Upper gastro-intestinal bleeding: Aetiology and demographic profile based on endoscopic examination at Dhulikhel Hospital, Kathmandu University Hospital

Abstract

Background: The upper gastrointestinal bleeding (UGIB) is defi ned as bleeding within the intraluminal gastrointestinal tract from any location between the upper oesophagus to the duodenum at the ligament of Treitz. It is one of the important medical emergencies worldwide. Objective: The objective of this study is to study the aetiology of upper gastrointestinal bleeding based on endoscopic examination fi ndings in patients of various demographic characteristics. Materials and methods: This is a retrospective observational study. The endoscopic record book from 2007 January to 2009 October was reviewed for all the cases who underwent oesophago-gastro-duodenoscopic examination for upper GI bleeding. The clinico-epidemiological data of all the patients was reviewed and analyzed in concert with the aetiology of bleeding. Results: A total of 90 patients (58 males, 32 females; mean age 45.32+ 18.47 years) of upper gastrointestinal bleeding was studied and analyzed in terms of aetiology of bleeding and demographic profi le. Among the ethnic groups, Aryan 46 (51%) was the most common ethnic group to have upper GI bleeding followed by Newars 24 (27%), Mongolians 16 (18%), Dalits 3 (3%) and others 1 (1%). Out of 90 patients, 47( 52.2%) cases was less than 45 years of age, 30(33.3%) of 46 to 65 age ; and 13(14.4 %) more than 65 years of age. Gastric ulcer 23(25.6%) was the most common endoscopic fi nding, followed by oesophageal varices 14 (15.6%), acute erosive/haemorrhagic gastropathy 11 (12.2%), duodenal ulcer 9(10%), growth 7(7.8%), vascular lesions 3(3.3%), Mallory-Weiss tear 1(1.1%), fundal varices 1(1.1%) and, no cause was identifi ed in 21(23.3%) cases. The peptic ulcer bleeding was the most common fi nding in Aryan 22(47.9%), whereas oesophageal varices and growth were more common in Newar 7(29.2%) and 3 (12.5%) respectively. Conclusion: Peptic ulcer disease is the most common cause of upper GI bleeding which was most commonly found in Aryan population; followed by oesophageal varices and growth as second and third most common causes and were more prevalent in Newar and Mongolian people.

A Study of Clinical and Endoscopic Profile of Acute Upper Gastrointestinal Bleeding

“…In other parts of Nepal also, male predominance was reported by Bhattarai et al 71% and Gurung et al 64.4%. 8,14 Similarly in other studies also male to female ratio 3:1 and 3.2:1, 70.1% male in Jamaican study, 79% male in Sudan study, 78.4% males reported by Kashyap et al and 59% in UK audit. [9][10][11][12][13]15 In Nepal various risk factors like smoking and alcohol consumption that are commoner in male population might have some role in the contribution to UGI bleeding.…”

“…In the present study, mean age was 48.76+17.19 which is similar to studies reported by from Nepal Gurung et al and Hussein et al that showed mean age 45.32+18.47 years and 44.6 years respectively. 8,9 From India, Anand et al reported mean age being 41 years and Rao et al reported a mean age of 43 years, from West Indies, Kaliamurthy et al reported higher mean age of 55 years. [10][11][12] Recent published UK audit showed even higher mean age of 64.4.…”

Complete Rockall score in predicting outcomes in acute upper gastrointestinal bleeding

“…71% similar to other parts of Nepal. 4,5 Some other studies 6,7,8,11,12 have also shown male predominance. In Southeast Asian countries, various risk factors like smoking, heavy alcohol consumption, alcoholic liver disease and low socioeconomic status might have some role in the contribution to UGI bleeding.…”

Clinical Presentation, Etiology and Outcome of Upper Gastrointestinal Bleed From a Tertiary Care Hospital of East Sikkim: An Observational Study.

“…[22] A study by Bedi TRS et al, Kathmandu, Nepal found hematemesis (56.7%), maelena (14.4%), recent onset anaemia with positive occult blood (22.2%) and both haemetemesis and maelena (6.7%) as presenting features. [23] Another study from northwestern Tanzania by Hyasinta et al found that the vast majority of patient presented with hematemesis (80.4%) alone. Maelena alone was reported in 9.2% patients.…”