TO STUDY THE CLINICAL PROFILE AND OUTCOME OF UPPER GASTROINTESTINAL BLEED - A TERTIARY CARE EXPERIENCE

Background:Acute upper gastrointestinal (UGI) bleeding is one of the common medical emergencies that have a hospital mortality of approximately 7% to 10%. Acute upper GI bleed is divided into variceal and non-variceal causes. Acute non-variceal upper GI bleeding remains one of the most common challenges faced by Gastroenterologists and Endoscopists in their day to day clinical practice. 

Objectives:To study the clinical profile and outcomeof upper gastrointestinal bleed.

Methodology: All patients underwent thorough history taking and meticulous physical examination (general physical and systemic examination) withcareful hemodynamic assessment of pulse and blood pressure includingorthostatic changes and urine output. Patients were first hemodynamicallystabilised (fluids, inotropic support, blood transfusion was given wherever required). Laboratory investigations such as CBC, liver/ kidney function tests, PT/INR, chest X-ray, electrocardiogram, urine microscopy, and ultrasonography of abdomen were done in all patients.

Results: 25% (n=90) patients had varicealhaemorrhage and 75% (n=290) had non-varicealhaemorrhage as the cause of Upper GI bleed. NSAIDs were the mostfrequently taken medication (16.6%, n=60).the commonest clinical presentation was hematemesis and melena (43%, n= 154) cases. The prevalence of other presentations wasmelena (34.4%, n=124), hematemesis (17.2%, n=62) and hematochezia (5.6%, n=20). Hematemesis with malena (82.2%, n=80) was the predominant presentationamong patients with variceal bleed. Malena was present in 17.8% (n=16) ofpatients with variceal bleed. None presented as haematochezia or hematemesis alone. The main presentation of non-variceal bleeding was melena (40%, n=108). Other presentation were hematemesis with melena (29.6%, n=80),hematemesis (22.9%, n=62) and hematochezia (7.5%, n=20).

Conclusion: Upper gastrointestinal bleeding is a common acute medical emergency. The Rockall score is an effective tool for outcome prediction in patients with acute upper GI bleeding.