In Africa, the shortage of data impedes understanding of the current epidemiology of upper gastrointestinal disorders [15] and there is almost no insight into trends over time. Towards the end of the twentieth century, the concept of the ‘African enigma’ gained currency, signifying that a high prevalence of H. pylori infection was not matched by a high burden of attributable upper gastrointestinal disease [16]. There is abundant evidence that H. pylori infection is common throughout Africa [17–19]. However, we and others have found that the burden of upper gastrointestinal disorders is actually considerably higher than it appeared at first, and a community survey in Lusaka using endoscopy found that peptic ulcers were present in 4 % of a poor urban community, only half of which were symptomatic [18]. Cancer registry data across Africa are incomplete [20], but such data as exist indicate that oesophageal carcinoma incidence is high [21]. Record linkage methods, used effectively in industrialised countries, are feasible in Africa but the lack of computerised medical records precludes optimal analysis of existing data [22]. As primary health care in sub-Saharan Africa is patchy, and frequently inaccessible to all but the urban middle class, there are few data on the burden of communicable and non-communicable gastrointestinal disorders. Endoscopy units, which are an important source of data on upper gastrointestinal disease [23], are much less well developed in Africa than in industrialised countries, and not many of them have records going back for more than a few years.