Retrospective Evaluation of Acute Upper Gastrointestinal System Bleeding Patients Admitted to Gastroenterology Clinic

Yıl 2020, , 343 - 347, 01.12.2020

Muhammed Fatih Sağıroğlu , Murat Çalapkulu , Macit Gülten

https://doi.org/10.32708/uutfd.747285

Cited By: 1

Öz

Upper gastrointestinal system (GIS) bleeding is an emergency with a high mortality and morbidity rate. In this study, it was aimed to obtain current data on demographic features, clinical findings, application complaints, hemodynamic findings, comorbid diseases, drug use histories, endoscopic findings, ES replacement numbers, hospitalization days of patients admitted to our hospital with upper GIS bleeding. This study was performed retrospectively on 300 patients who were admitted to Bursa Uludağ University Faculty of Medicine Gastroenterology Department between January 2012 and December 2017 and diagnosed with upper GIS bleeding. Patients' files were scanned from the hospital archive. The mean age of the patients was 61.80 (± 17.18). 63% of the patients were male, and 37% were female. The most common reason for admission was melena, with 37%. There was a comorbid disease accompanying 84.3% of the patients. The most common comorbid disease was hypertension, with 42.7%. 51.3% of the patients were using one or more drugs that were prone to bleeding, and nonsteroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid (ASA) were found to be significantly higher. Peptic ulcer in 43.4% of patients (duodenal ulcer in 24.7%; gastric ulcer in 18.7%), gastroesophageal varicose veins bleeding in 28%, gastritis (erythematous / erosive) in 9%, Esophagitis / esophageal ulcer in 7.7% and 5.7% had malignant ulcer-mass. Duodenal ulcer was most common in men. As a result, acute upper GIS bleeding is one of the most important emergency application reasons, and it can be fatal if not intervened in time despite the technological developments. In our study, peptic ulcer bleeding was found to be the most common cause of upper GIS bleeding. Especially, advanced age, male gender, ASA, and NSAID use were detected as an increased risk factor in upper GI bleeding.

Anahtar Kelimeler

Upper gastrointestinal system bleeding, etiology, peptıc ulcer, endoscopy, varicose veins bleeding

Gastroenteroloji Kliniğine Başvuran Akut Üst Gastrointestinal Sistem Kanamalı Hastaların Retrospektif Değerlendirilmesi

Öz

Üst gastrointestinal sistem (GİS) kanaması mortalite ve morbidite oranı oldukça yüksek olan acil bir durumdur. Bu çalışmamızda hastanemize üst GİS kanaması ile başvuran hastaların demografik özellikleri, klinik bulguları, başvuru şikayetleri, hemodinamik bulguları, komorbid hastalıkları, ilaç kullanım öyküleri, endoskopik bulguları, eritrosit süspansiyon (ES) replasman sayıları, yatış günleri ile ilgili güncel veri elde etmek ve literatürle karşılaştırmak amaçlanmıştır. Bu çalışma Ocak 2012-Aralık 2017 tarihleri arasında Bursa Uludağ Üniversitesi Tıp Fakültesi Gastroenteroloji Bölümüne başvuran endoskopi yapılan ve üst GİS kanama tanısı konulan 300 hasta üzerinde retrospektif olarak yapıldı. Hastaların dosyaları hastane arşivinden tarandı. Hastaların yaş ortalaması 61,80±17,18 olarak saptandı. Hastaların %63’ü erkek %37’si kadındı. Hastaların en sık başvuru nedeni %37 ile melena olarak saptandı. Hastaların %84,3’üne eşlik eden komorbid bir hastalık vardı. En sık komorbid hastalık %42,7 ile hipertansiyondu. Hastaların %51,3’ü kanamaya yatkınlık yaratan bir ve daha fazla ilaç kullanmaktaydı, bu ilaçlardan nonsteroid antiinflamatuar ilaçlar (NSAİİ) ve asetil salisilik asit (ASA) kullanımı belirgin şekilde fazla olduğu saptandı. Hastaların %43,4’ünde peptik ülser (%24,7’sinde duodenal ülser; %18,7’sinde mide ülseri), %28’inde gastroözofagial varis kanaması, %9’unda gastrit (eritematöz/eroziv), %7,7’sinde özofajit/özofagus ülseri, %5,7’sinde malign ülser-kitle saptandı. Duodenal ülser erkeklerde daha sık saptandı. Sonuç olarak çalışmamızda üst GİS kanamasının en sık nedeni olarak peptik ülser kanaması saptandı. Özellikle ileri yaş, erkek cinsiyet, ASA ve NSAİİ kullanımı üst GİS kanamasında artmış bir risk faktörü olarak saptandı.

