Management of overt upper gastrointestinal bleeding in a low resource setting: a real world report from Nigeria

Abstract

BackgroundUpper gastrointestinal bleeding (UGIB) remains a common medical problem worldwide that has significant associated morbidity, mortality, and health care resource use. This study outlines the aetiology, clinical presentation, and treatment outcomes of patients with UGIB in a Nigerian low resource health facility.MethodsThis was a descriptive study of consecutive patients who underwent upper gastrointestinal (GI) endoscopy for upper GI bleeding in the endoscopy unit of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria from January 2007 to December 2013.ResultsDuring the study period, 287 (12.4%) of 2,320 patients who underwent upper GI endoscopies had UGIB. Of these, 206 (72.0%) patients were males and their ages ranged from 3 to 100 years with a median age of 49 years. The main clinical presentation included passage of melaena stool in 268 (93.4%) of individuals, 173 (60.3%) had haematemesis, 110 (38.3%) had haematochezia, and 161 (56.1%) were dizzy at presentation. Observed in 88 (30.6%) of UGIB patients, duodenal ulcer was the most common cause, followed by varices [52 (18.1%)] and gastritis [51 (17.1%)]. For variceal bleeding, 15 (28.8%) and 21 (40.4%) of patients had injection sclerotherapy and variceal band ligation, respectively. The overall rebleeding rate for endoscopic therapy for varices was 16.7%. For patients with ulcers, only 42 of 55 who had Forrest grade Ia to IIb ulcers were offered endoscopic therapy. Endoscopic therapy was áin 90.5% of the cases. No rebleeding followed endoscopic therapy for the ulcers. The obtained Rockall scores ranged from 2 to 10 and the median was 5.0. Of all patients, 92.7% had medium or high risk scores. An increase in Rockall score was significantly associated with length of hospital stay and mortality (p < 0.001). The overall mortality rate was 5.9% (17 patients).ConclusionEndoscopic therapy for UGIB in a resource-poor setting such as Nigeria is feasible, significantly reduces morbidity and mortality, and is cost effective. Efforts should be made to improve the accessibility of these therapeutic procedure for patients with UGIB in Nigeria.

The Practice of Interventional Gastrointestinal Endoscopy at a Tertiary Referral Hospital

“…Portal hypertension secondary to schistosomal fibrosis is still common in Kenya complicating into upper GI bleeding (9). Kayamba et al in a study on trends of upper GI endoscopy in Zambia, showed that Esophageal varices were the commonest finding in patients presenting with haematemesis, increasing by 14 % per decade in that patient group (19) Evolution from injection sclerotherapy to endoscopic variceal ligation is portrayed in our findings as well as other studies (12,20). All patients with esophageal varices underwent variceal band ligation.…”

Profile and outcome of patients with upper gastrointestinal bleeding presenting to urban emergency departments of tertiary hospitals in Tanzania

“…It is not clear if the higher mortality seen in low and middle income countries (LIMC’s) is due to patient demographics, severity on presentation, etiology or compliance with care standards. Esophageal varices has been implicated as the most common cause of UGIB in several African studies [2–11]. Rather than being due to alcoholic liver disease as in high income countries (HIC’s), varices in sub-Saharan Africa result from Schistosoma-related portal hypertension [5, 8, 12].…”

Prevalence of gastrointestinal bleeding and frequency of selected predictors of mortality on the Medical Emergency Ward at Mulago Hospital

“…Indeed, they stated missing data as a major limitation in their study. Other studies in similar resource setting have evaluated causes of GI bleeding (Alema, Martin, & Okello, 2012), (Alatise et al, 2014), (Harries & Wirima, 1989) and as such, it is not possible to compare our findings with theirs since we did not study etiology of the GI bleeding in our study. GI bleeding has been characterized better in high resource settings with incidence rates of 134 per 100,000 in the UK and being the most common cause of hospitalization due to gastrointestinal disease in the United States, accounts for more than 507,000 hospitalizations annually in the US (Peery et al, 2015).…”