Etiology and outcome in patients with upper gastrointestinal bleeding: Study on 4747 patients in the central region of Iran

Abstract

Background and Aim: Upper gastrointestinal bleeding (UGIB) is a threatening condition leading to urgent hospitalization. This study aims to investigate etiology and outcome in UGIB patients in Iran. Methods: Medical records of GIB patients admitted to Alzahra referral hospital (in Isfahan) during 2010-2015 were retrospectively reviewed for demographic data, comorbidities, history of smoking and taking non-steroidal anti-inflammatory drugs (NSAIDs), presenting symptoms, endoscopic findings, therapeutic endoscopy, blood products' infusion, surgical intervention, rebleeding, and mortality. Results: A total of 4747 patients were enrolled in the study (69.2 men, mean age=55.46 +/- 21.98years). Hematemesis was the most frequent presenting symptom (63.5). Peptic ulcer (duodenal ulcer in most cases) was seen as the main reason for UGIB (42.4). Rebleeding (present in 16.5 of patients) was found to be more frequent in patients with older age, presenting sign of hematochezia and hypotension, history of taking NSAIDs and smoking, presence of comorbidities, history of bleeding because of UGI tract neoplasm and esophageal varices, history of needing blood products' infusion, and history of therapeutic endoscopy or surgical intervention (P<0.005). We found that mortality (5.5 in total) was also higher in the same group of patients that were seen to have a higher tendency for rebleeding (P<0.005). Conclusion: Peptic ulcers are the most common cause of UGIB. Comorbidities, hemodynamic instability, high-risk endoscopic stigmata, history of smoking and taking NSAIDs, gastric and esophageal malignancies, may be important predisposing factors for rebleeding and mortality in patients with UGIB.