Variceal Hemorrhage as the Commonest Cause of Presentation with Acute Upper Gastrointestinal Bleeding: A Paradigm Shift

Abstract

Background: Upper gastrointestinal bleeding, a life-threatening condition, is a common presentation of the emergency room visits. Objective: To determine the frequencies of various causes of acute upper gastrointestinal bleeding (AUGIB) amongst the patients presenting at emergency department with upper gastrointestinal bleed mandating urgent esophagogastroduodenoscopy (OGD). Study Design: It is a retrospective observational study. Settings: Department of Gastroenterology, Combined Military Hospital Lahore, Pakistan. Duration: 12 months from January 2019 to December 2019. Methods: All the patients who presented to emergency department with AUGIB and were referred for endoscopy after initial resuscitation were included in study. Their record was reviewed including the epidemiologic data, history, clinical details and endoscopic findings. Patients who had routine, non-urgent OGD to screen for varices or anemia, were excluded from the study. Results: Records of 270 patients, aged between 18-96 years were analyzed, 206(76.3%) were males and 64 (23.7%) were females. The most common finding was esophageal varices (26.0%) followed by gastritis (20.7%). Esophageal varices were found more frequently in males (76.1%) as compared to females (23.9%). Conclusion: This study strengthened the hypothesis that bleeding due to variceal hemorrhage is now actually the leading cause for AUGIB, mandating inclusion of medical treatment for variceal bleed in treatment protocol of all upper GI bleeds in the emergency assessment room, pending OGD.