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Year : 2020  |  Volume : 23  |  Issue : 12  |  Page : 1656-1659

Colonoscopy findings in lower gastrointestinal bleeding in Lagos: A comparative study based on age

1 ReMay Consultancy and Medical Services, Ikeja, Lagos, Nigeria
2 Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
3 Department of Pediatrics, College of Medicine, University of Lagos, Lagos, Nigeria

Date of Submission08-Jun-2020
Date of Acceptance02-Aug-2020
Date of Web Publication23-Dec-2020

Correspondence Address:
Dr. A Oluyemi
ReMay Consultancy and Medical Services, Ikeja, Lagos
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njcp.njcp_341_20

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Background: Lower gastrointestinal bleeding (LGIB) (hematochezia) is an important indication for colonoscopy, and may be caused by hemorrhoids, diverticulosis, and tumors. Aims: The aim of this study was to compare the endoscopic findings in the young (<50 years) versus older subjects (≥50 years) with LGIB in Nigeria. Subjects and Methods: This was a retrospective study of the endoscopic findings of all adults with LGIB from January 2017 to December 2019 in Lagos, Nigeria. The records of two centers that deliver outpatient gastrointestinal endoscopic services were ploughed for biodata, presenting complaints and findings in these individuals. These data were then analyzed and are thus presented. Results: A total of 1,774 colonoscopies performed during this period, 793 were for LGIB. Of those with LGIB, 548 (69.1%) were males, 245 (30.9%) were female, mean age was 50.7 (±14) years, and 403 (50.8%) were younger than 50 years old. The most frequent findings in patients younger than 50 years were hemorrhoids (316, 78.4%), tumors (35, 8.7%), and polyps (27, 6.7%), while in the older patients, they were hemorrhoids (259, 66.4%), tumors (74, 19%) and diverticulosis (55, 14.1%). Younger age was significantly associated with the presence of hemorrhoids (P < 0.005), while older age was significantly associated with the presence of tumors (P < 0.005) and diverticulosis (P < 0.005). Conclusion: Our study showed that hemorrhoids, tumors, and diverticulosis were the most common causes of LGIB in Nigerian patients - with younger age being significantly associated with hemorrhoids, and older age with tumors and diverticulosis. A third of the tumors in this study were found in younger patients. Unfortunately, this finding of such a high proportion of colorectal tumors being found in young Africans has been shown in previous reports - this work should help heighten concern and provoke further scientific probing into the phenomenon with a view to encouraging policy to help truncate its existence.

Keywords: Age, colonoscopy, hematochezia, colorectal cancer, Nigeria

How to cite this article:
Oluyemi A, Odeghe E, Adeniyi O. Colonoscopy findings in lower gastrointestinal bleeding in Lagos: A comparative study based on age. Niger J Clin Pract 2020;23:1656-9

How to cite this URL:
Oluyemi A, Odeghe E, Adeniyi O. Colonoscopy findings in lower gastrointestinal bleeding in Lagos: A comparative study based on age. Niger J Clin Pract [serial online] 2020 [cited 2022 Nov 30];23:1656-9. Available from:

   Introduction Top

During the course of the past decade, there has been a gradual increase in the use of colonoscopy in clinical management in Nigeria. This has reflected in the increasing body of published work to document the endoscopists' findings.[1],[2],[3],[4],[5],[6]

Data from our locality reveal that lower gastrointestinal bleeding (LGIB) is one of the most frequent indications for colonoscopy. LGIB in these parts appears to occur more commonly in men and in the older population, which is in agreement with most international published series.[7],[8],[9],[10] Common colonoscopic diagnoses in patients with LGIB include hemorrhoids, masses/polyps, diverticulosis,[1],[11],[13] which mirrors findings from international published works as well.[7],[8],[9],[10]

Presently, to the best of our knowledge, there is no local scientific work that critically examines differences in presentation and findings on an age basis. This article, by numbers, also presents one of the more robust endoscopy series from sub-Saharan Africa. The aims of this study were to determine the endoscopic findings, and diagnostic yield of colonoscopy in Nigerian patients undergoing the procedure for evaluation of LGIB, and to compare the findings in the young (<50 years) versus old (≥50 years) subjects.

