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Alruzug IM, Aldarsouny TA, Semaan T, Aldaher MK, AlMustafa A, Azzam N, Aljebreen A, Almadi MA. Time trends of causes of upper gastrointestinal bleeding and endoscopic findings. Saudi J Gastroenterol 2020; 27:28-34. [PMID: 33078720 PMCID: PMC8083243 DOI: 10.4103/sjg.sjg_378_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) is a frequent cause for emergency endoscopy and, in a proportion, requires the application of endotherapy. We aim to evaluate the proportion of variceal and nonvariceal upper gastrointestinal bleeding (NVUGIB), the endoscopic findings that were detected, as well as the temporal trends of endoscopic findings over a period of 13 years. METHODS This is a retrospective study of patients who underwent an esophagogastroduodenoscopy with an indication of UGIB or presented with hematemesis, melena, or both, as well as those who had hematochezia, from January 2004 to December 2016 (13 years). RESULTS A total of 2075 patients were included with a mean age of 56.8 years (range 18-113) and males constituted 67.9%, while 65.9% had at least one comorbidity. Symptoms on presentation included hematemesis (52.5%), melena (31.2%), both hematemesis & melena (15.1%), and hematochezia (1.2%). The majority of UGIB were from a NVUGIB source (80.5%) and a variceal source was found in 13.1%, while no endoscopic findings were found in 6.4% of cases. The most common endoscopic diagnosis was gastroduodenal erosions (23.8%), duodenal ulcers (23.5%), reflux esophagitis (16.0%), esophageal varices (12.1%), and gastric ulcers (10.8%). There was no change in the endoscopic findings over the time period of the study. A third of duodenal ulcers (33.3%) as well as 21.9% of gastric ulcers were actively bleeding at the time of endoscopy, while 3.3% of duodenal ulcers had an adherent clot. CONCLUSIONS NVUGIB composed the majority of cases presenting with UGIB and variceal bleeding was lower than that described in prior studies, but there were no clear trends in the proportion of causes of UGIB during the study duration.
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Affiliation(s)
| | | | - Toufic Semaan
- Department of Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | - Manhal K. Aldaher
- Department of Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | - Adnan AlMustafa
- Department of Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | - Nahla Azzam
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Aljebreen
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Majid A. Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia,Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Québec, Canada,Address for correspondence: Prof. Majid A. Almadi, Professor of Medicine and Consultant, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh 11451, Saudi Arabia. E-mail:
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Almadi MA, Almutairdi A, Alruzug IM, Aldarsouny TA, Semaan T, Aldaher MK, AlMustafa A, Azzam N, Batwa F, Albawardy B, Aljebreen A. Upper gastrointestinal bleeding: Causes and patient outcomes. Saudi J Gastroenterol 2020; 27:20-27. [PMID: 33047678 PMCID: PMC8083248 DOI: 10.4103/sjg.sjg_297_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) remains a healthcare burden and is associated with considerable morbidity and mortality. We aim to describe the presentation, clinical, and laboratory characteristics of patients presenting with UGIB as well as important patient outcomes. METHODS This is a retrospective study performed at a tertiary care university hospital in Riyadh. Electronic endoscopic reports of patients undergoing gastroscopies for the indication of UGIB from January 2006 to January 2015 were included. Demographic data, past medical conditions, medications used, symptoms on presentation, as well as the patients' hemodynamic status, laboratory investigations on presentations, the need for blood products, the need for admission to an intensive care unit, rebleeding, and in-hospital mortality rates were retrieved from medical records. RESULTS Two hundred fifty-nine patients were included with a mean age of 57.1 years and males constituted 66.8% of the study cohort. At least one comorbidity was present in 88.2%, while 20.7% had a history of prior UGIB, 12.6% had a history of peptic ulcer disease, and 9.2% had known esophageal varices. A nonvariceal source represented 80.1% of the causes (95% CI: 75.4 to 85.3%), 15.5% required admission to the intensive care unit (ICU), the rebleeding rate was 8.9% (95% CI; 5.7% to 12.2%) while the in-hospital mortality was 4.4% (95% CI; 2.4% to 6.9%). The mean pre-endoscopic Rockall score was 2.6 (range: 0 to 5), while the total Rockall score was 4.4 (range: 1 to 9). There was no association between the pre-endoscopic Rockall score and rebleeding (3.0 vs. 2.5, P = 0.27) or need for ICU admission (3.2 vs. 2.4, P = 0.08), the total Rockall score and rebleeding (5.0 vs. 4.4, P = 0.58) or need for ICU admission (5.0 vs. 4.3, P = 0.36). CONCLUSION Causes of UGIB in this patient population were predominantly nonvariceal and the rebleeding and mortality rates resembled those of other studies.
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Affiliation(s)
- Majid A. Almadi
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Jeddah, Saudi Arabia,Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Québec, Canada
| | - Abdulelah Almutairdi
- Gastroenterology Section, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim M. Alruzug
- Department of Medicine, Gastroenterology Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Thamer A. Aldarsouny
- Department of Medicine, Gastroenterology Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Toufic Semaan
- Department of Medicine, Gastroenterology Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Manhal K. Aldaher
- Department of Medicine, Gastroenterology Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Adnan AlMustafa
- Department of Medicine, Gastroenterology Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Nahla Azzam
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Jeddah, Saudi Arabia
| | - Faisal Batwa
- Department of Medicine, Gastroenterology Unit, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Badr Albawardy
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, USA
| | - Abdulrahman Aljebreen
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Jeddah, Saudi Arabia,Address for correspondence: Prof. Abdulrahman Aljebreen, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. E-mail:
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Pellicano R, Ribaldone DG, Caviglia GP. Strategies for Helicobacter pylori eradication in the year 2020. Saudi J Gastroenterol 2020; 26:63-65. [PMID: 32295934 PMCID: PMC7279073 DOI: 10.4103/sjg.sjg_95_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Rinaldo Pellicano
- Unit of Gastroenterology Molinette Hospital, University of Turin, Turin, Italy,Address for correspondence: Dr. Rinaldo Pellicano, Outpatients Clinic of Gastroenterology, Molinette.S.G.A.S. Hospitals, Via Cavour 31, III piano, 10100 Torino, Italy. E-mail:
| | - Davide Giuseppe Ribaldone
- Unit of Gastroenterology Molinette Hospital, University of Turin, Turin, Italy,Department of Medical Sciences, University of Turin, Turin, Italy
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