Sohail Sabir, Tassawar Hussain.
Aetiology and outcome of Acute Upper Gastrointestinal Hemorrhage cases admitted to Military Hospital Rawalpindi.
Pak Armed Forces Med J Jan ;52(1):84-8.

Acute upper gastrointestinal bleeding remains one of the most commonly encountered presentations in the emergency department of hospitals world wide. It has multifactorial aetiology which varies widely between different geographical areas of the world. Incidence in America ranges from 50-150 cases/100,000/year and in United Kingdom it varies from 100-107/100,000/year. The epidemiological analysis of such cases in Pakistan is yet to be formulated. In the last two decades the advent of state-of -the-art upper gastrointestinal endoscopy has considerably improved upon the diagnostic and therapeutic modalities in the management of upper gastrointestinal bleeding. This study included thirty seven patients admitted to Military Hospital Rawalpindi with manifestations of acute upper gastrointestinal haemorrhage between August 1996 and August 1997. Endoscopy was done within seventy-two hours of admission. Patients represented with male to female ratio of 8:1 and a mean age of 42 years. At presentation 48.6% had haematemesis alone whereas only 5.4% presented with melaena alone. Major causes of bleeding were oesophageal varices (35.2%), duodenal ulcer (21.6%) and reflux oesophagitis (8.1%). One case of Boerhave`s syndrome was also seen. Prior history of NSAIDs intake was obtained in 10.8% and 5.4% of cases gave history of previous episode of bleeding whereas 21.6% had suffered from jaundice. At presentation, haemorrhage was haemodynamically severe in 21.6% who also had Hb of <6 gm/dl with a raised urea level as well. This contributed to the overall mortality of 13.2% being highest with massively bleeding oesophageal varices. Out of the 13 cirrhotic patients, 5 had hepatitis B and 3 had hepatitis C. This study signifies predominance of the esophageal varices in incurring morbidity and somewhat higher mortality rate in our population as compared to other studies. These observations necessitate proper multicentre epidemiological survey in order to adequately prevent and effectively combat the adverse outcome of upper gastrointestinal haemorrhage. This is a review article.

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