Abstract

A STUDY OF CLINICAL AND ENDOSCOPIC PROFILE OF PATIENTS WITH ACUTE UPPER GASTROINTESTINAL BLEEDING IN A TERTIARY CARE REFERRAL CENTER OF KERALA, SOUTH INDIA

Waseem Raja*, Sunil K . Mathai, Rohey Jan, Benoy Sebastian.

Abstract

Background: Acute Upper Gastrointestinal Bleeding is a common medical emergency with a hospital mortality of approximately 10 percent. 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. Aims: The aim was to study the clinical and endoscopic profile of patients presenting with acute UGIB admitted, at our Gastroenterology center. Methods: A hospital based, prospective study was conducted in Gastroenterology unit of Medical Trust Hospital Kochi –Kerala, one of the tertiary care referral centre in South India over a period of one year, from march 2016 to march 2017. During this study period, 120 patients were identified who came to Emergency Department with UGIB and were subjected to endoscopy to identify the etiology. The clinical and endoscopic profile was analyzed and mortality pattern was studied. Results: The present study comprised of 120 patients of acute UGI bleeding. The age ranged from 14 to 88 years, mean age being 48.76+17.19. Ninety patients (75%) were male and 30 patients (25%) were female with M: F = 3:1. Eighty six patients (71.7%) presented with both hematemesis and malena, while 24 patients (20%) presented with only hematemesis and 10 patients (8.3%) presented with only melana. Upper Gastrointestinal endoscopy revealed esophageal varices in 57 patients (47.5%), Peptic ulcer disease in 40 (33.3%), Mallory Weiss tear in 10 (8.3%), Erosive mucosal disease 6 (5%), malignancy in 4 (3.2%) and GAVE (2.5%). Comorbidities were present in 43.3%. 11 patients (9.1%) expired. Risk factors for death being heavy alcoholic consumption, advanced cirrhosis, massive rebreeding, and associated co morbidities. Conclusions: Acute Upper Gastrointestinal bleeding is a medical emergency. In the present study, variceal bleed was the most common cause of UGIB, followed by peptic ulcer bleed. However, majority of mortality was seen in portal hypertension related bleeding. Urgent, appropriate hospital management definitely helps to reduce morbidity and mortality.

Keywords: Upper gastrointestinal bleed, Portal Hypertension, Peptic ulcer, UGI Endoscopy, Co morbidities.