Upper gastro intestinal bleed: causes, endoscopic profile and usefulness of Rockall score in determining the outcome

Heet Bharatkumar Katira; Shirish Srivastava

doi:10.18203/2320-6012.ijrms20231408

Authors

Heet Bharatkumar Katira Department of Surgery, Pramukhswami Medical College, Karamsad, Gujarat, India
Shirish Srivastava Department of Surgery, Pramukhswami Medical College, Karamsad, Gujarat, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20231408

Keywords:

Upper gastrointestinal hemorrhage, Rockall score, Endoscopy

Abstract

Background: Upper gastrointestinal hemorrhage is defined as any bleeding from a site in the gastrointestinal tract proximal to the ligament of Treitz (fore-gut). Patients with Upper gastrointestinal hemorrhage present with a wide range of clinical severity ranging from trivial bleeds to fulminant and lethal exsanguinations. It is associated with multiple risk factors and multiple co-morbid condition.

Methods: A prospective cross-sectional study was conducted in a tertiary care hospital. A total of 56 patients who were subjected to endoscopy and were studied for 6 months. Appropriate statistical method had been applied wherever needed.

Results: In the studied population among 56 patients, most common cause of UGIB was variceal bleed 45 (80%); most common of age group with variceal bleed belonged to 40-59 years, Grade III varices were most commonly found 23 (52%). The mean Rockall score was 4.7 which indicated that most patients belong to moderate risk group. The need of packed red blood cell transfusion and chances of rebleeding were more in high-risk group compared to low and moderate risk group. Patient mortality were only observed in high-risk group compared to low and moderate risk group.

Conclusions: Upper GI endoscopy is beneficial in both diagnostic and therapeutic treatment of patients with UGIB. Rockall score helped in identifying that most of the patients belonged to moderate and high-risk group. Rockall score has been found to correlate well with clinical outcome, including need for transfusions, rebleeding and mortality, and may be used for effective triage of patients.

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References

McQuaid KR, Laine L. Systematic review and meta-analysis of adverse events of low-dose aspirin and clopidogrel in randomized controlled trials. Am J Med. 2006;119:624-38.

Barkun A, Sabbah S, Enns R. The Canadian registry on nonvariceal Upper GI bleeding and Endoscopy( RUGBE):endoscopic haemostasis and proton pump inhibition are associated with improved outcomes in a real life setting. Am J Gastro. 2004;99:1238-46.

Rockall TA, Logan RFA, Devlin. Influencing the practice and outcome in acute upper gastrointestinal haemorrhage. Gut. 1997;41;606-11.

Yavorski RT, Wong RKH. Analysis of upper gastrointestinal bleeding in military medical care facilities. Am J Gastro. 1995;90:4.

Longstreth GF, Feitelberg SP. Outpatient care of selected patients with acute non-variceal upper gastrointestinal haemorrhage. Lancet. 1995; 345(8942):108-11.

Chak A, Cooper GS, Lloyd LE. Effectiveness of endoscopy in patents admitted to the intensive care unit with Upper GI hemorrhage. GI Endos. 2001;53:6-13.

Vreeburg EM, Terwee CB, Snel P, Rauws EA, Bartelsman JF, Meulen JH, Tytgat GN. Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut. 1999;44(3):331-5.

Akash C. Validation of Rockall score for non variceal Upper GI bleeda study from Chennai. Indian J Gastroenterol. 2007:26(2):A13.

Laine L, Peterson WL: Bleeding peptic ulcer. N Engl J Med. 1994;331:717-27.

Ghosh S, Watts D, Kinnear M. Management of gastrointestinal haemorrhage. Postgrad Med J. 2002;78:4-14.

Marshall JK, Collins SM, Gafni A. Prediction of resource utilization and case cost for acute nonvariceal upper gastrointestinal hemorrhage at a Canadian community hospital. Am J Gastroenterol. 1999;94:1841-6.

Barkun AN, Chiba N, Enns R, Marshall J, Armstrong D, Sabbah S, et al. Use of a national endoscopic database to determine the adoption of emerging pharmacological and endoscopic technologies in the everyday care of patients with upper GI bleeding: the RUGBE initiative. Am J Gastroenterol. 2001;96:S261.

Freeman ML. Stigmata of hemorrhage in bleeding ulcers. Gastrointest Endosc Clin North Am 1997;7:559-74.

Rockall TA, Logan RFA, Devlin HB. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38:316-21.

Laine L, Weinstein WM. Subepithelial hemorrhages and erosions of human stomach. Dig Dis Sci. 1988;33:490.

Kelly JP, Kaufman DW, Koff RS. Alcohol consumption and the risk of major upper gastrointestinal bleeding. Am J Gastroenterol. 1995;90:1058.

Wilcox CM, Alexander LN, Straub RF, Clark WS: A prospective endoscopic evaluation of the causes of upper GI hemorrhage in alcoholics: A focus on alcoholic gastropathy. Am J Gastroenterol. 1996;91:1343.

Sherman LM, Shenoy SS, Cerra FB. Selective intra-arterial vasopressin: Clinical efficacy and complications. Ann Surg. 1979;189:298.

Bharucha AE, Gostout CJ, Balm RK. Clinical and endoscopic risk factors in the Mallory-Weiss syndrome. Am J Gastroenterol. 1997;92:805-8.