e38\u003c/sup\u003e This is compounded by the actions of herbalists who mix all sorts of substances in the name of herbal remedies including different plant roots, leaves and barks of trees the safety of which is not known.\u003csup\u003e39\u003c/sup\u003e Some herbal remedies may be directly cytotoxic to the GI mucosa.\u003csup\u003e40\u003c/sup\u003e Poverty and illiteracy have also contributed to the popularity of these practices in our environment because they are cheap and wrongly believed to treat all types of ailments.\u003csup\u003e41\u003c/sup\u003e The common endoscopic diagnosis in the subjects were gastritis, normal findings and GERD. Others include gastric erosions, duodenal ulcer, gastric ulcer and gastric cancer. The high prevalence of non-specific gastritis (25.5%) in our subjects may be related to the effects of some spices in our diets on the GI tact, helicobacter pylori infection and high consumption rate of herbal mixtures wrongly recommended by herbalist as remedies to all illnesses in our environment. The rate of normal endoscopy in our study was (15.1%) which is high. This is comparable to findings by Ghamar -Chehreh et al in Iran\u003csup\u003e42\u003c/sup\u003e, Sahin et al in Istanbu.\u003csup\u003e43\u003c/sup\u003e, Olokoba et al at FMC, Yola.\u003csup\u003e44\u003c/sup\u003e and Emuobor et al in-Lagos\u003csup\u003e9\u003c/sup\u003e. The clinical implication of this finding is that endoscopic evaluation of dyspeptic patients in our environment is necessary to accurately make a diagnosis. Though some previous studies.\u003csup\u003e45,46\u003c/sup\u003e including a study in the USA by Khaled et al\u003csup\u003e12\u003c/sup\u003e reported high rates of normal endoscopy in most patients with dyspepsia, they did not recommend endoscopic evaluation as an initial step in the management of patients with dyspepsia, however.\u003csup\u003e47\u003c/sup\u003e The normal endoscopic findings in this study may be related to contributions by functional GI disorders, NERD and healthy subjects. In the UK, Mari-Ann Wallander et al.\u003csup\u003e16\u003c/sup\u003e found irritable bowel syndrome, GERD and peptic ulcer disease as common causes of dyspepsia.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eMany patients with dyspepsia have recognisable endoscopic lesions, comorbidities and identifiable predisposing factors. Endoscopic evaluation of dyspeptic patients irrespective of age, absence or presence of alarm symptoms will help to classify them early into organic and functional categories. This will guide appropriate patient management from very early in the doctor patient interaction.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e \u003cb\u003eETHICS DECLARATIONS\u003c/b\u003e \u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eHuman Ethics and consent to participate\u003c/strong\u003e \u003cp\u003e This study was conducted according to the principle expressed in the declaration of Helsinki and approved by the Alex-Ekwueme Federal University Teaching Hospital Ethics and Research Committee (approval numbers 04/07/2022-02/08/2022). Due to the retrospective study design, the requirement for written consent was waived (Alex-Ekwueme Federal University Teaching Hospital Ethics and Research Committee)\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests:\u003c/strong\u003e \u003cp\u003eAuthors declare no competing interests\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDr Obasi Emmanuel participated in the study design, data collection, interpretation and drafted the manuscript.Dr Nnnennaya Anthony Ajayi conceived the study and helped to draft the manuscript .Prof Neri G Picardo participated in the interpretation and critical appraisal.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003e We sincerely thank the hospital Ethics and Research Committee and the Chief Medical Director of Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State for granting us the approval to carry out this study. Special thanks to our study participants for their sacrifices.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials:\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFeldman M, Friedman LS, Brandt LJ. Sleisenger and Fordtran\u0026rsquo;s Gastrointestinal and Liver Disease,10th Edition. 2010. 1432\u0026ndash;3 p.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTalley NJ, Stanghellini V, Heading RC. Functional gastroduodenal disorders. Gut. 1999;45:1137\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFord AC, Bercik P, MorganDG, Bolino C, Pintos-Sanchez MI, Moayyedi P. The Rome III Criteria for the Diagnosis of Functional Dyspepsia in Secondary Care Are Not Superior to Previous Definitions. Gastroenterology. 