Peptic Ulcer Disease and Misuses of Ulcer Healing Drugs in a Tertiary Care Hospital in Dhaka City

Khan Abul Kalam Azad,Md Uzzwal Mallik,Md Hafiz Md Hafiz Sardar,Mohammad Murad Hossain,Moumita Chakraborty

doi:10.3329/jom.v16i1.22386

Abstract

This prospective cross sectional study was conducted in Dhaka Medical College Hospital, Dhaka during July, 2013 to December, 2013. Hundred patients were included in this study. Peptic ulcer disease, presented as upper abdominal pain is one of the common disease with a number of underlying causes. Prospective analyses of 100 patients with upper abdominal pain were studied at medicine units of Dhaka Medical College Hospital, Dhaka. Of these 36 patients belonged to peptic ulcer, 20 patients to irritable bowel syndrome and 22 patients to non-ulcer dyspepsia. Next in order were helminthiasis (5 patients), cholelithiasis (4 patients), gastric carcinoma (4 patients), liver abscess (5 patients) chronic pancreatitis (3 patients) and acute pancreatitis (1 patient). Mean age incidence in this series was 39.47 years. Male and female ratio was 1.54:1. Forty patients were smoker with male and female ratio of 3.44:1.All patients had presenting feature of upper abdominal pain. Commonest site of pain was in the epigastrium in 48.08% of cases.Pain was burning in 43.27% cases, periodic pain in 24.03%, and nocturnal hunger pain in 33.65% of cases.Relief of pain after taking food were observed in 38.46%. Epigastric tenderness was present in 56.73% patients.The diagnosis of peptic ulcer disease, irritable bowel syndrome and non-ulcer dyspepsia, the three leading causes of upper abdominal pain, were suspected by history and physical examination but it was difficult to interpret these on clinical ground alone .Some routine and some selected investigation were done for confirmatory diagnosis.In this series, significant disparity detected between clinically diagnosed peptic ulcer diseases 90.38% and endoscopically confirmed peptic ulcer disease, 34.62% cases. As a consequence of wrong diagnosis of PUD, there are huge misuses of ulcer healing drugs and a great economic burden on patients (300 taka per month) and on the nation.DOI: http://dx.doi.org/10.3329/jom.v16i1.22386 J MEDICINE 2015; 16 : 27-34

Highlights

Upper abdominal pain is one of the common complaints of a number of underlying diseases
Materials and methods: All patients irrespective of age and sex presenting with upper abdominal pain in the twelve medicine units of Dhaka Medical College Hospital, Dhaka between July, 2013 and December, 2013 were considered for the study.The diagnostic criteria for a particular disease include its-symptoms, signs and results of investigations
One hundred and four patients were included in the study.Out of total admitted patients, subjects presented with upper abdominal pain were 100 (2.19%) in number, in whom 61(60.58%) were male and 39 (39.42%) were female patients

Summary

Introduction

Upper abdominal pain is one of the common complaints of a number of underlying diseases. There are four types of abdominal pain: a) Visceral- Gut organs are sensitive to distention, contraction, torsion and stretching b) Parietalperitoneum is innervated by somatic nerve and its involvement by disease process e.g inflammation, infection and neoplasm causes sharp, well localized and lateralized pain c) Referred pain- e.g Gallbladder pain is referred to the back or shoulder tip and d) Psychogenic- depression or somatization disorder may be responsible for abdominal pain. 1. FCPS (Medicine), Associate Professor (Medicine), Dhaka Medical College. 2. FCPS (Medicine), Assistant Professor (Medicine), Dhaka Medical College. 3. FCPS (Medicine), MD, FACP, Professor (Medicine), Dhaka Medical College. 4. FCPS (Medicine), Lecturer, Forensic Medicine, Dhaka Medical College

Methods

Results

Discussion

Conclusion