Burden of peptic ulcer disease among patients with upper gastrointestinal bleeding

Abstract

Background: Peptic ulcer disease continues to be the most common cause of non-variceal upper gastrointestinal bleeding. The clinical presentation varies depending on the intensity of bleeding. It can range from an occult bleed to melena or hematemesis and haemorrhagic shock. The diagnostic procedure Esophagogastroduodenoscopy is gold standard for confirmation of peptic ulcer disease and is also helpful in identification of bleeding source. Irrespective of recent advances in medical treatment of peptic ulcer disease, it is important to quickly identify any signs and symptoms of bleeding. This allows for appropriate management of the bleed at an early stage. Therefore, it is important to know the frequency of peptic ulcer disease amongst upper GI bleeds. Aims and Objectives:The main aim of the current study is to identify the burden of peptic ulcer disease amongst patients with upper gastro-intestinal bleeding. Methodology: This retrospective study on 100 selected patients was conducted at the gastrointestinal unit, department of General Medicine, in a South Asian tertiary care centre, over a period of 6 months between May 2020 to December 2020.This period includes review of literature, collection and analysis of data, discussion and finalization of the report. 100 selected patients presenting to the outpatient department with GI symptoms and upper gastrointestinal bleeding, both male and female and above 18 years of age were enrolled in the study. The patient's medical history was recorded and diagnosis of peptic ulcer disease was confirmed by Esophagogastroduodenoscopy (EGD). Results: Out of 100 investigated cases of upper gastrointestinal bleeding, frequency of peptic ulcer disease was 53, of which 24 were duodenal ulcer, 21 were gastric ulcer,7 were with both gastric and duodenal ulcer and 1 was an esophageal ulcer. The age distribution in the study population ranged from 30 years to 90 years. With the youngest being 33 years of age and oldest 86years. The mean age was 55 years. Out of 100 cases 76 were males and 24 were females, giving a M: F ratio of 3:1.Risk factors included alcohol intake which was seen in 32 patients, smoking was seen in 41, and NSAID's use was seen in 8 patients; out of a total of 100 patients. Conclusion: Knowing the burden of peptic ulcer disease amongst upper gastrointestinal bleeds makes us aware of the morbidity it can cause. This makes us more alert and ensures mandatory evaluation for bleeding in any suspected or confirmed case of peptic ulcer disease.

Clinical Characteristics of Peptic Ulcer Disease & its Pharmacological Management in Primary Care

“…So PPIs are recommended as initial and definitive therapy for most patients. This feature is also similar to another study done by Ahmad Almeman et al 14 All gastric ulcers require repeat endoscopy to evaluate the success of healing.…”

“…Similar findings were found in other studies. [1][2][3]5,6,14,15 As the study was done in peripheral settings so maximum number of patients (58.66%) came from rural areas. Their socioeconomic status remains in the medium category (54.66%).…”

“…Moreover, patients may allow continuing an unhealthy lifestyle which may aggravate the symptom of heartburn and others feature. 14 Some studies even showed that these drugs may delay the diagnosis of gastric cancer 18 and increase the risk of Community-acquired pneumonia. 19 Based on the above discussion, there is no doubt that gastric acid suppressants (eg.…”

“…10 While proton pump inhibitors are undoubtedly effective agents, studies of their prescribing practice consistently suggest overuse of PPIs before endoscopy, use without appropriate indications and prescribing for indications in which less potent agents are used. 14 These issues can produce hazards to health and also an economic burden to the patients. So PPIs should be used in appropriate indications with proper dose & duration.…”