Common Causes, Various Spectrum of Clinical Profile and Outcome of Patients with Upper Gastrointestinal Bleeding

Introduction: The upper gastrointestinal bleeding (UGIB) is defined as bleeding within the intraluminal gastrointestinal tract from any location between the upper oesophagus to the duodenum proximal to the ligament of Treitz. It refers to intraluminal gastrointestinal tract bleeding (as Haematemesis, Malena, Haematochezia, Occult gastrointestinal bleeding, Risk factors that are associated with acute upper gastrointestinal bleeding are helicobacter pylori infection, non-steroidal anti-inflammatory drugs (NSAIDs) and liver disease, Peptic ulcer diseases, esophageal varies etc. Upper GI endoscopy is the gold standard investigation of choice in the diagnosis and treatment of upper gastrointestinal bleeding and can be lifesaving.

Objectives: To evaluate the common causes, various spectrum, clinical severity and outcomes of the patients presented with upper gastrointestinal bleeding.

Methods: Randomly selected 100 discharged file of UGI bleed patients from emergency ward were retrospectively studied thoroughly of previous 12 months to detect clinico-demography profile, different causes, spectrum of disease, clinical severity, and outcome of the patients and its application of UGI endoscopy.

Results: Out of 100 patients, most vulnerable age group for upper gastrointestinal bleeding is between 40-60 years. Sixty-four (64%) were Male and thirty-six (36%) were female with M: F=1.77:1. Regarding personal habbit, smoker 73 % (73) and chronic alcohol user especially homemade alcohol 50% (50) were most common person to have UGI bleed. Out of 100 patients, 69% (69) had anaemia prior to procedure. 87% (87) referred from Emergency ward and most of them had presented as 40% (40) haematemesis, 28% (28) Melaena, 15% (15) haematemesis and melaena both. Duodenal ulcer 33 (33%) was the most common endoscopic finding, followed by duodenal ulcer 32 (32%), esophageal varices 12 (12%), acute erosive/ haemorrhagic gastropathy 12 (12%), Relation between gender and outcome, among male 88% improved and discharged, 12% not improved while among female, 90% improved and discharged 10% not improved. Among age group, Age less than 60 years 88% improved and discharged, 12% not improved while more than 60 years among age group, 94% improved and discharged 6% not improved. Among smokers/ past smoker 91% improved and discharged, 9% not improved while among non- smokers, 90% improved and discharged 10% not improved.

Among Alcohol users, 93% improved and discharged, 7% not improved while among non- alcohol users, 84% improved and discharged 16% not improved. Ninety patients (90%) recovered and discharged from the hospital, one (1%) advised for surgery or intervention, 4 (4.0%) went on LAMA, 5 (5%) went on DOPR. 76 (76%) had no mortality recorded whereas one patient (1%) had mortality.

Conclusion: It is a common and potentially life-threatening medico-surgical emergency that remains a common cause of morbidity and mortality worldwide. Thus, Upper GI endoscopy is the gold standard investigation of choice in the diagnosis and treatment of upper gastrointestinal bleeding and can be lifesaving tool.

Keywords: Various Spectrum, Clinical Profile, Upper Gastrointestinal Bleeding.