   Materials and Methods Top

This was a retrospective study of the endoscopic records of all adults who had a colonoscopy for the evaluation of LGIB over a 3-year period (January 2017 to December 2019) at the endoscopy suites of two private diagnostic centers in Lagos, Nigeria (Arrive Alive Diagnostic and Imaging Services, and Clinix Healthcare Limited).

Ethical considerations

Ethical approval was obtained from the Lagos University Teaching Hospital Health Research Ethics Committee before the commencement of the study.

Statistical analysis

The following data were retrieved and entered into a proforma designed for this study: basic demographics, the indication for the procedure, and the endoscopic findings.

Data were analyzed using SPSS version 23 (SPSS Statistics for Windows, version 23.0, IBM Corp., USA). Basic descriptive statistics were performed and displayed as frequency tables. Continuous data and categorical data were compared using Student's t test, Chi-squared test or Fisher exact test, where appropriate. Valus of P < 0.05 were considered significant.

Role of the funding source

The study was funded solely by the authors. The corresponding authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

   Results Top

Demographics of study participants

A total of 1774 colonoscopy procedures were performed in the study period; of these 793 (44.7%) were for LGIB.

Patients with lower gastrointestinal bleeding

Among the 793 patients with LGIB, there were 548 males (69.1%) and 245 females (30.9%), giving a male: female ratio of 2.2:1. The mean age of the subjects was 50.7 (±14) years, with a range of 21-100 years. A little more than half of the subjects (403, 50.8%) were younger than 50 years, while 390 (49.2%) were at least 50 years old.

Endoscopic findings in patients with LGIB

Colonoscopy was normal in 59 (7.4%) of the subjects, giving a diagnostic yield of 92.6%. The commonest findings were hemorrhoids (575, 72.5%), tumors (109, 13.7%), diverticulosis (72, 9.1%), and polyps (68, 8.6%). Others were colitis (37, 4.7%), melanosis coli (18, 2.3%), ulcers (10, 1.3%), fistulae (4, 0.5%), fissures (2, 0.3%), radiation colitis (2, 0.3%), and angio-dysplasias (1, 0.1%). Hemorrhoids were significantly commoner in males (P = 0.008), while tumors were nearly twice as frequent in the females as in males (P = 0.001). There was no association of the other findings with gender [Table 1].
Table 1: Colonoscopy findings of subjects with LGIB based on gender

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Colonoscopy findings in younger versus older subjects

The diagnostic yield of colonoscopy was similar in the younger and older subjects (p = 1.00). The commonest findings in patients younger than 50 years were hemorrhoids (316, 78.4%), tumors (35, 8.7%), and polyps (27, 6.7%), while in the patients aged at least 50 years, they were hemorrhoids (259, 66.4%), tumors (74, 19%) and diverticulosis (55, 14.1%). Younger age was significantly associated with the presence of hemorrhoids (P < 0.005), while older age was significantly associated with the presence of tumors (P < 0.005) and diverticulosis (P < 0.005) [Table 2].
Table 2: Colonoscopy findings subjects with LGIB based on age

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   Discussion Top

LGIB bleeding was an important indication for colonoscopy in our study, constituting more than two-fifths of all procedures. This finding and the male preponderance results, both mirror what has been reported in other local studies.[1],[2],[3],[4],[5],[6] The higher frequency of LGIB as an indication for colonoscopy in men than women could be attributed to the greater occurrence of hemorrhoids and diverticular disease (DD) in men than women.[14],[15] Another possible reason might be hormonal differences or greater access to health care in men because of factors such as differences in education and economic power. The frequency of DD was not significantly different in men versus women in our study- this finding closely approximates that from a recent publication that reviewed African DD studies.[16] Surprisingly, our study found that tumors at colonoscopy occurred twice as frequently in women than in men, in contrast to a study from Zambia where it was the same in both genders.[17]

