Thirty Days Mortality and Morbidity in Non Variceal Upper Gastrointestinal Bleeding (NVUGIB)

Abstract

AIM: To determine the mortality and morbidity among patients presented with acute NVUGIB, co-morbid illnesses, the intake of aspirin, non-steroidal anti inflammatory drugs (NSAIDs), endoscopic therapy and proton pump inhibitors (PPIs) on clinical outcomes. METHODS: A prospective cohort study on all patients presented with acute NVUGIB to Specialized Arab Hospital (SAH), Nablus-Palestine, during the period April 2011-April 2013. The medical history for each patient was collected, all patients were given esomperazole 80 mg IV push and then 8mg/hour IV pump. Timing of endoscopy with Forrest grading, hospital course, and the 30 day mortality after being discharged from hospital, all variables analyzed and Chi square test was used to test the significance of relationships. A p value of < 0.05 was considered statistically significant. RESULTS: Total number, 86 patients, with a female to male ratio of 1:3, Patient's age: - 48/86(56%), 38/86(44%) were above and below the age of 60, respectively. Melena was the most common presentation, followed by hematemesis and general symptoms. Smokers 32/86(40%). Co-morbid illnesses 55/86 (64%), most common reported diseases were hypertension, diabetes, coronary artery diseases, and CHF. Ingestion of Aspirin or non-steroidal anti-inflammatory drugs (NSAID’s) was reported in (64/86)74% of patients. Upper endoscopy was done after 24 hours of symptoms in 64/86 (74%). The most common endoscopic diagnosis was peptic ulcer disease 64/86 (74%), Forrest grade 3 clean base ulcers 37/64 (57%), Forrest grade II black spot, adherent clot or non bleeding visible vessel (NBVV) 17/64 (26%), and Forrest grade I oozing or spurter10/64 (16%). Number of blood units given was more in patients with active bleeders (Forrest I). High dose of IV esomeprazol (80 mg then 8 mg/hour) was given, before endoscopic intervention, in 38/86 (44%), 24/38 (65%) found to have Grade 3 (clean base) ulcer. All of NVUGIB patients were subsequently given esomeprazol, after endoscopy. Blood transfusion was needed in 65/86 (76%). Re-bleeding events have occurred in 5/86 (6%). The overall mortality was 4/86 (4.6%) all have co-morbid illnesses. Endoscopic intervention failed in 5/86 (5.8%) 4 referred for surgical intervention and one referred to interventional radiologist. CONCLUSION: Peptic ulcer is the most common cause of NVUGIB, bleeding is highly associated with Aspirin and NSAID’s intake. High dose IV esomeprazol, (80 mg then 8 mg/hour), before EGD decreases the proportion of patients with stigmata of recent hemorrhage. The mortality and morbidity of NVUGIB in this study is slightly lower than that found in most previous studies.