RISK FACTORS IN NON-VARICEAL AND NON-MALIGNANCY UPPER GASTROINTESTINAL BLEEDING IN THE PATIENTS UNDERGOING SURGERY
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Keywords
Gastrointestinal bleeding, risk factors, mortality
Abstract
Background and Aim: Upper gastrointestinal bleeding (UGIB) pertains to the occurrence of bleeding in the digestive tract above the flexor ligament and its remains a significant concern and challenges despite the development of advance treatment. The objective of the current investigation was to determine different risk factors associated with UGIB of non-variceal and non-malignant among patients undergoing surgery.
Patients and Methods: This retrospective analysis was conducted on 32 upper gastrointestinal bleeding patients who underwent surgery in the general surgery wards of several tertiary units in the United Kingdom. De-identified patient data was obtained in this multi-centric study from January 2020 to December 2021. Patients’ details such as age, smoking status, gender, comorbidities, use of medication (NSAID), endoscopy findings, surgical procedures, and shock presence, duration of hospitalization, morbidity, and mortality rate were measured and recorded. Descriptive statistics was done using SPSS version 27.
Results: The overall mean age was 48.96±17.8 years with an age range 19 to 80 years. There were 24 (75%) female and 8 (25%) male. Approximately 11 (34.4%) patients had used aspirin and 15 (46.9%) were smokers. Patients most frequently reported melena as their presenting complaint, accounting for 50% (n=16) of cases. The predominant comorbid problems observed were cardiovascular diseases, affecting 28.1% (n=9) of the patients. Shock signs were evident in 19 (59.4%) of the cases. The primary pathology responsible for bleeding in patients was identified as a duodenal ulcer in the majority, accounting for 68.8% (n=22). The most commonly employed surgical methods were Bilateral Truncal Vagotomy (BTV) and pyloroplasty, combined with ligation of the gastroduodenal artery, and these procedures were administered in 23 (71.9%) patients. Approximately 29.2% of patients, totaling 7 individuals, experienced complications, with pulmonary complications being the most prevalent among them. The mortality rate was 18.8% (n=6).
Conclusion: Factors influencing mortality in cases of varicose veins and non-malignant UGIB, which are unresponsive to endoscopy and necessitate surgery, include advanced age, male gender, comorbid diseases, excessive blood transfusions, shock, and a high Rockall score.
References
2. Kim MS, Moon HS, Kwon IS, Park JH, Kim JS, Kang SH, Sung JK, Lee ES, Kim SH, Lee BS and Jeong HY. Validation of a new risk score system for non-variceal upper gastrointestinal bleeding. BMC Gastroenterol 2020; 20: 193.
3. Samuel R, Bilal M, Tayyem O and Guturu P. Evaluation and management of non-variceal upper gastrointestinal bleeding. Dis Mon 2018; 64: 333-343.
4. Mullady DK, Wang AY and Waschke KA. AGA clinical practice update on endoscopic therapies for non-variceal upper gastrointestinal bleeding: expert review. Gastroenterology 2020; 159: 1120-1128.
5. Mujtaba S, Chawla S and Massaad JF. Diagnosis and management of non-variceal gastrointestinal hemorrhage: a review of current guidelines and future perspectives. J Clin Med 2020; 9: 402.
6. Sasaki Y, Abe T, Kawamura N, Keitoku T, Shibata I, Ohno S, Ono K and Makishima M. Prediction of the need for emergency endoscopic treatment for upper gastrointestinal bleeding and new score model: a retrospective study. BMC Gastroenterol 2022; 22: 337.
7. Lanas A, Dumonceau JM, Hunt RH, Fujishiro M, Scheiman JM, Gralnek IM, Campbell HE, Rostom A, Villanueva C and Sung JJY. Non-variceal upper gastrointestinal bleeding. Nat Rev Dis Primers 2018; 4: 18020.
8. Poddar U. Diagnostic and therapeutic approach to upper gastrointestinal bleeding. Paediatr Int Child Health 2019; 39: 18-22
9. Kärkkäinen JM, Miilunpohja S, Rantanen T, Koskela JM, Jyrkkä J, Hartikainen J and Paajanen H. Alcohol abuse increases re-bleeding risk and mortality in patients with non-variceal upper gastrointestinal bleeding. Dig Dis Sci 2015;60: 3707-3715.
10. Ozel F, Yorulmaz E, Yorulmaz H, Davutoglu C, Guven A. The Evalation of Risk Scorings in Non-variceal Upper Gastrointestinal Bleedings/Varis Disi Ust Gastrointestinal Kanamalarda Risk Skorlamalarmin Degerlendirilmesi. Bagcilar Medical Bulletin. 2021 Jun 1;6(2):183-90.
11. Yamaguchi D, Sakata Y, Tsuruoka N, Shimoda R, Higuchi T, Sakata H, Fujimoto K and Iwakiri R. Characteristics of patients with non-variceal upper gastrointestinal bleeding taking antithrombotic agents. Dig Endosc 2015; 27: 30-36.
12. Yamaguchi D, Sakata Y, Yoshida H, Furukawa NE, Tsuruoka N, Higuchi T, Watanabe A, Shimoda R, Tsunada S, Iwakiri R and Fujimoto K. Effectiveness of endoscopic hemostasis with soft coagulation for non-variceal upper gastrointestinal bleeding over a 12-year period. Digestion 2017; 95: 319-326.
13. Dango S, Beißbarth T, Weiss E, Seif Amir Hosseini A, Raddatz D, Ellenrieder V, Lotz J, Ghadimi BM and Beham A. Relevance of surgery in patients with non-variceal upper gastrointestinal bleeding. Langenbecks Arch Surg 2017;402: 509-519.
