Abstract
Background and aimClinical and endoscopic parameters are predictive of patient outcome following acute upper gastrointestinal bleeding. The study aimed to investigate factors related to re-bleed and mortality following initial endoscopy among Nigerian patients with recent upper gastrointestinal bleeding (UGIB).MethodsThis is a cohort study of patients undergoing endoscopy for recent-onset UGIB at a referral endoscopy facility in Port Harcourt, Rivers State, Nigeria, from April 2014 to November 2020. Patients’ demographic and clinical data, American Society of Anesthesiologists (ASA) physical status, amount of blood transfusion, endoscopy results, and Rockall scores were retrieved from patients’ charts. The re-bleed and mortality rates were noted on follow-up by telephone. Statistical analysis was performed using SPSS version 20 (IMB Inc., Armonk, USA).ResultsA total of 560 patients had flexible video oesophagogastroduodenoscopy during the study period, and 46 (8.2%) of these were included in the study. Their age ranged from 28 years to 84 years (mean 58.6 ± 15.8 years) with 32 (69.6%) males and 14 (30.4%) females. Peptic ulcer disease (PUD) and gastritis/gastric erosions were the leading endoscopic diagnoses in 24 (52.2%) and 12 (26.1%) patients, respectively. Multiple comorbidities (p=0.021) and higher ASA score (mean 3.0; 95% confidence interval CI: 2.47-3.53; p=0.021) are associated with re-bleed, which was recorded in seven (15.2%) patients. Four (8.7%) cases of mortality were recorded in patients with a mean full Rockall score of 4.25 (95% CI: 1.52-6.97; p=0.021).ConclusionRe-bleed is more common in patients with multiple comorbidities, ASA score of three or more, and bleeding gastro-oesophageal varices at initial endoscopy. Mortality was significantly higher in patients with a full Rockall score of more than three.
Highlights
Acute upper gastrointestinal bleeding (AUGIB) is a potential cause of a life-threatening emergency
Common diseases associated with upper gastrointestinal bleeding (UGIB) include peptic ulcer disease, gastritis, and gastric erosion, gastrooesophageal varices, oesophagitis, angiodysplasia, Mallory Weiss tear, and upper gastrointestinal malignancies
This study aimed to investigate factors related to re-bleed and mortality following initial endoscopy among Nigerian patients with upper gastrointestinal bleeding in a metropolis of Nigeria
Summary
Acute upper gastrointestinal bleeding (AUGIB) is a potential cause of a life-threatening emergency. The modern methods used to determine upper gastrointestinal bleeding source include the radiological studies of triple vessel angiography or radionuclide studies, and endoscopy [3]. Upper gastrointestinal endoscopy (UGIE) is the procedure of choice in most patients with AUGIB, with a diagnostic accuracy of 80-95 percent [4]. Doctors managing patients with UGIB find the acronym BARE - bleeding, assessment, resuscitation, and endoscopy - useful [5]. Clinical and endoscopic parameters are predictive of patient outcome following acute upper gastrointestinal bleeding. The study aimed to investigate factors related to re-bleed and mortality following initial endoscopy among Nigerian patients with recent upper gastrointestinal bleeding (UGIB)
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