Comparison of Endoscopically Evaluated Etiologies of Upper GI Bleeding of Adult Sri Lankans with International Studies Admitted to a Medical Unit of a Tertiary Care Center

Abstract

Purpose: To compare etiology of upper GI bleeding affecting adult Sri Lankans, with results of international studies, admitted to a medical unit of a tertiary care center. Methods: Case notes of 1500 patients who had undergone upper GI endoscopy for varices from 13.3.2002 to 13.2.2004 were retrospectively analyzed and those who had clinical evidence of upper GI bleeding were selected.Table: [1394]Results: A total of 345 patients had upper GI bleeding with a male:female ratio of 229:114 (2:1). The majority was in the 51-70 age range. Endoscopy showed presence of severe antral gastritis with duodenitis, esophagitis, peptic ulcer disease, esophageal varices, pangastritis, erosions and malignancies in 48%, 28%, 28%, 32%, 15%, 17% and 5% of the instances, respectively. Vast majority showed overlapping pathologies. Only about 50% of the varices showed evidence of bleeding. 12% showed negative endoscopies. 10% were on NSAIDS and 9% were alcohol abusers. The table below depicts a comparison of above etiologies with several international studies. Table 01 is a comparison of causes of UGIB of other published studies with the current data. Conclusion: Upper GI bleeds are a major cause of acute medical admissions in Sri Lanka constituting about 25% of the endoscopy work. Amongst aetiological lesions of upper GI bleeding, AGML, osophagitis, and varices had been the major pathologies in this part of the world, in contrast to the West. NSAIDs and alcohol had been important associated contributory factors and there was a clear male preponderance in the bleeders. National and regional guidelines should be formulated based on these observations to educate general public of the contributory factors, mainly alcohol and NSAIDs.