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Upper and Lower Gastrointestinal Bleeding: A Retrospective Study on 10 Years Experiences in Southeastern Iran
Alireza Bakhshipour1, Raheleh Rafaiee2
1Professor, Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran.
Insights
Gastrointestinal bleeding (GIB) is common, with peptic ulcers being the leading cause of upper GIB and hemorrhoids for lower GIB. Both conditions affect men more than women and increase with age.
Area of Science:
- Gastroenterology
- Endoscopy
- Epidemiology
Background:
- Gastrointestinal bleeding (GIB) is a frequent medical emergency with significant morbidity, mortality, and healthcare costs.
- Understanding the endoscopic findings of upper GIB (UGIB) and lower GIB (LGIB) is crucial for effective management.
- Regional variations in GIB etiology necessitate localized epidemiological studies.
Purpose of the Study:
- To analyze the endoscopic evaluation of upper and lower GIB in Sistan and Balouchestan, Iran.
- To identify the primary causes and demographic patterns of GIB in the region.
- To provide data for updating diagnostic and management strategies.
Main Methods:
- Retrospective analysis of 5862 GIB patient reports from a 10-year period (2011-2020).
- Inclusion of endoscopy and colonoscopy data from 5053 adult patients at Ali-Ibn-Abitaleb hospital.
- Statistical comparison of age, sex, and endoscopic diagnoses using the chi-square test.
Main Results:
- Peptic ulcer disease was the most common cause of UGIB (29.7%), while hemorrhoids were the most frequent cause of LGIB (44.2%).
- UGIB affected 60.8% of patients and LGIB affected 39.2%.
- Mallory-Weiss syndrome was more prevalent in those under 40, while malignancy risk increased with age over 40.
Conclusions:
- Peptic ulcers and gastroesophageal varices are primary causes of UGIB, predominantly in men.
- Hemorrhoids and anal fissures are the leading causes of LGIB.
- GIB incidence rises with age and is more common in men, highlighting the need for updated regional disease spectrum knowledge.
Abstract:
Background: Gastrointestinal bleeding (GIB) is an emergency medical situation that is very common, although often benign but can cause considerable morbidity and mortality and health care costs. The aim of this study was to analyze the endoscopic evaluation of upper GIB (UGIB) and lower GIB (LGIB) in Sistan and Balouchestan, southeast Iran. Methods: Data from patients with GIB in a referral university-affiliated hospital in Zahedan, Southeastern Iran during a 10-year period, were obtained. A total of 21884 reports of adult patients' endoscopy and colonoscopy from 2011 to 2020 who were admitted to Ali-Ibn-Abitaleb hospital were studied of which 5862 reports were related to GIB. Incomplete files were excluded. Information on age, sex, and endoscopic diagnosis of the 5053 reports was analyzed and compared using chi-square statistical test. Results: There were 3310 men (65.6%) and 1743 women (34.4%) with a mean (±SD) of age 48.4 (±19.83) years. 3079 patients had UGIB (60.8%) and 1974 patients had LGIB (39.2%). Peptic ulcer (72.8% duodenal ulcer and 27.2% gastric ulcer) was seen as the main reason for UGIB (29.7%) and hemorrhoids were the main reason for LGIB (44.2%). Mallory-Weiss syndrome was significantly common in the age<40 years old, and the incidence rate of malignancy was significantly higher in those aged>40 years old than in the younger age group (P<0.001). Conclusion: Peptic ulcer was the most common etiological factor and it was more common in men than in women. Gastroesophageal varices were the second most common cause of UGIB. Hemorrhoids and anal fissures were observed as the most common colonoscopic findings of LGIB. The prevalences of UGIB and LGIB are more common in men than women and increase with age. It is important for physicians to constantly update their information about the spectrum of diseases in their region and their changing over time to provide accurate diagnosis and management timely.
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