The profile of patients with acute upper gastrointestinal tract bleeding as seen at Muhimbili National Hospital

Abstract

Background

The use of various endoscopic techniques has progressively reduced the role of surgery in

the emergent management of UGm, under certain circumstances the surgeon, however

still plays an important role in the management and in a specific group of patients. The

problem poses a greater challenge to the surgeons in developing countries, Tanzania

being among them, where endoscopy may not be widely available.

Objective

To study the profile of patients with acute upper gastrointestinal bleeding as seen at

Muhimbili National Hospital.

Results

A total of 77 patients were studied. Males were approximately five times more frequently

involved as compared to females. Upper gastrointestinal endoscopy was done in 67

patients. Oesophageal varices were the leading cause of acute upper gastrointestinal

bleeding (48.1%) followed by duodenal ulcer (22.I%). Varices had a peak at the age of

31 to 50 years. Duodenal ulcer was commonest in patients who were above 50 years of

age, A palpable spleen positively predicted varices as a source of bleeding in 91.9% of

patients, while impalpable spleen predicted a source of bleeding other than varices in

96.7% of patients. The association between splenomegaly and varices was statistically

significant (P value < 0.00l). The mean number of units of blood transfused in these

patients with acute upper gastrointestinal bleeding was 2.9 +/- 2.5. Patients with varices

needed more blood transfusion than other causes. Mean hospital stay was 12.9 +I- 12.2.

Hospital stay was prolonged in patients with varices. Overall mortality due to acute upper gastrointestinal bleeding was 15.6% Most deaths occurred in patients who had not

undergone upper GI Endoscopy due to haemodynamic instability.

Conclusion

In Tanzania, at ~, upper gastrointestinal bleeding was found to be five times more

common in males than females among patients admitted to hospital. Haematemesis

and/or melaena were the most common symptoms presenting in more than 90% of

patients. The majority of patients admitted with acute UGI bleeding had oesophageal

varices, most of whom were below 50 years. Splenomegaly is an important indicator for

varices. Patients with oesophageal varices had longer hospital stay and needed greater

number of units of blood transfusion.