Non-variceal Causes and Outcome of Acute Upper Gastro-intestinal bleeding among Cirrhotic Patients in Tropical Medicine Intensive Care Unit

Abstract

Background and aim of the work: non-variceal bleeding is less common than variceal bleeding among cirrhotic patients; hence there are fewer studies that pay attention to its causes and outcomes. The aim of this study is to shed light on the causes of acute non-variceal bleeding in cirrhotic patients and the outcome of acute upper gastrointestinal bleeding in those patients. Patients and Methods: this cross sectional study included 179 patients, they were allocated into two groups according to the source of bleeding; group I: included 104 patients with variceal bleeding and group II: included 75 patients with non-variceal bleeding. Results: The frequency of non-variceal bleeding was 41.9%. The mean period of intensive care unit stay was 5.03 ± 2.65 days ranging between 1and 17 days. The overall rate of early rebleeding was 3.7% and the mortality rate in intensive care unit was 4.5%. The most common cause of non variceal bleeding is ulceration (24%), followed by portal hypertensive gastropathy (17.3%), and in 24% of cases the cause of bleeding was obscure. Mortality is significantly correlated to white blood cells count (r=0.2 p=0.002), Child’s grade and score (r=0.217 p=0.003 and r= 0.16 p=0.03 successively) as well as Glasgow-Blachford score (r=0.18 p=0.01). Conclusion: The frequency of non-variceal bleeding among cirrhotic patients admitted with acute upper gastrointestinal bleeding bleeding is 41.9%. The mortality rate in those patients is 4.5%. The degree of deterioration of liver functions and the severity of initial bleeding episode were the most important predictors of mortality.