Assessment Of Public Perception On The Risk Factors Associated With Peptic Ulcer Disease Among Women In Rivers State
Peptic ulcer disease (PUD) is an erosion in the gastrointestinal mucosa with extension into muscularispropria. Peptic ulcer perforation is the second most common complication of PUD after bleeding peptic ulcers. There is paucity of data on magnitude and predictors of outcomes of perforated peptic ulcers among patients with acute abdomen in our setting and this study aimed to address such an existing gap. To determine magnitude and predictors of outcomes of perforated peptic ulcer among patient with acute abdomen at Iringa and Dodoma hospitals in Nigeria. This was a hospital based prospective longitudinal study conducted at Iringa and Dodoma regional referral hospitals from June, 2020 to december 2020. Acute abdomen was diagnosed based on history taking, physical examination, chest x-ray, abdominal ultrasound and perforated peptic ulcer confirmed at laparotomy. Surgical procedure performed, postoperative management and complications developed were all entered in the questionnaire, all patients were followed until discharge. Sample size was calculated using Kislie formula. Filled questionnaires were entered in statistical program and analyzed using SPSS version 25. Categorical variables were summarized into frequency and percentages, while numerical variables were summarized into means, median and standard deviation and a probability value (pvalue) of <0.05 was considered to be statistically significant. Of187 patients with acute abdomen53 had perforated PUD giving a proportion of 28.3%. 32(60.4%) were males and 21(39.6%) were females giving a male to female ratio of 1.5:1.The patient’s ages ranged from 15 to 70 years with a mean age of 38.54±16.36. The peak age group was in the 4th decade (30-40 years). Comorbid conditions were present in 18(34.0%) of cases. NSAIDs use was observed in 13(24.5%) patients.Forty-three (81.1%) patients presented to hospital after 24 hours of perforation. Of those 48 who had x-ray done 34(71.0%) had pneumoperitoneum on chest x-ray at presentation. Modified Graham’s patch was performed to 51(96.2%) and one patient underwent Billroth II partial gastrectomy. Postoperative complications occurred in 23(43.4%). 7 patients died giving a mortality of 13.2%. Perforated peptic ulcer has a higher magnitude among patients with acute abdomen in our setting. Timely presentation and management can reduce adverse outcomes. Advanced age, hyper or hypokalemia, long hospital stay and low hematocrit significantly predicted poor outcomes.
Keywords: Perforation, Peptic ulcer disease, omental patch, secondary peritonitis
1.1 Background of the Study
Peptic ulcer disease (PUD) is caused by an imbalance between acid secretion and acid-resistant mucosal defenses. Furthermore, investigations have shown a substantial link between H. pylori stomach antral infection and peptic ulcer disease. H. pylori infects more than 90% of patients with peptic ulcer disease, and eradicating the infection not only cures most uncomplicated ulcers but also dramatically reduces the risk of recurrent ulceration [Leontiadis,2007]. H. pylori infection affects about half of the world’s population, with rates as high as 80 percent to 90 percent in underdeveloped countries and 35 percent to 40 percent in the United States [Rosenstock, 2003]. H. pylori is thought to infect half of the world’s population, making it one of the most frequent bacterial infections in humans [Lee, 2017]. Approximately 20% of people infected with H. pylori develop gastroduodenal diseases during the course of their lives. Several studies in Iraq have been undertaken to determine the prevalence of H. pylori infection in peptic ulcer disease, with estimates ranging from 60% to 70% [Bhatia,2005]. The frequency of H. pylori infection among children in Egypt was 10% [Brzozowski,2008]. Between 1991 and 2000, there were 9323 deaths in Sweden owing to stomach cancer [Snowden, 2008]. In impoverished nations, the yearly incidence of H. pylori infection is roughly 4% to 15%, compared to around 0.5 percent in industrialized countries [GBD, 2013]. Low socioeconomic position, overcrowding, and inadequate sanitation or hygiene were all documented risk factors, which are often linked with underdeveloped countries. The infection was substantially related with socioeconomic situations in infancy, ethnicity, and the existence of dyspeptic disease. In basic studies, rising age, non–white skin tone, large family size, poor socioeconomic circumstances in childhood, larger number of siblings, kid visiting day-care facilities, and presence of dyspeptic symptoms are all linked to public perception of peptic ulcer disease risk factors. In Malaysia, the frequency of H. pylori infection among peptic ulcer disease patients was low, although ethnicity and smoking were important risk factors for infection. Lower socioeconomic groups with poor living standards, congested living situations, low levels of education, and poor hygiene are more likely to get the virus [Campbell,2015].
1.2 Statement of the Problem
The mechanism by which H. pylori causes distinct kinds of lesions in the gastroduodenal mucosa is not completely understood. The kind of peptic ulcer is determined by whether H. pylori infection causes hypochlorhydria or hyperchlorhydria. H. pylori infection is mostly mediated by cytokines that limit parietal cell secretion, but it may also directly alter the H+/K+ ATPase-subunit, activate calcitonin gene-related peptide (CGRP) sensory neurons connected to somatostatin, and reduce gastrin formation [Malfertheiner,2005]. Despite the fact that hyposecretion is linked to the development of gastric ulcers, 10–15 percent of individuals with H. pylori infection had enhanced gastric secretion due to hypergastrinemia and lower antral somatostatin levels [Bakka,2002]. Despite the use of H. pylori eradication treatment, proton-pump inhibitors (PPIs), and enhanced endoscopic therapeutic options available in recent decades, the death rate linked with PUD has not reduced in lockstep with the incidence rate. As a result, we want to enforce PUD prevention by identifying risk factors. The public view of the risk factors linked with peptic ulcer disease among women in Rivers State is investigated in this research.
