Seasonal variation in the incidence of endoscopically diagnosed duodenal ulcer in Sudan

Musa Mohamed Kheir; Sulieman Salih Fedail; Abdel Gadir El Kadrou

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Year : 1998 | Volume : 4 | Issue : 1 | Page : 17-19

Seasonal variation in the incidence of endoscopically diagnosed duodenal ulcer in Sudan

Musa Mohamed Kheir, Sulieman Salih Fedail, Abdel Gadir El Kadrou
Department of Medicine, University of Khartoum, P.O. Box 102, Sudan

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Date of Submission	21-Jul-1997
Date of Acceptance	29-Oct-1997

Abstract

The seasonal pattern of endoscopically diagnosed duodenal ulcer disease in an endoscopy unit in Suba University Hospital and Ibn Sina Hospital, Sudan, was evaluated retrospectively for the period 1980-1988. We reviewed all the 12443 endoscopy records and found 1348 cases of duodenal ulcers. The incidence of duodenal ulcer was then calculated for each month separately. We found that in Sudan the frequency of duodenal ulcer is significantly higher during winter (January-February), and significantly lower during summer (May-August).

How to cite this article:
Kheir MM, Fedail SS, El Kadrou AG. Seasonal variation in the incidence of endoscopically diagnosed duodenal ulcer in Sudan. Saudi J Gastroenterol 1998;4:17-9

How to cite this URL:
Kheir MM, Fedail SS, El Kadrou AG. Seasonal variation in the incidence of endoscopically diagnosed duodenal ulcer in Sudan. Saudi J Gastroenterol [serial online] 1998 [cited 2022 Jul 6];4:17-9. Available from: https://www.saudijgastro.com/text.asp?1998/4/1/17/33902

Duodenal ulcer is fairly common in Sudan. Fedail et al found active duodenal ulcer in 17% out of 2500 upper gastrointestinal endoscopies^[1] . It was more common in males (M-F ratio 4.5:1) and in youths (median age 34.5 years).

Seasonal variation in the incidence of duodenal ulcer is reported by doctors in every day clinical practice. Many studies were done to verify this aspect, most of which are epidemiological studies of complications of duodenal ulcer^{[2],[3],[4],[5],[6],[7],[8],[9]} . Seasonal variation of duodenal ulcler was also studied endoscopically and found to vary from one season to the other^{[10],[11],[12]} .

The purpose here is to determine the monthly variation in the presentation of endoscopically diagnosed duodenal ulcer in Sudan.

Patients and Methods

Endoscopies were done in Suba and Ibn Sina Teaching Hospitals by an experienced endoscopist. Olympus 24 was used in all cases. The endoscopies were done after an overnight fast under local anesthetic spray to the oropharynex. All the reports of endoscopic examinations from March 1, 1980 to December 31, 1988 were reviewed to identify patients with active duodenal ulcer. Patients with superficial erosions or duodenitis were not included. For each month, the number of endoscopic examinations performed and the number of duodenal ulcers encountered were recorded.

Statistical analysis

The X² test was used to compare the percentage of patients with duodenal ulcer in the months with peak and lowest incidences to that of the rest of the year.

Results

During the years 1980-1988, 12443 endoscopic examinations of the upper gastrointestinal tract were performed and 1348 active duodenal ulcers were diagnosed (10.8%). The number of active duodenal ulcers, (ulcers which do not show any sign of healing) was significantly correlated with the number of endoscopic procedures performed, i.e., the lager the number of endoscopies performed the bigger the number of active ulcers detected (P<0.001).

The percentage of duodenal ulcer in correlation with the number of endoscopies performed is shown in [Figure - 1] as bimonthly fluctuation. The frequency of duodenal ulcer was significantly greater in JanuaryFebruary compared to the rest of the year (P<0.001). During May-June and July-August, the frequency was significantly lower with respect to the rest of the year (P<0.001).

The high and lower frequency peak periods were consistent over the nine year period.

Discussion

Seasonal variations in the incidence of duodenal ulcer was reported by many authors^{[2],[3],[4],[5],[6],[7],[8],[9]} . However, most of these observations were based on either clinical manifestations or complications of the disease. Very few studies were based on endoscopically diagnosed duodenal ulcers.

This study is the first of its kind to be performed in Africa, dependent only on the endoscopic diagnosis of active duodenal ulcer. We have confirmed that in Sudan the monthly fluctuation of duodenal ulcer exists. In our study populations, a peak of duodenal ulcer frequency rate was observed during winter (January-February).

In contrast the frequency of active duodenal ulcer during the periods May-June and July-August was significantly lower compared to the rest of the year.

The results of our study are reliable and representative since they were based on a large number of patients and were retrieved during a period of nine years. They clearly demonstrate a higher incidence of duodenal ulcer during winter.

The results we obtained are consistant with the findings in the United Kingdom and the United States^[11] . The reason for higher incidence of duodenal ulcer disease during winter is not known. In UK high incidence during winter is thought to be due to depression from cold weather, in Sudan it is not the case. Variation in gastric secretions was studied in animals and was found to be higher in spring and autumn^[13],[14].

Despite the fact that tests for H-pylori were not routinely done at the time of the study, it is possible that H-pylori is more active during winter than in summer. However, this needs to be clarified. The exact mechanism of this significant seasonal variation needs to be clarified.

References

1.	Fedail SS, Arbab BMO. Upper gastrointestinal fibreoptic endoscopy experience in the Sudan. The Lancet, 1983:897-9.
2.	Ahmed SZ, Levine M, Finkbiner R. The seasonal incidence of complications of peptic ulcer. Ann Intern Mec 1963;59:165-71.
3.	Bradley RL, Bradley EJ. Seasonal incidence of perforatec ulcer. Am J Surg. 1966;111:656-8.
4.	Gardiner GC, Pinksy W, Myerson RM. The seasona incidence of peptic ulcer activity-fact of fancy ? Am Gastroenterol. 1966;45:22-3.
5.	Boles RS, Westerman MP. Seasonal incidence anc precipitating causes of hemorrhage from peptic ulcer. JAMA 1954;156:1379-83.
6.	Hall WH, Read RC, Mesard L, Lee LE. The calendar anc duodenal ulcer. Gastroenterology 1972;62:1120-4.
7.	Longman MJS, The seasonal incidence from bleeding from the upper gastrointestinal tract. Gut 1964;5:142-4.
8.	Bodhe YG, Modashi RY. Seasonal variation in the incidence of peptic ulcer perforations. Int J Biometerol 1975;19:85-92.
9.	Kurata JH, Maile BM, Epidemiology of peptic ulcer disease. Cli Gastroenterol 1984;13:289-307.
10.	William Beaument Society, US Army Report. Seasonal incidence of upper gastrointestinal bleeding. JAMA 1966; 198:184-5.
11.	Plams F, Andriulli A, Canepa G. Monthly fluctuations of active duodenal ulcers. Dig Dis Sci 1984;29:983-1008.
12.	Alexander Fich, Eran Golgen, Zimmerman J, Daniel R. Seasonal variations in the frequency of endoscopically diagnosed duodenal ulcer in Israel. J Cli Gastroenterol 1988;10:380-2.
13.	Mizell S. Seasonal variation in gastric hydrochloric acid production in rana pipiens. Am J physiol 1955; 180:650. [PUBMED] [FULLTEXT]
14.	Markoc I. Seasonal variation of scretions and acidity of gastric juice in healthy subjects and in dogs. Byall Eksp Bio Med.1959;47:33.