Upper Gastrointestinal Bleeding in the Emergency Department of Ibn Sina Hospital in Rabat: Etiological, Endoscopic, Therapeutic and Evolutive Aspects

Abstract

Introduction: Upper gastrointestinal bleeding (UGIB) is defined as a bleeding from a lesion in the digestive tract located upstream of the duodenojejunal angle of Treitz. It is a medical emergency with a mortality ranging from 2 to 10%. The aim of the study is to investigate the main etiologies of upper gastrointestinal bleeding in our setting, and specify the main endoscopic findings, therapeutic approaches, and evolutive aspects. Materials and methods: A prospective, descriptive study conducted over an eight month period from May 1st to December 1st, including 50 adult patients admitted for UGIB who underwent conclusive esophagogastroduodenoscopy (EGD). We collected data about patients demographics, comorbidities, clinical presentaiton, physical examination findings, laboratory data, EGD results, therapeutic procedures and patient outcomes. Results: UGD represented 0.5% of emergency admissions, with a mean age of 61.22 years and no gender predominance. The main risk factors were related to the use of anticoagulants and/or antiplatelet agents, a history of chronic liver disease, chronic gastritis, and alcohol and tobacco use. Patients presented with hematemesis, melena, or both. EGD was performed in all patients, the main etiologies were peptic ulcer disease, vatical pathology and peptic pathology. Endoscopic treatment was performed in 38% patients, surgery was required in one case. Red blood cell transfusion was necessary in 83% patients. A favorable outcome was observed in 84% patients, while 16% patients died because of hemorrhagic shock, cardiogenic shock, and one case of multiple myeloma. Conclusion: UGIB remans a common medical and surgical emergency in our setting. The etiologies are dominated by peptic ulcer disease. EGD is the key investigation, with a diagnostic, therapeutic, and prognostic interest. The outcome was generally favorable in our study, except for 16% of cases who resulted in death. Preventive measures are essential.