2014;146(4):932\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStanghellini V, Chan FK, Hasler WLM, Suzuki JR, Tack H. Gastroduodenal disorders. Gastroenterology. 2016;150:1380\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Gastroenterological Association. Medical position statement: evaluation of dyspepsia. Gastroenterology. 1998;114:579\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKnill-Jones RP. Geographical differences in the prevalence of dyspepsia. Scand J Gastroenterol. 1991;26:17\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFord AC, Marwaha A, Sood RMP. Global prevalence of, and risk factors for uninvestiated dyspepsia; a metaanalysis. Gut. 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNwokediuko CS, Ijoma U, Obienu O, Anigbo GE, Okafor O. High degree of duodenal inflammation in Nigerians with functional dyspepsia. Clin Exp Gastroenterol.2014;7\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOdeghe EA, Adeniyi OF, Oyeleke GK, Keshinro SA. Use of alarm features in predicting significant endoscopic findings in Nigerian patients with dyspepsia. Pan Afr Med J. 2019;34:66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGado A. Alexandria University Faculty of Medicine Endoscopic evaluation of patients with dyspepsia in a secondary referral hospital in Egypt. Alexandria J Med. 2015;51(3):179\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMbang K, Okonkkwo U, Ugbong E, Aniekan E, Chukwudike E, Donald E, Ogbu N. Prevalence of Helicobacter Pylori Infection among Dyspepsia Patients in Calabar. Global J Pure Appl Sci. 2019;25:145\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdeljawad K, Wehbeh A, Qayed E. Low Prevalence of Clinically Significant Endoscopic Findings in Outpatients with Dyspepsia. T\u003cem\u003ehe Pan African Medical Journal\u003c/em\u003e 2017;2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorum ML. Peptic ulcer disease in the eldely. Clin Geriatr Med. 1999;15(3):457\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePiotrowicz G, Stępień B, Rydzewska G. Socio-demographic characteristics of patients with diagnosed functional dyspepsia. Prz Gastroenterol. 2013;8(6):354\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNapthali K, Walker MM, Talley NJ. Women and functional dyspepsia. Womens Heal. 2016;12:241\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWallander MA, Johansson S, Ruigomez A, Rodriguez LA JR. Dyspepsia in general practice: incidence, risk factors, comorbidity and mortality. Fam Pr. 2007;24(5):403\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMak ADP, Wu JCY, Chan FKL, Chan Y, Chan FKL, Sung JJY, Lee S. Dyspepsia is strongly associated with major depression and genealized anxiety disorder- a community study. Aliment Pharmacol Ther. 2012;36:800\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSolovyova G, Alianova T, Taran A, Aleksieieva VGL. Risk factors and Co-morbidities functional dyspepsia. Retrospective Cohort Analysis. Georgian Med News. 2020;(307):104\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWuestenberghs F, Eugenicos MP. PWE-62 Reporting of Comorbidities and Overlap Syndromes in Functional Dyspepsia. review of 15 years of RCTs. Gut jnl. 2021;324.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBharucha AE, Locke GR, Murray JA. Gastrointestinal Manifestations of Diabetes. 3rd Editio. Diabetes Am. 2015. 21\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkonkwo UC, Umoh IO, Henshaw E, Victor A. Prevalence of dyspeptic symptoms among patients on low \u0026ndash; dose antiplatelet therapy. Nigerian J Cardiol. 2017;14(2):92\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShimazu H, Nakaji G, Fukata M, Odashiro K, Maruyama T, Akashi K. on behalf of the Fukuoka F-Scale F Scale Trial Group. Relationship between atrial fibrillation and gastroesophageal reflux disease: a multicenter questionnaire survey. Cardiology. 2011;119(4):217\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWormser D, Kaptoge SDAE, Wood AM, Pennells L, Thompson A, Sarwar N, et al. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet. 2011;377(9771):1085\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBytzer P, Talley NJ, Hammer J, Young LJ, Jones MP. HM. gastrointestinal symptoms in diabetes mellitus are associated with both poor glycemic control and diabetic complications. Am J Gastroenterol. 