Spectrum of Upper Gastrointestinal Hemorrhage in Coastal Odisha

Singh, Shivaram Prasad; Panigrahi, Manas

doi:10.7869/tg.2012.85

Cited by 38 publications

(40 citation statements)

References 9 publications

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“…This is consonance with some reports from North India but in other reports peptic ulcer disease remains the commonest cause. 4,5,12 Interestingly, some patients with variceal bleeding had small varices (grade I) which could be due to use of drugs like terlipressin and reduction of size after gastrointestinal bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…1 In studies done in Western population, as well as Southern and coastal India, peptic ulcer disease still constitutes the most common cause of upper gastrointestinal bleed. [2][3][4][5] Upper gastrointestinal endoscopy plays an important role in the diagnosis of etiology of bleed, stratification of patients according to the risk of rebleed based on the endoscopic stigmata and in treatment of such patients.…”

Section: Introductionmentioning

confidence: 99%

“…8 The Rockall score is used to predict mortality and consists of a pre-endoscopic clinical score and a complete endoscopic score after endoscopy. 5,9 While a number of studies are available from the Western population on the utility of these scores, the data from India is miniscule. We proposed to study the role of clinical and endoscopic Rockall scores in patients presenting with AUGIB at a large tertiary care center in India.…”

Section: Introductionmentioning

confidence: 99%

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Utility of clinical and complete Rockall score in Indian patients with upper gastrointestinal bleeding

Sharma¹

2016

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Introduction: Acute upper gastrointestinal bleeding (AUGIB) is an important gastroenterological emergency. Role of Rockall score in stratification of risk of mortality and rebleeding in Indian patients is uncertain. Methods: This study was prospectively conducted on 175 consecutive patients admitted with AUGIB who were 18 years or above. The clinical Rockall score and complete scores calculated at admission and after endoscopy were analyzed for association with the outcome (rebleeding and mortality) for both variceal and non-variceal bleeding. Results: The mean age of the patients was 48.4±16.4 years and 78.9% were males. History of inake of NSAIDs in patients of AUGIB was present in 13.7% and of antiplatelets in 13.7%. Variceal bleed was the most common etiology (45.7%) followed by peptic ulcer disease (24.0%). Overall rates of surgery, rebleed and mortality were 6.9%, 22.9% and 20% respectively. Both clinical and complete Rockall risk scoring systems were useful tools for stratifying patients with AUGIB into high and low risk categories for mortality. However, for the prediction of rebleed, the complete Rockall scoring system was found to be better than the clinical scoring system. These scoring systems performed much better in predicting the outcomes in non-variceal bleed than in patients with variceal bleed. Multivariate analysis showed that patients with age ≥65 years and albumin <3 g/dl were at an increased risk of mortality. Conclusion: Rockall scoring can be used to stratify patients with AUGIB and is more useful in non-variceal bleeding.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Utility of clinical and complete Rockall score in Indian patients with upper gastrointestinal bleeding

Sharma¹

2016

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“…In the study conducted by Anandet al 8 in north India, Variceal bleeding was most common cause of UGIB followed by peptic ulcer disease, gastric erosions, Mallory Weiss tear, gastric tumor and duodenal polyp. However in the study conducted by Singh et al 7 in eastern India, bleeding from duodenal ulcer was most common followed by variceal bleeding.…”

Section: Resultsmentioning

confidence: 91%

Frequency, Determinants and Outcome of Upper Gastrointestinal Bleed among Patients with Liver Cirrhosis

Sibia¹,

Sibia²,

Sharma³

et al. 2017

Int. J. Curr. Res. Med. Sci.

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Upper gastrointestinal bleed (UGIB) is among one of the common clinical manifestations encountered in emergency departments. UGIB can manifest in form of hematemesis, melena and/or hematochezia. This study was undertaken to study frequency and determinants of upper gastrointestinal bleed in patients with liver cirrhosis and to assess the outcome of patients of liver cirrhosis presenting with upper gastrointestinal bleed. This study was conducted among 100 patients with documented cirrhosis of liver admitted to different wards of Rajindra Hospital attached to Govt. Medical College, Patiala, India.. Patients of liver cirrhosis with presenting complaints of upper gastrointestinal bleed were recruited as the study group and the patients of liver cirrhosis without UGIB were assessed as the control group. Upper gastrointestinal endoscopy was done to identify cause of UGIB. Patients with UGIB were followed up at 0, 3 and 6 month interval to assess the outcome. UGIB was detected among 53 (53%) among 100 subjects enrolled in the study. Previous history of upper gastrointestinal Bleed, NSAIDs intake, Binge alcohol drinking, presence of red colour signs, presence of medium and large size varices, evidence of varices in esophagus and stomach, low platelet count, deranged coagulation profile (prothrombin time and INR) and increased portal vein diameter were determinants of upper gastrointestinal bleed. In conclusion, early identification of these determinants combined with logical prescription to those with cirrhosis of liver can aid in deceasing the frequency of upper gastrointestinal bleed.