Anahtar Kelimeler

Üst gastrointestinal sistem kanaması, etiyoloji, peptik ülser, endoskopi, varis kanaması

Kaynakça

• 1. Tham J, Stanley A. Clinical utility of pre-endoscopy risk scores in upper gastrointestinal bleeding. Expert Rev Gastroenterol Hepatol 2019;13(12):1161–7.
• 2. Hearnshaw SA, Logan RFA, Lowe D, Travis SPL, Murphy MF, Palmer KR. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011;60(10):1327–35.
• 3. Dutta AK, Chacko A, Balekuduru A, Sahu MK, Gangadharan SK. Time trends in epidemiology of peptic ulcer disease in India over two decades. Indian J Gastroenterol 2012;31(3):111–5.
• 4. Cappell MS, Friedel D. Initial management of acute upper gastrointestinal bleeding: from initial evaluation up to gastrointestinal endoscopy. Med Clin North Am 2008;92(3):491–509, xi.
• 5. Barkun AN, Almadi M, Kuipers EJ, et al. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Annals of Internal Medicine 2019;171(11):805–22.
• 6. Okutur SK, Alkim C, Bes C, et al. Akut üst gastrointestinal sistem kanamaları: 230 olgunun analizi. Akademik Gastroenteroloji Dergisi 2007;6(1):30–6.
• 7. Robertson M, Majumdar A, Boyapati R, et al. Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems. Gastrointest Endosc 2016;83(6):1151–60.
• 8. Zaltman C, Souza HSP de, Castro MEC, Sobral M de FS, Dias PCP, Lemos V. Upper gastrointestinal bleeding in a Brazilian hospital: a retrospective study of endoscopic records. Arq Gastroenterol 2002;39(2):74–80.
• 9. Wuerth BA, Rockey DC. Changing Epidemiology of Upper Gastrointestinal Hemorrhage in the Last Decade: A Nationwide Analysis. Dig Dis Sci 2018;63(5):1286–93.
• 10. Boonpongmanee S, Fleischer DE, Pezzullo JC, et al. The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated. Gastrointest Endosc 2004;59(7):788–94.
• 11. Gralnek IM, Dumonceau J-M, Kuipers EJ, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015;47(10):a1–46.
• 12. Gürel S, İmadoğlu O. Varis ve Malignite Dışı Üst Gastrointestinal Sistem Kanamalarının Değerlendirilmesi. Uludağ Üniversitesi Tıp Fakültesi Dergisi 2004;30(2):87–91.
• 13. Restellini S, Kherad O, Jairath V, Martel M, Barkun AN. Red blood cell transfusion is associated with increased rebleeding in patients with nonvariceal upper gastrointestinal bleeding. Aliment Pharmacol Ther 2013;37(3):316–22.
• 14. Gencay M, Mavis O, Ozgur R, Ozsiginan ZT, Arici G. Analysis of 148 Cases with Upper Gastrointestinal Bleeding. Okmeydani Medical Journal 2011;27(3):130–7.
• 15. Stanley AJ, Laine L, Dalton HR, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ [Internet] 2017 [cited 2020 May 1];356. Available from: https://www.bmj.com/content/356/bmj.i6432
• 16. Wang C-H, Chen Y-W, Young Y-R, Yang C-J, Chen I-C. A prospective comparison of 3 scoring systems in upper gastrointestinal bleeding. Am J Emerg Med 2013;31(5):775–8.
• 17. Sarin N, Monga N, Adams PC. Time to endoscopy and outcomes in upper gastrointestinal bleeding. Can J Gastroenterol 2009;23(7):489–93.
• 18. Lau JYW, Yu Y, Tang RSY, et al. Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding. N Engl J Med 2020;382(14):1299–308.
• 19. Kim JJ, Sheibani S, Park S, Buxbaum J, Laine L. Causes of bleeding and outcomes in patients hospitalized with upper gastrointestinal bleeding. J Clin Gastroenterol 2014;48(2):113–8.