2002;97(3):604\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBytzer PHJ. Drug-induced symptoms of functional dyspepsia and nausea. A symmetry analysis of one million prescriptions. Aliment Pharmacol Ther. 2000;14(11):1479\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSobieraj DM, White CM, Alikhanov S, Winkler S, Mediouni M, Kluger JCC. The impact of antiplatelet and anticoagulant therapies on gastrointestinal symptoms in patients with atrial fibrillation: a systematic review. Ann Pharmacother. 2012;46(9):1220\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdeniyi BA, Otegbayo JA, Lawal T, Oluwasola AO, Odaibo G, Okolo C, et al. Prevalence of Helicobacter pylori infection among dyspepsia patients in Ibadan, South West Nigeria. Afr J Microbiol Res. 2012;6(14):3399\u0026ndash;402.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEzugwu RICC. Epidemiology of Helicobacter pylori infection among dyspepsia patients in South-East, Nigeria. IOSR J Pharm Biol Sci. 2014;9(6):53\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIshaleku DIHA. Sero-prevalence of Helicobacter pylori infection among students of a Nigerian University. Asian Pac J Trop Med. 2010;584\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBello AK, Umar ABBM. Prevalence and risk factors for Helicobacter pylori infection in gastroduodenal diseases in Kano, Nigeria. Afr J Med Heal Sci. 2018;17:41\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArchampong TN, Asmah RH, Wiredu E, K G RK, Nkrumah K, N RK. Epidemiology of Helicobacter pylori infection in dyspeptic Ghanaian patients. Pan Afr Med J. 2015;20:178.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJemikalajah D, J OG. Health point prevalence of helicobacter pylori in Central Hospital Warri, Nigeria. Afr J Cell Pathol. 2014;3:57\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMnichi Z, Nibret E, Mekonnem D, Demelash M. Sero and faeco prevalence of Helicobacter pylori infection and its associated risk factors among adult dyspeptic patients visiting the outpatient department of Adet Primary Hospital, Yilmana Densa District, Ethiopia.Can J of Infect Dis Med microbiol. 2023; 2023(1)2 305681.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOzbey G, Hanafia A, Epidemiology. Diagnosis, and Risk Factors of Helicobacterpylori Infection in Children. Euroasian J Hepato- Gastroenterol. 2017;7(1):34\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOling M, Odongo J, Kituuka OGM. Prevalence of Helicobacter pyloriin dyspeptic patients at a tertiary hospital in a low resource setting. BMC Res Notes. 2015;8:256.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWanjohi W, Ogutu E, Oyoo, Kioko HM, Radia KMT. prevalence of gastrodoudenal leisions in chronic NSAIDS users pesening with dyspepsia at the Kenyaa National Hospial. Afr J rheumathology. 2014;2(1):2307\u0026ndash;482.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCekin AH, Taskoparan M, Duman A, Sezer C, Cekin Y, Yolcular BO et al. The Role of Helicobacter pylori and NSAIDs in the Pathogenesis of Uncomplicated Duodenal Ulcer. \u003cem\u003eGastroenterology Research and Practice\u003c/em\u003e. 2012; 2012.1-6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eButt JH, Barthel JS, Moore RA. Clinical spectrum of upper gastrointestinal effects of non-steroidal anti-inflammatory drugs. Natural history, symptomatology and significance. Am J Med. 1988;22(2A):84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith S, Oyedeji KS, Opere, Iwalokun AOE. The effects of some Nigerian Local herbs on Helicobacter pylori. Afr J Clin Exp Microbiol. 2003;4(2):29\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdeunji JS, Funmilayo GF, Ayodeji OO, Oguntimehin SA. Cytotoxic Activity of selected Nigerian Medicinal plants. J Herbs spices Med plants. 2019;26(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKate L, Mandeville. Justus Krabshuis SAK. gastroenterology in developing countries: Issues and advances. World J Gastroenterol. 2009;15(23):2839\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMe G, Shahverdi E, Khedmat H, Ghafoorian A, Amini M. Endoscopic Findings in Patients with Dyspepsia in Iran. iMedPub Journals: 2016;1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSahin M, Akbulut C, Dolapcioglu C, Ozpolat E, Dabak R, et al. Endoscopic findings of dyspeptic patients unresponsive to proton pump inhibitors. North Clin Istanbul 1. 