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“…In the current manuscript, Singh et al have described their experience of UGIB from coastal Odisha 5 . In this study, the commonest causes of UGIB are duodenal ulcer (57.5%) followed by esophageal varices (13.0%).…”

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confidence: 99%

Upper GI bleeding – Has mortality changed with advancements in therapy?

Gupta¹,

Reddy²

2013

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Upper gastrointestinal bleeding (UGIB) is one of the most common GI medical emergencies, which all GI units deal with everyday. UGIB is broadly categorized into variceal and non variceal bleeding .This distinction becomes crucial as the management strategies are different for variceal and nonvariceal bleeding .There has been tremendous advancement in pharmacological and endoscopic interventions in management of upper GI bleeding over the past decade. However, it still carries considerable morbidity, mortality and health economic burden. Peptic ulcer bleeding is the predominant cause of nonvariceal bleeding in the US and Europe. Recent data indicate a decline in the incidence of peptic ulcer disease and peptic ulcer bleeding in both the United States and Europe, which can be attributed to a decrease in H. pylori infection. Numerous studies from US, Europe and some Asian countries have reported peptic ulcer bleeding mortality 5-12% 1,2 . Furthermore, these peptic ulcer bleeding linked deaths are not a direct result of bleeding ulcers. Instead, death occurs due to multi organ failure and other associated co morbidities. These studies have also shown that endoscopic interventions and pharmacological treatments have reduced rebleeding rates, rates of surgical interventions, days of hospitalization and number of blood units transfused. However, none of these therapeutic approaches have reduced the overall mortality associated with the bleed event. Hence, there is a need to relook at factors associated with mortality and revise management strategies accordingly.Foremost, reasons for failure to reduce mortality rates despite major advances in endoscopic hemostatic modalities needs to be explored . A number of factors have been proposed as possible causes of persistently high mortality associated with peptic ulcer bleeding .Age and the presence of associated comorbidities are the most important factors for high mortality in a bleeding event. Sung et al reported an overall mortality of 6.2% in patients with peptic ulcer bleeding in a large cohort of 9,375 patients 3 . 80% of these deaths were not related to ulcer bleed as opposed to 20% of mortality directly relatedto peptic ulcer bleed.Among those who died of non-bleeding related causes, multi-organ failure (24%), pulmonary causes (23.5%) and terminal malignancies were the most common causes, while bleeding related deaths occurred when immediate control of bleed could not be achieved or failure of endoscopic therapy within 48 hrs. The mean age of patients who died of bleeding related causes was higher than those who died of non-bleeding related causes. (75.4 years Vs 71.7 years, p=0.01). The survivors were younger with less severe comorbid diseases than non survivors. (61years vs 72.5years).This data clearly indicate that pharmacological or endoscopic intervention will have little impact on overall mortality. Hence, the efforts should be focused on identifying non GI factors associated with poor outcomes and reduce the risk of multi organ failure, especially in elderly p...

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Spectrum of Upper Gastrointestinal Hemorrhage in Coastal Odisha

Abstract: Introduction: Upper gastrointestinal bleeding (UGIB) is one of the commonest gastrointestinal emergencies encountered by physicians and surgeons. The spectrum of upper gastrointestinal

Cited by 38 publications

References 9 publications

Utility of clinical and complete Rockall score in Indian patients with upper gastrointestinal bleeding

Utility of clinical and complete Rockall score in Indian patients with upper gastrointestinal bleeding

Frequency, Determinants and Outcome of Upper Gastrointestinal Bleed among Patients with Liver Cirrhosis

Upper GI bleeding – Has mortality changed with advancements in therapy?

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