Aetiology and other features of a cohort of adult Sri Lankans presenting with upper gastrointestinal bleeding (UGIB)

Abstract

OBJECTIVES: To ascertain major causes of UGIB and other related clinical features of adult Sri Lankan using open access endoscopy facilities. DESIGN AND SETTING: 1500 upper gastrointestinal endoscopies performed by Ward-06, Sri Jayewardenepura General Hospital, Kotte from 01/03/2002 to 01/03/2004 for whatever reason was retrospectively reviewed. Those who had endoscopy for UGIB were selected for the study, and their endoscopy findings and other clinical features analysed. RESULTS: There were 342 (24%) upper GI bleeders. The mean age of presentation was 55.5 years +/-14.4 SD. A high proportion was seen between 50-70 years of age. Sex distribution was, male:female = 229:114 (2:1). 45% have presented with haematemesis, 31% with malaena, and 24% with both. Endoscopy showed the presence of severe antral gastritis and duodenitis, oesophageal varices, oesaphagitis, erosive gastropathy, portal hypertensive gastropathy, pangastritis and peptic ulcer disease in 38%, 35%, 28%, 28%, 20%, 17% and 15% of the instances respectively. Hiatus herniae were seen in 43% although its role was unclear. Often combined pathologies were seen. Only 52% of the varices showed endoscopic evidence of bleeding. Excess alcohol consumption was seen in 36% while 5% were on NSAIDs. 5% had endoscopic negatives. CONCLUSIONS: UGIB is a major problem to the endoscopist, constituting about 25% of the work load, in this part of the continent. Although approximately 50% of the varices found had bled, portal hypertension related pathologies are a cause for concern. Alcohol was a contributory factor in 1/3 of the endoscoped population. Bleeding from PUD was not a dominant feature compared to the west.