Jaka Hyasinta, Koy Mheta, Liwa Anthony, Kabangila Rodrick, Mirambo Mariam, Scheppach Wolfgang, Mkongo Eliasa, McHembe Mabula D, Chalya Phillipo L
Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania.
BMC Res Notes. 2012 Jul 3;5:200. doi: 10.1186/1756-0500-5-200.
Upper gastrointestinal (GI) bleeding is recognized as a common and potentially life-threatening abdominal emergency that needs a prompt assessment and aggressive emergency treatment. A retrospective study was undertaken at Bugando Medical Centre in northwestern Tanzania between March 2010 and September 2011 to describe our own experiences with fibreoptic upper GI endoscopy in the management of patients with upper gastrointestinal bleeding in our setting and compare our results with those from other centers in the world.
A total of 240 patients representing 18.7% of all patients (i.e. 1292) who had fibreoptic upper GI endoscopy during the study period were studied. Males outnumbered female by a ratio of 2.1:1. Their median age was 37 years and most of patients (60.0%) were aged 40 years and below. The vast majority of the patients (80.4%) presented with haematemesis alone followed by malaena alone in 9.2% of cases. The use of non-steroidal anti-inflammatory drugs, alcohol and smoking prior to the onset of bleeding was recorded in 7.9%, 51.7% and 38.3% of cases respectively. Previous history of peptic ulcer disease was reported in 22(9.2%) patients. Nine (3.8%) patients were HIV positive. The source of bleeding was accurately identified in 97.7% of patients. Diagnostic accuracy was greater within the first 24 h of the bleeding onset, and in the presence of haematemesis. Oesophageal varices were the most frequent cause of upper GI bleeding (51.3%) followed by peptic ulcers in 25.0% of cases. The majority of patients (60.8%) were treated conservatively. Endoscopic and surgical treatments were performed in 30.8% and 5.8% of cases respectively. 140 (58.3%) patients received blood transfusion. The median length of hospitalization was 8 days and it was significantly longer in patients who underwent surgical treatment and those with higher Rockall scores (P < 0.001). Rebleeding was reported in 3.3% of the patients. The overall mortality rate of 11.7% was significantly higher in patients with variceal bleeding, shock, hepatic decompensation, HIV infection, comorbidities, malignancy, age > 60 years and in patients with higher Rockall scores and those who underwent surgery (P < 0.001).
Oesophageal varices are the commonest cause of upper gastrointestinal bleeding in our environment and it is associated with high morbidity and mortality. The diagnostic accuracy of fibreoptic endoscopy was related to the time interval between the onset of bleeding and endoscopy. Therefore, it is recommended that early endoscopy should be performed within 24 h of the onset of bleeding.
上消化道出血是一种常见且可能危及生命的腹部急症，需要迅速评估和积极的紧急治疗。2010年3月至2011年9月期间，在坦桑尼亚西北部的布甘多医疗中心进行了一项回顾性研究，以描述我们在本地区对上消化道出血患者进行纤维光学上消化道内镜检查的经验，并将我们的结果与世界其他中心的结果进行比较。
在研究期间，共有240例患者接受了纤维光学上消化道内镜检查，占所有患者（即1292例）的18.7%。男性与女性的比例为2.1:1。他们的中位年龄为37岁，大多数患者（60.0%）年龄在40岁及以下。绝大多数患者（80.4%）仅表现为呕血，9.2%的病例仅表现为黑便。出血发作前使用非甾体抗炎药、酒精和吸烟的比例分别为7.9%、51.7%和38.3%。22例（9.2%）患者有消化性溃疡病史。9例（3.8%）患者HIV阳性。97.7%的患者出血源被准确识别。在出血发作后的头24小时内以及存在呕血的情况下，诊断准确性更高。食管静脉曲张是上消化道出血最常见的原因（51.3%），其次是消化性溃疡，占25.0%。大多数患者（60.8%）接受了保守治疗。分别有30.8%和5.8%的病例进行了内镜治疗和手术治疗。140例（58.3%）患者接受了输血。中位住院时间为8天，接受手术治疗的患者和Rockall评分较高的患者住院时间明显更长（P<0.001）。3.3%的患者出现再出血。静脉曲张出血、休克、肝失代偿、HIV感染、合并症、恶性肿瘤、年龄>60岁以及Rockall评分较高和接受手术的患者的总死亡率为11.7%，明显更高（P<0.001）。
在我们的环境中，食管静脉曲张是上消化道出血最常见的原因，且与高发病率和死亡率相关。纤维内镜的诊断准确性与出血发作与内镜检查之间的时间间隔有关。因此，建议在出血发作后24小时内尽早进行内镜检查。
