Peptic ulcers

1.0 Introduction

Anti-ulcer agents are medications that are used to treat and prevent ulcers, which are sores that form on the lining of the stomach or upper part of the small intestine. There are several types of anti-ulcer agents, including proton pump inhibitors (PPIs), H2 receptor blockers, and mucosal protective agents. PPIs, such as omeprazole and lansoprazole, work by reducing the amount of acid produced in the stomach. H2 receptor blockers, such as ranitidine and famotidine, block the action of histamine, a substance that stimulates acid production. Mucosal protective agents, such as sucralfate, form a protective barrier on the lining of the stomach to prevent acid and enzymes from damaging the tissue (Sun et al, 2018). This chapter presents the background of the study, the problem statement, purpose, objectives of the study, research questions, study scope, justification of the study, significance, hypotheses, conceptual framework, as well as operational definition of key terms and concepts.

1.1 Background of the study

Peptic Ulcer Disease (PUD) is a digestive system disorder characterized by mucosal breaks greater than 3–5 mm, occurring mainly in the stomach and proximal duodenum (Jaiswal et al., 2021). Common symptoms include abdominal pain, indigestion, heartburn, loss of appetite, weight loss, nausea/vomiting, and black/tarry stools, indicating potential bleeding (Yaghoobi, & Armstrong, 2022), The pathogenesis involves an imbalance between gastric offensive factors like prostaglandins, mucus, and Helicobacter pylori, and defensive factors like antioxidants (Kulshreshtha, Srivastava, & Singh, 2017).

Globally, approximately 10% of the population experiences peptic ulcers, with varying prevalence based on region, socioeconomic status, sanitation, and H. pylori infection rates. Studies suggest higher prevalence in African countries like Ghana and Nigeria, but more research is needed for accurate data (Vijay, 2018). In Nigeria, prevalence ranges from 4% to 16.7%, depending on the region. In Uganda, limited research hinders establishing a clear prevalence, but studies in Kampala and southwestern regions suggest a significant impact, with H. pylori infection rates as high as 78.6% among dyspeptic patients (Pradeep, 2014).

The treatment approach for peptic ulcers depends on their underlying cause, which may stem from factors such as infection with the bacterium Helicobacter pylori, prolonged use of non-steroidal anti-inflammatory drugs (NSAIDs), excessive alcohol consumption, or stress (Popa, 2021).). Common treatment options include; Antibiotics, If the ulcer results from an H. pylori infection, a course of antibiotics is prescribed to eradicate the bacteria. Typically, a combination of two or more antibiotics is used along with a proton pump inhibitor (PPI) and/or bismuth subsalicylate, known as triple or quadruple therapy, Proton Pump Inhibitors (PPIs); These drugs reduce stomach acid production, alleviating pain and promoting ulcer healing (Gururatsakul et al., 2014). PPIs are often combined with antibiotics to treat H. pylori infection, H 2 Blockers, these medications also decrease stomach acid production, providing relief from pain and supporting ulcer healing, Antacids: These medications neutralize stomach acid, offering temporary symptom relief (Malmi, 2018). They are frequently used in combination with other drugs for more effective treatment, adopting a healthy lifestyle, including stress reduction, avoiding smoking and excessive alcohol consumption, and maintaining a balanced diet, can help reduce the risk of developing peptic ulcers and aid in the healing process (Bereda, 2022). The synthetic drugs used in the treatment of ulcers have serious side effects like H2 blockers is the precipitating cause of impotence, headache, skin rash. proton pump inhibitors (PPI) is a cause for atrophic gastritis (Sonnenberg, 2014).

The use of antacids leads to stomach distention, belching, and constipation. Other drugs like anticholinergics induce constipation, dry mouth, urinary retention, blurred vision, and precipitation of glaucoma ( Bai et al., 2023). Ulcer protectives causes constipation, triggers diarrhoea, dizziness. Peptic ulcer is the widespread disorder of gastrointestinal tract with recurrent relapses and several complications. Since allopathic drugs used in its treatment are associated with adverse effects causing further damage to human health, therefore Researchers are focusing on herbal plants having therapeutic effects. Herbal drugs have preserved their importance due to relatively less toxic, better cultural acceptability, better compatibility with human body, lesser adverse effects, economical, effective and easy availability (Pandey et al., 2008).

These herbal plants are rich in several phyto-chemicals such as alkaloids, tannins, flavonoids, phenlos, saponins etc; isolation and use of these compounds provide health benefits (Bai, 2023), Despite the lack of specific scientific proof for the efficacy of these plants, their popularity persists due to factors like cost, accessibility, individualized healthcare preferences, and concerns about negative effects associated with synthetic drugs (Al-Aidaroos et al., 2023), In affluent nations, 80% of people use traditional remedies made from plants, and approximately 25% of all globally prescribed drugs are derived from plants (Akinwumi & Sonibare, 2019; Kuna et al., 2019).

1.2 Statement of the problem

Peptic ulcers, affecting the stomach, duodenum, or esophagus, are commonly caused by H. pylori infection or prolonged use of NSAIDs, posing a significant global health burden. The economic impact is substantial, with high treatment costs and lost productivity (Zahid et al., 2020).

In Uganda, the incidence of peptic ulcers is increasing, attributed to NSAID use and a high prevalence of H. pylori. Limited data indicates it is a significant health concern in the country. The use of synthetic drugs for treatment introduces various risks, including side effects, drug interactions, drug resistance, masking of underlying conditions, and reduced effectiveness over time (Sweeney, 2022).

Herbal medicine is presented as a potential alternative with benefits such as fewer side effects, increased bioavailability, anti-inflammatory and antibacterial effects, cost-effectiveness, and an integrative approach to address underlying causes (Esmaeilzadeh et al., 2021), The argument is made for herbal medicine being an important and effective tool in treating peptic ulcers, offering advantages that can alleviate symptoms and promote healing.