Acute Upper Gastrointestinal Bleeding in a Tertiary Care Centre of Nepal

Abstract

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]

Findings of Esophagogastroduodenoscopy in Patients Suspected of Upper Gastrointestinal Bleeding Referred to the Main Endoscopy Unit at King Fahad Specialist Hospital

“…In this study, the median age of the studied patients was 45 years, and males outnumbered females (approximately 2:1 ratio). This finding coincides with several reports obtained from a prospective study on patients with UGIB in Iceland [9], a multicenter study in USA [8], a cohort of adult Sri Lankans [10], and a tertiary care center in Nepal [11].…”

“…Approximately one-fourth (22.78%) of our patients exhibited chronic duodenal and gastric ulcers. However, duodenal and gastric ulcers accounted for 43% of patients with UGIB in Nepal, followed by variceal bleeding in 23% of cases [ 11 ]. Another study in Sri Lanka identified severe erosive antral gastritis and duodenitis as the most frequent causes of UGIB, while chronic duodenal and gastric ulcers were less frequent [ 10 ].…”

Study of Endoscopic Findings in First Episode of Upper Gastrointestinal Bleeding

“…A previous study done at Bir Hospital Showed that average age of the patient with upper GI bleeding was 51.6 years. 6 Our finding is supported by findings of another study where 42% patients were in 41to 60 age group. 7 However a study from Dhulikhel hospital Nepal, 44.4% patients were in age group 15-45 years followed by 36.2% in age group 46-65 years which is different from the present study may be because they have included cases of GI bleeding irrespective of episodes, since most of the cases of chronic liver disease presented with variceal bleeding as a part of portal hypertension, however only first episodes of UGI bleeding was included in our study.…”

“…Previous study done in Bir hospital had shown that 48% were alcohol consumer and 53% were smoker. 6 Similar results were most probably due to the similar patient profile. A study done at JIPMER, Pondicherry, India showed that 32.8% patient consumed alcohol and 20.5% were smoker.…”

Analysis of Clinical Rockall Score in patients with Acute Upper Gastrointestinal Bleeding in the Emergency Services of a Tertiary Hospital

“…10 A previous study from Nepal by Paudel et al in 2017 among 100 patients had 43 patients with peptic ulcer followed by 23 of them with variceal bleed. 11,12 The Clinical Rockall score is a scoring system for UGIB which is calculated without the endoscopic indings and include 3 clinical variables: the patient's age, the haemodynamic status and the occurrence of a co morbid disease. A maximum score of 7 is possible.…”