We investigated the indications for and findings of gastrointestinal (GI) endoscopy in all children ≤ 16 years old referred for the procedure to the endoscopy unit at Soba University Hospital, Khartoum from January 2004 to January 2006. Thus 113 children were enrolled; 73% underwent upper GI endoscopy, 27% lower GI endoscopy (15% colonoscopy, 12% flexible sigmoidoscopy). Indications for upper GI endoscopy included haematemesis (24%), portal hypertension (21%), abdominal pain (16%) and vomiting (15%). Diagnoses included oesophageal varices (16%), gastritis (7%) and hiatus hernia (6%). Indications for lower GI endoscopy included rectal bleeding (87%), diarrhoea (19%) and anaemia (10%). ‫ﺍﻟﺴﻮﺩﺍﻥ‬ ‫ﰲ‬ ‫ﺟﺎﻣﻌﻲ‬ ‫ﻣﺴﺘﺸﻔﻰ‬ ‫ﺧﱪﺓ‬ ‫ﺍﻷﻃﻔﺎﻝ:‬ ‫ﻋﻨﺪ‬ ‫ﺍﳍﻀﻤﻲ‬ ‫ﺍﻟﺘﻨﻈﲑ‬

Zabargad is a small island located in the Red Sea about 50 km W of its axis, between 23º and 24ºN. The island is not volcanic but probably represents an uplifted block of upper mantle and crustal rocks, and yields information on the nature of the underlying lithosphere. Peridotites are the main rock type, consisting of exceptionally fresh spinel lherzolites, which equilibrated last at a depth >30 km in the mantle. Other ultramafic facies, some representing rocks which mixed with a basaltic melt fraction, and some which underwent metasomatic exchange at depth, are also present. The peridotite bodies are in tectonic contact with a metamorphic formation consisting of gneissic and amphibolitic rocks similar to those outcropping in the Pan African metamorphic basement of eastern Egypt, Peridotites and metamorphic rocks are both crossed by several generations of basaltic dykes. The sedimentary Zabargad Formation, of probable Cretaceous or Palaeocene age, consists of alternations of silicified limestones, sandstones, black shales and phosphoritic lenses, and is overlain by evaporites, probably of Miocene age, and by reef limestone units, one probably of early Pleistocene age, the other probably deposited during the last interglacial. Various formations are affected by localized metasomatic mineralizations (recrystallized large, gem-quality olivine, cancrinite, scapolite. garnierite). The uplift of upper mantle ultramafic bodies with fragments of crust, which created the island, might have occurred in connection with the early stages of development of the rift which preceded the formation of the Red Sea. An alternative explanation, that the Zabargad peridotites are remnants of a Pan-African Palaeozoic ophiolitic complex, is possible but less likely.

The objectives of this study were to define the utility of esophagogastroduodenoscopy in the diagnosis and management of patients presenting with dysphagia and to determine the relative incidence of the various causes of dysphagia in Sudan. This is a prospective, cross-sectional, descriptive, hospital-based study carried out at the endoscopy unit of Soba University Hospital, Khartoum, Sudan. All patients complaining of dysphagia underwent upper gastrointestinal endoscopy with therapeutic intervention when necessary. A total of 114 patients were enrolled in the study, with a mean age of 47 years SD +/- 19 and a male to female ratio of 1 : 1.04. A benign condition was diagnosed in 56% of the cases; this included esophageal strictures in 21% of the cases and achalasia in 14%. Malignant causes were mainly due to esophageal cancer (40.4%) and cancer of the stomach cardia (3.5%). Therapeutic intervention was attempted in 83% of the cases. Risk factors predictive of a malignant etiology were age over 40 years (P < 0.000), dysphagia lasting between 1 month and 1 year (P < 0.000), and weight loss (P < 0.000). A barium study was performed in 35 cases (31%) prior to endoscopic examination and proved to be inaccurate in three cases (8.6%). Upper gastrointestinal endoscopy in our African setting is an accurate and useful investigation in the diagnosis and management of patients presenting with dysphagia. Patients over the age of 40 years presenting with dysphagia and weight loss are more likely to have a neoplastic disease and should be referred for urgent endoscopy.

This study investigates the appropriateness and diagnostic yield of colonoscopy referrals in an African setting using the American Society of Gastrointestinal Endoscopy guidelines: a prospective, descriptive, cross-sectional hospital-based study. A total of 311 patients were included in the study; 228 referrals (73.3%) were considered appropriate and clinically significant pathology was found in 157 patients, giving an overall diagnostic yield of 50.5%. Diagnostic yield in those with appropriate referrals was 58.8% and 27.7% (P = 0.004) in those with inappropriate referrals. In our setting these guidelines are useful in improving diagnostic yield and reducing the rate of inappropriate referrals for colonoscopy. However, patients above the age of 50 presenting with lower gastrointestinal symptoms should undergo a colonoscopy even if the indication was inappropriate, especially in countries which are not implementing colorectal cancer screening programmes for average risk patients.

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