Introduction

Peptic ulcer is a chronic disease affecting up to 5-10% of the world’s population. Approximately 500,000 new cases are reported each year, with 5 million people affected in the United States alone. Peptic Ulcer Deaths in Cameroon reach 1,039 or 0.49% of total deaths yearly. It’s a gastrointestinal condition characterized by open sores that develop on the lining of the stomach, small intestine, or esophagus which can be caused by various factors, including infection with Helicobacter pylori bacteria, long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol consumption, and smoking

AIM: Investigating the knowledge, practices and challenges faced by nurses in the management of peptic ulcer disease in patients at Laquintinie Hospital Douala.

METHODOLOGY: It was a descriptive cross-sectional study with a prospective data collection implemented at the Gastroenterology unit, Emergency unit, and the Surgical Department (Theatre and Visceral units) the Laquintinie Hospital Douala from the month of October 2023 to March 2024. A questionnaire was administered to 43 nurses made up of open and close ended questions on their knowledge, practices and the challenges the face regarding peptic ulcer management. The questionnaire was given to each of them and later collected with their response. The data was then analysed using Ms Excel and Ms Word.

RESULT: Among 43 participants, most of the respondents 64.3% had a good knowledge about peptic ulcer disease, 64.3% had a good knowledge on the practices implemented in the management of peptic ulcer disease and 20.9% were found to face challenges in the management of the disease.

CONCLUSION: While majority of the nurses have good knowledge on peptic ulcer and on the practices implemented in its management, it still remains a challenge for some. Therefore, suggest that seminars should constantly be set up to review on the updates regarding the management of peptic ulcer should be regularly held to refresh

CHAPTER ONE

GENERAL INTRODUCTION

1.0 Introduction

An ulcer is an open sore on an external or internal surface of the body, caused by a break in the skin or mucous membrane which fails to heal (Malfertheiner et al., 2009). Peptic ulcer is an acid-induced lesion of the digestive tract that is usually located in the stomach or proximal duodenum (Narayanan et al., 2018). Peptic Ulcer Disease (PUD) is a prevalent gastrointestinal condition characterised by the formation of sores or erosions (ulcer) in the lining of the stomach or the first part of the small intestine. An ulcer in the stomach is called a Gastric ulcer, while one in the first part of the intestines is a duodenal ulcer (Njam WI, 2011). Normally, a thick layer of mucus protects the stomach lining from the effect of its digestive juices. But many things can reduce this protective layer, allowing stomach acid to damage the tissue (Cleveland Clinic, 2020). Peptic ulcer disease is common with a lifetime prevalence in the general population of 5-10% and an incidence of 0.1–0.3% per year (Lanas A and Chan FKL, 2017). Peptic ulceration occurs due to acid peptic damage to the gastro-duodenal mucosa, resulting in mucosal erosion that exposes the underlying tissues to the digestive action of gastro-duodenal secretions (Leow AH et al., 2016). This pathology was traditionally related to a hypersecretory acid environment, dietary factors and stress. However, the increasing incidence of the Helicobacter pylori infection, the extensive use of NSAIDs such as; Aspirin, ibuprofen and naproxen or even both, the increase in alcohol and smoking abuse and Zollinger–Ellison syndrom are associated risk factors that causes the onset of peptic ulcer diseases (Kavitt RT et al., 2019). Complications of peptic ulcer disease include perforation and bleeding but it was found that hemorrhage was by far the most common complication of peptic ulcer disease (Søreide K et al., 2015).

An ulcer is diagnosed by either a barium upper gastrointestinal X-ray (upper GI series) or an upper gastrointestinal endoscopy (EGD or esophagogastroduodenoscopy). The barium upper gastrointestinal (GI) X-ray is easy to perform and involves no risk (other than radiation exposure) or discomfort. An upper gastrointestinal endoscopy is more accurate than X-rays but usually involves sedation of the patient and the insertion of a flexible tube through the mouth to inspect the oesophagus, stomach, and duodenum. Upper endoscopy can remove small tissue samples (biopsies) to test for H. pylori infection (Jay W. et al., 2023).

Nearly all peptic ulcers will be treated with a proton pump inhibitor (PPI) such ass omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), esomeprazole (Nexi um), and rabeprazole (Aciphex). PPIs are powerful acid blocking drugs that can be taken as a pill or given in an IV. PPIs require a meal to activate them. Patients should eat a meal within 30 minutes to 1 hour after taking this medication for the acid suppression therapy to work most effectively. Waiting later than this time can decrease the positive effect of this medication. This might delay healing or even result in the failure of the ulcer to heal (John DeBanto et al., 2021).

