Upper gastro-intestinal hemorrhage in Upper Egypt [El-Minia] an endoscopic survey of 142 cases

One hundred and forty two [142] consecutive patients with upper gastrointestinal haemorrhage [UGIH], admitted to Menia University Hospital over the 3-year period 1989-91, were studied prospectively. The mean age was 41 years, the male: female ratio was 3:1, causes of bleeding were most common oesophageal varices causing 43% [61 cases], followed by bleeding duodenal peptic ulcers 21.1% [30 cases], and 8.5% [12 cases] from gastric ulcer, drug induced bleeding lesions forming 7.1% [10 cases]; [9 cases] had erosive mucosal gastritis 6.3%, and [20 cases] 14% had additional causes. Forty three patients [30%] had operations with an overall mortality of [14%] 6 cases, while 22 cases [22%] of the unoperated patients died. The prognosis of the oesophageal varices depends on liver function, with mortality 19%. While the overall mortality in the peptic ulcer group is low [7%], the presence of stigmata of recent haemorrhage is associated with a high risk of rebleeding

Incidence and management of bile reflux in cases of duodenal ulcer and after operations of vagotomy with gastrojejunostomy drainage

Duodenogastric bile reflux [DGBR] is reported to be increased in patients with duodenal ulcer [DU] and following gastrojejunostomy drainage operation after vagotomy [GJV]. The pH, total bacterial counts, total and free bile acids were measured in gastric juice aspirated, hourly for 24 h, in 36 patients with [DU], 37 patients with a [GJV] performed for [DU] and in 27 healthy [normal] controls. Intragastric pH was significantly higher in the [GJV] group during the day [P<0.001] and at night [P<0.001], compared with [normals] and the [DU] group. There were no differences between [DUs] and normal patients. Bile acid concentration in the gastric juice were not significantly different between [DU] and control groups over the 24 h. Median and range values were 0.14 [0.06-0.52] mol/L[-1] in [DU] patients and 0.14 [0.05-0.67] mmol/L[-1] in the [normals]. However, total bile acid concentrations were significantly greater in the [GJV] group 0.23 [0.04-0.84] compared with [DU] or controls. [P=0.04, P=0.02] our data nicley support the role of [GJV] in the pathogenesis of [DGBR], deoxycholic acid was detected in significantly greater amounts in [GJV] subjects than controls [P<0.001] or [DU] subjects [none detected]; and may be important in the pathogenesis of bile reflux. The management of such cases [GJV] were, by urgent and continuous removal of the bile which accumulated and crusted over the gastric mucosa, gastric rest for certain period, till accomodation takes place