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Endoscopy in the upper G.I. bleedings
Insights
Upper G.I. bleeding causes include duodenal ulcers and esophageal varices. Mortality risk increases with age, but chronic liver disease or organ failure can equalize risk across age groups.
Area of Science:
- Gastroenterology and Hepatology
- Internal Medicine
Background:
- Upper gastrointestinal (G.I.) bleeding is a significant clinical concern.
- Etiologies vary, impacting patient outcomes and management strategies.
- Liver cirrhosis is a known risk factor for specific bleeding sources.
Purpose of the Study:
- To investigate the primary causes of upper G.I. bleeding in a diverse patient cohort.
- To analyze the relationship between patient demographics (age) and bleeding sources.
- To assess mortality rates in relation to age and underlying comorbidities.
Main Methods:
- Retrospective analysis of 388 patients with upper G.I. bleeding.
- Diagnostic methods included endoscopy, radiology, and emergent surgery.
- Subgroup analysis of 53 patients with liver cirrhosis.
Main Results:
- Duodenal ulcer and esophageal varices were the most frequent causes (approx. 33% each).
- Gastric ulcer (14%) and gastric cancer (9%) were also significant contributors.
- In liver cirrhosis patients, varices accounted for 66% of bleeding.
- Esophageal varices bleeding was more common in patients under 60.
- Mortality was higher in patients over 60, unless complicated by chronic liver disease or organ failure.
Conclusions:
- Upper G.I. bleeding has multiple common causes, with ulcers and varices predominating.
- Age influences the likelihood of variceal bleeding, but comorbidities significantly alter age-related mortality risks.
- Effective management requires accurate diagnosis and consideration of patient-specific factors.
Abstract:
From 388 patients with upper G.I. bleeding investigated by endoscopy, radiology or emergent surgery, one third bled from duodenal ulcer, one third oesophageal varices, and from the remain the most frequent were gastric ulcer (14%) and gastric cancer (9%). From a sample of 53 patients with liver cirrhosis, 66% bled from varices and 34% from other lesions. The proportion of patients who bled from oesophageal varices is higher under 60 yrs. The mortality was higher after 60 yrs, except when there was associated chronic liver disease or renal or cardio-respiratory failure. In this group of patients, near half in our series, the mortality is the same under and above 60 years.