Upper gastrointestinal bleeding at Al-Thawra Teaching Hospital Sana'a Yemen during 1996 -1998 .


Research type: Research Paper

Authors: Ghaleb, Amin Mohamed Abdel Rab .

Abstract: Upper gastrointestinal bleeding remains one of the most difficult emergency situations faced by both physicians and surgeons. The purpose of this work was to study, the magnitude of the problem of acute Upper Gastrointestinal Bleeding (UGIB), the aetiology of upper gastrointestinal bleeding line of management and the factors affecting further bleeding and hospital mortality at Al-Thawra-Teaching Hospital Sana'a. The present study included, 230 patients presented to the hospital with acute upper gastrointestinal bleeding during (1996-1998). There were 146 patients with bleeding oesophageal varices and 84 patients with non-variceal bleeding. All cases were subjected to the following: Full history taking. Thorough clinical examination including, vital signs, mental state, presence of Jaundice, ascites, spleen and liver size. Laboratory investigations including Hb, SGOT, SGPT serum albumin, serum bilirubin and prothrombin time, to evalute the serverity of liver diseases, and it's grade according to child-pugh classification. Endoscopic evaluation, stressing on site and source of bleeding. Ultrasonographic examination was carried out to assess the degree of periportal fibrosis, presence of cirrhosis, splenic size and presence of ascites. Mode of management, resuscitation, number of units of blood transfusion, I.V vasopressin, balloon tamponade, injection sclerotherapy and surgery were recorded. Progress of bleeding; control, further bleeding. Hospital outcome discharge, death. All the data were grouped, tabulted, compared and subjected to statistical analysis. The results of the present study showed the following: The source of upper gastrointestinal bleeding was diagnosed in 94.8 percent of all cases. Reupture of oesophageal varices was the most common cause of upper gastrointestinal bleeding representing 63.5 percent, while duodenal ulcer was the second common causes of upper gastrointestinal bleeding comprising (18.7 percent)of all cases. The other casuses were, gastric ulcer, gastritis and erosion, gastric tumour and Mallory Weiss tear represented (5.7 percent, 4.3 percent. 1.7 percent, 0.9 percent) respectively. Specific source of bleeding could not be identified in 5.2 percent cases. There was a trend of increase UGI bleeding in the ages groups from 26-55 years old, with a mean age of variceal bleeders was (42 plus or equal 18) young than the mean age (47 plus or equal 13) of non-variceal bleeders. Most cases of upper gastrointestinal bleeding were males and males to females ratio was 7.8:1. The in-hospital mortality of upper gastrointestinal bleeding was 24 percent and variceal bleeding was responsible for (69.1 percent) of that mortality while non-variceal bleeding was responsible for (30.9) of that mortality. In variceal bleeding, the overall control of haemorrhage was 82.2 percent and the in hospital mortality was reaching up to (26 percent) while, in non-variceal bleeding; the overall control of haemorrhage was (76 percent) and the in hospital mortality was (20 percent). It was found that active bleeding at endoscopy, continuous bleeding after admission, blood transfusion of 5 units or more, and age over 55 were risk factors, for mortality in upper gastrointestinal bleeding. In oesophageal varices it was found that blood transfusion encephaleopathy, presence of ascites and prologed prothromin time were independent factor that enhanced rebleeding and mortality. From this study it could be concluded that upper gastrointestinal endoscopy is the suitable methods for identifying the source of haemorrhage in UGIB. The oesophageal varices are the most common causes of upper gastrointestinal bleeding in Yemen, due to complications of schistosomiasis and or heptitis B and C viruses infections. The high mortality rate is related to several risk factors, such as continuos bleeding, rebleeding and the degree of the liver reseve..