One hundred and sixty nine cases of upper gastrointestinal bleeding admitted in National Medical Center from January 1975 to July 1977 were clinically reviewed.
The results were as follows.
1) The casuative diseases of upper gastrointestinal bleeding were in the order of peptic ulcer (40.3%), hemorrhagic gastritis(18.3%), esophageal varix rupture(11.8%), and stomach cancer (8.2%). The incidence of unknown origin was 17.8%.
2) The sex incidence of upper gastrointestinal bleeding showed male preponderance with a. ratio of 4.5 to 1 and peak incidence was in the 4th-6th decade.
3) Hematemesis only was noted in 35.5% and melena only in 28.4%, while hematemesis and melena were seen in 36.1%.
4) The incidence of associated diseases was 29.6% of total cases and 62% of them were in the peptic ulcer cases. Most common associated disease was gastritis.
5) 22.5% of patients had possible precipitating factors of upper gastrointestinal bleeding and alcohol was most common precipitating factor with its incidence of 13%.
6) 82% of patients were diagnosed within 7 days, while half of the total cases were diagnosed within 3 days.
7) The frequency of bleeding episode accounted for 75.2% at 1st bleeding, 18.9% at 2nd bleeding, 4.7% at 3rd bleeding and 1.2% at more than 3rd bleeding. The mortality rate of bleeding accounted , for 3.9% at 1st bleeding, 6.3% at 2nd bleeding, 25% at 3rd bleeding and 50% at more than 3rd bleeding.
8) Diagnostic accuracy of gastroscopy or stomach X-ray was compared. Diagnostic accuracy of each group with gastroscopy 96.7% in hemorrhagic gastritis, 91.7% in gastric ulcer and 92.9% in gastric cancer, where as all negative in hemorrhagic gastritis, 85.7% in gastric ulcer and 83.3% in gastric cancer with stomach X-ray.
9) Conservative treatment was done in 131 cases (77.5%) and surgical intervention was performed in 38 cases (22.5%). 84% of medically treated group were improved and mortality rate was 4.6%, whereas 86.8% of surgically treated group were improved & mortality rate was 10.5%. The overall mortality rate was 5.9%(10 cases) and the main causes of death were, cerebral thromboembolism, hepatic failure, acute renal shut down and shock.
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