Introduction:-

It refers to intraluminal gastrointestinal tract bleeding (as Haematemesis, Malena, Haematochezia, Occult gastrointestinal bleeding, Features of blood loss or anaemia) from the esophagus, stomach, or duodenum at the ligament of Treitz presented as light headedness, syncope, angina, or dyspnea. Risk factors that are associated with acute upper gastrointestinal bleeding are helicobacter pylori infection, non steroidal anti-inflammatory drugs (NSAIDs) and liver disease, Peptic ulcer diseases, esophageal varies etc.

The incidence of upper GI bleeding is 2-fold greater in males than in females, in all age groups; however, the death rate is similar in both sexes. Bleeding from the upper GI tract is approximately 4 times as common as bleeding from the lower GI tract. It  leads to huge economic costs to patients and to the healthcare system.

Upper GI endoscopy is the gold standard investigation of choice in the diagnosis and treatment of upper gastrointestinal bleeding and can be life saving.

Objectives:-

1) To evaluate the common causes, various spectrum, clinical severity and outcomes of the patients presented with upper gastrointestinal bleeding.

2) To evaluate the role of the Upper Gastro Intestinal (UGI) endoscopy in patients with upper gastrointestinal bleeding.

Method:-

Randomly selected 121 discharged file of UGI bleed patients from emergency ward were retrospectively studied thoroughly of previous 12 months to detect clinico-demography profile, different causes, spectrum of disease, clinical severity, and outcome of the patients and its application of UGI endoscopy.

Result:-

Out of 121 patients, most vulnerable age group for upper gastrointestinal bleeding is between 40-60 years.  Male (77 %), Janajati ethnic groups 52 %( 83) and illiterate people from plain region (84%) specially from sunsari district were predominant population. Regarding personal habbit, smoker 73 % (88) and chronic alcohol user especially homemade alcohol 50.4 % (61) were most common person to have UGI bleed. Out of 121 patients, 69.4% (84) had anaemia prior to procedure. 87% (107) referred from Emergency ward  and most of them had  presented as 30.5 %( 37) haematemesis, 24.7% (30) Melaena, 12,4% (15)haematemesis and melaena both.

Duodenal ulcer 46(33.5%) was the most common endoscopic finding, followed by duodenal ulcer 43(31.6%), esophageal varices 14 (11.6%), acute erosive/ haemorrhagic gastropathy 11 (12.2%),

Relation between gender and outcome, among male 88% improved and discharged, 12% not improved while among female,90% improved and discharged  10 % not improved . Among age group, Age less than 60 years 88% improved and discharged, 12% not improved while more than 60 years among age group,93.6% improved and discharged  6.4 % not improved .Among smokers/ past smoker 91% improved and discharged, 9% not improved while among non- smokers, 90% improved and discharged  10% not improved. Among Alcohol users, 93% improved and discharged, 7% not improved while among non- alcohol users,84% improved and discharged  16% not improved .

90% (109) had improved with discharge, 0.8 %(1) advised for surgery or intervention, 4.1% (5) went on LAMA(left against medical advice), 5% (6) went on DOPR(discharge on persistent request). 76 % (92) had no mortality recorded whereas 0.8 % (1) had mortality

Conclusion:- It is a common and potentially life-threatening medico-surgical emergency that remains a common cause of morbidity and mortality worldwide. Thus, Upper GI endoscopy is the gold standard investigation of choice in the diagnosis and treatment of upper gastrointestinal bleeding and can be life saving tool.