THE PROFILE OF PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL TRACT BLEEDING IN BASRAH TEACHING HOSPITAL
Basrah Journal of Surgery,
Volume 24, Issue 2, Pages 39-45
Upper gastrointestinal tract bleeding is a common emergency and life threatening condition. During the last three decades, many factors have been evolved that might change the incidence, age of presentation, site of bleeding and the outcome of patients with non variceal upper gastrointestinal tract bleeding.
This study aimed to assess the profile and the mode of presentation of the patients with non-variceal upper gastrointestinal tract bleeding and to assess the etiology and the effect of different factors (demographic, mode of presentation and the treatment options) on the patient's outcome.
This observational prospective study was carried out from May 2008 to October 2014 in Basrah Teaching Hospital. All adult patients who were presented with non-variceal upper gastrointestinal tract bleeding were included. All the demographic, clinical and treatment modalities in addition to the mortality rate and complications data were collected and analyzed.
A total of 238 patients with non-variceal upper gastrointestinal tract bleeding were included in this study, 161 (67.6 %) patients were males and 77 (32.3 %) were females. The mean age was 50.62±17.06. Hematemesis was the commonest presentation in 125 (52.5%) followed by melena in 81 (34.03%). Duodenal ulcer was the commonest cause in 99 (41.59%) patients followed by erosive gastritis in 37 (15.5%) patients. The most common treatment modality was the medical treatment used in 186 (78.15%) patients which was successful in 179 (96.23%) with relatively low complications and rebleeding rates. Interventional endoscopy was used for 40 (16.8%) and was successful in 38 (95%) with 2 (5%) patients developed rebleeding. Surgery was done for 12 (5.04%) patients and was successful in 8(66.6%) and it was associated with highest rate of mortality (33.3%). Concerning the factors that might affect the outcome, there was a statistically significant effect of mode of treatment (odd ratio 6.42, p=0.03) and smoking (odd ratio 5.86, p=0.047) on the rate of development of complications. The mode of treatment had a statistically significant effect on mortality rate (odd ratio 20.24 p=0.001). The use of aspirin and/or NSAID affects significantly the rebleeding rate (odd ratio 7.4 p=0.025).
In conclusion, the profile of our patients with non-variceal upper gastrointestinal tract bleeding was not greatly different from that of surrounding Middle East countries. We found that peptic ulcer disease was the commonest cause for which medical treatment was the most successful mode of treatment. Among many known risk factors, the mode of treatment and smoking were the factors that increase the complication rate. The mode of treatment was the only factor that affects the mortality rate. Use of aspirin or non-steroidal anti-inflammatory drugs influenced the rebleeding rate.
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