DEPARTMENT OF PHARMACY PRACTICE MESCO COLLEGE OF PHARMACY

(AFFILIATED TO OSMANIA UNIVERISTY, HYDERABAD)

PHARM D – V YEAR PROJECT – FINAL PROGRESS REPORT PRESENTATION

ENTITLED

A PROSPECTIVE OBSERVATIONAL STUDY OF PRESCRIBING PATTERN IN PEPTIC

ULCER DISEASE AND ITS PREVALENCE AT A TERTIARY CARE TEACHING
HOSPITAL

INVESTIGATORS: Under the supervision of:

Academic Guide
1. Ms. ARSHIYA BASHEER (Roll No: 170316882009)
Ms. MAHE NAAZ SULTANA
2. Ms. MAIMUNA KHANAM (Roll No:170316882013) Assistant Professor
3. Mrs. KAUKAB JAHAN (Roll No: 170316882019)
INDEX
S.NO. CONTENTS
1. INTRODUCTION
2. AIMS AND OBJECTIVES
3. NEED OF THE STUDY

4. REVIEW OF THE LITERATURE

5. METHODOLOGY
6. STUDY CRITERIA
7. PLAN OF WORK
8. RESULTS
9. DISCUSSION
10. CONCLUSION
11. DATA COLLECTION FORM
12. INFORMED CONSENT FORM
13. REFERENCES
 PEPTIC ULCER DISEASE
INTRODUCTION:

Peptic ulcer disease represents a serious medical problem. Interestingly, those at the highest risk of contracting peptic ulcer disease are those
generations born around the middle of the 20th century. Ulcer disease has become a disease predominantly affecting the older
population, with the peak incidence occurring between 55 and 65 years of age. In men, duodenal ulcers were more common than
gastric ulcers; in women, the converse was found to be true. Thirty-five percent of patients diagnosed with gastric ulcers will suffer
serious complications. Although mortality rates from peptic ulcer disease are low, the high prevalence and the resulting pain,
suffering, and expense are very costly.

DEFINITION:

‘’Condition in which there is a discontinuity in the entire thickness of the gastric or duodenal mucosa that persists as a result of acid and
pepsin in the gastric juice’’

•The term peptic ulcer applies to mucosal ulceration near the acid bearing regions of GIT.
 • Peptic ulcer disease (PUD) = Mucosal defect in the GIT (gastric or duodenal) exposed to acid and pepsin secretion.
ETIOLOGY AND RISK FACTORS

Common

Helicobacter pylori infection 

Nonsteroidal antiinflammatory drugs
Critical illness (stress-related mucosal damage) 

Uncommon 

Hypersecretion of gastric acid (e.g., Zollinger-Ellison’s

syndrome)
Viral infections (e.g., cytomegalovirus) 
Vascular insufficiency (crack cocaine associated) 
Radiation 
Chemotherapy (e.g., hepatic artery infusions) 
Rare genetic subtypes 
Idiopathic
 PATHOPHYSIOLOGY
•  The mechanisms of mucosal injury in PUD is thought to be i
mbalance of aggressive factors such as acid production, produ
ction of pepsin and defensive factors such as mucous producti
on, bicarbonate and blood flow.

• Infection with helicobacter pylori is the leading factor in PUD

formation and is associated with all ulcers not induced by NS
AIDS.

• The pylori colonize the deep layers of the mucosal gel that co
ats the gastric mucosa and disrupts its protective properties. 

• NSAIDs also interfere with the protective mucus layer by inhi

biting mucosal activity, reducing mucosal prostaglandins whic
h cause abnormal permeability of the mucus layer. 

• The common sites where ulcerations occur are: duodenum, an

trum, lesser curvature, and gastro- esophageal junction
DIAGNOSIS OF PEPTIC ULCER DISEASE

• Radiological Diagnosis: Barium x-ray or

upper GI series is a widely used for diagnosis.
Barium x-ray is difficult to analysis and less
sensitive and accurate.
• Laboratory test:
– Noninvasive urea breath test.
– Patient with refractory or recurrent peptic
ulcer may have underlying H. pylori
infection, histopathology investigation may
req.
– Serologic test for detecting H. pylori (levels
of IgG and IgA ELISA test)
– Stool antigen test for non-invasive detecting
the presence of H. pylori.
• Endoscopic diagnosis
COMPLICATIONS OF PEPTIC ULCER DISEASE

HEMORRHAGE:

Blood vessels damaged as ulcer erodes into the muscles of sto

mach or duodenal wall
Coffee ground vomitus or occult blood in tarry stools

PERFORATION:

An ulcer can erode through the entire wall Bacteria and partiall

y digested fool spill into peritoneum=peritonitis

GASTRIC OUTLET OBSTRUCTION

Swelling and scarring can cause obstruction of food leaving sto

mach=repeated vomiting
MANAGEMENT OF PEPTIC ULCER DISEASE
 AIM:

To study the prescribing patterns of peptic ulcer disease and to determine its prevalence
among patients in general medicine department at a tertiary care teaching hospital.

