Spectrum of Endoscopic Findings in Patients of Upper Gastrointestinal Bleeding at a Tertiary Care Hospital

Abstract

Background & aims Upper gastrointestinal bleeding (UGIB) is a common medical emergency that results in high patient morbidity and mortality. There are numerous causes of UGIB. The aim of our study was to evaluate the endoscopic findings in patients of UGIB in this part of the world. Methods This retrospective study was conducted at the Department of Gastroenterology Nishtar Medical University & Hospital Multan from June 2018 to March 2019. Record of all patients undergoing esophagogastroduodenoscopy (EGD) for evaluation of UGIB was reviewed. Data was entered and analyzed using SPSS version 20 (IBM, Armonk, NY, USA). Results Record of 730 (464 male and 266 females) patients undergoing EGD for UGIB was reviewed. Mean age of study population was 49.38 years with standard deviation of 14.86 years. Age of the youngest patient was 14 years while the oldest patient was 99 years of age. More than half of the patients (53%) belonged to the 41-60 years age group. The most common endoscopic finding was esophageal varices in 371 (50.8%) patients, followed by gastropathy (114, 15.6%), gastritis (68, 9.3%), cardio-fundal varices (58, 7.9%) and duodenal ulcer (26, 3.6%). Esophageal varices, gastritis, duodenal ulcers and gastric carcinomas were more likely to be found in male UGIB patients as compared to female patients (p = 0.039). Gastropathy, esophageal ulcer and gastric ulcer were more likely to be found in female UGIB patients. Esophageal varices and cardio-fundal varices were more likely to be found in UGIB patients from middle age group (p = 0.000). Whereas gastritis, duodenal ulcer, gastric erosions and duodenitis were more likely to be found in older (>60 years) UGIB patients (p = 0.000). Conclusion UGIB was more likely to occur in male gender. In our study, bleeding from esophageal varices was the most important cause of UGIB in this part of the world and bleeding from duodenal ulcer was quite uncommon as compared to the western world. Variceal bleeding had a significant association with male gender and middle age group patients. While duodenal ulcer bleed had a significant association with older age.

Endoscopic Findings in Patients with Upper Gastrointestinal Bleeding in Upper Egypt: A Single Centre Study

“…Moreover, we found that UGIB was more common in male patients than females, with a male to female ratio of 1.7:1. This is the same as that of Malghani in Pakistan, and comparable to the data reported in other studies in which male patients having UGIB was greater than females, in different populations [11,13,14].…”

“…In our study, the mean age of our patients was 48.33 years. This was slightly lower than the mean age of UGIB patients reported in other studies [9][10][11]. The majority of the patients (47%) were in the age group 41-60 years, followed by age group > 60 years (n = 212; 23%) and 26-40 years (n = 202; 22%), the least common age group was less than or equals to 25 years (n = 74; 8%).…”

Study of Endoscopic Findings in First Episode of Upper Gastrointestinal Bleeding

“…18 The study done in Dhulikhel hospital Nepal among 90 patients of UGI bleeding, Gastric ulcer in 25.6% was the most common endoscopic finding, followed by oesophageal varices 15.6% which is similar to our study population and methods, however they have also included patient with or without previous GI bleeding. 1,9 Another study from Lahore medical college Pakistan the most common endoscopic finding was esophageal varices in 50.8% patients, followed by gastropathy in 15.6%, gastritis 9.3%, cardio-fundal varices 7.9% and duodenal ulcer 3.6% apart from our study they have analyzed every cases presenting to their hospital emergency with UGI bleeding irrespective of previous history of GI Bleeding. 9 Another study done in College of Medical science, Bharatpur showed Upper Gastrointestinal Bleeding endoscopy revealed esophageal varices 47.5%, peptic ulcer disease 33.3%, erosive mucosal disease 11.6%, Mallory Weiss tear 4.1% and malignancy 3.3%.…”

“…1 Another similar study done in Lahore Medical college Pakistan , 63.6% were male and 36.4% were female. 9 In Nepal various risk factors like smoking and alcohol consumption that are commoner in male population which might have some role in the contribution to UGI bleeding.…”

Clinical and endoscopic profile in acute upper gastrointestinal bleeding in tertiary health care centre- a retrospective study

“…Dewan KR et al7 studied the clinical and endoscopic profile of acute upper gastrointestinal bleed to know the etiology, clinical presentation, severity of bleeding and outcome. 3%), erosive mucosal disease (11.6%), Mallory Weiss tear (4.1%) and malignancy (3.3%).Malghani WS et al[8] evaluated the endoscopic findings in patients of UGIB in this part of the world.They studied records of 730 (464 male and 266 females) patients undergoing EGD for UGIB. Mean age of study population was 49.38 years, similar to our study.…”