Clinical outcome of acute upper gastrointestinal hemorrhage among patients admitted to a government hospital in Egypt

ABSTRACT

Acute upper gastrointestinal hemorrhage [AUGIH] is a life-threatening emergency that results in high morbidity and mortality. The mortality rate varies between 4% and 14%. The aim of the study was to determine the clinical outcome of AUGIH among patients admitted to a government hospital in Egypt. This was a cross-sectional hospital-based study performed in 1000 patients presenting with AUGIH over a 7-year period between January 2004 and January 2011. One thousand patients were analyzed. Fifty-four percent were male. Mean age was 52 +/- 17 years. Eighty-eight percent were emergency admissions and 12% were inpatients at the time of bleeding. At presentation 68% had major comorbidity and 50% had liver disease. Seven hundred and twenty-four patients [72%] underwent endoscopy. Bleeding varices accounted for 31% of AUGIH and peptic ulcer 28%. Two hundred and thirty-two patients had endoscopically diagnosed bleeding varices or peptic ulcer with a visible vessel or active bleeding. These received endoscopic therapy. Initial hemostasis was achieved in 207 [89%]. Thirteen patients [6%] had therapy at a subsequent endoscopy for further bleeding. Surgery was performed on 9 patients [0.9%] with AUGIH. Complications were reported in 70 patients [7%] mainly liver failure [4%]. Six hundred and eighty-four patients [68%] were discharged improved, 162 [16%] left hospital without a diagnosis and 4 [0.4%] were referred to another facility. The overall mortality was 15%. Mortality was 24% in patients>/=60 years, 37% among inpatients, and 21% in those who had a major comorbidity. Mortality was 22% in patients who had liver disease and 9% in variceal bleeding. The most common cause of AUGIH was variceal in origin. Endoscopic therapy was successful in most cases. Mortality after AUGIH was particularly high among elderly patients, inpatients, and patients who had a major comorbidity, liver disease, and variceal bleeding