Early Endoscopy of Oesophagus, Stomach, and Duodenal Bulb in Patients with Haematemesis and Melaena

Cotton, P. B.; Rosenberg, Mervyn; Waldram, Richard; Axon, A. T. R.

doi:10.1136/bmj.2.5865.505

Cited by 183 publications

(43 citation statements)

References 18 publications

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“…[15][16][17][18][19] Chronic duodenal and gastric ulcers were the most common cause of UGI bleeding in most of the published studies in this field. 14,20,21 In this study, similar findings were reported in five of the six most common causes identified. Mallory-Weiss tears and esophageal varices were less than what was reported by others, including some studies published from the same region.…”

Section: Discussionsupporting

confidence: 76%

“…NSAIDs were found to be an important predisposing factor to UGI bleeding, the finding which was established by many other investigators. [13][14][15]20,28 Mortality from UGI bleeding is still 10%, which represents almost no decline over the past 30 years. 10,14,16,[22][23][24] The mortality in this study was 6.9%; the reason for this lower mortality rate is attributed to the lower rate of massive UGI bleeding cases (28.5%) and to the lower rate of bleeding esophageal varices (5.6%).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Etiology of Upper Gastrointestinal Bleeding in Jordanian Patients: A Prospective Study

Shennak

1995

Annals of Saudi Medicine

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Endoscopy within 24 hours from the onset of upper gastrointestinal (UGI) bleeding was carried out on 853 Jordanian patients. Lesions as a bleeding source were identified in 799 (93.7%) patients. Radioactively tagged red blood cell (RBC) scan, angiography and upper gastrointestinal follow-through radiography were complementary studies in endoscopy negative patients. Etiology remained unidentified in 16 patients. The six most common causes of UGI bleeding in this study were duodenal ulcer, gastric erosions, duodenal erosions, esophagitis, gastric ulcer and esophageal varices. Nonsteroidal anti-inflammatory drugs (NSAIDs) were a significant predisposing factor for UGI bleeding (28.6%). Mortality at the first admission was 3.4% and increased during 12 month follow-up to 6.9%. Upper gastrointestinal (UGI) bleeding is a common and serious problem and management is both complicated and demanding.1 There is evidence confirming older concepts that the clinical picture at the time of presentation of the patient cannot and should not be considered as the basis for the diagnosis of the origin of the bleeding. [2][3][4][5] It is now accepted that barium studies are inappropriate in the investigation of acute upper GI bleeding; not only may the results be equivocal or misleading, but the presence of barium in the bowel precludes the effective subsequent use of angiography.6 Fiberoptic endoscopy is generally regarded as the primary investigative procedure in UGI hemorrhage 7,8 but has important limitations, particularly when the bleeding emanates from a lesion in the upper gut. 9The importance of this procedure is that it allows not only accurate identification of the bleeding site in well over 90% of patients but also provides valuable information in terms of surgical intervention should this become necessary. 10 Endoscopy not only offers information on the origin of the bleeding but also delineates a few prognostic factors which are relevant. 11 Patients and MethodsDuring the period from January 1983 to December 1992, 1355 patients with UGI bleeding were admitted to the GI and Liver Unit. Criteria for inclusion in this study were the following: 1) Jordanian patients who never lived outside Jordan prior to their bleeding attack; 2) history of hematemesis and/or melena on presentation, witnessed by medical personnel and/or melena by rectal examination. 3) positive occult blood in the stool if the hematemesis was not witnessed by medical personnel on presentation with the exclusion of an actively bleeding anorectal lesion.Eight hundred and fifty-three patients were endoscoped by the investigator and fulfilled the criteria for inclusion in this study.During the same period, 365 patients with age and sex matching were selected from patients who were admitted for reasons other than UGI bleeding, from whom 103 patients (28.4%) had a history of aspirin or nonsteroidal antiinflammatory drug (NSAID) ingestion within a week prior to admission. This group of patients was investigated and used as a control group for cases presenting with...

