Last week, a group of medical delegates from the Institute of Dartmouth-Hitchcock Medical Center, USA, conducted joint medical clinics in the country alongside a Rwandan medical team, where, among others, they attended to several patients using endoscopy.

According to medics, this is a procedure that helps examine the esophagus and duodenum using a thin flexible tube called endoscopy through which the lining of the esophagus, stomach and duodenum can be viewed.

The clinics was carried out at University Teaching Hospital (CHUK), University Teaching Hospital Butare (CHUB), Rwanda Military Hospital, as well Gisenyi Hospital.

CHUK director-general Dr Theobald Hategekimana says the activities were aimed at improving the quality of gastroenterological care using endoscopy.

This followed a successful medical mission carried out in Rwanda two months ago at CHUK by delegates from India, England and Belgium, who did various procedures, among them, urology and neuro-surgery, plastic and orthopedic surgery, as well as laparoscopic surgery.

Hategekimana explained that through endoscopy, a patient with digestive disorders can be treated successfully without surgery.

During the clinics, another procedure known as endoscopic retrograde cholangiopancreatography (ERCP) was also done. ERCP is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems.

According to Dr Erick Rutaganda, an internal physician and endoscopist at CHUK, 240 patients from the five hospitals were screened and attended to.

Rutaganda says most of the patients attended to had carried these complications for more than one year without proper medication. Eighty per cent of the cases were treated using endoscopy.

"We attended to several cases successfully. This is an important procedure that allows the management of diseases of the bile duct and pancreas. Previously, treatment required a surgical procedure,” says Dr Vincent Dusabejambo, an internal medicine and endoscopy specialist.

What’s ERCP?

According to Dr Steve Bensen, MD, Associate Professor of medicine, one of the delegates from US, this technique combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems.

He says, through the endoscope, the physician can see the inside of the stomach and duodenum.

In most cases, Dr Bensen says ERCP is used primarily to diagnose and treat conditions of the bile ducts and main pancreatic duct, including gallstones, inflammatory strictures, leaks as well as cancer.

However, Dr Rutaganda says gastrointestinal diseases come in various forms, starting from the esophagus, to the stomach, pancreases, rectum, anus as well as intestines.

Among the most common problems identified during the clinics was peptic ulcer disease. He says these ulcers develop mainly in the stomach, the first part of the small intestine or the lower esophagus.

An ulcer in the stomach is known as a gastric ulcer, while that in the intestines is known as a duodenal ulcer.

These, Dr Rutaganda says, are the more prevalent ulcers, adding that 90 per cent of these cases are caused by helicobacter pylori bacteria.

Risk factors

Dr Rutaganda says this condition mostly accrues from oral contamination resulting from eating contaminated foods.

He points out that one can appear to be in good health, but then one day they wake up vomiting blood because of the ulcers.

These ulcers, Dr Rutaganda says, can result in cancers of the gastrointestinal system.

On the other hand, he adds that use of some medicines, especially those bought over the counter such as aspirins, ibuprofen and naproxen, can also expose one to peptic ulcer disease.

"This medication is most of the time used by people with chronic pain. Some are called suppository medicines which are normally taken through the anus,” he says.

Dr Rutaganda points out that whichever way such medicines are used, they can still cause one to develop peptic cancers because most of the time they are not prescribed by physicians.

He also says the helicobacter pylori infection is another risk factor for peptic ulcer disease.

This condition can result in massive and severe bleeding which can lead to death if such patients don’t receive immediate medication, according to Dr Bensen.

"This is very dangerous as there are some patients who can even lose up to five liters of blood within a short period of time. When this happens without immediate medication, the patient risks losing their life,” says Dr Rutaganda.

He notes that endoscopy can be done to rule out the exact cause of such bleeding in a patient.

Another common condition also noticed by the team was cirrhosis, which Stuart Gordon, a professor of medicine from Dartmouth Hitchcock Medical Center, USA, says is an infection of the liver.

Gordon points out that alcohol and Hepatitis B and C are the main causes of cirrhosis. These, he says, cause the liver to be fibrotic.

Here, he explains that the vessels within the easophugus are dilated, and then they burst, leading to one losing a lot of blood which can result in death.

Dr Rutaganda says what was being done in the five hospitals was screening the patients and when found to have  some conditions endoscopy is done to close the vessels that are bleeding.

"By use of endoscopy, the patient can be treated without being subjected to a lot of risks that come with surgical operations.” He notes that its costs less compared to surgery.

Dr Rutaganda also notes that colonoscopy is another procedure that was carried out during the clinics.

This is a procedure in which the inside of the large intestine is examined. It’s commonly used to evaluate gastrointestinal symptoms, such as rectal and intestinal bleeding or changes in bowel habits.

Bloody stool in most cases can be mistaken with one having hemorrhoids but it can also be indication of chronic cancers which maybe running in the family. This can be ruled out by colonoscopy, he says.

He points out that some patients are told they have amoeba infection, yet these symptoms could be pointing to intestinal complications. "With endoscopy, these cases will be dealt with more easily.”

Experts share tips

Dr Jean Da mascene Makuza, senior officer in STIs and treatment at RBC

When someone starts to experience signs such as abdominal pains, mild fever, jaundice and fatigue, they should seek medication immediately as these are some of the symptoms that manifest when one is suffering from Hepatitis B and C.

Venuste Muhamyankaka, nutritionist

When a patient has ulcers, they should avoid consuming foods such as whole milk, any beverage with caffeine, drinks that contain alcohol, as well as grape fruit juices. This is because such foods can cause considerable discomfort in the stomach, which can lead to further complications.

Francis Kazungu, general practitioner

Avoiding alcohol as well as getting vaccinated against Hepatitis is important as it keeps one from getting cirrhosis, which is a major complication of the liver. Besides, it’s always good to stick to a well-balanced diet so that they don’t develop non-communicable diseases.

Dr Celestine Karangwa, physiotherapist

For constipation, which is one of the problems that results from gastronstinal diseases, one should make sure they eat foods which are rich in fiber as well as a lot of fruits so that they prevent further complications.