Acute upper gastrointestinal bleeding in Kasr El-Aini gastrointestinal endoscopy unit, Cairo, Egypt from the years 1991 to 2000

Acute upper gastrointestinal bleeding [UGIB] is a common and potentially serious problem in Egypt and worldwide. It remains a common cause for hospital admission with constant mortality despite advances in therapy and patient care. Endoscopy is the primary tool for diagnosis of UGIB. The present study aimed at investigating the etiology of UGIB in Egypt and whether any change has occurred in the period from 1991 to 2000. Files of patients undergoing upper GI endoscopy in one of the largest endoscopy units in Egypt [Kasr-El-Aini hospital, Cairo University, Cairo] during this period have been reviewed and analyzed. From 11567 patients who underwent upper GI endoscopy, 1763 [15.2%] had active or recent UGIB, mostly in the form of hematemesis and melena. Most of these patients were males [64.5%] with no age predilection. The commonest finding in bleeding cases was esophagogastric varices [53.3%]. The risk of bleeding increased with the grade of varices and was highest [odds ratio= 11] in the presence of gastric extension of varices. Varices was the commonest finding in all age groups in both males and females although significantly commoner in males [60% vs. 41 %]. Erosive and non-erosive gastritis were the second common finding followed by duodenal ulcer and esophageal erosions [15.8%, 21.1 %, 13.6% and 11.1 %, respectively]. Esophageal varices were associated with one or more other lesions in 31 % of cases and were the only finding in 650 cases with UGIB. Compared to cases presenting with hematemesis, patients with melena alone [n = 195] had significantly lower prevalence of varices and higher prevalence of gastritis and duodenal ulcer. Analysis of findings in 1991 and 2000 revealed a similar pattern of endoscopic findings in cases with UGIB indicating that no significant change has occurred in the underlying medical diseases predisposing to UGIB. Results were discussed in comparison with previous Egyptian and foreign studies