Etiology and outcome of patients with upper gastrointestinal bleeding: A study from South of Iran

Abstract

Background/Aim:The prevalence of acute upper gastrointestinal bleeding (AUGIB) has undergone a change after implementation of eradication therapy for Helicobacter pylori in peptic ulcers effective prevention of esophageal variceal bleeding and eventually, progressive use of low dose aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs). To evaluate this subject, we performed a prospective study in two main University Hospitals of Shiraz (the largest city of southern Iran).Materials and Methods:All adults who were admitted in emergency room with impression of AUGIB and existing patients who developed AUGIB were included in the study. Gastroscopy was done with a follow-up for the next 15 days.Results:572 patients (mean age: 54.9 years) entered in the study. The most common presenting symptom was hematemesis or coffee-ground vomits (68%). 75% of patients gave history of consumption of low dose aspirin or other NSAIDs regularly. Gastric and/or duodenal ulcers were the most common causes (252/572, 44%) of AUGIB (Gastric ulcer: 173/572, 30% and duodenal ulcer: 93/572, 16%, respectively). Esophageal varices were the third common cause (64/572, 11%). 36 (6%) of the patients died. Mean age of these patients was higher than the patients who were alive (64.8 vs. 54.2 years, P = 0.001). Other than age, orthostatic hypotension on arrival (267/536 vs. 24/36, P = 0.018) and consumption of steroids (43/536 vs. 10/36, P = 0.001) were significant factors for increasing mortality.Conclusions:The most common cause of AUGIB, secondary only to NSAIDs consumption, is gastric ulcer. Mortality of older patients, patients who consumed NSAIDs and steroids concomitantly, and patients with hemodynamic instability on arrival were higher.

The characteristics of adults with upper gastrointestinal bleeding admitted to Tripoli Medical Center: a retrospective case-series analysis

“…Of the 928 cases included in this analysis, males constituted the larger proportion of cases in all age groups and were significantly younger than their female counterparts. These findings were similar to reports from Jordan and Iran ( 4 , 5 , 7 ), but our patients were older than reported in Pakistan and Kuwait ( 9 , 10 ). Although many studies have documented increasing age of patients with UGIB ( 8 , 11 ), only 13.6% of our patients were older than 75 years.…”

“…The most common cause of UGIB was peptic ulcer, which represents 37.1% of all cases, followed by bleeding due to varices in 29.8% of the cases. These findings were similar to those from Kuwait ( 10 ), Iran ( 5 ), Pakistan ( 12 ), and Greece ( 8 ), but different to data from Saudi Arabia ( 6 ) and Jordan ( 4 ).…”

Cost-effectiveness evaluation of aspirin in primary prevention of myocardial infarction amongst males with average cardiovascular risk in Iran

“…Tables 1 and 2 show the parameters used in the model. The probability used for mortality with GIB was considered to be 4% for ages ≤ 60 and 10% for ages > 60, respectively(35). To consider the impact of aging on individual’s health (obviously, as a person ages, his health-related quality of life diminishes) age-specific utility weights were also applied to the model.…”

Tranexamic acid for acute gastrointestinal bleeding (the HALT-IT trial): statistical analysis plan for an international, randomised, double-blind, placebo-controlled trial

“…The main causes of GI bleeding are peptic ulcer disease, erosive mucosal disease, oesophageal varices and malignancy [10]. Peptic ulcer disease and erosions due to Helicobacter pylori infection and non-steroidal anti-inflammatory drug (NSAID) use are common causes of GI bleeding worldwide [1, 6, 10, 12, 18, 21–25]. Bleeding from gastro-oesophageal varices due to liver cirrhosis is an increasing cause of bleeding in the West, but is also a major cause in parts of South America, Asia, Africa and the Middle East where there is high prevalence of hepatitis or schistosomiasis [26–33].…”