OBJECTIVES:

1. To assess the prevalence of peptic ulcer disease at a tertiary care hospital.

2. To evaluate the prescription pattern of peptic ulcer medications.

3. To observe the various risk factors associated with peptic ulcer disease.
NEED OF STUDY:

• This study will help in providing data on prevalence of Peptic ulcer disease in leading tertiary care
hospital and prescribing patterns of peptic ulcer disease.
• To analyze and correlate the clinical data for better management of Peptic ulcer disease.
• In recent years, several studies were conducted in assessing prescription patterns. This study will
be considered as an update to previously conducted studies .
• This study aims to improve the outcomes of prescription pattern and to reduce the mortality rate.

CLINICAL PHARMACIST 'S  ROLE:

   As it is more prevalent, clinical pharmacist plays an important role in prevention of peptic ulcer
disease through patient counselling  and increasing awareness among patients regarding various risk
factors- age, alcohol consumption, drug associated risk factors (e.g, use of NSAIDS and aspirin), spicy
food, irregular eating habits ,hot beverages and obesity.
 LITERATURE REVIEW
S.NO. AUTHOR/JOURNAL TITLE DETAILS OF STUDY
1. Cuckoo Aiyappa, et, al PRESCRIPTION PATTERN OF DRUGS This study aims to provide insight into the prescription pattern of drugs used in PUD in
USED IN THE TREATMENT OF PEPTIC India. A retrospective analysis was done to study the prescribing pattern of the 
2019: ULCER DISEASE IN THE DEPARTMENT
OF GASTROENTEROLOGY IN A drugs.91% of  patients were prescribed anti H. pylori kit Esomeprazole H.P kit
TERTIARY CARE (59.7%) followed by Pantoprazole H P kit. Following this, all patients were started
on Proton pump inhibitors (PPI) for duration of about 6.89±2.25 weeks. 

2. S.Jain et al (2019) prescription pattern of drugs used in
the treatment of peptic ulcer disease
in a tertiary care hospital
To study the prescribing pattern of medications used in the management of peptic ulcer
disease and to identify and manage the drug related problems.  A prospective
interventional study was conducted. About 111 (61.66%) participants were started on
 fixed drug dose combination therapy for H. pylori eradication followed by
 PPI maintainance treatment for 42.12±5.94 days. 

3. Ahmad Almeman et Prescribing Practices and Cost of Drugs Description of the prescribing patterns of gastric acid suppressant treatment in peptic ulcer
for Peptic Ulcer in a Primary Health disease and the cost analysis. A cross sectional retrospective study was conducted. The most
al(2013): frequently prescribed monotherapy antiulcer drugs were ranitidine (83 %) and omeprazole (17
Center in Pulau
%), while for combination therapy
(with antacids), it was ranitidine (85 %). The practitioners in this study preferred to prescribe
ranitidine much more frequently than omeprazole.

4. Pooja Chandran et, al TO ANALYSE THE RISK FACTOR AND
DRUG UTILIZATION REVIEW OF PEPTIC
(2020): ULCER DISEASE IN A TERTIARY CARE
HOSPITAL
The study aims to identify risk factors for PUD and estimate their relative impact on ulcer
incidence in patients and to evaluate the drug utilization pattern of anti peptic drugs. From the
study it may be concluded that the mostly prescribed anti-peptic ulcer agent in our hospital is
Pantoprazole (54.61%) and Food habits (47.44%) are the main risk factor in peptic ulcer
disease.

