Clinical Characteristics, Risk factors and Outcomes of Patients with Acute Upper Gastrointestinal Bleeding in Sakaeo Crown Prince Hospital
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Abstract
Background: Acute upper gastrointestinal bleeding (UGIB) is a common surgical emergency. Proper assessment of clinical characteristics is essential for planning management.
Objective: To investigate the clinical characteristics, risk factors, and outcomes of patients with acute UGIB.
Methods: A retrospective study was conducted on 170 patients with acute UGIB admitted to Sakaeo Crown Prince Hospital. Baseline characteristics, clinical presentations, laboratory results, endoscopic findings, treatments, and outcomes were analyzed and compared between variceal UGIB (VUGIB) and non-variceal UGIB (NVUGIB).
Results: The majority of patients were male (70.0%) with a mean age of 61.45 ± 14.20 years. Endoscopy revealed NVUGIB in 158 patients (92.9%) and VUGIB in 12 patients (7.1%). Among NVUGIB patients, peptic ulcer disease (PUD) was the most common cause (67.1%). The most common bleeding stigmata was a clean base (58.5%). Alcohol consumption was reported in 39.4% of all cases, and NSAID use was found in 24.7% of NVUGIB cases. Compared with NVUGIB, patients with VUGIB more often had liver cirrhosis (p < 0.001), ascites (p = 0.005), frequent hemodynamic instability (p = 0.032) and lower hemoglobin levels (p = 0.033). They also showed prolonged prothrombin time (p = 0.002), low albumin levels (p < 0.001), higher total bilirubin levels (p = 0.001), higher rates of endoscopic therapeutic interventions (p < 0.001), and greater blood transfusion requirements (p = 0.021). Overall, complications occurred in 5.9%, rebleeding in 5.3%, and mortality in 6.5%.
Conclusions: NVUGIB was the predominant cause of acute UGIB, and overall outcomes were favorable. Although less common, VUGIB required more endoscopic interventions and blood transfusions. Clinical and laboratory factors may guide early identification of VUGIB, which may lead to the development of a simple screening tool for community hospitals.
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References
Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021;116(5):899−917. doi:10.14309/ajg.0000000000001245.
Lau JYW, Barkun A, Fan D-M, Kuipers EJ, Yang Y-S, Chan FKL. Challenges in the management of acute peptic ulcer bleeding. Lancet. 2013;381(9882):2033−43. doi:10.1016/S0140-6736(13)60596-6.
Kiattiweerasak A, Bongkotvirawan P, Aumpan N, Yamaoka Y, Miftahussurur M, Vilaichone RK. Predictive factors and prognosis of upper gastrointestinal bleeding in gastric cancer: a large population-based study (UGIB-GC trial). PLoS One. 2023;18(9):e0291926. doi:10.1371/journal.pone.0291926.
Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, et al. The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated. Gastrointest Endosc. 2004;59(7):788−94. doi:10.1016/S0016-5107(04)00181-6.
Loperfido S, Baldo V, Piovesana E, Bellina L, Rossi K, Groppo M, et al. Changing trends in acute upper-GI bleeding: a population-based study. Gastrointest Endosc. 2009;70(2):212−24. doi:10.1016/j.gie.2008.10.051.
Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G. An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium. Gastrointest Endosc. 2008;67(3):422−9. doi:10.1016/j.gie.2007.09.024.
Bunchorntavakul C, Yodket Y, Singhasena N. Clinical characteristics, treatment outcomes and risk assessment of patients with acute upper gastrointestinal bleeding in Rajavithi Hospital, Thailand. J Med Assoc Thai. 2017;100(Suppl 1):S104−15. Available from: https://pubmed.ncbi.nlm.nih.gov/29927224/
Lebkhao P. Retrospective study of upper gastrointestinal bleeding in Kratumbaen Hospital. Reg 4−5 Med J. 2011;30(1):1−8. Available from: https://he02.tci-thaijo.org/index.php/reg45/article/view/130707/
Kerdsin S, Laohawee P, Juthathippatai M, Dangsuwan W. Clinical risk factors of variceal or non-variceal upper gastrointestinal bleeding. BJM. 2019;6(2):45−56. Available from: https://he01.tci-thaijo.org/index.php/bjmed/article/view/23118/
Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W; Practice Guidelines Committee of the American Association for the Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46(3):922−38. doi:10.1002/hep.21907.
Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet. 2000;356(9238):1318−21. doi:10.1016/S0140-6736(00)02816-6.
Skok P. Fatal hemorrhage from a giant Mallory-Weiss tear. Endoscopy. 2003;35(7):635. doi:10.1055/s-2003-40214.
Sangchan A, Sawadpanitch K, Mairiang P, Chunlertrith K, Sukeepaisarnjaroen W, Sutra S, et al. Hospitalized incidence and outcomes of upper gastrointestinal bleeding in Thailand. J Med Assoc Thai. 2012;95(Suppl 2):S190−5. Available from: https://pubmed.ncbi.nlm.nih.gov/23130453/
Sirisunhirun P. Factors associated with mortality among patients admitted to King Narai Hospital due to acute upper gastrointestinal bleeding. J Med Health Sci. 2024;31(1):1−18. Available from: https://he01.tci-thaijo.org/index.php/jmhs/article/view/268803/
Pinto C, Parra P, Magna J, Gajardo A, Berger Z, Montenegro C, et al. Variceal and non-variceal upper gastrointestinal bleeding: analysis of 249 hospitalized patients. Rev Med Chil. 2020;148(3):288−94. doi:10.4067/S0034-98872020000300288.
Suchartlikitwong S, Lapumnuaypol K, Rerknimitr R, Werawatganon D. Epidemiology of upper gastrointestinal bleeding and Helicobacter pylori infection: review of 3,488 Thai patients. Asian Biomed. 2015;9(1):87−93. doi:10.5372/1905-7415.0901.373.
Kaplan DE, Ripoll C, Thiele M, Fortune BE, Simonetto DA, Garcia-Tsao G, et al. AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis. Hepatology. 2024;79(5):1180−1211. doi:10.1097/HEP.0000000000000647.
Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the international consensus group. Ann Intern Med. 2019;171(11):805−22. doi:10.7326/M19-1795.