1.3 Objective of the Study
The primary objective of the study is as follows
- To investigate public perception on the causes of peptic ulcer disease.
- To examine public perception on the effect of peptic ulcer disease among women in Rivers state.
- To find out public perception on the challenges peptic ulcer disease patient go through in finding solution to the disease.
- To find out public perception on the probable solution to peptic ulcer disease among Rivers women.
1.4 Research Questions
The following questions have been prepared for this study
- What is the public perception on the causes of peptic ulcer disease?
- What is the public perception on the effect of peptic ulcer disease among women in Rivers state?
- What is the public perception on the challenges peptic ulcer disease patient go through in finding solution to the disease?
- What is the public perception on the probable solution to peptic ulcer disease among Rivers women?
1.5 Significance of the Study
This study examines public perception on the risk factors associated with peptic ulcer disease, hence it will be of benefit to health workers as it will help them know the right approach to go about treating peptic ulcer patient.
The study will be of benefit to the academic community as it will contribute to the existing literature.
1.6 Scope of the Study
This study will investigate public perception on the causes of peptic ulcer disease. The study will also, examine public perception on the effect of peptic ulcer disease among women in Rivers state. More so the study will find out public perception on the challenges peptic ulcer disease patient go through in finding solution to the disease. Lastly, the study will find out public perception on the probable solution to peptic ulcer disease among Rivers women. Hence this study will be delimited to Rivers state.
1.7 Limitation of the Study
This study was constrained by a number of factors which are as follows:
Just like any other research, ranging from unavailability of needed accurate materials on the topic under study, inability to get data
Financial constraint, was faced by the researcher ,in getting relevant materials and in printing and collation of questionnaires
Time factor: time factor pose another constraint since having to shuttle between writing of the research and also engaging in other academic work making it uneasy for the researcher
1.8 Definition of Terms
Peptic Ulcer Disease:
A sore on the lining of your stomach, small intestine or esophagus
Conclusion and Recommendations.
Perforated peptic ulcer has a higher magnitude among patients with acute abdomen in our setting. Advanced age, hyper or hypokalemia, long hospital stay and low hematocrit significantly predicted poor outcomes. Timely presentation and management of patients with perforated peptic ulcer can reduce adverse outcomes observed in this study.
Repair with pedicle omental patch was done to 51(96.2%), simple repair to 1(1.9%) and one Billroth II gastrectomy(1.9%) was performed. This appear to be similar to what was found in Nigeria by(Dongo et al., 2017) where Graham’s Omentopexy was the procedure of choicesame as observed in Ethiopia by(Bupicha & Gebresellassie, 2020). This is because Graham’s omentopexy has fair results when used by providing an extra seal and blood to repaired ulcer.
Peritoneal collection was seen in all patients and ranged between 2-6 liters in the current study, dissimilar to 74% and less than a liter which was observed by (Bupicha & Gebresellassie, 2020). In this study significant morbidities (SSI, reperforation and burst abdomen) were observed in 18 of 53(34%) patients, lower to what was reported by (Thorsen et al., 2014) but higher compared to a study in Ethiopia (Bupicha & Gebresellassie, 2020) which was (16.5%), this may be due to peritoneal contaminations by leaked fluid leading to fulminant peritonitis and subsequent wound infection mostly to those with late presentation to health facilities.
Leakege from repaired ulcer occurred in 2(3.8%) in this study, which was slightly lower to 5.8% observed in a study done in Norway by (Thorsen et al., 2014). It may due to different surgical techniques used such as open and laparoscopic procedure used in the former study.
We observed seven postoperative deaths making fatality rate of 13.2% similar to that observed in tertiary hospital in Northern Nigeria by (Chalya et al., 2011) which was 10.7%, this may be due to similar geographical region, but higher to what was observed in Korea where the overall 30-day PPU mortality rate was 3.17%, for patients older than 60 years and 1.05% for patients younger than 60 years (Bae et al., 2012).
In this study, 56.6% of all the patients had no complications and they stayed less than 7 days in the hospital, similar to a study done in Kenya by (Kinghomella, 2015), which found 59% had no complications and stayed less than ten days in the hospital. 42.3% patients had complications in which surgical site infection was the most frequent in agreement with a study done by (Ugochukwu et al., 2013) from Nigeria who reported the same findings
- Perforated peptic ulcers are associated with high morbidity and mortality which are partly attributed by shock to patients on presentation to the hospital due to delay, leading to hemodynamic instability and or death. A timely surgery within 24hours of onset of symptoms will reduce adverse outcomes which may be attributed by delays.
- Hyper or hypokalemia and anaemia was significantly associated with poor outcomes, I therefore imphasize on pre and postoperative electrolyte and level of hemoglobin investigations to all patients with perforated PUD.
- Further research is recommended to evaluate prevalence of Helicobacter pylori and malignancy among patients with perforated peptic ulcers which our study did not ascertain or include.
- The study involved two Regional Referral Hospitals in Dodoma and Iringa in Nigeria, hence can be inferred to these areas.
- The presented data were under direct observation as they were collected by researcher and well trained research assistants and examined by researcher hence it appears to be of greater validity.
The study was done at regional referral hospitals where some investigations like arterial blood gases (ABG) and serum lactate are not done which are also helpful in predicting the outcomes of the patients with PPU.
Few numbers of patients with PPU regardless of large number of patients presented with acute abdomen, which may be due to some of the patients being operated in other peripheral health facilities.
The study didn’t consider the size of the perforation.
The study did not include H pylori and histopathology of the tissue biopsy taken during surgery.
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