5. Subrata Roy et al 2016 Clinical Study of Peptic Ulcer Disease From the study it has been found that Duodenal ulcers are more common than gastric ulcers.
The comments age of the ulcers are above 30 years. The majorly observed site of the ulcer pain
is the epigastrium. The burning & the hunger is the commonest type of pain observed in the
Duodenal ulcer. All patients suffering from the ulcers are doing smoking as well as alcohol
consumption. The previous regular consumptions of the NSAID’s & Steroids are the also one of
the factors for the duodenal & gastric ulcers.
SNO AUTHOR/JOURNAL TITLE DETAILS OF STUDY
Nehad J. Ahmed1* The Outpatient Objective: The present study aimed to explore the prescribing trends of aluminum hydroxide - magnesium hydroxide
6. et al 2020 Prescribing Pattern of Results: A total of 146 outpatients received aluminum hydroxide - magnesium hydroxide antacid between 1st of July till the end of
Aluminum - December 2018. Most of the patients were female (61.64%). Out of the 146 prescriptions, 145 were written by residents (99.32%) and
Magnesium only 1 prescription was written by a specialist (0.68%). Most of the prescriptions were written by emergency department (91.79%).
Hydroxide Antacid Conclusion: The use of aluminum hydroxide - magnesium hydroxide was uncommon but it should be prescribed carefully and a
continuous assessment of its prescribing is required to prevent its adverse events and drug interactions.
in the outpatient setting
Syed Farheen*, B. Prospective Study on The current objective of study is to determine the prescription pattern of peptic ulcer drugs and outcomes in outpatient department of
7. Kumar Prescribing Pattern of gastroenterology in a tertiary care hospital. To assess the diagnostic pattern of the peptic ulcer. To assess the risk factors associated with
Et al 2021 Peptic Ulcer Drugs peptic ulcer.In our study H. Pylori infection patients were more 74(29.6%) comparing with other risk factors. In our study H. Pylori
and Outcomes in A infected ulcers was more 90 (36%) comparing with other types of ulcers. In our study PPI’s (Proton Pump inhibitors) was prescribed more
Tertiary Care Hospital 85(34%) comparing with other drugs. In our study prescription containing tablet drug formulation was more 92 (36.8%) comparing with
other formulations. In our study abdominal pain clinical symptom reported patients were more 89(35.6%) comparing with other clinical
symptoms.
T. A Descriptive The study was aimed to assess the prevalence, risk factors and the treatment pattern of peptic ulcer among the patients attending
8. Balasubramanian Observational Study on department of gastroenterology in a tertiary care hospital.The prevalence of peptic ulcer among the entire patient attending for
et al, 2020 Assessment of endoscopic examination was found to be 13.4%. Out of them 75% were duodenal ulcer patients and 57.70% were H. pylori infected. Thus,
Prevalence, Risk Factors this study identified that the predominant reason for the development of peptic ulcer was H. Pylori infection, followed by smoking.
and Prescription Trends
Physician chose esomeprazole more frequently than other PPIs due to its greater efficiency.
in the Management of
Peptic Ulcer Disease

Medapati Neeraja, ASSESSMENT OF This study aims to assess the symptoms, risk factors, prescribing patterns and quality of life inpeptic ulcer disease in a tertiary care
9. SYMPTOMS, RISK hospital. In the present study, risk for PUD was associated with H. pylori and NSAID’s. Most commonly used drugs were esomeprazole
FACTORS, PRESCRIBING based H.P kit. The study concludes that H. pylori is the major risk factor and is effectively managed by using esomeprazole based triple
PATTERNS AND therapy. Peptic ulcer invariably affects the quality of life of the affected individuals through changes in daily routine.
QUALITY OF LIFE IN
PEPTIC ULCER DISEASE
AT A TERTIARY CARE
HOSPITAL
Peptic ulcer disease and The study aimed to assess the correlation of peptic ulcer disease with psychological factors such as stress.It It has been demonstrated that
10. László Hersz stress stress can cause peptic ulcer disease even in the absence of Helicobacter pylori infection, supporting a multicausal model of peptic ulcer
ényi etiology. Psychological stress among other risk factors can function as a cofactor with Helicobacter pylori infection.
 
 METHODOLOGY
STUDY DESIGN        :   Prospective observational study.

STUDY LOCATION    : The study was conducted in Osmania General Hospital, Hyderabad

STUDY POPULATION: All patients attending general medicine with peptic

                                        ulcer disease.

STUDY DURATION    :    6 months

SAMPLE SIZE              :   100

 STUDY CRITERIA:

INCLUSION CRITERIA EXCLUSION CRITERIA

Patients above 18 years of age of either gender. Pregnant and lactating women

Inpatients and outpatients. Patients who are receiving immunosuppressant drugs.

Patients suffering from extremely transmittable diseases

Patients suffering from Peptic ulcer disease or its like covid-19, AIDS and all patients suffering from
complications with or without co-morbidities. malignancies.

Patients willing to participate. Patients unwilling to participate

 Getting IEC approval

PROCEDURE FOR DATA COLLECTION:

Designing data collection form

This study was conducted at the Department of General

Medicine of Osmania General Hospital (OGH). Patients fulfilling
inclusion criteria were included in the study. Obtaining patients data

Approval was taken from institutional ethics committee (IEC).

