dc.description.abstract |
Background: Upper gastrointestinal bleeding is bleeding into the lumen of the
gastrointestinal tract involving the esophagus, stomach and the duodenum. It is the most
common form of gastrointestinal bleeding being four times more common than lower
gastrointestinal bleeding. It represents approximately 1% of emergency room admissions
with a mortality rate of 4 – 14% worldwide. Leading causes worldwide include peptic
ulcer disease and esophageal varices. Management requires initial resuscitation and
stabilization followed by endoscopic evaluation to make a definitive diagnosis. Ultimate
management is medical, endoscopic surgery or open surgery. Although this type of
bleeding is common, it has not been described in the Western Kenya region.
Objective: To describe the etiology, management and outcome of upper gastrointestinal
bleeding among patients seen at the Moi Teaching and Referral Hospital.
Methods: This was a prospective descriptive census study conducted at the Moi
Teaching and Referral Hospital, Eldoret, Kenya, between October 2015 and September
2016. A total of 63 patients aged 18 years and above presenting with upper
gastrointestinal bleeding were recruited into the study. Data was collected using a
structured data collection form by interviewing the patients and checking their files. The
etiology, management and outcome were recorded. Data analysis was done using R
statistical package version 3.4.2, year 2017. Frequency tables were generated for
categorical variables. Factors associated with control of bleeding and re-bleeding were
assessed using logistic regression model with odds ratio and 95% confidence intervals
reported. Time to death was described using Kaplan-Meier survival curve. Predictors of
death were assessed using Cox proportional hazards regression model. Results were
presented using tables and graphs.
Results: The leading etiologies of upper gastrointestinal bleeding at Moi Teaching and
Referral Hospital were gastroduodenal erosions (27.6%), gastroesophageal tumors
(25.6%), varices (14.9%) and ulcer (14.8%). Diagnostic endoscopy was done in 74.6%
of the participants. Definitive management was medical (81.0%), endoscopic surgery
(12.7%) and open surgery (6.3%). Control of bleeding was achieved for 81.0% of
participants with a 46.0% re-bleeding rate reported. A higher pulse rate (>100bpm) had
up to 86% reduced odds of bleeding control, OR: 0.14(95% CI: 0.03, 0.62). On the other
hand, high SBP (>90mmHg) was associated with increased odds of controlling bleeding,
OR: 10.63 (95% CI: 2.86, 39.49). However, participants with normal platelet count were
less likely to re-bleed, OR: 0.29 (95% CI 0.10, 0.81). Mortality rate was 20.6% with
death occurring faster within the first 5 days.
Conclusion: At Moi Teaching and Referral Hospital, the main etiologies were
gastroduodenal erosions, gastroesophageal tumors, varices and ulcers. Majority of the
patients underwent medical management. Re-bleeding and mortality rates were high.
Recommendations: High index of suspicion on etiology of upper gastrointestinal bleed
being a tumor. Measures to be put in place to mitigate the high morbidity and mortality
by using the mentioned predictors in clinical practice such as thrombocytopenia and
appropriate primary diagnosis of bleeding |
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