14. Forgerini M, Lucchetta RC, Urbano G, de Nadai TR and de Carvalho Mastroianni P. Genetic polymorphisms associated with upper gastrointestinal bleeding: a systematic review. Pharmacogenomics J 2021; 21: 20-36.
15. Rockall TA. Management and outcome of patients undergoing surgery after acute upper gastrointestinal haemorrhage. JR Soc Med 1998;91:518-523.
16. Hajiagha Mohammadi AA and Reza Azizi M. Prognostic factors in patients with active nonvariceal upper gastrointestinal bleeding. Arab J Gastroenterol 2019; 20: 23-27.
17. Abougergi MS, Peluso H and Saltzman JR. Thirty-day readmission among patients with nonvariceal upper gastrointestinal hemorrhage and effects on outcomes. Gastroenterology 2018; 155: 38-46.
18. Liu BX, Wang XZ, Yan YL, Xiao X, Yang L and Luo XF. Efficacy analysis of transcatheter arterial embolization in acute non-variceal upper gastrointestinal bleeding. Sichuan Da Xue Xue Bao Yi Xue Ban 2022; 53: 398-403.
19. Lakatos L, Gonczi L, Lontai L, Izbeki F, Patai A, Racz I, Gasztonyi B, Varga-Szabo L, Ilias A and Lakatos PL. Incidence, predictive factors, clinical characteristics and outcome of non-variceal upper gastrointestinal bleeding - a prospective population-based study from hungary. J Gastrointestin Liver Dis 2021; 30: 327-333.
20. Park HW and Jeon SW. Clinical outcomes of patients with non-ulcer and non-variceal upper gastrointestinal bleeding: a prospective multicenter study of risk prediction using a scoring system. Dig Dis Sci 2018; 63: 3253-3261.
21. Luo PJ, Lin XH, Lin CC, Luo JC, Hu HY, Ting PH and Hou MC. Risk factors for upper gastrointestinal bleeding among aspirin users: an old issue with new fndings from a populationbased cohort study. J Formos Med Assoc 2019; 118: 939-944.
22. Lu Y, Adam V, Teich V and Barkun A. Timing or dosing of intravenous proton pump inhibitors in acute upper gastrointestinal bleeding has low impact on costs. Am J Gastroenterol 2016;111: 1389-1398.
23. Ito N, Funasaka K, Furukawa K, Kakushima N, Hirose T, Muroi K, Suzuki T, Suzuki T, Hida E, Ishikawa T, Yamamura T, Ohno E, Nakamura M, Kawashima H, Miyahara R and Fujishiro M. A novel scoring system to predict therapeutic intervention for non-variceal upper gastrointestinal bleeding. Intern Emerg Med 2022; 17:423-430.
24. Cho SH, Lee YS, Kim YJ, Sohn CH, Ahn S, Seo DW, Kim WY, Lee JH, Lim KS. Outcomes and Role of Urgent Endoscopy in High-Risk Patients With Acute Nonvariceal Gastrointestinal Bleeding. Clin Gastroenterol Hepatol. 2018 Mar;16(3):370-377
25. Oguri N, Ikeya T, Kobayashi D, Yamamoto K, Yoshimoto T, Takasu A, Okamoto T, Shiratori Y, Okuyama S, Takagi K, Nakamura K, Fukuda K. Effectiveness of risk scoring systems in predicting endoscopic treatment in colonic diverticular bleeding. J Gastroenterol Hepatol. 2020 May;35(5):815-820.
26. Elsebaey MA, Tawfik MA, Ezzat S, Selim A, Elashry H, Abd-Elsalam S. Endoscopic injection sclerotherapy versus N-Butyl-2 Cyanoacrylate injection in the management of actively bleeding esophageal varices: a randomized controlled trial. BMC Gastroenterol. 2019 Feb 4;19(1):23.
27. Wuerth BA, Rockey DC. Changing Epidemiology of Upper Gastrointestinal Hemorrhage in the Last Decade: A Nationwide Analysis. Dig Dis Sci. 2018 May;63(5):1286-1293.
28. Klebl F, Bregenzer N, Schöfer L, et al. Risk factors for mortality in severe upper gastrointestinal bleeding. Int J Colorectal Dis 2005; 20:49-56. doi:10.1007/ s00384-004-0624-2 http://dx.doi. org/10.1007/s00384-004-0624-2 doi:10.1007/s00384-004-0642-0 http://dx.doi. org/10.1007/s00384-004-0642-0
29. Phang TS, Vornik V, Stubbs R. Risk assessment in upper gastrointestinal haemorrhage: implications for resource utilisation. NZ Med J 2000;113:331-333.
30. Clarke CS, Afifi AY. Impact of blood transfusion on outcome in patients admitted for gastrointestinal hemorrhage. Current Surg 2000; 57: 493–496. doi:10.1016/ S0149-7944(00)00311-1 http://dx.doi. org/10.1016/S0149-7944(00)00311-1
31. Aldemir M, Yılmaz G, Öztürk A, et al. Surgical treatment for upper gastrointestinal system bleeding. Journal of Contemporary Surgery 2002;16:72-77
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Ahmed Taymour Algahiny
Royal College of Surgeons Ireland - Bahrain
Ishan Antony
Lahey Hospital and Medical Center, Burlington, MA
Fareeha Akram
House Officer, Ayub Teaching Hospital, Abbottabad - Pakistan
Abdullah Ahmed Almesri
Royal College of Surgeons in Ireland
Iqra Zulfiqar
Demonstrator Pharmacology, Mohi-ud-din Islamic Medical College, Mirpur - AJK
Abdulhamid Diab
Royal College of Surgeons Ireland - Bahrain