Recording of patients prescription patterns and follow-up

After explaining to the subjects regarding the purpose of the b

study, an Informed consent was obtained from the subject.
Analyzing the prescription patterns
Data was collected in pre-designed data collection form from
case notes, patient and representatives.
Percentage and graphical representation of data
Data collection form includes patients demographic details,
social history, complaints, comorbidities, medications, drug interactions
and patient counselling. Discussion

Conclusion
RESULTS
Table no. 1 Distribution of patients based on gender Figure no 1 Distribution of patients based on gender

GENDER DISTRIBUTION

TOTAL PERCENTAGE
37%
No. of cases 100 100%
MALE
Male 63 63%
63% FEMALE
Female 37 37%

Out of 100 patients, 63 patients were male which accounted for 63% and 37 patients were
females which accounted for 37% . Hence, Peptic Ulcer Disease was found to be more common
in men than women.
Table no 2. Drug Distribution Based On In-Patients and Out-Patients Fig no 2. Drug Distribution Based On In-Patients And Out Patients
Fig no 2. Drug Distribution Based On
In-Patients And Out-Patients.

PATIENTS NO. OF CASES Percentage

IN-PATIENT 68 68%
32%

OUT-PATIENT 32 32% IN-PATIENT

68%

From the drug distribution based on in-patient and out-patient setting, it was found that about 68% were in –patients
and 32% were out-patients including male and female patients.
Table no. 3 Distribution of patients based on age Fig no. 3 Distribution of patients based on age
20
AGE NO. OF NO.OF TOTAL PERCENT 18
GROUP MALES FEMALES NO. OF AGE 16
PATIENT 14
S 12
18-27 7 5 12 12% 10 Male
8 Female
28-37 10 18 28 28%
6
38-47 8 7 15 15% 4
48-57 16 6 22 22% 2
58-67 12 0 12 12% 0
68-77 8 0 8 8% 18-27 28-37 38-47 48-57 58-67 68-77 >77
>77 2 1 3 3%

Age groups affected commonly were 28-37 years, which accounted for 28% followed by age group 48-57
years, which accounted for 22%. Age groups 38-47 years accounted for 15%. Age groups 18-27 years and
58-67 years accounted for 12% each. Age groups 68-77 years accounted for 8%. Age groups above 77
years accounted for 3%.
Table no. 4 Distribution Of Study Population based On Risk factors

RISK FACTORS NO. OF PERCENTAGE Fig no. 4 DISTRIBUTION OF STUDY POPULATION BASED ON RISK
PATIENTS FACTORS
NSAIDS 28 12.22%
ALCOHOL 25 10.91%
15.28% 12.22% NSAIDS
SMOKING 16 6.98%
10.91% ALCOHOL
AGE >60 years 21 9.17% 12.22% SMOKING
6.98%
AGE >60 years
9.17% HISTORY OF ULCERS
HISTORY OF 12 5.24% 27.94%
H.PYLORI
ULCERS
FOOD HABITS
H.PYLORI 64 27.94% 5.24% STRESS

FOOD HABITS 28 12.22%

STRESS 35 15.28%

Among risk factors H.pylori infection (27.94%) was found to be more prevalent followed by stress
(15.28%), NSAIDS and food habits (12.22%), Age related risk (9.17%), smoking (6.98%) ,Alcohol(10.91) and
history of ulcers (5.24%).
Table no. 5 Prominent symptoms observed Fig no. 5 Prominent symptoms observed

SYMPTOM NO. OF PERCENTAG

20.00%
CASES E(%)
18.00%
ABDOMINAL DISTENTION 17 6.56%
WATER BRASH 2 0.77%
16.00%
EPIGASTRIC PAIN 46 17.76% 14.00%
FLATULENCE 7 2.70% 12.00%
BELCHING 4 1.54% 10.00%
HEART BURN 22 8.49% 8.00%
NAUSEA 21 8.10% 6.00%
VOMITING 27 10.42% 4.00%
GI BLEED 5 1.93% 2.00%
LOSS OF APPETITE 16 6.17%
0.00%
WEIGHT LOSS 16 6.17%
ABDOMINAL PAIN 50 19.30%
HEMATEMESIS 19 7.33%
HEMOPTYSIS 2 0.77%
DIARRHOEA 5 1.93%

Abdominal pain was the most common symptom which accounts for 19.30%, followed by epigastric pain, vomiting, heart burn,
Nausea, Hematemesis, Abdominal Distention, weight loss,loss of appetite, GI bleed,diarrhoea,flatulence,belching,waterbrash and
haemoptysis.
Table no.6 Distribution based on location of ulcers Fig no.6 Distribution based on location of ulcers

LOCATION NO. OF CASES PERCENTAGE LOCATION OF ULCERS

8.00%

Gastric 58 58%
Gastric
34.00% Duodenal
Duodenal 34 34%
58.00%
Both
Both 8 8%

Most common type of peptic ulcer disease observed was Gastric ulcer which accounted for 58% of total
peptic ulcer disease cases, followed by duodenal ulcers and Gastro-duodenal ulcers which accounted
for 34% and 8% respectively.
Table no. 7 Distribution based on co morbidities.

