ORIGINAL ARTICLE J Rehman Med Inst. Vol. 2, No. 3, 2016 ENDOSCOPIC FINDINGS OF PATIENTS PRESENTING WITH UPPER GASTROINTESTINAL HEMORRHAGE IN A TERTIARY CARE Saqib Malik, Muhammad Amjad Khan, Farhat Naz Submitted: August 22, 2016 ABSTRACT Accepted: September 12, 2016 Introduction: One of the commonest medical emergencies faced by physicians and Author Information gastroenterologists is upper GI hemorrhage, having incidence rate of 103 cases per 100,000 Dr. Saqib Malik, Assistant Professor, per year in UK and mortality rate of 10%. Variceal and Non variceal causes are the two major Medical B Unit, Department of causes of upper GI hemorrhage. Massive GI hemorrhage is the life threatening complication Medicine, Ayub , , Hazara, Khyber that leads to severe anemia in patients with upper GI hemorrhage. The present study was Pakhtunkhwa, . conducted to determine the endoscopic findings in anemic patients with upper GI (Corresponding Author) hemorrhage presenting to Ayub Teaching Hospital, Abbottabad, Hazara, Khyber Email: [email protected]. Pakhtunkhwa, Pakistan. Dr. Muhammad Amjad Khan, Medical Materials & Methods: Our study was conducted in department, Ayub Officer, DHQ Hospital, Abbottabad, teaching hospital as a descriptive cross sectional study since March 2011 to August 2011. Hazara, , Pakistan. Results: Out of total 292 patients with upper GI hemorrhage and resulting anemia included in this study, there were 184 male and 18 female patients with a male to female ratio of 1.7:1, Dr. Farhat Naz, Registrar, Medical B Unit, Department of Medicine, Ayub and mean age of 48.09±15.71 years. The most common cause of upper GI hemorrhage was Teaching Hospital, Abbottabad, found to be esophageal varices (55.5%) followed by peptic ulcer (36.6%), gastric erosions Hazara, Khyber Pakhtunkhwa, (5.8%), Mallory-Weiss tear (1.3%) and esophagitis (0.5%). Pakistan. Conclusion: As compared to Western countries where peptic ulcer disease is the most common cause of upper GI hemorrhage, esophageal varices were the more common cause of upper GI hemorrhage in the study population. Keywords: Gastrointestinal Hemorrhage; Endoscopy, Gastrointestinal; Esophageal & Gastric Varices; Peptic Ulcer; Esophagitis, Peptic.

The authors declared no conflict of interest. All authors contributed substantially to the planning of research (SM), data collection (MAK, FN), data analysis (SM, MAK) and write-up of the article (SM, FN) and agreed to be accountable for all aspects of the work. Citation: Malik S, Khan MA, Naz F. Endoscopic findings of patients presenting with upper gastrointestinal hemorrhage in a tertiary care hospital. J Rehman Med Inst. 2016;2(3):40-46. INTRODUCTION One of the commonest medical emergencies Gastric varices or combined Gastroesophageal faced by physicians and gastroenterologists is varices while gastric erosions, peptic ulcer upper GI hemorrhage, having incidence rate of disease and Mallory-Weiss tear, esophagitis and 103 cases per 100,000 per year in the UK1 and gastric tumors are the non- variceal causes of hospital mortality rate of about 10%.2 upper GI hemorrhage.5 Massive GI hemorrhage is the life threatening complication in these Upper GI Bleed is defined as hemorrhage that patients that lead to severe anemia.6 First aid occurs proximal to the Trietz ligament given to patients with Upper Gastrointestinal presenting either with hematemesis or melena.3 Bleeding starts with stabilizing the airway, Variceal and non variceal are the two major breathing and circulation. Hypotensive patients causes of Upper GI hemorrhage..4 In other are resuscitated with normal saline, hemacele studies, frequency of the variceal hemorrhage and blood transfusion. After resuscitation, has been shown to be 2-9%.5 Variceal Proton pump inhibitors & Prokinetics are hemorrhage may be due to Esophageal varices, given.3,7 Upper Gastrointestinal Endoscopy is

40 then performed ideally within 24 hours. It MATERIALS & METHODS yields a diagnosis in 80% of the cases and has This study was conducted in Gastroenterology a therapeutic purpose as well.5,8 Therapeutic department, Ayub Teaching Hospital, procedures includes Epinephrine injection, Abbottabad, as a descriptive cross sectional thermal therapy, Argon plasma coagulation, study from March to August 2011. Sample size Endoscopic Banding and Clipping.8 With the was calculated and Consecutive non-probability help of the upper GI endoscopy, the mortality sampling technique was employed to collect and morbidity rates associated with upper GI data on predesigned Performa. All patients hemorrhage have significantly reduced as it has presenting with hematemesis or melena of either both diagnostic and therapeutic significance.9 gender and having age of more than 18 years Upper GI endoscopy is relatively a very safe were included in the study. procedure when it comes to consider the risk for complication with this procedure with a In order to avoid any error in results, those rate of one per 1000 procedures.10 Out of patients were excluded who had any underlying 10,000 procedures done, the mortality rate is hemorrhagic disorders, on anti-coagulants, on 0.5-3 deaths.10 Bleeding, infection, perforation, PPIs or H1 receptor blockers. As a preliminary, cardiopulmonary problems and adverse permission was sought from the ethical and reaction to medications are some common research committees to conduct this study. All complications with upper GI endoscopy.10 those patients suitable for the study were admitted in the department and first informed The objective of this study is to determine the consent was taken, explaining both the purpose endoscopic findings in anemic patients with and advantages/disadvantages of the procedure. upper GI hemorrhage presenting to Ayub Teaching Hospital, Abbottabad. Frequency of the After thorough history, examination and general common causes varies among different studies; baselines were done, Upper GI endoscopy was the purpose of our study was to enlist the causes performed as early as possible. All procedures of upper GI hemorrhage in our population in were done by a single expert gastroenterologist order to compare it with the literature provided. having minimum of 5 years’ experience so that In addition, it will help to determine whether the the common endoscopic findings such as etiology of upper GI hemorrhage changes esophageal varices, peptic ulcer disease, according to the demographic features like age esophagitis, gastric erosions and Mallory-Weiss and gender of the patient. Patients presenting tear were not missed. with upper GI hemorrhage usually have The information regarding the patients collected underlying serious complications such as data was recorded on a predesigned Performa. malignancy which can be treated if diagnosed and treated early, and it is possible only when upper SPSS version 14.0 was used to record, process GI endoscopy is done in time. Need for urgent and analyze the data for descriptive statistics. and early upper GI endoscopy should be Variables like gender and common upper GI considered in our population in case of more Endoscopic findings (i.e. esophageal varices, prevalence of serious underlying complications peptic ulcer disease, esophagitis, gastric among patients of upper GI hemorrhage in our erosions and Mallory-Weiss tear) had their study. frequency and percentages calculated. Mean and SD was calculated for age. Common upper GI Endoscopic findings were also stratified by age and gender.

41 JOURNAL OF REHMAN MEDICAL INSTITUTE RESULTS Out of total 292 patients with upper GI Ages of patients ranged from 23-85 years hemorrhage and resulting anemia included in with a mean age of 48.09±15.71 years (Table1). the study, there were 184(63%) male and Majority of the patients were of age group 108(37%) female p