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Etiology of Upper Gastrointestinal Bleeding in Jordanian Patients: A Prospective Study

Shennak

1995

Annals of Saudi Medicine

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“…Western studies have described bleeding from multiple sites in much higher percentage of patients [8,9]. We found oesophagitis, gastritis and duodenal ulcer coexisting with oesophageal varices but active bleeding was from varices in all except three patients where it was due to gastritis or duodenal ulcer.…”

Section: Discussionmentioning

confidence: 53%

Aetiology of Upper Gastrointestinal Haemorrhagean Endoscopic Study

Pruthi

Sharma

Singh

et al. 2000

Medical Journal Armed Forces India

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610 patients of upper gastrointestinal haemorrhage were endoscoped over a period of eleven years from July 1985 to June 1996. Average age of the patients was 39.2 years. 82.6% were males and 17.4% were females. Duodenal ulcer (31.5%), erosive mucosal disease (30.8%), oesophageal varices (31.5%) and gastric ulcer (6.2%) were the major causes. Other causes included Mallory Weiss syndrome (10 patients), gastric polyp (3 patients), stomal ulcer (5 patients) and self-induced bleeding (3 patients). Multiple lesions responsible for bleeding were detectable in 6.6% of patients. Endoscopy was non-contributory in 50 (11.2%) patients. Haemorrhage was the first presentation in 8.5% patients of duodenal ulcer. A known ulcerogenic agent in 21 % of duodenal ulcer cases precipitated the bleeding. 77.4% of duodenal ulcer patients responded to conservative management. Erosive gastritis (57.5%) was the commonest finding in the erosive mucosal group. Alcohol and analgesics were the major precipitating factors in these patients. Majority of oesophageal varices were treated 'JY sclerotherapy. Mortality (20%) were highest in the oesophageal varices group. MJAFI 2000, 56: 188-191

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“…In other published studies, oesophagitis had not been a major source of upper GI bleeding, ranging from about zero percentage 13,20 to 12.8% 12 . Oesophageal ulcers were reported in 3.8%, denoting severe GORD, which is a high prevalence compared to other studies 12,15 .…”

Section: Discussionmentioning

confidence: 99%

“…Admissions to the surgical units and other medical units with upper gastrointestinal bleeding had not been evaluated in this study. Chronic duodenal and gastric ulcers were the most common causes of upper gastrointestinal bleeding in most of the published studies 12,13,14,15 . In contrast the present study showed peptic ulcer disease in only 15% of the bleeders.…”

Section: Discussionmentioning

confidence: 99%

Aetiology and other features of a cohort of adult Sri Lankans presenting with upper gastrointestinal bleeding (UGIB)

Satarasinghe¹,

Silva²,

Arulnithy³

et al. 2011

J of Cey Coll of Phy

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Results: There were 342 (24%) upper GI bleeders. The mean age of presentation was 55.5 years +/-14.4 SD. A high proportion was seen between 50-70 years of age. Sex distribution was, male:female = 229:114 (2:1). 45% have presented with haematemesis, 31% with malaena, and 24% with both. Endoscopy showed the presence of severe antral gastritis and duodenitis, oesophageal varices, oesaphagitis, erosive gastropathy, portal hypertensive gastropathy, pangastritis and peptic ulcer disease in 38%, 35%, 28%, 28%, 20%, 17% and 15% of the instances respectively. Hiatus herniae were seen in 43% although its role was unclear. Often combined pathologies were seen. Only 52% of the varices showed endoscopic evidence of bleeding. Excess alcohol consumption was seen in 36% while 5% were on NSAIDs. 5% had endoscopic negatives.Conclusions: UGIB is a major problem to the endoscopist, constituting about 25% of the work load, in this part of the continent. Although approximately 50% of the varices found had bled, portal hypertension related pathologies are a cause for concern. Alcohol was a contributory factor in 1/3 of the endoscoped population. Bleeding from PUD was not a dominant feature compared to the west.

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Early Endoscopy of Oesophagus, Stomach, and Duodenal Bulb in Patients with Haematemesis and Melaena

Cited by 183 publications

References 18 publications

Etiology of Upper Gastrointestinal Bleeding in Jordanian Patients: A Prospective Study

Etiology of Upper Gastrointestinal Bleeding in Jordanian Patients: A Prospective Study

Aetiology of Upper Gastrointestinal Haemorrhagean Endoscopic Study

Aetiology and other features of a cohort of adult Sri Lankans presenting with upper gastrointestinal bleeding (UGIB)

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