Upper Gastrointestinal Bleeding (UGIB), In Al-Gamhourea Teaching Hospital: A retrospective study of endoscopy records. Salem Ben Silm, MD, PhD Introduction: Upper gastrointestinal bleeding (UGIB) is a common and serious complication of most digestive diseases of upper digestive tract. Introduction: . Despite modern diagnostic and therapeutic modalities, about 10% of patients with upper gastrointestinal bleeding still die. Introduction: A review of the literature reveals that peptic ulcer disease accounts for about two third of all cases of upper gastrointestinal bleeding as diagnosis by upper gastrointestinal endoscopy, while esophageal varices bleeding accounts for 2% to 20% of all upper gastrointestinal bleeding Introduction: However reports from the Middle East shows that esophageal varices occupied the first line in the cases of upper gastrointestinal bleeding and gastro-esophageal varices develop in 50% to 60% of cirrhotic patients. Introduction: However epidemiological studies are still limited in our country. Objectives: To identify the main causes of upper gastrointstinal bleeding in our patients and their distribution by sex, age, diagnosis, and seasonal pattern. Methodology: All the reports of endoscopic findings of the patients performed gastrointestinal endoscopy at AlGamhourea teaching hospital, in Aden Governorate, during a period of (two years), were reviewed and analyzed according to sex, age, diagnosis, and possible seasonal occurrence. Results: A total of 154 (11.5%), out of 1339 cases underwent endoscopy, were found having upper gastrointestinal bleeding. Most patients were males 133/41 (73.3%), male to female ratio was 3:1, with age ranged from 18 to 75 years, as illustrated in fig 1. Results: Fig 1. UGIB Distribution by age and sex 50 40 35 26 18 14 7 6 2 Male Female 46 No. 30 20 10 0 18-30 31-40 Age 41-50 51-75 Fig 2. Distribution by presenting symptoms 8% 3% 89% Haematemesis/Melena Epigastric pain Dysphagia The presenting symptoms for which endoscopy was indicated were haematemesis and/or melena in 136 patients (88.3%), epigastric pain in 13 patients (8.4%), and dysphagia in 5 patients (3.3%), as illustrated in Fig 2. The main diagnosis were esophageal varices in 57 patients (36%), erosive gastritis in 44 patients (29%), peptic ulcer in 30 patients (26%), duodenal ulcer account (20%), while gastric ulcer account (6%), malignancies account (4%), MWS account (2%)and in (3%) patients with HH, as illustrated in figure 3. Fig 3. Distribution by causes of bleeding 4% 2%3% 26% 36% 29% Esophageal varices Erosive gastritis Peptic ulcer Malignancy Mallery W, Syndrome HH The overall number of patients with acute upper gastrointestinal bleeding peaked during January up to June, in contrast, the number of patients dropped during October through December, as shown in figure 4. Discussion As we know that more men than women develop ulcers for unknown reasons. Our results also coincided with reports that found more substantial increases in risk of UGIB with male sex. In this study male to female ratio was 3:1, consistent to other reports Discussion in our study we found higher absolute rates of upper gastrointestinal bleeding at younger ages (20-50 years), consistent with data reported in other epidemiological studies Discussion Our results differ from other reports in which peptic ulcer accounts for about two thirds of all cases of acute upper gastrointestinal bleeding diagnosed by endoscopy. Also studies from different countries of Middle East and India indicated that a greater proportion of upper gastrointestinal bleeding could be attributed to bleeding from esophageal varices (approximately 50% vs. 15%) Discussion Also our results differ from other reports in which peptic ulcers are the first cause of upper gastrointestinal bleeding and occupied the third cause of upper gastrointestinal bleeding with a percentage of 26% in comparison with esophagus varices which occupied the first line in upper digestive bleeding with average of 36%, similar to other reports from same region. This could be explained by wide spread of chronic liver diseases in this area. Discussion In literature malignancies account for 1% to 5% of upper digestive bleeding, while in our study malignancies account for 4%, gastric cancer account for 2.6%, while esophageal carcinoma represented 1.4% of all UGIB. Discussion Regarding the seasonal pattern of UGIB a review of the literature reveals that the most consistent seasonal pattern was an increased incidence during Winter. In our study, the overall of patients with upper gastrointestinal bleeding peaked during January up to May , in contrast, the number of patients with UGIB dropped during October through December. Conclusion: This study of Yemeni patients with UGIB indicated the following: Both the age and sex distribution of Yemeni patients with Upper digestive bleeding are different from those encountered in the Western Countries. (3:1 vs. 2:1 respectively male to female ratio). A greater proportion of upper gastrointestinal bleeders can be attributed to bleeding from varices. ( approximately 36% vs. 26% respectively varices to peptic ulcer bleeders), indicates a high rate of underlying chronic liver diseases in Yemen. The leading cause of upper gastrointestinal bleeding in Yemen, as in other part from middle East and India, was esophageal varice, followed by peptic ulcers. Upper gastrointestinal endoscopy has a crucial role in the diagnosis and treatment of upper digestive tract hemorrhage. Recommendation A further prospective studies are recommended on a large number of subjects periodically.
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