The aetiology, management and clinical outcome of upper gastrointestinal bleeding among patients admitted at the Kilimanjaro Christian Medical Centre in Moshi, Tanzania

Abstract

Upper gastro-intestinal (GI) bleeding is a life-threatening emergency that results in high morbidity and mortality and therefore requires admission to hospital for urgent diagnosis and management. The aim of this study was to determine the causes of upper GI bleeding and clinical outcome of patients admitted to medical department with the diagnosis of upper GI bleeding. A retrospective study of records of all upper GI bleeding patients who were admitted to medical department, Kilimanjaro Christian Medical Centre (KCMC) from January 2007 to December 2008 was conducted. A total of 130 patients (13-96 years old) were enrolled in the study, whereby 73 (56.2%) were males. The causes of bleeding, all endoscopically diagnosed included oesophageal varices in 55 (42.3%) cases, followed by duodenal ulcers 20 (15.4%), hemorrhagic/erosive gastritis 10 (7.7%), gastric ulcer 6 (4.6%) and Mallory Weiss tear 2 (1.5%). No cause was identified in the remaining 27 % of cases. Conservative medical therapy alone was carried out in 52.3% of the patients. Endoscopic therapy was used in 61 (46.9%) of patients. Only 2 (1.5%) patients underwent surgical intervention. The overall mortality at discharge was 17%, while 107 (82%) patients were discharged improved. In conclusion, the commonest causes of upper GI bleeding are oesophageal varices and duodenal ulcer. Most cases of upper GI bleeding were successfully treated with pharmacologic and endoscopic treatment. The high mortality may be influenced by delayed presentation to health facilities, and comorbidities. There is a need for strengthening preventive programmes and conducting studies to identify predictors of outcome of upper GI bleeding to develop evidence based management protocols.