Dyspepsia in Sudan yielded abnormal endoscopy in nearly every case
Chronic upper abdominal symptoms rarely look identical from one setting to another, and this two-center Sudanese series makes that point with unusual force. Among 385 consecutive patients evaluated for dyspepsia between 2016 and 2024, pathologic findings appeared in 91.7% of cases, while 97.4% of patients were undergoing oesophago-gastro-duodenoscopy for the first time. Repeated examinations were even less ambiguous: every repeat OGD showed abnormal findings.
In practical terms, dyspepsia in this cohort was not behaving like a vague symptom alone. It was frequently a marker of visible upper gastrointestinal disease, and the dominant lesion was antral gastritis. That finding is clinically important because antral inflammation often sits at the crossroads of acid exposure, mucosal injury, and, in some patients, broader gastroduodenal irritation that can coexist with duodenitis or bile reflux. The burden of abnormal endoscopy also argues against over-assuming functional disease in resource-limited settings where symptom-based triage can miss treatable pathology.
Age, sex, and the backdrop of armed conflict all shaped the diagnostic picture. The study found a statistically significant association between antral gastritis and age, with a p value of 0.022. Male predominance was seen for bile reflux gastritis, while gastric mass was more common in patients older than 65 years. Those patterns matter because dyspepsia is not a single entity in older adults: inflammatory disease, reflux-related injury, and neoplastic lesions can share the same symptom label while carrying very different risks at the bedside.
Conflict-era shifts changed the symptom profile and the endoscopic mix
The most striking comparison in this series came from the pre-war and post-war periods. Endoscopic results differed significantly for antral gastritis, with a p value of 0.008, and weight loss was more common after the conflict began. That is not a trivial shift. In a population already vulnerable to interruptions in care, stress-related dietary change, delayed presentation, medication shortages, and reduced access to early evaluation can all influence how dyspepsia is expressed and how advanced disease appears when patients finally reach endoscopy.
Armed conflict does not create a new mucosa overnight, but it can alter the conditions under which mucosal disease is detected. Delayed workup tends to enrich a clinic population with more advanced or persistent lesions, while weight loss raises the clinical stakes by nudging the differential diagnosis away from simple dyspepsia and toward ulcer disease, malignancy, or severe inflammatory pathology. The elevated proportion of abnormal findings in this cohort fits that pattern.
Even the distribution of specific diagnoses points to the need for more deliberate endoscopic triage. After antral gastritis, the next most frequent findings were antral gastritis combined with duodenitis and then duodenitis alone. Esophageal findings were mostly normal, suggesting that the symptom complex was usually arising from the stomach and duodenum rather than from primary esophageal disease. For clinicians, that means the symptom “indigestion” should not automatically pull attention upward to the esophagus when the local disease burden sits lower in the upper gastrointestinal tract.
What repeated endoscopy and the age signal mean for practice
Two observations stand out because they connect directly to decision-making. First, repeated OGD never yielded a normal result in this dataset. Second, older age tracked with the more concerning lesions, including gastric mass. Together, those findings support a lower threshold for endoscopic evaluation when dyspepsia persists, recurs, or presents with alarm features, especially in older adults.
This is where pathology and logistics intersect. In lower-resource environments, the cost of missing a structural lesion is high, but so is the cost of indiscriminate endoscopy. A data set showing that more than nine in ten patients had abnormal findings gives local clinicians a stronger case for prioritizing endoscopy when symptoms, age, or weight loss raise concern. At the same time, the high rate of first-time OGD suggests that access barriers may have limited earlier evaluation, leaving endoscopy to function as a late diagnostic checkpoint rather than an early sorting tool.
Context-adapted dyspepsia care needs local endoscopic evidence
The study does not claim universal generalizability, and it does not need to. Its value lies in showing how the presentation of dyspepsia can be shaped by local disease prevalence, age structure, sex distribution, and the pressures of war. In many settings, dyspepsia algorithms are imported from populations with different infection burdens, different cancer profiles, and more stable access to care. A Sudanese cohort seen during and after armed conflict may not follow those templates cleanly.
The pathology observed here points toward a management approach anchored in local endoscopic data rather than borrowed assumptions. Antral gastritis dominated the findings, duodenal disease followed closely behind, and malignancy remained a concern in the oldest patients. Weight loss after the conflict adds another layer of concern because it may signal both worsening nutritional status and more serious organic disease. Those are bedside clues that should not be flattened into a generic dyspepsia label.
The most actionable message is also the simplest: in this setting, dyspepsia was overwhelmingly associated with organic upper gastrointestinal findings. A high abnormality rate, a conflict-associated shift in presentation, and an age-linked signal for more serious pathology argue for context-specific endoscopic pathways in Sudan, especially when patients are older, losing weight, or returning with persistent symptoms. Future work will need to separate the effects of conflict, delayed care, and underlying disease prevalence more precisely, but this retrospective series already shows that local patterns can change fast enough to influence everyday gastrointestinal practice.