Etiological Profile and Clinical Outcome of Upper GI Bleeding

Abstract

Background: Upper GI Bleeding is a common emergency department presentation with high morbidity and mortality. There is paucity of data on the profile and outcome of patients who present with UGIB to emergency department especially in resource poor settings. We aim to describe the patient profile and outcome of patients with UGIB who present to emergency department of our tertiary referral hospital.

Objective: To look for etiological profile and clinical outcome of upper GI bleeding.

Study design: Hospital based prospective study.

Participants: The study population consisted of 200 patients ;Age ranged from 3-85 years (mean 43.5) ;127 (63.5%) were males and 73 (36.5%) were females.

Materials and methods: The current study was a prospective study performed on patients who presented in emergency room with acute upper GI bleeding over a period of two years from August 2017 to August 2019. Complete history was taken and physical examination was done. Baseline investigations were done and Upper GI endoscopy was performed within 24 hrs and end-points including mortality and re-bleeding and need for blood transfusion and surgery was recorded.

Results: During the study period 200 patients presented to emergency department with upper GI bleeding. Mean age was 43.5 years (range 3-85) and 63.5% were male. Melena was the most common presentation. Forty-five patients required blood transfusion. Upper GI endoscopy was performed in all patients and 141 patients were managed with some form of endotherapy, majority of whom received Inj. Adrenaline. Peptic ulcer was the most common cause of UGI bleeding followed by Erosive Mucosal Disease, Variceal bleeding and Upper GI malignancy. Within 15 days 8 patients died. Presence of various co-morbidities, malignancies and Rockall score > 5 were associated with increased mortality.

Conclusion: Peptic ulcer disease was the most common cause of UGI bleeding followed by erosive mucosal disease. UGI bleeding is more commonly seen in males. Melena was the commonest presentation in non-variceal bleeding and hematemesis was more common in variceal bleeding. Factors associated with increased mortality include presence of various co-morbidities, malignancies and Rockall score > 5.

Implications: Etiological spectrum of UGI bleeding is changing with our study showing erosive mucosal disease as the second most common cause of UGI bleeding which should be kept in mind by the doctor in emergency department evaluating cases of UGI bleeding.