Prevalence Of Peptic Ulcer Disease Among Patients In Primary Health Care Settings

1.1 Background of the Study

A chronic illness known as peptic ulcer arises from an imbalance between endogenous protective factors of gastric mucosa (mucus and bicarbonate secretion, adequate blood flow, prostaglandin E2, nitric oxide, sulfhydryl compounds and antioxidants enzymes, and others) and aggressive factors (acid and pepsin secretions). However, behavioral and environmental factors such as smoking, poor diet, alcohol and non-steroidal anti-inflammatory drugs ingestion, and Helicobacter pylori infection, among others have also been implicated in the etiology of gastric ulcer(Lemos, 2012).

Defining medically,  ulcers are an open sore of the skin or mucus membrane characterized by sloughing of inflamed dead tissue. Lesions on the skin's surface or a mucous membrane that exhibit a superficial tissue loss are called ulcers. Although they can occur practically anywhere, ulcers are most frequently found on the skin of the lower limbs and in the gastrointestinal tract. According to Shoba FG(2014), there are numerous varieties of ulcers, including genital, mouth, esophageal, and peptic ulcers.  

Peptic ulcer disease is often regarded as a mucosal break greater than 3-5 mm in the stomach or duodenum with a visible depth. It is therefore an endoscopic diagnosis in contrast to dyspepsia, which is a clinical diagnosis based on symptoms alone. This disease results from an imbalance between factors that protect the mucosa of the stomach and duodenum, and factors that cause damage to it patients with gastric and duodenal ulcers present similarly. However, patients may report epigastric or retrosternal pain, early satiety, nausea, bloating, belching, or postprandial distress. These symptoms are non-specific and may be difficult to distinguish clinically from functional dyspepsia( Jason, 2019). Beyond that, peptic ulcer is one of the world’s major gastrointestinal disorders and affecting 10% of the world population. About 19 out of 20 peptic ulcers are duodenal. An estimated 15000 deaths occur each year as a consequence of peptic ulcer. Annual incidence estimates of peptic ulcer hemorrhage and perforation were 19.4–57 and 3.8–14 per 100,000 individuals, respectively(Singh, 2018). However, in Nigeria, where self-medication is prevalent, the misuse of NSAIDs without proper medical supervision contributes to the burden of peptic ulcers. The use of NSAIDs, common medications for pain relief among adults in Nigeria especially in Offa can increase the risk of peptic ulcer development.

Furthermore, several factors contribute to the development of peptic ulcers, and understanding these factors is crucial for effective prevention and management. One of the primary culprits is infection with Helicobacter pylori (H. pylori), a bacterium that weakens the protective mucous lining of the stomach and duodenum, making them more susceptible to the corrosive effects of stomach acid.  While the secondary culprits is Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, also play a significant role in peptic ulcer development by interfering with the stomach's ability to protect itself from digestive juices. In addition to these, external factors such as lifestyle choices, genetic predisposition, and stress have been implicated in the pathogenesis of peptic ulcers. However, managing peptic ulcers involves a combination of lifestyle modifications, medication, and, in some cases, surgical intervention. Therefore, a survey will be conducted in order to assess the knowledge and attitude of peptic ulcer among elderly.

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1.2 Statement of the Problem

Despite advances in medical science, the causes of peptic ulcer disease and its management remain complex and multifaceted. However, there are various risk factors associated with the development of peptic ulcers, including H. pylori infection, NSAID use, genetic predisposition, lifestyle choices, and stress. 

Additionally, peptic ulcer disease is a significant health concern in Nigeria, as it is in many parts of the world. The prevalence of peptic ulcers among the elderly in Nigeria is influenced by a combination of factors, including socioeconomic conditions, lifestyle, dietary habits, and the prevalence of Helicobacter pylori (H. pylori) infection.  On the other hand, access to healthcare services and facilities is a significant factor in the management of peptic ulcers. In some regions of Nigeria, especially rural areas, there are challenges in accessing timely and appropriate medical care. Inline with the aforementioned, this study seek to assess the prevalence of peptic ulcer disease among patients in primary health care settings.

1.3 Objectives of the Study

The main purpose of this study is to assess the prevalence of peptic ulcer disease among patients in primary health care settings in Dutse Alhaji, Bwari Area Council, Abuja. Specifically, the study will;

1. Determine the prevalence of peptic ulcers among patients in primary health care settings in Dutse Alhaji, Bwari Area Council.

2. Assess the causes of peptic ulcers among patients in primary health care settings in Dutse Alhaji, Abujat.

3. Assess the effects of peptic ulcer among patients in primary health care settings in Dutse Alhaji, Abujat.

4. Ascertain the attitude towards the management of peptic ulcer among patients in primary health care settings in Dutse Alhaji, Abuja.

1.4 Research Questions

The following questions have been prepared for the study:

1. What is the prevalence of peptic ulcers among patients in primary health care settings in Dutse Alhaji, Bwari Area Council?

2. What are the causes of peptic ulcers among patients in primary health care settings in Dutse Alhaji, Abuja?

3. What are the effects of peptic ulcer among patients in primary health care settings in Dutse Alhaji, Abuja?

4. What is the attitude towards the management of peptic ulcer among patients in primary health care settings in Dutse Alhaji, Abuja?

1.5 Research Hypothesis

Ho: There is no high prevalence of peptic ulcers among patients in primary health care settings in Dutse Alhaji.

Ha: There is a high prevalence of peptic ulcers among patients in primary health care settings in Dutse Alhaji.

1.6  Significant of the Study

This research would provide valuable epidemiological information about the magnitude of the disease which will in turn help to create awareness among the people regarding the disease, will open the gateway for further researches and will help design and implement adequate intervention measures.

Findings and recommendation offered should not only add to existing literature for academic purposes, but also provide useful insights on peptic ulcer incidence nationally and internationally.

1.7 Scope of the study

This study focuses on the prevalence of peptic ulcer disease among patients in primary health care settings in Dutse Alhaji, Bwari Area Council, Abuja. The respondents for this study will comprise of patients in selected primary health care settings in Dutse Alhaji, Bwari Area Council, Abuja.

1.8 Limitation of the study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents.

In addition, there was the element of researcher bias. Here, the researcher possessed some biases that may have been reflected in the way the data was collected, the type of people interviewed or sampled, and how the data gathered was interpreted thereafter. The potential for all this to influence the findings and conclusions could not be downplayed. 

More so, the findings of this study are limited to the sample population in the study area, hence they may not be suitable for use in comparison to other schools, local governments, states, and other countries in the world.

 1.8 Definition of Terms

Ulcers:  are an open sore of the skin or mucus membrane characterized by sloughing of inflamed dead tissue.

Peptic ulcer: is a broad term which includes ulcers of digestive tract in the stomach or the duodenum. 

Gastric Acid: plays a stringent role in gastric defense. It is the first line of mucosal defense to prevent bacterial colonization and reduced their ability to entrance in the mucosal layer

1.10 Organization Of The Study

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the  review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study,  sample size determination,  sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.