Abstract
BackgroundUpper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency, which is potentially fatal. Proper management of UGIB requires risk-stratification of patients which can guide the type and aggressiveness of management. The aim of this was study was identify the causes of UGIB and factors that increase the risk of mortality in these patients.MethodsThis was a prospective cohort study conducted over a period of seven months at a tertiary hospital. Adults admitted with UGIB were included in the study. Demographic data, laboratory parameters and endoscopic findings were recorded. Patients were then followed up for 60 days to identify the occurrence of mortality. Chi-square tests and cox-regression was used to determine association between risk factors and mortality in the bivariate and multivariate analysis, respectively.ResultsA total of 170 patients with UGIB were included. Males accounted for the majority (71.2%). Median age of the study population was 40.0 years. Chronic liver disease was present in 30.6% of study patients. The most common cause of UGIB among the 86 patients who underwent endoscopy was oesophageal varices (57%), followed by peptic ulcer disease (18%) and gastritis (10%). Mortality occurred in 57 patients (33.5%) and was significantly higher in patients with high white blood cell count (HR 2.45, p 0.011), raised serum alanine aminotransferase (HR 4.22, p 0.016), raised serum total bilirubin (HR 5.79, p 0.008) and lack of an endoscopic procedure done (HR 4.40, p <0.001). Rebleeding was reported in 12 patients (7.1%) and readmission due to UGIB in 4 patients (2.4%)ConclusionsOesophageal varices was the most common cause of UGIB. One-third of patients admitted with upper gastrointestinal bleeding died within 60 days of admission, signifying a high burden. Rebleeding and readmission rates were low. A high WBC count, raised serum ALT, raised serum total bilirubin and a lack of endoscopy were independent predictors of mortality. These findings can be used to risk-stratify patients who may benefit from early and more aggressive management.
Highlights
Upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency, which is potentially fatal
This prospective, cohort study aimed at identifying the major causes of upper gastrointestinal bleeding and the magnitude of mortality, rebleeding and readmission and their risk factors in a tertiary level hospital in Tanzania
peptic ulcer disease (PUD) was the most common cause of UGIB in studies done in Korea [8], USA [9] and various European countries [3, 10]
Summary
Upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency, which is potentially fatal. Upper Gastrointestinal Bleeding is defined as hemorrhage originating from anywhere between the esophagus and the ligament of Treitz [1] It is one of the most common gastrointestinal emergencies, with an average mortality rate of 10% [2, 3]. The most frequently used risk scoring system is the Rockall score which was developed in 1996 This score assesses the risk of death following UGIB and incorporates the patient’s age, systolic blood pressure, heart rate, presence of other comorbidities and endoscopic findings [3]. Another frequently used scoring system is the Glasgow Blatchford Score [3]
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