Upper Gastrointestinal Bleeding During the Holy Month of Ramadan

Abstract

Letters to the EditorUpper Gastrointestinal Bleeding During the Holy Month of Ramadan Ala U. ToukanFRCP(C), FACP Ala U. Toukan Gastroenterology Unit, Jordan University Hospital Amman, Jordan Search for more papers by this author Published Online::1 Jan 1989https://doi.org/10.5144/0256-4947.1989.93SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor. The holy month of Ramadan is a month of fasting for Muslims. Patients with upper gastrointestinal (UGI) lesions are often exempted from fasting by prescription of their physicians on the basis that symptoms might worsen or complications may occur. Upper gastrointestinal tract bleeding is a complication often said to occur as a consequence of the action of unbuffered gastric acid on UGI lesions, in particular duodenal ulceration, thus leading to an increased prevalence of UGI bleeding during Ramadan. However, these claims have not been supported by convincing analysis.We have reviewed episodes of massive UGI bleeding presenting to Jordan University Hospital during Ramadan for a 10-year period (1978-1987), and compared these to an equivalent nonfasting period. Massive UGI bleeding was defined as loss of 1000 mL or more of blood, estimated by a blood pressure of < 100/60 mm Hg or a postural decrease in BP of > 20/10 mm Hg, and/or a drop in hemoglobin level of a minimum of 10%, in the presence of hematemesis, blood per nasogastric tube, or melena at presentation. Cause of bleeding was diagnosed by endoscopy performed within 24 hours of admission. Chi-square test was used to assess differences between the number of bleeding episodes in the fasting and nonfasting periods.Bleeding episodes during Ramadan months over the 10-year study period were aggregated and compared to the number of episodes presenting during an equivalent period of nonfasting Months. We have noted previously that all UGI bleeding episodes, including those caused by duodenal ulcer, present less frequently in the months of April and September, than October to March (unpublished data). Ramadan is the ninth month of the Hejira (lunar) year, which is approximately 12 days shorter than the Gregorian year. During the 10-year period of this study, Ramadan has always fallen between the months of April to September, and we included the aggregate of the mean number of bleeding episodes counted for each of these months (with the exception of the Ramadan months) over the 10-year study period as the nonfasting control period in our analysis. This analysis was carried out for each of the total number of bleeding episodes as well as those due to duodenal ulcer.There were slightly more bleeding episodes in the nonfasting months than the fasting months of Ramadan over the 10-year study period in respect to both the total number of episodes and those in whom duodenal ulcer was the source of bleeding (Figure 1). This difference, however, did not reach statistical significance. Thus, it would appear that there is no increased frequency of UGI bleeding episodes during the fasting month of Ramadan.Figure 1. Number of bleeding episodes during Ramadan compared to the nonfasting control period, by total number of bleeds and those from duodenal ulcer (DU).Download Figure Previous article Next article FiguresReferencesRelatedDetails Volume 9, Issue 1January 1989 Metrics History Published online1 January 1989 InformationCopyright © 1989, Annals of Saudi MedicinePDF download