Spectrum of Upper Gastrointestinal Hemorrhage in Coastal Odisha

Abstract

Upper gastrointestinal bleeding (UGIB) is one of the commonest gastrointestinal emergencies encountered by physicians and surgeons. The spectrum of upper gastrointestinal bleeding varies from region to region and depends on the status of the center in healthcare hierarchy. To determine the etiology of UGIB at a gastroenterology clinic in coastal Orissa and to compare it with other regions of India. Six hundred and eight consecutive patients with UGIB reporting to a gastroenterology outpatient clinic were subjected to upper gastrointestinal endoscopy (UGIE) to find out the etiology. The clinical profile and endoscopic findings were analyzed and compared with the data on UGIB from other regions of the country. The mean age of patients was 42+/-18.2 years. Majority of them were males (85.53%) and male: female ratio was 6:1. The commonest cause of UGIB was duodenal ulcer (DU) which accounted for 57.57% cases. Portal hypertension was responsible for bleed in only 12.83%. Benign prepyloric ulcer accounted for 6.41% cases and concomitant duodenal ulcer and benign pyloric ulcer were seen in 3.61%. Gastric ulcer was responsible for 1.8% only. Neoplasm accounted for 7.73% of cases. Other less common causes were erosive gastritis (1.8%), Mallory Weiss tear (1.8%), and retch gastropathy (1.1%). Non steroidal anti inflammatory (NSAID) ingestion was reported in 7.56% of cases. Melena was the commonest mode of presentation. Surprisingly, over two third cases of DU bleeds were not associated with abdominal pain. Bleeding duodenal ulcer was the commonest cause of UGIB in coastal Odisha. This is in contrast to reports from other parts of India, where variceal bleeding is the predominant etiology. The differences could be due to the reason that the studies which have portrayed variceal bleeding as the commonest cause of UGIB reflect the etiology of bleed of only severe cases which were referred to these centers - all of whom needed urgent hospitalization. The figures from our study are true reflection of the real etiological spectrum of UGIB in this region.