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Upper gastrointestinal bleeding: audit of a single center experience in Western India
Jignesh B Rathod1, Dharmendra K Shah2, Bhargav D Yagnik3
1Department of Surgery, Pramukhswami Medical College, Karamsad;
Insights
Upper gastrointestinal bleeding management is crucial for patient outcomes. Endoscopy is a valuable tool for diagnosing and treating common causes like acute erosive gastritis and peptic ulcers.
Area of Science:
- Gastroenterology
- Endoscopic interventions
- Clinical research
Background:
- Upper gastrointestinal (GI) bleeding, proximal to the ligament of Treitz, necessitates accurate diagnosis and management.
- Effective control of GI bleeding reduces re-bleeding rates, hospital stay, and mortality.
Purpose of the Study:
- To determine common etiologies, clinical presentations, and management strategies for upper GI bleeding.
- To evaluate the role and efficacy of upper GI endoscopy in diagnosing and treating upper GI bleeding.
Main Methods:
- A prospective study involving 50 patients with suspected upper GI bleeding (UGIB).
- All patients underwent upper GI endoscopy for diagnosis and potential intervention.
- Treatment strategies included conservative management, endotherapy, and surgical intervention when necessary.
Main Results:
- The most frequent causes of UGIB were acute erosive gastritis (34%), portal hypertension (24%), and peptic ulcer (22%).
- Endoscopy was performed on all 50 patients; 11 received endotherapy, while 39 were managed conservatively.
- Six patients treated non-endoscopically required laparotomy, and one underwent de-vascularization due to failed hemostatic methods.
Conclusions:
- Acute erosive gastritis and portal hypertension are leading causes of upper GI bleeding in this study population.
- Upper GI endoscopy is an effective, minimally invasive method for diagnosing and treating upper GI bleeding, with endotherapy as the initial treatment of choice.
Abstract:
Upper gastrointestinal (GI) bleeding is defined as bleeding proximal to the ligament of Treitz. The most important aspect of management of GI bleeding is to locate the site and cause of bleeding. The aim of the study is to find out the common etiology, presentation and management, including the role of upper GI endoscopy. Recent advances have meant that endoscopic hemostatic methods are now associated with a reduced rate of re-bleeding, cost, blood transfusion, length of hospital stay and mortality. A prospective study of 50 cases was carried out between August 2001 and July 2003. Patients with signs and symptoms suggestive of upper GI bleeding (UGIB) such as hematemesis, melena, aspirated blood from nasogastric tubes, profuse hematochezia, etc., were included in the study. The patients were selected randomly. The most common cause of UGIB in the present study was acute erosive gastritis (34%) followed by portal hypertension (24%) and peptic ulcer (22%). All 50 patients underwent upper GI endoscopy, of whom 39 patients were treated conservatively and 11 patients underwent endotherapy to control bleeding. Out of 39 patients treated non-endoscopically, 6 cases required laparotomy to control UGIB. 8 of 50 cases had past history of UGIB, 5 of whom had a previous history of endotherapy. One case was treated with de-vascularization as routine hemostatic methods failed. So, initial method of choice to control the bleeding was endotherapy and surgery was undertaken if an endoscopic method failed. The most common cause of hematemesis in our setting was acute erosive gastritis followed by portal hypertension. Endoscopy is a valuable minimal invasive method to diagnose and treat upper GI bleeding.
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