Gastrointestinal and hepatobiliary disorders of patients from countries with low to middle income: a retrospective observational study in a Swiss emergency department

Abstract

IntroductionThe composition of Europe has changed drastically in recent decades, and a major contributing factor is the increasing wave of migrants and refugees from countries with low and middle income (LMIC). Switzerland’s resident foreigners make up about a quarter of its citizens. Gastrointestinal (GI)-hepatobiliary pathologies seen in emergency departments include a wide spectrum of interesting conditions, some of which are potentially fatal. The aim of this study was to investigate and analyze all records of adult patients from LMIC admitted to the emergency department (ED) of Bern University Hospital with alleged symptoms of the GI and hepatobiliary systems.Material and methodsAn observational retrospective study was conducted in a single center from 1 January 2013 to 31 December 2016 in LMIC adults who presented at the ED of Bern University with GI-hepatobiliary problems.ResultsAfter reviewing a total of 10,308 cases, 176 cases were found to have GI and hepatobiliary problems. Thirty-six percent (n = 63) of the urgent problems of LMIC patients were hepatobiliary disorders, and acute pancreatitis was the commonest disorder (n = 30, 17%). Female patients were 5.14 times more prone to cholecystolithiasis (gallstones) than male patients (p < 0.01). Likelihood of cholecystolithiasis was significantly higher for European than non-European patients (p < 0.05). Moreover, with increasing age there was an annual 6.0% decrease in likelihood of appendicitis (p < 0.01). Liver cirrhosis was also commoner in non-European patients (p < 0.001).ConclusionsTo our knowledge, this is the first analytical study of the epidemiological aspects of patients from LMIC who presented to a Swiss ED with GI-hepatobiliary problems. Validation from larger studies is warranted to reveal the actual burden of disease.