The mean age of 51 years reported in this study is similar to what has been reported in other local and African studies,[8],[11],[12],[13] but is much less than findings from the west where LGIB commonly occurred in the 7th and 8th decades of life perhaps due to increased life expectancy in the western population.[18],[19]

Colonoscopy yielded abnormalities in 92.6% of those with LGIB in this study. These high figures are seen in other similar studies[11],[20] and are not to be compared to figures from research that only examined LGIB as part of their general colonoscopy audit results. LGIB has been reported to have a high endoscopic yield, especially if performed within 44 hours after the bleeding episode, after which time it may be difficult to detect any stigma of recent hemorrhage.[21] The high diagnostic yield of colonoscopy has resulted in guidelines from major gastroenterology bodies listing the procedure as an appropriate tool in the clinical management of LGIB.[22]

The commonest colonoscopy findings in this study were hemorrhoids, tumors, diverticulae, and polyps, as has been reported in other studies.[1],[6],[7],[23] Our age-centered comparative analysis revealed that hemorrhoids were significantly associated with younger age, while tumors and diverticulosis were significantly associated with older age, as in other studies.[7],[8],[17] The excess prevalence of tumors and diverticulosis with advancing age is predictable but what is of grave concern in our data is that it showed that a third of the tumors were encountered in younger patients. This important statistic reflects an often overlooked but frequently reported phenomenon that colorectal cancers (CRC) in Africa appear not to have identical characteristics with those from the West.

A systematic review of 53 years of published CRC data concurs that relatively younger patients continue to constitute an unsettling high proportion of patients with CRC in Nigeria.[24] Also, more recent countrywide data in Nigeria agree with this view [Table 3].
Table 3: High proportions of young patients having CRC from various loco-regional studies

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These local data are mirrored by those from across the African continent.[30],[31],[32] There is not yet a hypothesis-driven, robust, prospective research to tackle this unique African problem.[33]

