Peptic Ulcer Disease among Patients Undergoing Upper Gastrointestinal Endoscopy in a Tertiary Care Centre: A Descriptive Cross-sectional Study

ABSTRACT Introduction: Peptic ulcer is a common disease of gastrointestinal tract usually present with epigastric pain and discomfort. Upper gastrointestinal endoscopy is its gold standard investigation. There has been limited study on the prevalence of peptic ulcer disease among patients undergoing upper GI endoscopy especially in Nepal. Our study aimed to find the prevalence of peptic ulcer disease among patients undergoing upper GI endoscopy at our center. Methods: A descriptive cross-sectional study was conducted among patients undergoing upper gastrointestinal endoscopy at a tertiary care center from October 1, 2022 to March 31, 2023. Data was retrieved from hospital records using a preformed proforma and sample size of 219 was calculated and data of 273 cases was collected using the convenience method of sampling. Results: Among 273 patients, peptic ulcer disease was found in 29 (10.62%) of patients among which 28 (10.25%) had antral ulcer and only 1 (0.36%) had duodenal ulcer. Conclusions: The prevalence of peptic ulcer disease is lower in our study center compared to other studies and further studies can be conducted on the associated risk factors and socio-demographic distribution of peptic ulcer disease.


INTRODUCTION
Peptic ulcer disease (PUD) is defined as disruption in gastrointestinal (GI) tract epithelium extending upto muscularis propria and usually involves stomach and proximal duodenum but may extend upto the lower esophagus, distal duodenum, or jejunum. 1 PUD is a common disease with prevalence of 5-15% among adult population of world. 2,3tient usually present with epigastric pain, discomfort, anorexia and weight loss and has complications like upper GI bleeding, perforation or gastric outlet obstruction. 4Helicobacter pylori infection and Nonsteroidal anti-inflammatory drugs (NSAID) use are the major cause of PUD, which is still high in developing country whereas emerging antimicrobial resistance pose a therapeutic challenge. 5,6Though PUD is a common disease presentation in gastro medicine OPD, there has been limited study on its prevalence among patients undergoing upper GI endoscopy.
In Nepal our study aimed to find the prevalence of peptic ulcer disease among patients undergoing upper GI endoscopy at center.

METHODS
This study was a descriptive cross-sectional study conducted among adults undergoing upper gastrointestinal endoscopy at a tertiary care center, Kathmandu Medical College Teaching Hospital, Nepal.We retrieved the medical records of all the patients who presented with gastrointestinal symptoms and underwent upper GI endoscopy from October 1 2022 to March 31 2023.Ethical clearance was obtained from the Institutional Review Board (Reference number: 21042023/06).No identifiable individual information was used and patient records were removed before being included in the analysis.Adult patients presenting with gastrointestinal symptoms undergoing upper GI endoscopy during the study period were included in the study.Convenience sampling was done.The sample size was calculated using the formula:

RESULTS
Among 273 patients, where 128 (46.90%) of them were male and 145 (53.10%) of them were female, peptic ulcer disease was detected in 29 (10.62%) of patients undergoing upper GI endoscopy.Out of the 29 patients diagnosed with peptic ulcers, 15 (51.72%) were female, and 14 (48.27%) were male, with a confidence interval of 95%.

DISCUSSION
Among 273 individuals who had upper GI endoscopy in our study, 29 (10.62%) had peptic ulcer disease (Table 1).Similar research on gastrointestinal endoscopies on 2735 symptomatic patients in the Van region revealed a somewhat greater prevalence of peptic ulcer disease 298 (10.9%) in those patients than in our study. 9Similarly there are other studies with higher prevalence of peptic ulcer disease than of ours. 7,8,10In another similar study, peptic ulcer disease was found to be significantly lower where it was 27 (8.47%) of symptomatic patients undergoing upper GI endoscopy. 6Also in our study, females had a slightly greater proportion of peptic ulcer disease than males: 15 (51.72%) vs 14 (48.27%).8][9][10][11][12][13] The age range of 30-39 years, which accounted for 15 (51.72%) of all cases, showed a high frequency of PUD (Table 2).In some other similar studies peptic ulcer disease is most commonly seen in the age group of 40-50 years. 9,11Work, busy schedule, as well as inappropriate and irregular eating habits may be the reason for high prevalence of peptic ulcer in middle aged people.
Out of 29 peptic ulcers, 28 (96.55%) had antral ulcer and only 1 (3.45%) had duodenal ulcer.Similar to our study, gastric ulcer occurred higher than duodenal ulcer in a study among asymptomatic patient under upper GI endoscopy. 12In contrast to our study, many of the studies showed higher prevalence of duodenal ulcers than gastric ulcer. 9,11number of studies carried out over the previous 20-30 years have shown a sharp decline in the prevalence of PUD, PUD-related hospital admissions, and PUDassociated mortality as a result of the use of new anti-PUD therapies, such as the removal of Helicobacter pylori (H.pylori) and the use of proton-pump inhibitors (PPIs). 14The picture of PUD has evolved recently, though, as increased physiological stress, histamine 2 receptor antagonists, and selective serotonin reuptake medications, along with their widespread use, have been identified as risk factors. 14ince the study is done only in a single medical institution and in a single nation, this research cannot be generalized to all the patients of other places.Also, as convenience sampling was used, selection bias and sampling bias was unavoidable.

CONCLUSIONS
Our study demonstrated a relatively lower proportion of peptic ulcer among patients undergoing upper GI