S.N COMORBID CONDITIONS NO. OF PATIENTS PERCENTAGE

O
1 JAUNDICE 3 2.20%
2 OESOPHAGITIS 6 4.41%
3 GERD 8 5.88%
4 PANGASTRITIS 23 16.91%
5 UGI BLEED 9 6.61%
6 HYPERTENTION 13 9.55%
7 DIABETES MELLITUS 8 5.88%
8 PULMONARY KOCH 4 2.94%
9 ALCOHOLIC LIVER DISEASE 7 5.14%
10 ANEMIA 4 2.94%
11 GASTRITIS 36 26.47%
12 ALCOHOLIC CIRRHOSIS 3 2.20%
13 HYPOTHYROIDISM 2 1.47%
14 HIATUS HERNIA 10 7.35%
 Fig no.7 Distribution based on co morbidities.

Distribution based on co morbidities.

30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%

Gastritis accounted for (26.47%) was the most common comorbidity .Other comorbidities were GERD(5.88%), hy
pertension (9.55%), diabetes mellitus (5.88%) ,UGI bleed ( 6.61%), Anemia (2.94%), Alcoholic Liver Disease (5.14
%), pangastritis (16.91%), Jaundice(2.20%) , Pulmonary koch(2.94%), Hypothyroidism (1.47%), Alcoholic
cirrhosis(2.20%), esophagitis (4.41%) and hiatus hernia (7.35%)
 Table no. 8 Drug therapy given to peptic ulcer disease patients. Fig no. 8 Drug therapy given to peptic ulcer disease patients.

Percentage
DRUG THERAPY NO.OF CASES PERCENTAGE 70.00%
MONOTHERAPY 12 12% 60.00%
50.00%
TRIPLE THERAPY 64 64% 40.00%
30.00%
PPI+ ULCER PROTECTIVE 6 6% 20.00%
AGENT(UPA) 10.00%
0.00% Percentage
PPI+UPA+ANTIBIOTIC+ANT 3 3%
ACID
PPI + ANTIBIOTIC 5 5%
PPI + ANTIBIOTIC + UPA 3 3%
PPI+ PROKINETIC 6 6%
PPI+ UPA+ H2RA 1 1%

The most widely used drug therapy is triple therapy which accounts for 64%.
The next most widely used drug therapy is monotherapy which accounts for 12%
Followed by other therapies such as :PPI+Ulcer protective agent (Sucralfate) and PPI + Prokinetic which account for 6% each; PPI
+ Antibiotic ( Metronidazole) accounted for 5%, PPI+ Ulcer protective agent +Antibiotic(Metronidazole) + Antacid and PPI+ Antibi
otic + UPA which account for 3% each and PPI+UPA+H2RA accounted for 1%.
Table no. 9 Different Types Of H. Pylori Kit Prescribed Fig no. 9 Different Types Of H. Pylori Kit Prescribed

H.Pylori KIT NO. OF CASES PERCENTAGE

NEXPRO HP KIT 14 21.875%

PANTOCID HP KIT 20 31.25%

PANTOP HP KIT 14 21.875%

SOMPRAZ HP KIT 16 25%

A total of 64 cases of H.pylori were found, out of which

14 cases were given Nexpro HP kit;
20 cases were given Pantocid HP kit;
14 cases were given Pantop HP kit and
16 cases were given Sompraz HP kit.
Nexpro HP kit and Sompraz HP kit comprises of Esomeprazole, Clarithromycin and Amoxicillin
Pantocid HP kit and Pantop HP kit comprises of Pantoprazole, Clarithromycin and Amoxicillin
Table no.10 Types of Proton Pump Inhibitors prescribed Fig no.10 Types of Proton Pump Inhibitors prescribed