   Conclusion Top

The findings in this study reinforce what has been documented in other studies, which is that hemorrhoids, tumors, and diverticulae are the commonest findings in patients with LGIB, with younger age being significantly associated with hemorrhoids, and older age with tumors and diverticulae. The unfortunate phenomenon of a high proportion of CRC being found in young Africans is by no means “negligible” as described by Graham, et al.[34], it is in need of science to explain its existence and policy to truncate its persistence.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Alatise OI, Arigbabu AO, Agbakwuru EA, Lawal OO, Ndububa DA, Ojo OS. Spectrum of colonoscopy findings in Ile-Ife Nigeria. Niger Postgrad Med J 2012;19:219-224.  Back to cited text no. 1
  [Full text]  
Onyekwere CA, Odiagah JN, Ogunleye OO, Chibututu C, Lesi OA. Colonoscopy practice in Lagos, Nigeria: A report of an audit. Diag Ther Endosc 2013;798651. doi: 10.1155/2013/798651.  Back to cited text no. 2
Olokoba AB, Obateru OA, Bojuwoye MO, Olatoke SA, Bolarinwa OA, Olokoba LB. Indications and findings at colonoscopy in Ilorin, Nigeria. Nigeria Medical J 2013;54:111-4.  Back to cited text no. 3
Oluyemi AO, Oyedeji OA, Babayomi AO. Lower intestinal endoscopy- inaugural year experience from a private centre in Lagos, Nigeria. Orient J Med 2016;28:73-78.  Back to cited text no. 4
Picardo NG, Ajayi NA, Ajayi IA. Lower gastrointestinal endoscopy in Enugu, Nigeria: An experience with 151 cases. Niger J Gastroenterol Hepatol 2017;9:15-20.  Back to cited text no. 5
AbdulKadir Y. Clinical profile and colonoscopy findings among patients with lower gastrointestinal bleeding in Kano, Nigeria. A Publication of the Faculty of Internal Medicine, National Postgraduate Medical College of Nigeria, 2017.  Back to cited text no. 6
Gralnek IM, Ron-Tal Fisher O, Holub JL, Eisen GM. The role of colonoscopy in evaluating hematochezia: A population-based study in a large consortium of endoscopy practices. Gastrointest Endosc 2013;77:410-8.  Back to cited text no. 7
Arabi NA, Musaad AM, Mohammed FAH, Ahmed EE, Abdelaziz MSE. Acute lower gastrointestinal bleeding in Sudanese patients: A study on 301 patients in a specialized centre. Arab J Gastroenterol 2018;19:84-7.  Back to cited text no. 8
Ng KS, Nassar N, Soares D, Stewart P, Gladman MA. Acute lower gastrointestinal hemorrhage: Outcomes and risk factors for intervention in 949 emergency cases. Int J Colorectal Dis 2017;32:1327-35.  Back to cited text no. 9
Gayer C, Chino A, Lucas C, Tokioka S, Yamasaki T, Edelman DA, et al. Acute lower gastrointestinal bleeding in 1,112 patients admitted to an urban emergency medical center. Surgery 2009;146:600-6.  Back to cited text no. 10
Ajayi AO, Ajayi EA, Solomon OA, Udo E. Lower gastrointestinal bleeding: Spectrum of colonoscopy findings in Ado-Ekiti, Nigeria. Int J Med Med Sci 2014;6:128-33.  Back to cited text no. 11
Ray-Offor E, Elenwo SN. Endoscopic evaluation of upper and lower gastro-intestinal bleeding. Niger J Surg 2015;21:106-10.  Back to cited text no. 12
  [Full text]  
Akere A, Oke, TO, Fakoya TO. Colonoscopic findings in patients presenting with lower gastrointestinal bleeding at the University College Hospital, Ibadan, Nigeria. Niger J Gastroenterol Hepatol 2017;9:7-13.  Back to cited text no. 13
Ray-Offor E, Amadi S. Hemorrhoidal disease: Predilection sites, pattern of presentation, and treatment. Ann Afr Med 2019;18:12-16.  Back to cited text no. 14
[PUBMED]  [Full text]  
Peery AF, Keku TO, Galanko JA, Sandler RS. Sex and race disparities in diverticulosis prevalence. Clin Gastroenterol Hepatol 2020;18:1980-6.  Back to cited text no. 15
Vally M, Koto MZ, Govender M. An investigation of diverticular disease among black patients undergoing colonoscopy at Dr George Mukhari Academic Hospital, Pretoria, South Africa. S Afr Med J 2017;107:137-9.  Back to cited text no. 16