1.1.      BACKGROUND

The word peptic ulcer comes from two Greek words peptikos and eli meaning “able to digest” and “wound” respectively (Since 1660), It is defined as a non-malignant mucosal lesion of the stomach or duodenum or both in which occur from over production of acid (Canada verters, 2005). The history of peptic ulcer starts with the identification of duodenal perforation in a preserved body of 167BC in China. In 1670 king Charles I’s daughter Princess Henriette Anne of England died suddenly at the age of 26years a day after she complained of abdominal pain and tenderness. As poisoning was suspected, an autopsy was performed that revealed peritonitis and a small hole in the anterior wall of the stomach (Prabhu & Shivani, 2014). John Lykoudis, a general practitioner in Greece, treated people for peptic ulcer disease with antibiotics beginning in 1958, long before it was commonly recognized that bacteria were a dominant cause for the disease (John Wiley & Sons., 2016). H. pylori was first identified as a causative factor of peptic ulcers by Barry Marshall and Robin Warren in 1982 (Warren JR & Marshall B, 1983)

In 2005, the Karolinska Institute in Stockholm awarded the Nobel Prize in Physiology or Medicine to Marshall and his long-time collaborator Warren “For their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease.” (Barry J. Marshall – Facts – NobelPrize.org, s. d.). In their original paper, Warren and Marshall contended that most gastric ulcers and gastritis were caused by colonization with this bacterium, not by stress or spicy food, as had been assumed before (Barry J. Marshall – Facts – NobelPrize.org, s. d.). The H. pylori hypothesis was still poorly received, so in an act of self- experimentation Marshall drank a Petri dish containing a culture of organisms extracted from a person with an ulcer and five days later developed gastritis (Schluz K, 2010).

In 1997, the Centers for Disease Control and Prevention, with other government agencies, academic institutions, and industry, launched a national education campaign to inform health care providers and consumers about the link between H. pylori and ulcers. This campaign reinforced the news that ulcers are a curable infection and that health can be greatly improved and money saved by disseminating information about H. pylori.

From a review history and treatment of peptic ulcer, approximately two-third of patients were found to have peptic ulcer disease (PUD) are associated to H Pylori infection or the use of non- steroidal anti-inflammatory drugs (NSAID) or both in 1843. H. pylori was first identified as a causative factor of peptic ulcers by Barry Marshall and Robin Warren in 1982 (Wang AY, 2011) for which they received the Nobel Prize in 2005 (Barry J. Marshall – Facts – NobelPrize.org, s. d.) Edward Crips first reported 50 cases of peptic perforation and accurately described the clinical aspects of perforation “the symptoms are so typical; I hardly believe it possible that anyone can fail to make the correct diagnoses”. The basis ideas for treatment came from crips who noted that perforation of the stomach was filled by adhesion to the surrounding viscera which prevented leakage from the stomach into the perineal cavity (Prabhu & Shivani, 2014). Mikulicz Radeck often referred to as the first surgeon who closed a peptic ulcer by simple closure said “every doctor faced with a perforated duodenal of the stomach or intestine must consider opening the abdomen sewing up the hole and averting a possible inflammation by careful cleansing of the abdominal cavity” (Bertleff & Lange, 2010). Although this therapy sounds very simple PUD still remain a dangerous surgical condition associated to high mortality and morbidity which led to the introduction of the Taylor methods of conservation management presented in 1946 based on decompression and continuous drainage will enhance self-healing leading to treatment by nasogastric aspiration antibiotic intravenous fluid (S. Karger, 2010)

The typical patient with PUD are males aged about 48years(29%) (20%)NSAIDS users .H Pylori account for (50% ) (Zapata-Colindres et al., 2006)

1.2.      STATEMENT OF THE PROBLEM

Peptic ulcer disease has gradually become an endemic disease in developing countries specifically in Cameroon (Andoulo F.A., 2015)(WHO, 2018). It is a prevalent gastrointestinal disorder that affects millions of individuals worldwide. Despite of all the technological and treatment schedules implemented by the health bodies, it still has an incidence of 1per 1000 persons which remain a major source of significant mortality and morbidity worldwide (Robert T. Kavitt,MD,MPH et al., 2019).

Nurses play a crucial role in the management of PUD because, they are essential members of the healthcare team who are often at the forefront and involved in the care and management of patients with peptic ulcer disease (Ndip Agbor V. et al., 2019). The problem statement here aims to explore the knowledge practices and challenges faced by these nurses in the management of peptic ulcer disease, with a focus on their understanding of the disease, treatment modalities, patient education, and different challenges nurses still face.

1.3.      RESEARCH QUESTIONS

1. What is the knowledge of nurses regarding the management of peptic ulcer disease at LHD?
2. What are the nurses’ practices in the management of peptic ulcer disease in patients at LHD?
3. What are the challenges nurses face in the management of peptic ulcer disease at LHD?

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