Peptic ulceration at Muhimbili Medical Centre at Dar es Salaam

Abstract

Sity peptic ulcer patients diagnosed endoscopical1y or by barium meal or by both and 60 controls matched for age and sex but without abdominal problem were studied between May 17th and November 22nd 1982. The sources of patients were the gastroenterology clinic and proximal endoscopy sessions and that for the controls were the medical wards. The study was both descriptive and analytical. Medical characteristics and psycho social factor wore studied The information was collected by questionnaire an analyzed by TRS 80 computer and electronic calculating machine. In the analytical study the following were the results. The prevalence of peptic ulcer was positively correlated with education, social class, working-extra hours because of benefit derived from it, and death of one of the parents before 16 years. There Was however a. negative correlation with income, number of friends, contact with confident friends, number of reliable people to turn to in times of difficulty and active religious association. e rove were statistically significant at a level of p< 0.05. Contrary to popular belief blood group and urbanization did not have any significant correlation. The descriptive study gave the following results. Most of the patients had duodenal ulcer, duodenal ulcer:gastric ulcer ratio 12.75:1. There was a preponderance of males over females in a ratio of approximately 3:1. The mean age was 36 years 35.79 years with a range of 15 to 72 years 65.52% of the patients had definite stressful events within six months before the onset of the disease (l.1.d 31, 1 d positive family history of a simi1 problem.61., of patients presented with burning abdominal Painful followed by 15.7% who only had abdominal discomfort. 110st of the pain wan felt in the epigastrium followed by umbilical and right hypochondrium (56.9%, 17.25% and 12.07% respectively). Hunger worsened the pain in 8O%t in 43% a big meal worsened the pain but a moderate amount of food relieved it, in 4% any amount of food relieved the pain, in 17% food had no effect and in 36% food made the pain worse.' Radiation of the pain Has inconclusive. 89% had gradual mode of onset and 98% had periodicity. Duration of the pain had a mean of 6.22 years with a range of one week to 30 years. In approximately 50% in each case of malaena or haematemesis there was a positive history. Vomiting did not occur in 37.9~, h d no relationship with pain in 12.07%, relieved pain in 44.83f, and aggravated it in 5.17%. 45% of the patients had epigastric tenderness, no tenderness in 36% and the rest forming the remaining percentage. Only 291 had a positive history of ingestion of ingestion of asprin. Patients had three follow ups at the gastrointestinal clinic at an interval of three weeks each. The Patients were treated With anti-acid magnesium trisilicate antispasmodic sedative combination (belladona with phenobarbitone) one tablet of each When they felt pain. They were also advised to avoid alcohol and smoking and to take frequent milk and frequent moderate quantities of none iritant foods 84% of patients (43 out of 58) who turned up during the first follow up. satisfactory relief and 93% for those who turned up at all the three follow ups on the third follow up satisfactory relief here means some relief to definite relief. It is recommended that dyspepsi clinic be established in peripheral hospitals and to start with Dar es Salaam and manage Patients along the above lines and this 11i11 help to enable patients get proper follow up and lessen the time 'lasted in moving from hospital to the other. A further study is indica.ted to make an index of score based on t e above findings to determine a score will be used to diagnose peptic ulcer in the majority r of our hospitals where we dont have personnel ( equipment for either barium meals n or proximal endoscopies. It is further suggested that since this study touches crudely on the management of peptic ulcer, a subject whose known and unknown knowledge is very vast and further studies are indicated on this. It might prove cheaper to treat patients with, definitely active duodenal ulcer with oimetidine than the conventional methods being used now if you consider that the patients will be able to return to his job earlier. But this needs to be studied to arrive at any conclusion.