Upper endoscopy in Solomon Islands: A four-year retrospective study

ObjectiveGastrointestinal diseases are common, yet some countries still lack endoscopy. Modern flexible endoscopy was introduced to the Solomon Islands National Referral Hospital (NRH) in 2012, but little is known about gastrointestinal disease in the country.MethodsThis retrospective cohort study describes trends in upper gastrointestinal diseases to inform local research and health programming. Demographic, clinical, and endoscopic data, including rapid urease test (RUT) results for H. pylori, were abstracted from consecutively entered patient medical records at the NRH.ResultsA total of 761 patients underwent upper endoscopy and RUT (2019-2022). Although RUT was positive in only 25.8% of patients (N = 196), relatively common findings of erosions (N = 90, 11.8%) and ulcers (N = 89, 11.7%), as well as frequently reported symptoms of upper gastrointestinal bleeding (N = 168, 22.1%), suggest a higher true prevalence of H. pylori-associated peptic ulcer disease in this cohort. Age was associated with an endoscopic finding of ulcers on univariate analysis. Multivariable modeling indicated a significant association between the presence of gastric erythema and erosions and the diagnosis of duodenitis. Multivariable regression also showed symptoms of melena and hematemesis to be significantly associated with the endoscopic finding of ulcers. Among patients treated for H. pylori who underwent follow-up endoscopy and RUT, 28.8% failed treatment.ConclusionThere was a high degree of concern regarding gastrointestinal symptomology and pathology in this cohort. Access to endoscopy and RUT in Solomon Islands remains limited to a single endoscopy unit. Future efforts should explore non-invasive clinical pathways for the expansion of RUT and the management of ulcer disease in Solomon Islands.