2014;1:158\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlokoba AB, Salawu FK, Ja V. Functional dyspepsia in Yola, Nigeria La dyspepsie fonctionnelle \u0026agrave; Yola au Nigeria. Res J Health Sci. 2015;3(1):38\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTack J, Talley NJ, Camilleri M, Holtmann G, Hu P, et al. Functional gastroduodenal disorders. Gastroenterology. 2006;130:1466\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpiller RC. Anorexia, nausea, vomiting, and pain. Br Med J. 2001;323(7325):1354\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaji S, Brunt P, Hagen S, Mowat N, Russell I, et al. Improving the selection of patients for upper gastrointestinal endoscopy. Gut. 1993;34:187\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pattern, Endoscopic, Diagnosis, Dyspepsia","lastPublishedDoi":"10.21203/rs.3.rs-4609582/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4609582/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDyspepsia refers to a heterogeneous group of symptoms (pain or discomfort) originating from the upper abdomen and may include epigastric pain, postprandial fullness, early satiation, anorexia, belching, nausea, vomiting, upper abdominal bloating, and heartburn and regurgitation. It is very common, and may be associated with serious morbidity and occasionally mortality. It may also adversely affect the socioeconomic status of the sufferer. This study examined patients with dyspepsia and determined their common endoscopic diagnoses, risk factors and comorbidities.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a hospital-based Retrospective study carried out at the gastroenterology and hepatology unit of Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria. Case notes and endoscopic records of patients who had endoscopy for dyspepsia between October 2018 and October 2020 were reviewed and information relating to demographics, dyspeptic symptoms, risk factors, comorbidities and endoscopic diagnoses were extracted.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 278 patients were studied with age range between 17 to 98 years. The mean age (SD) of the patients was 48.4 (15.6) years. There were more females than males 148 (53.2%) vs 130 (46.8%). The commonest symptom and associated risk factor in the subjects were epigastric pain 207(74.5%) and Helicobacter pylori infection 113 (40.6%) respectively. Other identified risk factors were use of NSAIDs 50 (18%), Alcohol 37 (13.3%) and herbal remedies 28 (10.1%). The commonest endoscopic diagnosis was gastritis 94 (33.8%) followed by normal findings 42 (15.1%) and GERD 37 (13.3%).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe commonest endoscopic finding in dyspepsia from this study was gastritis followed by normal findings. Thus, non-ulcer dyspepsias are the commonest cause of dyspepsia in the environment studied.\u003c/p\u003e","manuscriptTitle":"Pattern of Endoscopic Diagnoses in Patients with Dyspepsia in a tertiary hospital in Nigeria: A Three-Year Hospital based Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-11 05:36:55","doi":"10.21203/rs.3.rs-4609582/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-28T13:50:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-22T15:28:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"108381604153706529281144451944146326985","date":"2024-08-14T11:38:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"168719444888660817254011593750397535629","date":"2024-08-12T11:15:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"72328119191229654356646724766845237138","date":"2024-08-10T09:37:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-29T06:21:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"77162758146999690266058732633707571293","date":"2024-07-29T05:47:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212229263575285127228956657824120478665","date":"2024-07-28T15:44:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-25T17:19:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-21T10:45:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-21T05:42:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-21T05:42:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2024-06-20T06:30:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bffff2ab-cf43-4ef5-b8dc-24d2a5e5ee81","owner":[],"postedDate":"July 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-15T14:10:01+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-11 05:36:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4609582","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4609582","identity":"rs-4609582","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}