Elwakil Reda, Reda Mohga A, Abdelhakam Sara M, Ghoraba Dalia M, Ibrahim Wesam A
Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt.
J Egypt Soc Parasitol. 2011 Aug;41(2):455-67.
This prospective follow-up study was designed to analyze the causes and outcome of upper gastrointestinal bleeding among patients presenting by hematemesis and/or melena to Emergency Endoscopy Unit, Ain Shams University Hospitals. One thousand patients presented by upper GIT bleeding were subjected to complete clinical evaluation, emergency upper gastrointestinal endoscopy and therapeutic interventions as indicated. Follow up was done for occurrence of re-bleeding or mortality. Variceal causes of bleeding were the most common, representing 70.1% followed by non-variceal causes (26.1%) and obscure causes (3.8%). Esophageal varices (EV) alone represented 17.8% of causes of variceal bleeding, while combined esophageal and gastric varices represented 39.5% and isolated gastric varices 12.8%. Gastric lesions were the most common causes of non variceal bleeding. Recurrence of bleeding occurred in 19.4% of variceal group in comparison to 6.1% of non variceal group, while mortality was found in 4.3% of variceal group in comparison to 1.5% of non variceal group with very highly significant difference (P <0.001). Hypertension, ascites, EV columns, EV grade IV, presence of gastric varices and associated respiratory disorder were independent factors associated with recurrence of bleeding in variceal group. In non variceal group, recurrence of bleeding was significantly related only to the presence of gastric ulcers (P=0.035). Independent factors associated with mortality in studied patients were age, associated diabetes, presence of esophageal varices and associated duodenal ulcer.
这项前瞻性随访研究旨在分析因呕血和/或黑便就诊于艾因夏姆斯大学医院急诊内镜科的患者上消化道出血的原因及结局。1000例因上消化道出血就诊的患者接受了全面的临床评估、急诊上消化道内镜检查及必要的治疗干预。对再出血或死亡情况进行了随访。出血的静脉曲张病因最为常见，占70.1%，其次是非静脉曲张病因（26.1%）和不明病因（3.8%）。仅食管静脉曲张（EV）占静脉曲张出血病因的17.8%，而食管和胃静脉曲张合并占39.5%，孤立性胃静脉曲张占12.8%。胃部病变是非静脉曲张出血最常见的原因。静脉曲张组出血复发率为19.4%，而非静脉曲张组为6.1%；静脉曲张组死亡率为4.3%，而非静脉曲张组为1.5%，差异具有高度显著性（P<0.001）。高血压、腹水、EV柱、IV级EV、胃静脉曲张的存在及相关呼吸系统疾病是静脉曲张组出血复发的独立相关因素。在非静脉曲张组，出血复发仅与胃溃疡的存在显著相关（P=0.035）。研究患者中与死亡相关的独立因素为年龄、合并糖尿病、食管静脉曲张的存在及合并十二指肠溃疡。
