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Introduction: Acute gastrointestinal (GI) bleeding is a lifethreatening emergency that remains a common cause ofhospitalization worldwide. The aetiology of acute uppergastrointestinal bleed (UGIB) varies with each geographicalregion. Study aimed to analyse clinical profile, endoscopicprofile and in-hospital mortality in patients with acute uppergastrointestinal bleeding.Material and methods: This was a retrospective analysisconducted in a Tertiary care centre in Bangalore. In this studywe analysed the records of consecutive patients admitted withUpper Gastro-Intestinal bleeding over period of three yearsfrom January 2016 till January 2019.Results: We analysed two thirty consecutive patientsdiagnosed with acute upper gastrointestinal bleeding, 77.4%patients were males and 22.6% were females, mean age ofpresentation was 49.10 years. Most of the patients, oneseventy-three (75%) were between the age group of 31-70 years. Melena was the most common symptom 80.4%followed by hematemesis 47%. History of chronic alcoholintake was noted in ninety three (40.4%) and smoking in sixtyfive (28.3%), medication history depicted that sixteen (6.92%)patients were on NSAIDS; fifteen (6.49%) patients were onanti-platelet drugs, five (2.1%) patients were on steroids, one(0.4%) patient was on Newer Oral Anti Coagulants.Conclusion: The present study reported peptic ulcer diseaseas the most common cause of upper GI bleeding, followedby portal hypertension related bleeding. The most commonendoscopic lesions reported were esophageal varices,followed by duodenal ulcer. Upper G.I endoscopy is animportant modality in both diagnosis and therapy in upperG.I bleed, concomitant medical and Endoscopic therapy mayreduce mortality, morbidity and also the need for surgery/interventional radiology assisted haemostasis.
RESUMO
Background: Guidelines recommends upper gastrointestinal endoscopy for all the patients with cirrhosis of liver to rule out portal hypertension. Many patients may not be willing to undergo this unpleasant procedure or resources may not be available. In this study, authors aim to identify the effectiveness of portal vein size as a non-invasive predictor of esophageal varices.Methods: In this prospective observational study of 30 patients, patients with liver cirrhosis without a previous history of upper GI bleeding were included between November 2012 and October 2014. Relevant clinical parameters were assessed which included physical examination, complete hemogram, biochemical workup, upper GI endoscopy and ultrasonographic measurement of portal vein diameter.Results: Out of the study population 70% of the patients had Oesophageal varices. Ultrasonography abdomen showed portal vein dilatation(>13mm) in 66.6% cases. The mean portal vein diameter in our study group was 13.1mm and majority of patients had portal vein between 13-13.9 mm (43.3%). A cut-off point of more than 13 mm had strong significant relationship (p<0.01) with presence of esophageal varices (sensitivity of 100%, specificity of 90% and positive predictive value of 95.24%). Higher grades of esophageal varices exists with larger portal vein size.Conclusions: From present study, authors conclude that portal vein size and its dilatation detected ultrasonographically can determine the presence of esophageal varices and can hence identify the subset of patients who require endoscopy for the prophylactic management of variceal bleeding. Therefore, reduce the burden on the endoscopy units, avoiding unnecessary screening endoscopies. Apart from being non-invasive, portal vein diameter is a relatively inexpensive and easily reproducible parameter.