Upper Gastrointestinal Bleed - Causes, Endoscopic profile and usefulness of Rockall Score.

Rema, Krishnakumar (2008) Upper Gastrointestinal Bleed - Causes, Endoscopic profile and usefulness of Rockall Score. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Upper Gastrointestinal Bleeding (UGIB) is a common medical emergency associated with significant morbidity and mortality and forms a bulk of admissions to medical centres and may encompass many different scenarios. A broad spectrum of lesions may be responsible for bleeding from the upper gastrointestinal tract; the bleed being massive or trivial and either clinically apparent or obscure. Gastrointestinal (GI) bleeding is an extremely common clinical problem resulting in more than 3,00,000 hospitalizations annually in the United States. The overall incidence of upper GI bleeding is approximately 125 hospitalizations for every 1,00,000 people, with a male to female ratio of 2:1. Bleeding from upper GI tract is five times as common as lower GI bleed. Over the past 45 years, the mortality from upper GI bleeding has remained stable at approximately 10%.2 Mortality from acute GI bleeding is much greater than that for chronic bleeding. Therefore, it is important to understand the pathogenesis of acute GI bleeding, with an emphasis on early detection, prevention and intervention, in order to minimize morbidity and mortality. The clinical presentation reflects the site, etiology and rate of bleeding and may manifest in one or more ways. Hematemesis, melena and hematochezia are the most common manifestations. The bleeding may be obscure in about 5% of cases and at times may manifest as an occult bleed. Peptic ulcers are the most common causes of upper GI bleeding and are followed by variceal bleeding, gastric and duodenal erosive disease and Mallory-Weiss tears in prevalence. The associated factors include H. pylori infection, NSAID intake and alcohol abuse. AIM OF THE STUDY : (i) To study predisposing factors, clinical profile and endoscopic findings of patients presenting with Upper Gastrointestinal Bleed (UGIB) to the endoscopic unit of our institution. (ii) To apply Rockall score in the assessment of upper gastrointestinal bleed. CONCLUSION : Upper GI bleed is an important indication for endoscopic referral to this Institution. • The majority of patients were noted to be less than 60 years of age, with a male predilection. • Most cases presented with minor or moderate upper GI bleed, with massive bleeds constituting a minority. • NSAID and alcohol use as well as smoking were notable associated factors. • Nonvariceal bleed predominated in all age groups, with peptic ulcers and gastroduodenal erosions accounting for the majority of cases. • Good clinicoendoscopic correlation in varices, MW tears, and duodenal ulcer compared to gastric ulcer and malignancy. • Based on the Rockall score,most of the cases fell into the low and moderate risk groups( score<6). In the high risk group, the number of patients with variceal bleed were significantly higher compared to the low risk group. • The rebleed was not significantly higher in patients with varices, as compared to nonvariceal causes. • The requirement of packed red cell transfusion and rebleed were higher in patients with higher Rockall score (moderate and high risk groups). The mortality was significantly higher in the high risk group as compared to the low risk group. Hence, 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 into outpatient and inpatient care, as well as to predict prognosis in upper GI bleed.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Upper Gastrointestinal Bleed ; Causes, Endoscopic profile ; Rockall Score.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:06
Last Modified: 13 Jul 2017 04:06
URI: http://repository-tnmgrmu.ac.in/id/eprint/1555

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