Paradigm shift in Etiology of Upper Gastrointestinal Bleed in Emergency Department

Abstract

Background and Aims: Acute upper gastrointestinal (UGI) bleed is an emergency requiring immediate intervention. Recent data have shown peptic ulcer disease (PUD) to be commonest cause of UGI bleed. We aimed to evaluate all patients of UGI bleed reporting in emergency department. Methods: A cross-sectional, observational study from a tertiary care centre and evaluated all patients with UGI bleed presenting to outpatient and emergency department between December 2017 and December 2018 conducted. Results: 356 patients with UGI bleed were undertaken for diagnostic and therapeutic endoscopy. Variceal bleed was present in 231 (65%) [cirrhosis 217(61%) vs non-cirrhotic 14 (4%)], non-variceal 93 (26%) [cirrhosis 22(6%) vs non-cirrhotic 71(20%)] and no cause determined in 32 (9%). Among cirrhotic patients, alcoholic liver disease (n=172) was most common followed by cryptogenic (n=32), HCV (n=22) and HBV (n=7) and AIH (n=6) related cirrhosis. Among variceal non-cirrhotic causes, non-cirrhotic portal hypertension was present in 14 patients. In non-cirrhotic non-variceal group, causes of UGI bleed included esophagitis (n=26), erosive gastritis (n=9) and Mallory Weiss Tear (n=7) followed by PUD (n=23), carcinoma stomach (n=3), carcinoma esophagus (n=2) and duodenal polyp (n=1). Non-variceal cirrhotic patients had portal hypertensive gastropathy (n=8), PUD (n=5), duodenal erosions (n=1), esophagitis (n=7), antral varix (n=1). Interestingly, even in non-variceal group, alcohol was the underlying cause of UGI bleed in majority of patients with esophagitis and erosive gastritis. Conclusion: Alcohol was the commonest cause of UGI bleed in majority of cases with or without chronic liver disease followed by PUD in small number in emergency department.