UPPER GASTRO-INTESTINAL BLEEDING IN A TERTIARY CARE CENTER IN NORTH-EAST INDIA: A RETROSPECTIVE STUDY

1. Associate Professor, Dept. of Medicine, Jorhat Medical College. 2. Assistant Professor, Dept. of Medicine, Jorhat Medical College. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 07 April 2020 Final Accepted: 10 May 2020 Published: June 2020 Copy Right, IJAR, 2020,. All rights reserved.

The mean age of the patients were 46.92 years. The youngest was 13 years and oldest was 80 years. The presenting symptoms of patients were passage of tarry black stool or vomiting of blood or both. Immediately during admission patients were assessed for vital signs and immediate resuscitation was done with intravenous isotonic saline or synthetic colloid if they presented in shock. Blood transfusion was given if required.
After stabilisation all patients were subjected to upper gastro-intestinal endoscopy after their consent.The instrument used was Olympus CV 70. Biopsy material was taken in patients with peptic ulcer disease for rapid urease test to detect the presence of H.Pylori. Biopsy material was also taken for histopathological study if neoplastic conditions were suspected. The collected results and observation is given in the below section of the monograph.

Results And Observations:-
Out of 120 patients with UGIB maximum number of patients (29.16%) were in the age group of 41-50 years followed by 21.67% in the age group of 51-60 years.

Sex distribution
Male Female
In this study peptic ulcer was found to be highest (26) in the age group of 41-50years, gastro-esophageal varices were found highest between 41-50 years and gastro-esopheageal neoplasm between the age group of 50 to 70 years. The Rapid Urease test for helicobacter pylori infection was found positive in 56.92% of peptic ulcer disease. H pylori was found in 62.50% of duodenal ulcer and 48.00% of gastric ulcer patients. H pylori was found only in 17.67% of erosive mucosal disease patients. Amongst peptic ulcer & erosive mucosal disease alcohol ingestion was found to be the commonest associated risk factor (35%) followed by non steroidal anti inflammatory drug use (14.63%), smoking (13.82%) and steroid (3.25%). Erosive mucosal disease was commonest endoscopic finding in those taking non-steroidal anti-inflammatory drugs (77.78%) followed by gastric ulcer (16.66%) and duodenal ulcer (5.66%) Among those taking alcohol (42 patients) gastroesophageal varices was the commonest endoscopic finding (69.05%) followed by erosive mucosal disease (16.67%), peptic ulcer disease (9.52%) and Malory Weiss tear (4.76%).

Discussion:-
Upper gastro intestinal bleed is a common medical emergency with significant morbidity and mortality leading to high economic loss for the patient. This loss is even more if the hospital stays increases. In our study maximum (29.16%) patients were of age group 41-50years, followed by 21.67% in the age group of 51-60 years. Age of patients ranged from 13 to 80 years with a mean age of 46.92 years. In a study done in Nigeria age ranged from 14 -75 years with mean of 41. years. 13 A study done in Morocco in 2011 showed age of patients ranged from 12 -100 years of age with a mean of 49 years. 14 18 John Del valle (2008) in a compilation of data from three meta analysis reported the incidence of H.pylori infection in gastric ulcer as 30 to 70% and duodenal ulcer as 50-70%. The commonest associated risk factor was alcohol (35.82%) and steroids (3.25%) in patients with peptic ulcer disease and erosive gastroduodenal disease. Alcohol intake was found to be different in studies of different geographical areas ranging from 10% (A. Timraz, 2011) to 70% (Fiore et al, 2000). 14,22 It was found that the earlier UGI endoscopy was done the better and conclusive were the results.The UGI endoscopy of patients done within 24 hours of admission were generally informative. Interestingly patients showing normal study were done more than 48 hours later as these patients presented in shock and it took time to stabilise them.
It depends on many factors like geographic distribution, religion, custom etc. Alcohol intake was found to be high probably because of taking traditional homemade alcohol and its association with local customs.

Conclusion:-
In this retro-spective study we found that UGI endoscopy is the most effective means for finding the etiology of UGI bleed and also the definitive tool if any active intervention is needed at the bleeding site.The efficacy of UGI endoscopy was best if done within 48 hours of bleeding. Most patients of bleeding were due to peptic ulcer disease. The 2 nd most common cause was due to rapture of oesophageal varix as a complication of ch. liver disease.Interestingly chronic alcoholism (with more than 2 pegs/day) was a very common factor in the patients of peptic ulcer disease and chronic liver disease. If alcoholism was a contributing factor in these patients of peptic ulcer disease could not be made out from this study. For that further prospective studies would be needed with more amount of participants. Bibliography:-