ABSTRACT
Background: Upper gastrointestinal bleed (UGIB) and dyspepsia are the commonest indications for an upper GI endoscopy (UGIE), which has the potential to provide both diagnostic and therapeutic intervention. Alarm symptoms in patients with dyspepsia need proper evaluation.Methods: In an observational hospital-based study, 5117 patient undergoing upper GI endoscopy were evaluated at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India. Detailed clinical and endoscopic profile was evaluated for subjects with dyspepsia and UGIB. Statistical analysis was done using SPSS version 21.0.Results: Dyspepsia (2887, 56.41%) followed by upper GI bleed (1124, 21.97%) were the most common indications for UGIE. In subjects presenting with UGIB, most patients had both hematemesis with Malena (48.04%), 48.93% were chronic alcoholics and nearly one fourth (26.96%) were on NSAIDS. Variceal bleeding (52.94%), followed by peptic ulcer bleed (13.43%) were the most common causes of bleed. In subjects undergoing UGIE for dyspepsia, 37.41% revealed no endoscopic lesion followed by gastro-duodenitis (25.01%). Peptic ulcer was cause of dyspepsia in 18.05% and was significantly more in those with alarm symptoms (<0.001). Alarm symptoms in dyspepsia has a significant high likelihood of finding a malignant lesion on endoscopic evaluation (p 0.013).Conclusions: Variceal bleed is the most common cause of UGIB in the adult Indian population. In patients with dyspepsia, presence of alarm symptoms is significantly associated with organic lesion on endoscopy. Although the incidence of malignancy is low, endoscopy in more than 50years subjects presenting with dyspepsia may help in early diagnosis and reducing morbidity.
ABSTRACT
Back ground: It is highly unfortunate that many patients are admitted daily with hematemesis and or malena due to the adverse effects of drugs either prescribed or self-medicated. Incidence of such cases can be greatly reduced if medical practitioners are not only aware of the adverse effects of drugs on gastrointestinal tract but also assess the patients for the risk factors of drug-induced UGI bleeding before prescribing these drugs and also by properly educating the patients. Aim: To study the clinical profile and risk factors in fifty cases of drug induced UGI bleeding. Materials and methods: Fifty patients (32 males and 18 females) admitted with drug-induced hematemesis and or malena were studied with respect to age group, number of bouts of hematemesis, approximate quantity of total blood loss, causative drug responsible for UGI bleeding, risk factors of GI bleeding, number of individual risk factors in each patients. The prevalence of individual risk factors in those fifty patients and the prevalence of number of risk factors in those fifty patients were studied. Thorough clinical and laboratory investigations were done. Results: Hematemesis was the common symptom. Ibuprofen was responsible for the majority of cases (38%) followed by diclofenac (22%). Prevalence of risk factors among the patients are as follows: Age > 50 years of age - 66%, ‘O’ Blood group – 50%, Alcoholism – 42%, Not using Gastro protective agents – 40%, Self-medication / OTC drugs – 36%, Smoking – 30%, Stress and Serious systemic illnesses – 12%, Helicobacter pylori – 12%, Known Peptic ulcer disease – 10% , High doses/ Chronic drug intake – 10%, Concomitant use of Steroids – 8% and Concomitant use of anticoagulants – 4%. Conclusion: NSAIDs were the commonest cause for UGI bleeding. Age > 50 years (66%) was the commonest risk factor for UGI bleeding. All those fifty cases had at least one known risk factor and majority (80%) had more than one risk factors of drug-induced UGI bleeding
ABSTRACT
Background: Non-steroidal anti-inflammatory drugs (NSAIDs) including aspirin are among the most frequently prescribed drugs worldwide and are available ‘Over-The-Counter’ (OTC) also. Though reasonably safe in most cases in prescribed dosages and for short durations, these drugs cause serious gastrointestinal toxicity in a large number of cases. They can affect all segments of the gastrointestinal tract causing ulcers, severe bleeding, perforation, and obstruction. Aim: To study the endoscopic abnormalities in fifty cases of drug induced UGI bleeding. Materials and methods: Fifty patients (32 males and 18 females) admitted with drug-induced hematemesis and or malena were studied with respect to age group, number of bouts of hematemesis, approximate quantity of total blood loss, causative drug responsible for UGI bleeding, risk factors of GI bleeding, number of individual risk factors in each patients. Thorough clinical and laboratory investigations were done. UGI scopy was done for all patients. Results: NSAIDs were the commonest cause for UGI bleeding. Age > 50 years (66%) was the commonest risk factor for UGI bleeding. It was observed that ten patients were having normal endoscopic study, twenty five patients were having lesions in stomach only, ten patients were having lesions in duodenum only and five were having lesions in both stomach and duodenum. None of the patients studied, had lesions in the esophagus. It was found that ulcers were more common than erosions. Conclusion: Stomach is the commonest site affected (50%) and ulcers (64%) were common than erosion.