Prevalence of gastric cancer and its associated mortality among patients undergoing upper gastrointestinal endoscopy at a tertiary level hospital in Tanzania.

BACKGROUND: Descriptive data on gastric cancer (GC) from African countries are limited. We describe the prevalence, clinicopathological features, short-term outcomes and factors associated with gastric cancer at Muhimbili National Hospital (MNH), which is a tertiary-level facility in Tanzania. METHODS: This cross-sectional study enrolled consenting patients aged ≥ 18 years who underwent diagnostic upper endoscopy at MNH from September 2023 to February 2024. The participants were followed up for 90 days to determine whether they died or developed gastrointestinal bleeding or gastric outlet obstruction. Sociodemographic and clinicopathological data were collected through a questionnaire and analysed via SPSS software. The prevalence of gastric cancer and short-term outcomes are expressed as proportions. Logistic regression analysis was used to test the significance of the associations between predictor variables and gastric cancer. A p value of < 0.05 was considered significant. RESULTS: A total of 870 patients were included, 459 (52.8%) of whom were male. The mean (± SD) age of the participants was 53.3 (± 17.4) years. GC was observed in 77 (8.9%) patients, with a male to female ratio of 0.83:1 and a mean age of 59.4 (± 10.6) years. The symptoms associated with GC were upper abdominal pain in 71(92.2%), weight loss 39(50.6%), abdominal fullness 24(31.2%), and vomiting 23(29.9%). H. pylori antibody testing was positive in 63 (81.8%) GC patients. The antrum was the most common location for GC in 51 (66.2%) patients, with ulcerative morphology in 47 (61.0%) patients. Histologically, 72 patients (96.1%) had adenocarcinomas. H. pylori infection (aOR 4.711; 2.493-8.902; P < 0.001), and cigarette smoking (aOR 2.477; 1.453-4.221; P = 0.001) were independently associated with GC. The 90-day mortality rate was 45.5% (35/77). Within the 90-day follow-up period, 88.3% (68/77) of the patients received palliative care, and 9.1% (7/77) were eligible for curative treatment. CONCLUSIONS: The prevalence of gastric cancer among patients undergoing upper gastrointestinal endoscopy at Muhimbili National Hospital is high. Most patients have advanced disease at presentation, and the 90-day mortality rate is high. Cigarette smoking and H. pylori infection were independently associated with GC in this population.