Upper digestive hemorrhage : clinical, endoscopic and evolutionary particularities between patients with community and intra-hospital hemorrhage, prospective study

Aims The occurrence of upper GI hemorrhage (UGI) remains a potentially serious event, most often resulting in emergency endoscopy even though the majority of UGI is not immediately life-threatening. However, there is a lack of studies comparing the epidemiological profile, risk factors, and endoscopic management between non-hospitalized patients newly admitted to the emergency department for upper GI bleeding (HDH) and those already hospitalized.

The purpose of this study was to compare the clinical, endoscopic, and evolution aryfeatures between patients with community-acquired and in-hospital hemorrhage.

Methods This is a prospective cross-sectional single-center study about 332 patients, conducted over a one-year period between June 2022 and August 2023. We included in our study all patients admitted to our training in the emergency endoscopy unit for HDH.

We divided our patients into 2 groups, group A corresponding to patients with community hemorrhage and group B corresponding to patients with in-hospital hemorrhage.

Results Among the 332 FOGD sperformed for HDH, 81% of the cases (n=269) presented with community hemorrhage versus 19% (n=63) with intrahospital hemorrhage.

For group A the meanage was 58.8±17.2 years (17-90 years) with a M/F sex ratio of 2.2. 20.44% had comorbidities, the endoscopy was described as abnormalin 88.9% of the cases, the cause of which was dominated by ulcer originin 42% of the cases, followed by varicose originin 21% of the cases and neoplastic originin 11% of the cases, active bleeding was foundin 13.3% of the cases, and no deaths occurred.

For group B, the averageage was 61.7±14.2 years (17-88 years) with a sex ratio M/F of 3.5. 58.7% had comorbidities, the endoscopy was described as abnormalin 85.7%, the cause of which was dominated by ulcer originin 51%, followed by neoplastic origin, active bleeding was foundin 26.9% of the cases, 3 cases of death occurred post-endoscopy in patients who had already been hospitalized in the intensive care unit for another reason

There was no statistically significant difference between the two groups A and B concerning the age of the patients (p=0.21), the sex (p=0.19) and the origin of the bleeding (p=0.23). On the other hand, there was a statistically significant difference between the two groups A and B concerning the presence of comorbidities (10.9% vs. 40.2%, p=0.01), the use of antithrombotic drugs (16.4% vs. 30, 2%, p=0.012), the presence of active bleeding (16.1% vs. 32.1%, 0.008), the use of an endoscopic hemostatic procedure (17.3% vs. 29.2%, p=0.04), the need for transfusion (14.3% vs. 37%, p=0.002). The median Blatchford score was 9±3.5 and 12±3 respectively (p<0.001). The Rockall score was 4.22±0.079 and 5.04±0.131 respectively (p<0.01).

Conclusions In this comparative study, There was a higher transfusion requirement, active bleeding rate, use of endoscopic hemostasis and mortality for in-hospital bleeding.

Publikationsverlauf

Artikel online veröffentlicht:
15. April 2024