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Alexandria Journal of Medicine

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The management of low-risk acute upper gastrointestinal haemorrhage in the community in Egypt

A Gado, B Ebeid, A Abdelmohsen, A Axon

Abstract


Background: Acute upper gastrointestinal haemorrhage (AUGIH) is a common emergency, initially managed with in-patient care. Bleeding stops spontaneously in over 80% of cases indicating patients with low-risk AUGIH might be better managed in the community.
Aim: The aim of the study was to assess the safety of managing patients with low risk AUGIH without admission to hospital.
Material and methods: This was a cross sectional hospital based study performed in patients presenting with low risk AUGIH over an eight-year period between January 2004 and 2012. Patients in this category were discharged home and underwent endoscopy on the next available list.
Results: Two hundred and twenty-three patients were analysed. 34% were male. Mean age 32 ±11 years. The main presentation was haematemesis in 209 patients (94%). The mean time from the index attack of bleeding to presentation was 38 ±11 h. Endoscopy was performed at a median of two days. One hundred and nine patients (49%) had a normal endoscopy. Ninety eight patients(44%) had significant endoscopic findings (SEF)  (peptic ulcer, mucosal erosions, oesophagitis, ectasias, Mallory-Weiss tear and mass). SEF were related to age (P = 0.01). SEF were reported in 61 patients (62%) P30 years and 37 patients (38%) <30 years. One patient (0.5%) rebled. No patient required endoscopic intervention or emergency surgery. The 15-day mortality was nil.
Conclusion: Patients with low risk AUGIH can be safely managed in the community. Reduction of admissions for such patients allows more  appropriate use of in-patient resources with consequent financial savings. Patients with low risk AUGIH should however undergo endoscopy because it
often reveals SEF.

KEYWORDS Upper gastrointestinal haemorrhage; Low risk; Outcome; Egypt



http://dx.doi.org/10.1016/j.ajme.2012.10.006
AJOL African Journals Online