Abstract

STUDY OF AETIOLOGY, CLINICAL PROFILE AND ENDOSCOPIC FINDINGS OF PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING- A STUDY FROM RURAL BASE MULTISPECIALTY TEACHING HOSPITAL

Author(s): Santosh Kumar, Jitendra D. Lakhani, Chaitri Shah, Meera Shah Praful

BACKGROUND Upper gastrointestinal bleeding (UGIB) is one of the common life-threatening emergency hospital admissions. Upper GI Endoscopy is one of the common diagnostic examinations for identifying the cause of bleeding in our as well as in resourcelimited setup which ultimately help a clinician for “resource-sensitive approach”. METHODS This observational study (2015-2017) of upper gastrointestinal bleeding (UGIB) was performed at rural based multispecialty teaching hospital in consecutive 115 adult admitted patients (age>12 years) to find out aetiology and clinical as well as esophagogastroduodenoscopic profile. RESULTS Of 115 patients of UGIB, 75 were male (65.21%) and 40 female (34.78%). Mean age was 42.06 ±16.31. 77 (66.95%) presented with hematemesis, 21 (18.26%) with melena, 16 (13.91%) with hematemesis combined with melena and 1 patient presented with hematemesis as well as haematochezia. Endoscopy was able to detect definite cause of UGIB in 104 and in 11 patients it was normal (90.43%). Variceal bleed was commonest and was present in 48 patients, of whom 44 patients (38.26%) had oesophageal, 02 had gastric and other 2 had both oesophageal as well as gastric varices. In non-variceal bleeding, gastric and duodenal ulcer disease was present in 12, esophagitis in 10, oesophageal vascular ectasia in 02, erosive gastritis in 17, gastric malignancy in 04; Mallory Weiss tear in 06, erosive gastritis with duodenitis in 04, and esophagitis with gastric ulcer and duodenal ulcer in 01. 10 of 17 patients who had erosive gastritis gave history of NSAID use. Of the 48 patients who had variceal bleeding, 33 were due to cirrhosis of liver, and 15 were because of non-cirrhotic portal hypertension. Aetiology of 33 patients, who had hospital admission due to cirrhosis of liver related UGIB, was alcohol, hepatitis B, and hepatitis C in 29, 2 and 1 patients respectively. 81 (70.43%) had acute bleeding while 34 (29.56%) had recurrent bleeding. 17 patients were admitted in 2015, 45 in 2016 and 53 in 2017 for UGIB. There was no seasonal variation in incidence of UGIB. CONCLUSIONS Esophagogastroduodenoscopy is one of the very important diagnostic tools to find out aetiology of UGIB. This facility should be available widely at health centers of India which may help clinicians for better management of UGIB.