Upper GI bleeding: Causes, morbidity and mortality in admitted patients at Tertiary Care Hospital of Karachi.

  • Naresh Kumar Seetlani Civil Hospital Karachi.
  • Khalid Imran Civil Hospital Karachi.
  • Pooja Deepak Civil Hospital Karachi.
  • Fizza Tariq Dow Medical College.
  • Daniyal Mirza Civil Hospital Karachi.
  • Amanullah Abbasi DIMC, Dow University Hospital Karachi.
  • Nadia Shams Rawal Medical College Rawal Pindi.
  • Tehseen Akhtar Dow Medical College, Civil Hospital Karachi.
Keywords: Esophago-gastro-Duodenoscopy, Morbidity, Mortality, Non-variceal Bleed, Rebleeding, Upper Gastrointestinal Bleed, Variceal Bleed

Abstract

Objectives: Acute upper gastrointestinal bleed is one of the most common emergencies. Despite advancement in the medical field, gastrointestinal bleeding still carries significant mortality and fiscal burden on healthcare system. At present, limited data is available on the predictors of morbidity and mortality associated with acute upper gastrointestinal bleeding in our part of the country. Study Design: Descriptive analytical study. Setting: Medical wards of Civil Hospital Karachi. Period: From January 2018 to June 2018. Material and Methods: 260 patients of 12 years and above with complaint of upper gastrointestinal bleeding. After hemodynamic stabilization, patients were referred to undergo esophago-gastro-duodenoscopy at the endoscopy suite of the hospital. Their personal data and endoscopic findings were recorded after obtaining a written consent. The patients were followed for 2 weeks to document the factors leading to their morbidity and mortality. We used Rockall scoring system to identify risk of patient mortality. Data collected was analyzed using SPSS 22·0. Results: The survey included 260 patients having males (62·3%) more than females (37·7%) with age ranging from 12 to 85 years. Among all, variceal bleed was accounted in 186 (71·5%) patients while remaining 74 (28·4%) patients had non-variceal bleed; peptic ulcer disease being the most common etiology. The overall mortality rate of our study was 5·76%. Some factors influencing mortality of the patients were age > 60 years, comorbid, use of NSAIDS, rebleeding, deranged laboratory tests at the time of presentation- anemia (hemoglobin of < 10 g\dl), grade 3 thrombocytopenia (platelet count of < 50 cells\dl), serum creatinine > 1·5 and serum INR of > 1·6. Additionally, a direct proportion was seen in between Rockall scoring system and patient mortality with a significant p-value (0·000). Conclusion: In this study, variceal bleeding was found as the predominant lesion of upper gastro-intestinal bleeding followed by peptic ulcer disease. Certain factors are found that are strongly related in deteriorating patient’s outcome. Along with it, Rockall score is also a good predictor of outcome of patients.

Author Biographies

Naresh Kumar Seetlani, Civil Hospital Karachi.

MBBS FCPS

Assistant Professor

Department of Medicine Unit 4

Khalid Imran, Civil Hospital Karachi.

MBBS FCPS

Professor

Department of Medicine

 

Pooja Deepak, Civil Hospital Karachi.

MBBS

House Physician



Fizza Tariq, Dow Medical College.

Final Year MBBS Student

Daniyal Mirza, Civil Hospital Karachi.

MBBS

House Physician


Amanullah Abbasi, DIMC, Dow University Hospital Karachi.

MBBS, FCPS

Professor

Department of Medicine


Nadia Shams, Rawal Medical College Rawal Pindi.

MBBS, FCPS

Associate Professor

Department of Medicine

Tehseen Akhtar, Dow Medical College, Civil Hospital Karachi.

MBBS FCPS

Associate Professor

Department of Medicine

 

Published
2019-11-01