Upper Gastrointestinal Bleeding: Audit of a Single Center Experience in Western India

Abstract

Upper gastrointestinal (GI) bleeding is defined as bleeding proximal to the ligament of Treitz. The most important aspect of management of GI bleeding is to locate the site and cause of bleeding. The aim of the study is to find out the common etiology, presentation and management, including the role of upper GI endoscopy. Recent advances have meant that endoscopic hemostatic methods are now associated with a reduced rate of re-bleeding, cost, blood transfusion, length of hospital stay and mortality. A prospective study of 50 cases was carried out between August 2001 and July 2003. Patients with signs and symptoms suggestive of upper GI bleeding (UGIB) such as hematemesis, melena, aspirated blood from nasogastric tubes, profuse hematochezia, etc., were included in the study. The patients were selected randomly. The most common cause of UGIB in the present study was acute erosive gastritis (34%) followed by portal hypertension (24%) and peptic ulcer (22%). All 50 patients underwent upper GI endoscopy, of whom 39 patients were treated conservatively and 11 patients underwent endotherapy to control bleeding. Out of 39 patients treated non-endoscopically, 6 cases required laparotomy to control UGIB. 8 of 50 cases had past history of UGIB, 5 of whom had a previous history of endotherapy. One case was treated with de-vascularization as routine hemostatic methods failed. So, initial method of choice to control the bleeding was endotherapy and surgery was undertaken if an endoscopic method failed. The most common cause of hematemesis in our setting was acute erosive gastritis followed by portal hypertension. Endoscopy is a valuable minimal invasive method to diagnose and treat upper GI bleeding.

Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal

“…Based on the clinical presentation, a greater number of our patients presented with hematemesis only (43.8%). Hematemesis was the most common presentation in studies from 48% 12 to 100% 17 , which was consistent with our findings. Both hematemesis and melena were present in 71.7% 8 and 51% 16 .…”

“…In our study, 19(15.7%) presented with shock (systolic blood pressure SBP<90 mmHg). Similar findings of patients presenting with shock were seen in 21.7% 8 , 14% 12 , 36.7% 17 of UGIBD. Mean arterial blood pressure was low (73.71±10.95) 12 and hypotension was noted in 14.8% 18 of patients at presentation.…”

Aetiological Profile of Patients Presenting With Upper Gastrointestinal Bleeding

“…The mean age in this study was found to be 52.78 ± 13.52 years. Rathod JB et al 13 in 2011 reported haematemesis as most common presenting symptom same comparable as with our study. However, a bleeding duodenal ulcer is likely to be presented with melaena more frequently than haematemesis while a bleeding gastric ulcer patient may present with haematemesis more frequently than melaena.…”

“…A study 6 from Rajshahi also reported that most of the patients with upper gastrointestinal haemorrhage presented with both haematemesis and melaena (42%). Rathod JB et al 13 in 2011 reported haematemesis as most common presenting symptom. In a study 2 from Sikkim, India the commonest presentation was haematemesis and melaena in over half of the patients like other studies, 4,14 which predict massive bleeding.…”

Acute upper gastrointestinal bleeding in a tertiary care hospital in South India - Have we Improved the outcomes?

“…6,7,8 But western studies report a higher age at presentation, 9,10,11 which is due to elderly population in their community. Eighty percentage of the study population presented with haematemesis, 27.2% had massive haematemesis, and 39.4% presented with shock but unlike other studies 12 pain abdomen was present only in 13% that is due to higher number of patients with variceal bleed in our study. In our study population, 67 patients had co-morbidities with diabetes (55.2%) being the commonest co-morbidity.…”