Endoscopic evaluation of upper and lower gastro-intestinal bleeding

Abstract

Introduction:A myriad of pathologies lead to gastro-intestinal bleeding (GIB). The common clinical presentations are hematemesis, melena, and hematochezia. Endoscopy aids localization and treatment of these lesions.Aims:The aim was to study the differential diagnosis of GIB emphasizing the role of endoscopy in diagnosis and treatment of GIB.Patients and Methods:A prospective study of patients with GIB referred to the Endoscopy unit of two health facilities in Port Harcourt Nigeria from February 2012 to August 2014. The variables studied included: Demographics, clinical presentation, risk score, endoscopic findings, therapeutic procedure, and outcome. Data were collated and analyzed using SPSS version 20 software.Results:A total of 159 upper and lower gastro-intestinal (GI) endoscopies were performed during the study period with 59 cases of GI bleeding. There were 50 males and 9 females with an age range of 13–86 years (mean age 52.4 ± 20.6 years). The primary presentations were hematochezia, hematemesis, and melena in 44 (75%), 9 (15%), and 6 (10%) cases, respectively. Hemorrhoids were the leading cause of lower GIB seen in 15 cases (41%). The majority of pathologies in upper GIB were seen in the stomach (39%): Gastritis and benign gastric ulcer. Injection sclerotherapy was successfully performed in the hemorrhoids and a case of gastric varices. The mortality recorded was 0%.Conclusion:Endoscopy is vital in the diagnosis and treatment of GIB. Gastritis and Haemorrhoid are the most common causes of upper and lower GI bleeding respectively, in our environment

Hemorrhoidal disease: Predilection sites, pattern of presentation, and treatment

“…Hemorrhoids are a leading cause of lower gastrointestinal bleeding with a high impact on quality of life. [12] The pathophysiology is multifactorial including: sliding anal cushion; hyperperfusion of hemorrhoid plexus; vascular abnormality; tissue inflammation; and internal rectal prolapse (rectal redundancy). [345] The predisposing conditions to increased incidence of symptomatic hemorrhoids include state of elevated intra-abdominal pressure such as pregnancy and straining.…”

Re-bleed and Mortality Amongst Patients Following Initial Endoscopy for Upper Gastrointestinal Bleeding: A Single-Center Nigeria Study

“…Similar reports are documented from Europe and North America [ 3 , 6 , 19 ]. In an earlier report from our center involving half of the present study population, gastritis/erosions (39%), peptic ulcer disease (13%), and oesophageal varices (4.3%), among others, were reported as common causes of UGIB diagnosed by endoscopy [ 20 ]. The trend of UGIB may have changed due to increased patient referrals.…”

Worldwide Disease — Haemorrhoids. How Much Do We Know?

“…Previous studies confirmed the association of anorectal varices with portal hypertension in cirrhotic patients (Li et al, 2015). However, later studies showed the absence of differences in the hepatic venous pressure in cirrhotic patients with and without anorectal varices (Ray-Offor et al, 2015). Sinusoids are hyperperfused and overloaded, whereas connective tissue loses its capacity to support the vascular network and impedes venous return (Kuivaniemi et al, 2019).…”

“…Increased pressure on anorectal vascular plexus. Increased pressure on anorectal vascular plexus is a chronic rise in intraabdominal pressure when even cough in combination with the absence of valves within rectal veins can limit venous drainage from sinusoids during defecation, leading to abnormal dilatation of the arterio-venous anastomoses in internal haemorrhoidal plexus (Li et al, 2015;Ray-Offor et al, 2015). Defecation habits change over time to sitting down instead of squatting.…”