Dewan K R, Patowary B S, Bhattarai S
Department of Gastroenterology, College of Medical Sciences, Bharatpur, Nepal.
Kathmandu Univ Med J (KUMJ). 2014 Jan-Mar;12(45):21-5. doi: 10.3126/kumj.v12i1.13628.
Acute Upper Gastrointestinal Bleeding is a common medical emergency with a hospital mortality of approximately 10 percent. Higher mortality rate is associated with rebleeding. Rockall scoring system identifies patients at higher risk of rebleed and mortality.
To study the clinical and endoscopic profile of acute upper gastrointestinal bleed to know the etiology, clinical presentation, severity of bleeding and outcome.
This is a prospective, descriptive hospital based study conducted in Gastroenterology unit of College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal from January 2012 to January 2013. It included 120 patients at random presenting with manifestations of upper gastrointestinal bleed. Their clinical and endoscopic profiles were studied. Rockall scoring system was used to assess their prognosis.
Males were predominant (75%). Age ranged from 14 to 88 years, mean being 48.76+17.19. At presentation 86 patients (71.7%) had both hematemesis and malena, 24 patients (20%) had only malena and 10 patients (8.3%) had only hematemesis. Shock was detected in 21.7%, severe anemia and high blood urea were found in 34.2% and 38.3% respectively. Upper Gastrointestinal Bleeding endoscopy revealed esophageal varices (47.5%), peptic ulcer disease (33.3%), erosive mucosal disease (11.6%), Mallory Weiss tear (4.1%) and malignancy (3.3%). Median hospital stay was 7.28+3.18 days. Comorbidities were present in 43.3%. Eighty six patients (71.7%) had Rockall score < 5 and 34 (28.3%) had >6. Five patients (4.2%) expired. Risk factors for death being massive rebleeeding, comorbidities and Rockall score >6.
Acute Upper Gastrointestinal bleeding is a medical emergency. Mortality is associated with massive bleeding, comorbidities and Rockall score >6. Urgent, appropriate hospital management definitely helps to reduce morbidity and mortality.
急性上消化道出血是一种常见的医疗急症，医院死亡率约为10%。再出血与更高的死亡率相关。罗卡尔评分系统可识别再出血和死亡风险较高的患者。
研究急性上消化道出血的临床和内镜特征，以了解病因、临床表现、出血严重程度及预后。
这是一项于2012年1月至2013年1月在尼泊尔巴拉特普尔医学科学学院教学医院胃肠病科进行的前瞻性、描述性医院研究。随机纳入120例出现上消化道出血表现的患者。对他们的临床和内镜特征进行研究。采用罗卡尔评分系统评估其预后。
男性占主导（75%）。年龄范围为14至88岁，平均年龄为48.76±17.19岁。就诊时，86例患者（71.7%）既有呕血又有黑便，24例患者（20%）仅有黑便，10例患者（8.3%）仅有呕血。21.7%的患者出现休克，34.2%和38.3%的患者分别出现严重贫血和高血尿素。上消化道出血内镜检查显示食管静脉曲张（47.5%）、消化性溃疡病（33.3%）、糜烂性黏膜病（11.6%）、马洛里-魏斯撕裂（4.1%）和恶性肿瘤（3.3%）。中位住院时间为7.28±3.18天。43.3%的患者存在合并症。86例患者（71.7%）的罗卡尔评分<5分，34例（28.3%）的评分>6分。5例患者（4.2%）死亡。死亡的危险因素为大量再出血、合并症和罗卡尔评分>6分。
急性上消化道出血是一种医疗急症。死亡率与大量出血、合并症和罗卡尔评分>6分相关。紧急、恰当的医院管理肯定有助于降低发病率和死亡率。
