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Acute upper gastrointestinal bleed: An audit of the causes and outcomes from a tertiary care center in eastern India

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Abstract

Background/Purpose of the study

Acute upper gastrointestinal (UGI) bleed is a life-threatening emergency carrying risks of rebleed and mortality despite standard pharmacological and endoscopic management. We aimed to determine etiologies of acute UGI bleed in hospitalized patients and outcomes (rebleed rates, 5-day mortality, in-hospital mortality, 6-week mortality, need for surgery) and to determine predictors of rebleed and mortality.

Methods

Clinical and endoscopic findings were recorded in patients aged > 12 years who presented within 72 h of onset of UGI bleed. Outcomes were recorded during the hospital stay and 6 weeks after discharge.

Results

A total of 305 patients were included in this study, mean age being 44 ± 17 years. Most common etiology of UGI bleed was portal hypertension (62.3%) followed by peptic ulcer disease (PUD) (16.7%). Rebleed rate within 6 weeks was 37.4% (portal hypertension 47.9%, PUD 21.6%, malignancy 71.4%). Five-day mortality was 2.3% (malignancy 14.3%, portal hypertension 3.2%); the in-hospital mortality rate was 3.0% (malignancy 14.3%, portal hypertension 3.2%, PUD 0.0%) and 4.9% at 6 weeks (malignancy 28.6%, portal hypertension 5.8%, PUD 0.0%). Surgery was required in 4.59% patients. On multivariate analysis, post-endoscopy Rockall score was significantly predictive of rebleed in both portal hypertension- and PUD-related rebleed. No factors were found predictive of mortality in multivariate analysis.

Conclusion

Portal hypertension remains the commonest cause of UGI bleed in India and carries a higher risk of rebleed and mortality as compared to PUD-related bleed. Post-endoscopy Rockall score is a useful tool for clinicians to assess risk of rebleed.

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Acknowledgments

The authors gratefully acknowledge the assistance and contributions of the following persons at the School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research and SSKM Hospital, Kolkata: (1) Kshaunish Das, Professor, Department of Gastroenterology; (2) Kausik Das, Associate Professor, Department of Hepatology; (3) Rajib Sarkar (RS), Associate Professor, Department of Gastroenterology; and (4) Partha Sarathi Patra (PSP), Associate Professor, Department of Gastroenterology.

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Authors and Affiliations

  1. Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research and SSKM Hospital, Kolkata, 700 020, India

    Arka Banerjee & Gopal Krishna Dhali

  2. Department of Hepatology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research and SSKM Hospital, Kolkata, 700 020, India

    Saptarshi Bishnu

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  1. Arka Banerjee
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Correspondence to Saptarshi Bishnu.

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AB, SB, and GKD declare that they have no conflict of interest.

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The authors declare that the study was performed in a manner conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Informed consent was obtained from all individual participants included in the study.

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Banerjee, A., Bishnu, S. & Dhali, G.K. Acute upper gastrointestinal bleed: An audit of the causes and outcomes from a tertiary care center in eastern India. Indian J Gastroenterol 38, 190–202 (2019). https://doi.org/10.1007/s12664-018-00930-7

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