Acute Upper Gastrointestinal Bleeding in a Tertiary Care Centre of Nepal
Introduction: AUGIB is characterized by hematemesis or melena or both. Peptic ulcers and variceal bleed account for majority of cases. Use of proton pump inhibitors in current era is associated with a gradual reduction in burden of peptic ulcer disease. We conducted this study to look into the cause of AUGIB in our community.
Methods: We studied 100 patients in one year period who presented to us with hematemesis or melena. The study was conducted in department of Gastroenterology, Bir hospital, Kathmandu. We identified the culprit lesions by upper gastrointestinal endoscopy.
Results: The average age of patients with AUGIB was 51.6 years with 59 (59%) males. Duodenal ulcers are most common 29 (29%), followed by varices 23 (23%) and gastric ulcers 14 (14%). More than one lesion was identified in 38 (38%) patients. Patients with variceal bleed were more likely to present with hematemesis alone as compared to those with ulcer bleed (p=0.005). Variceal bleed patients presented earlier to the hospital (p=0.005), had lower MAP at presentation (p=0.0002), had lower hemoglobin level (p=0.0001) and higher serum creatinine level at presentation (p=0.001). Patients with variceal bleed were more likely to have consumed alcohol 20 (86.9%) and patients with ulcer bleed were more likely to be smokers 29 (67.4%) or consume tobacco 14 (32.5%) (p=0.006).
Conclusions: Ulcer related bleeding is still the most common cause of AUGIB. Many patients with AUGIB have more than one lesions identified during upper gastrointestinal endoscopy.
Keywords: bleeding; endoscopy; peptic ulcer; upper gastrointestinal;varices. [PubMed]
2. Hearnshaw SA, Logan RFA, Palmer KR, et al. Outcomes following early red blood cell transfusion in acute upper gastrointestinal bleeding. Aliment Pharmacol Ther. 2010;32(2):215–24. [PubMed]
3. Palmer K. Acute upper gastrointestinal bleeding. Medicine. 2011;39(2):94–100. [Full Text]
4. Gralnek IM, Dumonceau JM, Kuipers EJ, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47(10):a1–46. [PubMed]
5. Kim JJ, Sheibani S, Park S, et al. Causes of bleeding and outcomes in patients hospitalized with upper gastrointestinal bleeding. J Clin Gastroenterol. 2014;48(2):113–8. [Full Text]
6. Bhattarai J, Acharya P, Barun B, et al. Comparision of endoscopic findings in patients from different ethnic groups undergoing endoscopy for upper gastrointestinal bleed in eastern Nepal. Nepal Med Coll J. 2007;9(3):173-5. [PubMed]
7. Hreinsson JP, Kalaitzakis E, Gudmundsson S, et al. Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting. Scand J Gastroenterol. 2013;48(4):439-47. [Full Text]
8. Mustafa M, Menon J, Muiandy RK, et al. Risk Factors, Diagnosis, and Management of Peptic ulcer Disease. IOSR-JDMS. 2015;14(7):40–6. [Full Text]
9. Satarasinghe RL, Silva AD, Arulnithy K, et al. Aetiology and other features of a cohort of adult Sri Lankans presenting with upper gastrointestinal bleeding (UGIB). J Ceylon College Physic. 2011;41:57-60. [Full Text]
10. Masclee GMC, Valkhoff VE, Coloma PM, et al. Risk of upper gastrointestinal bleeding from different drug combinations. Gastroenterology. 2014;147(4):784-792. [PubMed]
11. Crooks CJ, West J, Card TR. Comorbidities Affect Risk of Nonvariceal Upper Gastrointestinal Bleeding. Gastroenterology. 2013 Jun;144(7):1384–1393. [PubMed]
12. Parvez MN, Goenka MK, Tiwari IK, et al. Spectrum of upper gastrointestinal bleed: An experience from Eastern India. Journal of Digestive Endoscopy. 2016;7(2):55. [Full Text]
13. Rao SSP, Kedar T, Sailaja P, et al. A study on upper gastrointestinal endoscopic findings in patients with upper gastrointestinal bleeding. J. Evid. Based Med. Healthc. 2016; 3(85), 4650-4655. [Full Text]
14. Dewan KR, Patowary BS, Bhattarai S. A study of clinical and endoscopic profile of acute upper, gastrointestinal bleeding. Kathmandu Univ Med J (KUMJ). 2014;12(45):21-5. [PubMed]
15. Gurung RB, Joshi G, Gautam N, et al. Upper gastro-intestinal bleeding: aetiology and demographic profile based on endoscopic examination at Dhulikhel Hospital, Kathmandu University Hospital. Kathmandu Univ Med J (KUMJ). 2010;8(30):208-11. [PubMed]
16. Montoliu S, Ballesté B, Planas R, et al. Incidence and prognosis of different types of functional renal failure in cirrhotic patients with ascites. Clin Gastroenterol Hepatol. 2010;8(7):616–622. [PubMed]
17. Wong F, Nadim MK, Kellum JA, et al. Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis. Gut. 2011;60(5):702–9. [Full Text | PubMed]
18. Warner NS, Cuthbert JA, Bhore R, et al. Acute kidney injury and chronic kidney disease in hospitalized patients with cirrhosis. J Investig Med. 2011;59(8):1244–51. [PubMed]
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