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

Deep Anand; Rohit Gupta; Minakshi Dhar; Vivek Ahuja

doi:10.4103/0976-5042.150660

Journal of Digestive Endoscopy, Table of Contents

CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2014; 05(04): 139-143
DOI: 10.4103/0976-5042.150660

Original Article

Society of Gastrointestinal Endoscopy of India

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

Deep Anand

Department of Medicine, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grants, Doiwala, Dehradun, Uttarakhand, India

,

Rohit Gupta

¹Department of Medicine, Unit of Gastroenterology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grants, Doiwala, Dehradun, Uttarakhand, India

,

Minakshi Dhar

Department of Medicine, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grants, Doiwala, Dehradun, Uttarakhand, India

,

Vivek Ahuja

¹Department of Medicine, Unit of Gastroenterology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grants, Doiwala, Dehradun, Uttarakhand, India

› Author Affiliations

Abstract

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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.

Key words

Child-turcotte-pugh - international normalized ratio - mortality - portal hypertension - upper gastrointestinal bleeding

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References

References
1 Ghosh S, Watts D, Kinnear M. Management of gastrointestinal haemorrhage. Postgrad Med J 2002;78:4-14.
2 Hernández-Díaz S, Rodríguez LA. Incidence of serious upper gastrointestinal bleeding/perforation in the general population: Review of epidemiologic studies. J Clin Epidemiol 2002;55:157-63.
3 Longstreth GF. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: A population-based study. Am J Gastroenterol 1995;90:206-10.
4 Ginn JL, Ducharme J. Recurrent bleeding in acute upper gastrointestinal hemorrhage: Transfusion confusion. CJEM 2001;3:193-8.
5 Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996;38:316-21.
6 Rathi P, Abraham P, Jakareddy R, Pai N. Spectrum of upper gastrointestinal bleeding in Western India. Indian J Gastroenterol 2001;20 suppl 2:A37.
7 Lakhwani MN, Ismail AR, Barras CD, Tan WJ. Upper gastrointestinal bleeding in Kuala Lumpur Hospital, Malaysia. Med J Malaysia 2000;55:498-505.
8 Singh SP, Panigrahi MK. Spectrum of upper gastrointestinal hemorrhage in coastal Odisha. Trop Gastroenterol 2013;34:14-7.
9 Rodrigues G, Shenoy R, Rao A. Profile of nonvariceal upper gastrointestinal: Bleeding in a tertiary referral hospital. Internet J Surg 2004;5:17-22.
10 Kashyap R, Mahajan S, Sharma B, Jaret P, Patial RK, Rana S, et al. A clinical profile of acute upper gastrointestinal bleeding at moderate altitude. J Indian Acad Clin Med 2005;6:224-8.
11 Bambha K, Kim WR, Pedersen R, Bida JP, Kremers WK, Kamath PS. Predictors of early re-bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis. Gut 2008;57:814-20.
12 Anand CS, Tandon BN, Nundy S. The causes, management and outcome of upper gastrointestinal haemorrhage in an Indian hospital. Br J Surg 1983;70:209-11.
13 Dilawari JB, Kaur U, Narayanan VA, Augustine P, Das J, Ali H, et al. Pattern of upper gastrointestinal haemorrhage in northern India – An endoscopic study of 316 patients. J Gastroenterol Hepatol 1987;2:443-9.
14 Gado AS, Ebeid BA, Abdelmohsen AM, Axon AT. Clinical outcome of acute upper gastrointestinal hemorrhage among patients admitted to a government hospital in Egypt. Saudi J Gastroenterol 2012;18:34-9.
15 Chaikitamnuaychok R, Patumanond J. Clinical risk characteristics of upper gastrointestinal hemorrhage severity: A multivariable risk analysis. Gastroenterol Res 2012;5:149-55.
16 Shingina A, Barkun AN, Razzaghi A, Martel M, Bardou M, Gralnek I, et al. Systematic review: The presenting international normalised ratio (INR) as a predictor of outcome in patients with upper nonvariceal gastrointestinal bleeding. Aliment Pharmacol Ther 2011;33:1010-8.
17 Cook DJ, Fuller HD, Guyatt GH, Marshall JC, Leasa D, Hall R, et al. Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group. N Engl J Med 1994;330:377-81.
18 Ismail FW, Mumtaz K, Shah HA, Hamid S, Abbas Z, Abid S, et al. Factors predicting in-hospital mortality in patients with cirrhosis hospitalized with gastro-esophageal variceal hemorrhage. Indian J Gastroenterol 2006;25:240-3.
19 Thomopoulos K, Theocharis G, Mimidis K, Lampropoulou-Karatza Ch, Alexandridis E, Nikolopoulou V. Improved survival of patients presenting with acute variceal bleeding. Prognostic indicators of short-and long-term mortality. Dig Liver Dis 2006;38:899-904.
20 Rockall TA, Logan RF, Devlin HB, Northfield TC. Influencing the practice and outcome in acute upper gastrointestinal haemorrhage. Steering Committee of the National Audit of acute upper gastrointestinal haemorrhage. Gut 1997;41:606-11.
21 Schiller KF, Truelove SC, Williams DG. Haematemesis and melaena, with special reference to factors influencing the outcome. Br Med J 1970;2:7-14.
22 Chalasani N, Kahi C, Francois F, Pinto A, Marathe A, Bini EJ, et al. Improved patient survival after acute variceal bleeding: A multicenter, cohort study. Am J Gastroenterol 2003;98:653-9.
23 Carbonell N, Pauwels A, Serfaty L, Fourdan O, Lévy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology 2004;40:652-9.