Kayamba V, Nicholls K, Morgan C, Kelly P. A seven-year retrospective review of colonoscopy records from a single centre in Zambia. Malawi Med J 2018;30:17-21.  Back to cited text no. 17
Lenti MV, Pasina L, Cococcia S, Cortesi L, Miceli E, Caccia Dominioni C, et al. Mortality rate and risk factors for gastrointestinal bleeding in elderly patients. Eur J Intern Med 2019;61:54-61.  Back to cited text no. 18
Sengupta N, Tapper EB, Patwardhan VR, Ketwaroo GA, Thaker AM, Leffler DA, et al. Risk factors for adverse outcomes in patients hospitalized with lower gastrointestinal bleeding. Mayo Clin Proc 2015;90:1021-1029.  Back to cited text no. 19
Strate LL, Syngal S. Timing of colonoscopy: Impact on length of hospital stay in patients with acute lower intestinal bleeding. Am J Gastroenterol 2003;98:317-22.  Back to cited text no. 20
Niikura R, Nagata N, Yamada A, Honda T, Hasatani K, Ishii N, et al. Efficacy and safety of early vs elective colonoscopy for acute lower gastrointestinal bleeding. Gastroenterology 2019;158:168-75.  Back to cited text no. 21
Early DS, Ben-Menachem T, Decker GA, Evans JA, Fanelli RD, Fisher DA, et al. Appropriate use of GI endoscopy. Gastrointest Endosc 2012;75:1127-31.  Back to cited text no. 22
Akere A, Oke TO, Otegbayo JA. Colonoscopy at a tertiary healthcare facility in Southwest Nigeria: Spectrum of indications and colonic abnormalities. Ann Afr Med 2016;15:109-13.  Back to cited text no. 23
[PUBMED]  [Full text]  
Olorunda R, Abdulkareem FB. Fifty-three years of reporting colorectal cancer in Nigerians-a systematic review of the published literature. Niger Postgrad Med J 2014;21:68-73.  Back to cited text no. 24
Irabor DO, Afuwape OO, Ayandipo OO. The present status of the management of colon and rectal cancer in Nigeria. J Cancer Research 2014, Article ID 267190.  Back to cited text no. 25
Silas OA, Manasseh AN, Musa J, Dauda AM, Zoakah AI, Mandong BM, et al. Changing patterns in trend of top 10 cancers in the Jos University Teaching Hospital's (JUTH) cancer registry (1996-2018), Jos, north-central Nigeria. J Med Trop 2019;21:81-86.  Back to cited text no. 26
  [Full text]  
Aliyu S, Ningi AB, Babayo UD. The Burden of Colorectal Cancers in Nigeria: Patterns and Presentations in North-Eastern Nigeria. J Anaesth Surg Res 2020;3:1-14.  Back to cited text no. 27
Ray-Offor E, Gbaanador GBM, Madubuike CO, Obiorah CC, Jebbin, NJ. Colorectal Cancer in Niger Delta, Nigeria: Multi-centre lower gastrointestinal endoscopy study. J Med Res Case Rep 2020;2:1-5.  Back to cited text no. 28
Umana IO, Obaseki DE, Ekanem VJ. The clinicopathological features of lower gastrointestinal tract endoscopic biopsies in Benin City, Nigeria. Saudi Surg J 2017;5:9-20.  Back to cited text no. 29
  [Full text]  
Asombang AW, Madsen, R, Simuyandi, M, Phiri G, Bechtold M, Ibdah JA, et al. Descriptive analysis of colorectal cancer in Zambia, Southern Africa using the National Cancer Disease Hospital Database. Pan Afr Med J 2018;30:248.  Back to cited text no. 30
gyemang-Yeboah F, Yorke J, Obirikorang C, Batu EN, Acheampong E, Frempong EA, et al. Patterns and presentations of colorectal cancer at Komfo-Anokye teaching hospital Kumasi, Ghana. Pan Afr Med J 2017;28:121.  Back to cited text no. 31
Medhin LB, Achila OO, Abrham AT, Efrem B, Hailu K, Abraha DM, et al. Incidence of colorectal cancer in Eritrea: Data from the National Health Laboratory, 2011-2017. PLoS One 2019;14:e0224045. doi: 10.1371/journal.pone. 0224045.  Back to cited text no. 32
Katsidzira L, Gangaidzo I, Thomson S, Rusakaniko S, Matenga J, Ramesar, R. The shifting epidemiology of colorectal cancer in sub-Saharan Africa. Lancet Gastroenterol Hepatol 2017;2;377-83.  Back to cited text no. 33
Graham A, Adeloye D, Grant L, Theodoratou E, Campbell, H. The incidence of colorectal cancer in sub-Saharan Africa: A systematic analysis. J Glob Health 2012;2:020404.  Back to cited text no. 34


  [Table 1], [Table 2], [Table 3]

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