Patterns and Outcomes of Upper Gastrointestinal Bleeding: A Retrospective Audit of a High-volume Center from Karachi,...

Upper gastrointestinal bleeding (UGIB) is a major cause of morbidity and death on a global scale, with etiology differing between populations. Variceal bleeding predominates in patients with chronic liver disease (CLD), and the nonvariceal causes include peptic ulcer disease (PUD), malignancy, and corrosive injuries. This audit aimed to assess the clinical and endoscopic features, therapeutic interventions, and outcomes of patients presenting with UGIB over a 4-year period at a tertiary care center.

This clinical audit comprised 3,448 patients who attended the hospital with UGIB between 2022 and 2025, and data were collected retrospectively. Patients of all ages were included in the study, whereas those with incomplete records, prior major gastrointestinal surgery, or unrelated coagulopathies were excluded. Data on demographics, etiology, clinical symptoms (hematemesis, melena, and hematochezia), endoscopic findings, interventions, and outcomes were obtained from hospital records. Endoscopic evaluation was carried out using high-definition video endoscopes. Therapeutic interventions consisted of variceal band ligation, sclerotherapy, adrenaline injection, and hemoclip placement. Data were analyzed using the statistical package SPSS (version 26). Quantitative variables were reported as mean and standard deviation, and categorical variables as frequencies and percentages. Chi-square test and analysis of variance were performed for year-wise comparisons. Statistical significance was determined at the level of p < 0.05.

Hematemesis was the most common clinical presentation, observed in 2,855 (82.8%) of 3,448 patients, followed by melena in 408 (11.8%). Variceal bleeding was predominant, esophageal varices were in 1,374 (39.8%), and gastric varices were in 378 (11.0%). Peptic ulcer disease was the most common nonvariceal cause, 724 (21.0%). Variceal band ligation was the most commonly performed intervention, 1,625 (47.1%). Discharge was done in 2,950 (85.5%), while 341 (9.9%) died. Year-wise analysis revealed consistent trends in presentation and intervention, with significant differences by age, gender, and etiology (p < 0.05).

Upper gastrointestinal bleeding in this cohort is mainly related to variceal bleeding, mainly in patients with CLD. Endoscopic evaluation and early therapeutic intervention are pivotal to management and are associated with high discharge rates. Regular audits are essential in order to optimize patient care and outcomes.