Causes, Management and Short Term Outcomes of Upper Gastrointestinal Bleeding at Kenyatta National Hospital

Abstract

BACKGROUND Upper gastrointestinal bleeding is considered as the most common gastroenterological emergency and is a significant cause of morbidity and mortality worldwide. This study aimed at evaluating the causes, management and short-term outcomes of UGIB at Kenyatta National Hospital as these had not been evaluated in the past two decades OBJECTIVE To document the causes at endoscopy, management and determine short term outcomes of patients with upper gastrointestinal bleeding at Kenyatta National Hospital. METHODOLOGY This was a prospective cohort study carried out at in patient medical wards and endoscopy unit of the Kenyatta National Hospital. 150 adult patients who presented with upper gastrointestinal bleeding at the Kenyatta National Hospital were consecutively recruited. Demographic information and clinical history was obtained from subjects. Subjects were also examined and their physical examination findings, laboratory and endoscopy results were recorded. Data was extracted from patient files. The study population was described using demographic and clinical characteristics. RESULTS The male to female ratio was 2.8:1. The mean age was 45.07 ± 16.57 years. 20 patients did not have endoscopy done. Time to endoscopy ranged from 1 to 29 days with a median time of 5 days. The source of bleeding was identified in 80.8% of patients. Varices were the most common cause (39.2%) followed by peptic ulcer disease ( 25.3%) and erosive mucosal diseases. Forty-eight patients had therapy at endoscopy, the most common method used was band ligation. Sixty five (43.3 %) patients had blood transfusion during their hospital stay. The mean blood transfused was 1.98 ± 0.94 unit. Following transfusion, 81.6 % of those transfused had check Hb and the mean post transfusion Hb level was 7.59 ± 2.06. The most common pharmacological treatment was PPI administered to 76.3% of all patients. The length of hospital stay ranged from 1 to 35 days with a median length of hospital stay of 9 days. Patients were followed up to 14 days following discharge. There was control of bleeding in 145,(96.7 %) of patients, Re-bleeding occurred in 14 (9.3%) of patients and 11 (7.3%) patients died within the two week follow up. CONCLUSION Gastro-esophageal varices were found to be the most common cause of UGIB following endoscopy. It is likely that there were challenges in access to endoscopy and in xiii obtaining blood products and this was reflected in long duration of hospital stay and time to endoscopy. In comparison to other regions in SSA there was a lower re-bleeding and mortality rate. This could have been due to a smaller sample size and shorter duration of follow up.