PROTON PUMP INH NO. OF CASES PERCENTAGE

IBITORS
PANTOPRAZOLE 63 63%
ESOMEPRAZOLE 27 27%
RABEPRAZOLE 10 10%

Among proton pump inhibitors(PPIs),Pantoprazole was

the most widely used PPI which accounts for 63%, follo
wed by Esomeprazole 27% and Rabeprazole 10%.
Table no. 11 Drug distribution based on route of administration Fig no 11 Drug distribution based on route of administration
DRUG NAME PARENTRAL ORAL TOTAL NO
OF CASES

PANTOPRAZOLE 35 28 63
METRONIDAZOLE 11 - 11
SUCRALFATE - 39 39
ANTACIDS - 4 4
RAZO-D - 5 5
RAZO - 2 2
RABIUM - 1 1
RABIUM DSR - 3 3
SUPERIA DSR - 1 1
SOMPRAZ-D - 8 8
SOMPRAZ - 11 11
NEXPRO PLUS - 2 2
From the drugs prescribed, Pantoprazole was prescribed both in parenteral
RACIPER - 4 4
and oral dosage formulations.Metronidazole was prescribed only parenterall
SUPERIA - 1 1 y.Other drugs prescribed in oral dosage form were sucralfate, antacids, raz
o-d, razo, rabium, rabium DSR, superia DSR, sompraz-d sompraz, nexpro p
NEXPRO - 2 2 lus, nexpro, Raciper, Superia.
TABLE NO. 12 COMMONLY PRESCRIBED DRUGS Fig no. 12 COMMONLY PRESCRIBED DRUGS:
DRUG NAME TOTAL NO OF PERCENT
CASES AGE
PANTOPRAZOLE 63 40.12%
METRONIDAZOLE 11 7%
SUCRALFATE 39 24.84%
ANTACIDS 4 2.54%
RAZO-D 5 3.18%
RAZO 2 1.27%
RABIUM 1 0.63%
RABIUM DSR 3 1.91%
SUPERIA DSR 1 0.63%
SOMPRAZ-D 8 5.09%
SOMPRAZ 11 7%
NEXPRO PLUS 2 1.27%
From the drug therapy given to patients affected with peptic ulcer di
RACIPER 4 2.54% sease, pantoprazole was the most widely prescribed drug , followed
SUPERIA 1 0.63% by sucralfate, metronidazole and sompraz,sompraz-d,antacids and
NEXPRO 2 1.24% raciper, razo-d, nexpro plus, nexpro, razo, rabium ,rabium DSR,
superia and superia DSR.
 Table No. 14 Efficacy Of The Treatment. Fig no. 14 Efficacy Of The Treatment

NO. OF CASES Percentage

CURED 88 88%

RECURRENT 12 12%

Patients were said to be cured when their symptoms resolved, and about 88 % cases were cured. Patients in
whom symptoms reappear even after taking therapy successfully, were listed under recurrent cases and about
& 12%of cases had recurrent symptoms.
DRUG INTERACTIONS:

SIGNIFICANT INTERACTIONS WERE NOT FOUND

MINOR INTERACTION:

1) sucralfate + aluminum hydroxide

sucralfate increases levels of aluminum hydroxide by pharmacodynamic synergism

PREVALENCE OF PEPTIC ULCER DISEASE

• Peptic ulcer disease is more prevalent in men (63%) tha

n women(37%).
•Peptic ulcer disease was more frequent in the age group
28-37 years.
•Gastric ulcers were found to be more prevalent when c
ompared to duodenal ulcers and gastroduodenal ulcers.
DISCUSSION:

We have conducted this Prospective observational study in general medicine department in Osmania General Hospital
(OGH) to study the prescription patterns and to determine the prevalence of peptic ulcer disease.

In the present study, a total number of 100 patients were enrolled of which male popultion was the majority with 63 cas
es (63%) compared to female population with 37 cases (37%). The finding is in accordance with that of the study conducted b
y Sridhar Stk, et al.(2020) , Syed Farheen, et al.(2021) and Cuckoo Aiyappa, et al.( 2019).

Out of 100 patients , it was found that 68 patient were hospitalised and 32 cases were found in ambulatory setting.

It was seen that people of the age group 28 years to 37 years were more affected with disease (28%). The finding is in
contrastwith that of the study conducted by Syed Farheen, et al.(2021) where the age group 50-59 years was more affected
with peptic ulcer disease.

In the current study, most common type of peptic ulcer disease observed was gastric ulcers which constituted
58% of total peptic ulcer disease cases , followed by duodenal ulcer and gastro-duodenal ulcers which accounted for 34% and
8 % respectively.A similar conclusion was obtained by Cuckoo Aiyappa, et al.( 2019).

