Adherence to guidelines of managing peptic ulcer disease at Mulago Hospital

Abstract

Background. Peptic ulcer disease (PUD) is defined as the mucosal break of the upper gastrointestinal tract due to acid peptic digestion which results in ulcer formation that extends beyond the muscularis mucosae into the submucosa. Globally over 250,000 people die from Peptic Ulcer Disease (PUD) each year, 70% of which are due to perforated disease. This study aims to identify the diagnostic tests for PUD and to assess the treatment of PUD at Mulago hospital in line with the Uganda Clinical Guidelines (UCG), 2016. Methodology. A descriptive retrospective study design involving a 1-year chart review of patients diagnosed with PUD and managed for PUD at Mulago hospital in the year 2020 to 2021 was done. The sample size of the study was 80 files which were selected by simple random sampling technique. However, only 65 files met our inclusion criteria and were thus reviewed and the data collected was entered into excel spreadsheets and STATA version 14.0 for analysis. Results. Out of the 65 files selected, 5 (7.7%) were for patients aged between below 20 years, 38 (58.5%) for 21-40 years, 14(21.5%) for 41-60 years and 8(12.3%) for patients above 61 years. Female were 43(66%) and males were 22(34%). The most marked presenting complaints were epigastric pain that worsens with eating 30(46%), epigastric pain that reduces with eating 23 (35%) and nausea and vomiting at 14(26%). The commonest risk factor identified was irregular meals 17 (26%), use of NSAIDs 6(9%) and stress 3 (5%). Endoscopy 61(94%) and stool antigen test 43(66%) were the commonest diagnostic tests for the diagnosis of PUD. Among the medication prescribed, esomeprazole 24(36.9%), followed by Triple therapy 20(30.85%) was most prescribed. Conclusions. The most commonly ordered investigation was endoscopy followed by the stool antigen test. The most prescribed medication was esomeprazole and then triple therapy, with percentage adherence of 38.46%. . There is therefore need to conduct further research in lower health facilities since results of this study are not generalised.