Upper Gastrointestinal Bleeding in Nigeria: A Systematic Review of Aetiology, Demographic Patterns, and Regional Variations

Abstract

Background: In Nigeria, upper gastrointestinal bleeding (UGIB) is a life-threatening medical emergency with an estimated death rate of 30%. There is limited comprehensive data on its epidemiology and regional distribution, which impedes efficient healthcare strategies. This is a systematic review that combines existing evidence regarding the prevalence, aetiology, and demographic trends of UGIB in Nigeria. Methods: We searched PubMed, Google Scholar, AJOL, Scopus, and WHO Global Health Library (2000-2024) using PRISMA guidelines to locate studies that reported UGIB prevalence, incidence, or aetiology in Nigeria. Inclusion demanded primary data from Nigerian observational studies (English language). The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of studies. Data were narratively synthesised owing to expected heterogeneity. Results: Six studies involving a total of 1,047 study participants met the inclusion criteria. No studies reported national prevalence or incidence rates. A striking male predominance was consistent (pooled average: 69.6%; M:F ratio ~2.3:1), with a mean age range of 43.5-52.4 years. Significant regional variations in aetiology were found: • North-West Nigeria: Oesophageal varices were the leading cause (46.5%). • South-West, South-South & North-Central Nigeria: Peptic ulcer disease (PUD) was predominant (prevalence: 32.8%-53%), followed by varices (12.4%-25.6%). Gastritis/erosions (5.1%-35.7%) and malignancies (4.2%-8.5%) were also significant. A notable proportion (7.6%-26.2%) had no identifiable lesions. Studies were absent from the South-East and North-East regions. Conclusion/Recommendation: UGIB in Nigeria typically occurs in middle-aged males and shows significant etiological regional variation, with varices being preponderant in the North-West and PUD prevailing elsewhere. A key evidence gap is the critical absence of population-based prevalence/incidence estimates and a comprehensive assessment of risk factors. Results highlight the necessity of region-specific prevention efforts (e.g., varices in the North, NSAID abuse/PUD in the South), improved endoscopic access, and strong multi-regional research to define accurate disease burden and shape national policy.