The data of our present study regarding risk factors of PUD revealed that H.pylori infection (27.94)was more prevalent
followed by, stress (15.28%), food habits (12.22%) and NSAIDs (12.22%), Alcohol consumption (10.91%%), age related risk
(9.17%),, smoking (6.98%) and history of ulcers (5.24%), In contrast to our study the study conducted by Chandran et al. (202
0) reported that there is a high risk for Food habits (47.44%) followed by other diseases (24.54%), smoking (13.63%) alcohol c
onsumption (9.09%) and NSAIDs (4.5%).
 Concerning clinical symptoms, Abdominal pain was most common symptom which accounted for
19.30%, followed by vomiting (10.42%), heart burn(8.49%), Nausea(8.10%), Hematemesis(7.33%), Abdominal
Distention(6.56%), weight loss(6.17%), loss of appetite(6.17%), GI bleed(1.93%), diarrhoea(1.93%), belching(1.54%),
waterbrash(0.77%) and haemoptysis(0.77%). Similarly in the study conducted by Sridhar stk et al., (2020), Cuckoo Aiyapp
a, et al.( 2019) and S.T. Mohammed Ashraf  et al., (2020) and most patients presented with complain of abdominal pain.

In case of co morbidities, gastritis(26.47%) was observed to be the commonest comorbidity in contrast t

o the study conducted by S.T. Mohammed Ashraf,  et al. (2020) and Sonali Jain H, et al. (2019) where it was found that d
iabetes mellitus (18.60%)and Alcoholic liver disease were the significant co-morbidities respectively.

The other co-morbidities found in our study were GERD(5.88%), hypertension (9.55%), diabetes mellitu
s (5.88%) ,UGI bleed ( 6.61%), Anemia (2.94%), Alcoholic Liver Disease (5.14%), pangastritis (16.91%),
Jaundice(2.20%) , Pulmonary koch(2.94%), Hypothyroidism (1.47%), Alcoholic cirrhosis(2.20%), esophagitis (4.41%) and
hiatus hernia (7.35%)

It was observed in our study that the The most widely used drug therapy is triple therapy which accounted f
or 64% which is consistent with the finding obtained from the previous study conducted by T.Balasubramanian, et al.
(2020).
Our findings indicated that the next most widely used drug therapy is monotherapy which accounted for 12%.
Followed by other therapies such as :PPI+Ulcer protective agent (Sucralfate) and PPI + Prokinetic which accounted for
6% each; PPI+ Antibiotic ( Metronidazole) accounted for 5%, PPI+ Ulcer protective agent +Antibiotic(Metronidazole) + Ant
acid and PPI+ Antibiotic + UPA which accounted for 3% each and PPI+UPA+H2RA accounted for 1%.
 In the current study it was found that Pantoprazole was the most frequently used PPI which accounts for
63%, followed by Esomeprazole 27% and Rabeprazole 10% in contrast to the study conducted by A.T. Jaseera, et al. (2020)
where Esomeprazole was the most prescribed PPI followed by Pantoprazole, Omeprazole, Rabeprazole.

With respect to HP kits, out of 64 cases of H.pylori , 14 cases were given Nexpro HP kit; 20 cases were given Pa
ntocid HP kit; 14 cases were given Pantop HP kit and 16 cases were given Sompraz HP kit. Notably pantoprazole based HP
kits were more prescribed than Esomeprazole based HP Kits. In contrast, the study conducted by Veeksha Jayaram, et al.
(2019) and A.T. Jaseera, et al. (2020) demonstrated that Esomeprazole based HP kits were given to more number of patients
as compared to pantoprazole based HP kits.

Our findings revealed that Pantoprazole was prescribed both in parenteral and oral dosage formulations.Metron
idazole was prescribed only parenterally.Other drugs prescribed in oral dosage form were sucralfate, antacids, razo-d, razo, r
abium, rabium DSR, Superia, superia DSR, sompraz-d sompraz, nexpro plus, nexpro and raciper.

In this study, from the drug therapy given to patients affected with peptic ulcer disease, pantoprazole was the mo
st widely prescribed drug , followed by sucralfate, metronidazole, sompraz,sompraz-d,antacids, razo-d, nexpro plus, nexpro,
razo, rabium ,rabiumDSR, and superia DSR.

No prescription was found with any significant interactions. Although one minor drug interaction of sucralfate +
aluminum hydroxide was found.
CONCLUSION

This study concentrated on prescribing patterns of Peptic Ulcer Disease (PUD) and its prevalence. The peptic ulcer disease was more
prevalent in males (63%) than in females (37%). The age group 28 years -37 years (28%) was more liable to develop peptic ulcer disease.

