Background: Prevalence of Peptic Ulcer Disease (PUD) is decreasing in developed countries since the use of the treatments for eradication of Helicobacter pylori. Objectives: To revalue the sociodemographic, clinical and evolutionary aspects of the PUD among hospitalized patients in CHUYO. Methodology: This prospective study is related to 65 files of patients hospitalized in hepato-gastroenterology and general surgical services of the CHUYO between March 1st and August 31st, 2015. Results: Hospital utilization rate was 6.59%. The average age of patients was 40.6 years with extremes of 17 and 80 years. The sex ratio was 9.8. The location of the ulcer was 69.23% in stomach. A notion of taking aggressive gastrointestinal products was found in 62 patients (95.4%). The clinical picture was represented by diffuse abdominal pain (76.92%), peritoneal irritation syndrome (64.61%) and epigastric pain (56.92%), anemia (23.07%). Gastric perforations (64.61%) and gastrointestinal bleeding (12.30%) were the main complications. Consumption of non-steroidal anti-inflammatory drugs (NSAIDs) was found in 81.5% of cases. The management was medical and/or surgical with an overall mortality rate of 7.7%. Conclusion: The PUD rate decreased from 10.12% to 6.59% in 5 years. The complications are dominated by stomach perforations. They are relative increase and seem related to NSAIDs. Better management of this disease requires awareness of the population to self-medication.
The Peptic Ulcer Disease (PUD) is a universal affection affecting about eight to ten percent people in Occident. It is a public health problem because of its prevalence, the risk of complications and socioeconomic impact (absenteeism, high cost of the explorations and treatments). Studies led in Australia and in Great Britain gave prevalence between 5.2% and 9.9% in the general population [
The advent of potent inhibitors of gastric secretion and eradication of Helicobacter pylori has revolutionized the treatment of peptic ulcer disease (PUD) [
In Burkina Faso, an earlier study conducted in 2010 on the gastroduodenal ulcer prevalence reported his hospitalization rate to 10.12% [
The purpose of this study was to reassess the sociodemographic, clinical and evolutionary aspects of peptic ulcer disease in hospital at the University Hospital Yalgado Ouédraogo.
A prospective and cross-sectional study was conducted among patients hospitalized in the period from 01 March to 31 August 2015 or 6 months in the service of Hepato- Gastroenterology (HGE) and General and Digestive Surgery (CGD). The diagnosis of peptic ulcer disease was selected based on the results of gastroscopy and/or surgery.
Inclusion criteria: All patients, of all sexes, and hospitalized with a clinical case in which the diagnosis of peptic ulcer disease has been retained on the records of gastroscopy and/or surgery.
The selection of the study population was made from an interview and physical ex- amination. The studied variables were sociodemographic data, personal history, clinical and laboratory data, treatment history, and evolutionary aspects.
The socioeconomic level was evaluated based on means of transportation into three levels: low (walking, bicycle), medium (motorbike) and high (personal vehicle).
Data were analyzed using software Epi-info 3.5.4 of the French version and Excel 2007.
Sixty-five cases of patients with PUD in both services were found during the study period among 986 patients. In total the PUD rate was 6.59%. The frequency of the PUD was 12.23% in the HGE Service (23 cases out of 188) and 5.26% by CGD (42 cases out of 798).
Age and sex of patients
Ages ranged between 17 and 80 years with a mean of 40.6 years (42.4 years for Duedonal Ulcer and 40.29 for Gastric Ulcer).
There were 59 men (90.8%) and 6 women (9.2%) as a sex ratio of 9.8.
The distribution of patients by socio-economic level and origin is summarized in
Antecedents
Thirteen persons (20%) were already been treated by anti-ulcer treatment. This treatment was essentially based on inhibitors of proton pump.
The main clinical signs depending on the location were represented in
Different clinical forms of PUD are shown in
The site of perforation was gastric (anterior antrum) in 95.2% and 4.8% was duodenal.
Frequency | Percentage | |
---|---|---|
Socioeconomic level | ||
Average | 49 | 75.4 |
Low | 14 | 21.5 |
high | 2 | 3.1 |
Living | ||
Urban | 27 | 41.5 |
Rural | 25 | 38.5 |
Semi urban | 13 | 20 |
Antecedents | UG | UD | UGD |
---|---|---|---|
Epigastralgia | 30 | 13 | 43 (66%) |
PUD | 0 | 2 | 2 (3.07%) |
NSAIDs | 38 | 15 | 53 (81.5%) |
Alcohol | 22 | 10 | 32 (49.2%) |
Tobacco | 23 | 10 | 33 (50.8%) |
Spices | 20 | 9 | 29 (44.6%) |
Treatment antiulcer | 5 | 8 | 13 (20%) |
UG: Gastric Ulcer; UD: Duodenal perforation; UGD: Gastro Duodenal Ulcer.
Clinical signs | U.G | U.D | UGD |
---|---|---|---|
Peritoneal irritation | 40 | 2 | 42 (64.6%) |
Epigastralgia | 35 | 12 | 37 (56.9%) |
Diffuse abdominal pain | 40 | 10 | 50 (76.9%) |
Hematemesis/melena | 2 | 6 | 8 (12.30%) |
Clinical anemia | 5 | 10 | 15 (23.07) |
Rectal bleeding | 1 | 0 | 1 (2%) |
UG: Gastric Ulcer; UD: Duodenal perforation; UGD: Gastro Duodenal Ulcer.
Clinical forms | Frequency | Percentage |
---|---|---|
Duodenal perforation | 2 | 3.1 |
Gastric perforation | 40 | 61.5 |
Uncomplicated duodenal ulcer | 11 | 16.9 |
Uncomplicated gastric ulcer | 4 | 6.2 |
Hemorrhagic ulcer duodenal | 7 | 10.8 |
Hemorrhagic ulcer gastric | 1 | 1.5 |
Total | 65 | 100 |
Gastroscopy was performed in 23 patients or 35.38% of patients. Duodenal localization was predominant in 18 patients (78.3%) against five cases (21.7%) for gastric localization.
The ulcer was located on the anterior surface of the bulb in eight cases (34.8%), on the floor in four cases (17.4%), on the rear side in four cases (17.4%) and the roof in eight cases (8.7%). In the stomach, ulcer was located at the prepyloric lair in two cases (8.7%), the juxtapylorique lair in two cases (8.7%) on the lesser curvature in one case.
The macroscopic appearance was dominated by oval type in 52.38% of cases.
It was conducted a sample (biopsy or resection surgical specimens) in 43 patients (66.15%); histological analysis of the pieces was made in 26 patients. No malignancy was found in our sampling. A case of intestinal metaplasia was found. Inflammatory aspect of the gastric mucosa was found in all patients. The test for Helicobacter pylori was specified in ten patients and was positive in three patients.
The specific medical treatment consisted of the administration of anti-secretory with or without antibiotics. This treatment was retrieved in all patients and especially based on the intravenous administration initially followed by associated per os relay anti secretory or not to antibiotics.
A surgical intervention was performed in all perforations. The intervention consisted of a cutting of banks followed by suturing the breach: gastric (40 patients either 95.23%) or duodenal (two patients either 4.76%). This practice was completed in all patients with an omentoplasty.
The average hospital stay was 8.2 days with extremes of 3 and 25 days. The
The main complications were suture line failure (1 case) and the parietal suppuration (1 case).
Five patients died during hospitalization (7.7%).
Among the deceased patients, three (7.14%) had perforation. The other deaths were related to the presence of severe comorbidity including primary liver cancer.
The specific rate of perforations mortality rate was 7.14%.
Complete healing after endoscopic control was observed in 18 patients (72%). In seven cases (28%), control has still found an ulcer.
In our study, the overall prevalence of peptic ulcers was 6.59%. An earlier study by
Millogo [
In Brazil, Carli DM et al. [
New studies on the current prevalence of PUD in other health facilities in Ouagadougou are needed to confirm this downward trend.
The average age of our patients was 40.6 years. Our results confirmed those of other African authors including Millogo [
Our study found male predominance reported by most authors [
At the first rank of the gastro-toxic drugs involved in PUD, NSAIDs were found in 53 patients (81.6%). Of these, 69.8% showed gastroduodenal perforations and 30.2% were hospitalized in the Gastroenterology service. This strong association of NSAIDs to PUD especially to acute complications was also reported at 46% by Ibara [
The factors related to tobacco, alcohol and spices were found in respectively 50.8%, 49.2% and 44.6% patients. Ibara et al. [
The consumption of tobacco and alcohol was observed in our study with great frequency. This finding corroborates the results of many authors who [
Gastric localization was 2.25 times more frequent than duodenal in our study. This finding was not found in the literature and was opposed to the results reported by several authors [
This discrepancy could be explained by the diagnostic confusion between intraoperative duodenal and gastric location that is attributable to the effect of anesthesia; anesthesia could lead to a relaxation and a dilatation of pyloric, important reference that separates the lair of the bulb; this situation makes difficult to assess the boundaries between the pyloric and duodenal bulb. Indeed we found that for the case of PUD confirmed by gastroscopy which is the diagnostic test of reference, the UD/UG ratio (18/5) was comparable to that found in literature. In contrary, the diagnoses made during surgery show a clear predominance of gastric location. More than half of the cases in our study (64.61%) were diagnosed intraoperative, the trend of our study was therefore determined by this method.
The clinical cases in our study were dominated by complications 76.9% or 50 cases. In a study conducted in Spain, Perez [
Hemorrhagic complications were found in eight patients. This was hematemesis associated to melena in five patients. Ibara [
The specific rate of perforations mortality rate was 7.14%. This specific mortality varies according to different authors: 19.3% with Gona in Ivory Coast [
PUD rate in hospital increased from 10.12% to 6.59% in 5 years. This decline may be related to treatment of Helicobacter pylori eradication commonly prescribed by practitioners. The complications are dominated by stomach perforations with a high specific mortality (7.14%). These gastric perforations are increase and seem related to NSAIDs. Better management of this disease requires awareness of the population to self-medi- cation.
Coulibaly, A., Sermé, A.K., Godonou, H., Somda, K.S., Cissé, K., Romond, S., Roch, K., Sombié, R.A. and Bougouma, A. (2016) Peptic Ulcer Disease in CHUYO. Open Journal of Gastroenterology, 6, 353-361. http://dx.doi.org/10.4236/ojgas.2016.611038