Clinical and endoscopic profile of patients with upper gastrointestinal bleeding at tertiary care center of North India

Abstract

Background: Upper gastrointestinal bleeding (UGIB) is a common medical emergency associated with significant morbidity and mortality. The presentation of bleeding depends on the amount and location of hemorrhage and the endoscopic profile varies according to different etiology. Despite advancements in medical intervention UGIB still carries considerable morbidity, mortality and economic burden on health care system. At present, there is limited epidemiological data on UGIB and associated mortality from India. Aims: The aim was to study clinical, endoscopic profile, and associated mortality in patients presenting with UGIB. Materials and Methods: One hundred and fourteen patients came to Emergency Department with UGIB during the study period and were subjected to endoscopy to identify the etiology. The clinical and endoscopic profile was analyzed and mortality pattern was studied. Results: The mean age of patients was 49 ± 14.26. Majority of them were males (83.33%) and male to female ratio was 5:1. The most common cause of UGIB was portal hypertension related (Esophageal and gastric varices) seen in 56.14% of patients, peptic ulcer-related bleed was seen in 14.91% patients, gastric erosions were responsible for bleed in 12.28% patients, Mallory–Weiss tear was seen in 8.77% cases, gastric malignancy accounted for 4.38% of cases, Dieulafoy’s lesion was responsible for bleed in 1.75% cases and 1.75% had Duodenal polyp. The mortality rate because of UGIB in our cohort of patients was 21.05%. Conclusions: In the present study, variceal bleed was the most common cause of UGIB, followed by peptic ulcer bleed. Overall mortality was seen in 21.05% of cases; however, majority of mortality was seen in portal hypertension related bleeding.

Clinical and Endoscopic Profile of Patients with Upper Gastro-Intestinal Bleeding (UGIB)

“…Aetiological spectrum of UGIB showed that peptic ulcer disease was the most common cause, which is consistent with the study of Rocall et al 2 whereas in Indian studies portal hypertension-related UGIB was the most common cause. 11,13 The cause of portal hypertension is mostly due to alcohol-related liver disease in India 11,13 whereas in our study most common cause of portal hypertension was chronic liver disease due to hepatitis B. A significant portion of our patients presented with UGIB due to corrosive burn (harpic) which was mostly due to suicidal attempt.…”

“…In the study of Mahajan & Chandail 13 68.11% presented with both haematemesis and melaena while 20.95% presented with haematemesis only, and 10.94% had melaena only. In the study of Anand et al 11 27.19% patients presented with haematemesis, 12.28% patients presented with isolated melaena, 0.87% patient presented with haematochezia and 59.64% patients presented with complaints of haematemesis and melaena.…”

“…This finding is consistent with previous studies. 10,11,13 Rocall et al 2 also reported male predominance in British population. Around 48% of our patients were over 40 years whereas a study in India showed that 70.95% of their patients were above 40 years.…”

“…In a study in India, patients who presented with a systolic blood pressure of <100 mm Hg had a higher mortality (65.71%) in comparison to those whose blood pressure was >100 mm Hg at the time of hospital admission (1.40%). 11 There is no consistent relationship between the haemoglobin levels and prognosis. The mean haemoglobin of our patients was 8.65 ± 2.9 gm/dL indicating significant haemorrhage.…”

Study of Aetiology, Clinical Profile and Endoscopic Findings of Patients With Upper Gastrointestinal Bleeding- A Study From Rural Base Multispecialty Teaching Hospital

“…Similar prevalence studies are done in India as well as from other developing countries. [9][10][11][12][13][14][15][16][17] As studies are from different geographical locations and having different infrastructural facilities, results in relation to causes, clinical profile and outcome may vary. Table no 6 shows analysis of different studies having almost similar objectives of their research.…”