H.pylori infection (27.94%) was found to be more prevalent followed by stress (15.28%), NSAIDS and food habits (12.2%), Age
related risk (9.17%), smoking (6.98%) ,Alcohol(10.91) and history of ulcers (5.24%).It is suggested to raise heightened awareness among
people as regards nature and risk factors involved in the peptic ulcer disease.

Most common type of peptic ulcer disease observed was gastric ulcer which accounted for 58% of total peptic ulcer disease cases,
followed by duodenal ulcers which accounted for 34%, Gastro-duodenal ulcers which accounted for 8%.

The drug therapy mostly prescribed was triple therapy which accounted for 64%. the next most widely used drug therapy was
monotherapy ( Pantoprazole ) .The other drugs used in combination with PPIs were antibiotics, ulcer protective agents, prokinetc and
antacids.Pantoprazole was the most prescribed proton pump inhibitor.

The most commonly prescribed kit in the study was PANTOCID KIT which accounted for 31.25% followed by SOMPRAZ HP
KIT, NEXPRO HP KIT, PANTOP HP KIT. That allowed the conclusion that pantoprazole based HP kits (53.12%) were more prescribed than
Esomeprazole based HP Kits (46.87%).

To conclude, the eradication of H.pylori is highly recommended in all perceived patients, the use of NSAIDs should be closely
monitored and stress should be managed. Out of 100 cases, 88 (88%) cases were cured.

Clinical Pharmacist provides patient education and management of risk factors associated with peptic ulcer development and
recurrence. The pharmacist can instruct each patient on the proper use of medication and consult with physician on drug therapy with regard to
choice of drugs. The pharmacist ought to advise the patients as to non-prescription drugs that might be harmful. Importance of adherence and
counseling on proper administration of drug therapy is an important part of treatment success.
REFERENCES:

1. Veeksha Jayaram*, Cuckoo Aiyappa, Umesh Jallihal and M.C. Shivamurthy

PRESCRIPTION PATTERN OF DRUGS USED IN THE TREATMENT OF PEPTIC ULCER DISEASE IN THE DEPARTMENT OF GASTROENTEROLOGY IN A TERTIARY CAR
E
HOSPITAL. INTERNATIONAL JOURNAL OF PHARMACEUTICAL SCIENCES AND RESEARCH
A Web of Science - ESCI Indexed Journal 
Projected Impact Factor (2019): 1.230

2. A study on prescription pattern of drugs used in the treatment of peptic ulcer disease in a tertiary care hospital
 S. Jain
 Published 2019
https://www.semanticscholar.org/paper/A-study-on-prescription-pattern-of-drugs-used-in-of- Jain/b1fe9248a0c8b4ce78326b00c93e151443a4ea4b

3. Prescribing Practices and Cost of Drugs for Peptic Ulcer in a Primary Health Center in Pulau
Penang, Malaysia Ahmad Almeman, Ali Saleh Alkhoshaiban and Seemab Rasool
Available online at http://www.tjpr.org http://dx.doi.org/10.4314/tjpr.v12i4.28

4. TO ANALYSE THE RISK FACTOR AND DRUG UTILIZATION REVIEW OF PEPTIC

ULCER DISEASE IN A TERTIARY CARE HOSPITAL *Corresponding Author
 March 2020
 World Journal of Pharmaceutical Research 9(3):239-247.
DOI: 10.20959/wjpr20203-16500

5. Treatment algorithm – Pharmacotherapy A pathophysiologic Approach by dipiro textbook

6. Diagnosis – Principle and practice of medicene by Davidson
 INFORMED CONSENT FORM

Title Of The Study

A PROSPECTIVE OBSERVATIONAL STUDY OF PRESCRIBING PATTERN IN PEPTIC ULCER DISEASE AND ITS PREVALENCE AT A TERTIARY CARE TEACHING
HOSPITAL.

Principal Investigators – Arshiya Basheer, Maimuna Khanam, Kaukab Jahan.

Purpose Of The Study

This is to inform you that we are carrying out a research study on the assessment of prescribing patterns & to determine the prevalence of peptic ulcer disease in
patients .

Benefits
Participating in this study will help you understand about your medications and disease better. The safety of your medicine for your condition will be understood.

Confidentiality
This information provided b you will be strictly confidential. All filled in forms will be anonymous and treated as numbers, not particular individuals.

Consent

I,_________________________ have read and understood the provided information and have had the opportunity to ask questions, I voluntarily agree to take
part in this study and give my consent for this information about myself relating to subject matter above to appear in the study.

Participant’s sign : Date :

Investigator’s sign : Date: