Preferred Abstract (Original):
AIM: To determine the mortality and morbidity among patients
presented with acute NVUGIB, co-morbid illnesses, the intake of aspirin,
non-steroidal anti inflammatory drugs (NSAIDs), endoscopic therapy and
proton pump inhibitors (PPIs) on clinical outcomes. METHODS: A
prospective cohort study on all patients presented with acute NVUGIB to
Specialized Arab Hospital (SAH), Nablus-Palestine, during the period
April 2011-April 2013. The medical history for each patient was
collected, all patients were given esomperazole 80 mg IV push and then
8mg/hour IV pump. Timing of endoscopy with Forrest grading, hospital
course, and the 30 day mortality after being discharged from hospital,
all variables analyzed and Chi square test was used to test the
significance of relationships. A p value of < 0.05 was considered
statistically significant. RESULTS: Total number, 86 patients, with a
female to male ratio of 1:3, Patient's age: - 48/86(56%), 38/86(44%)
were above and below the age of 60, respectively. Melena was the most
common presentation, followed by hematemesis and general symptoms.
Smokers 32/86(40%). Co-morbid illnesses 55/86 (64%), most common
reported diseases were hypertension, diabetes, coronary artery diseases,
and CHF. Ingestion of Aspirin or non-steroidal anti-inflammatory drugs
(NSAID’s) was reported in (64/86)74% of patients. Upper endoscopy was
done after 24 hours of symptoms in 64/86 (74%). The most common
endoscopic diagnosis was peptic ulcer disease 64/86 (74%), Forrest grade
3 clean base ulcers 37/64 (57%), Forrest grade II black spot, adherent
clot or non bleeding visible vessel (NBVV) 17/64 (26%), and Forrest
grade I oozing or spurter10/64 (16%). Number of blood units given was
more in patients with active bleeders (Forrest I). High dose of IV
esomeprazol (80 mg then 8 mg/hour) was given, before endoscopic
intervention, in 38/86 (44%), 24/38 (65%) found to have Grade 3 (clean
base) ulcer. All of NVUGIB patients were subsequently given esomeprazol,
after endoscopy. Blood transfusion was needed in 65/86 (76%).
Re-bleeding events have occurred in 5/86 (6%). The overall mortality was
4/86 (4.6%) all have co-morbid illnesses. Endoscopic intervention
failed in 5/86 (5.8%) 4 referred for surgical intervention and one
referred to interventional radiologist. CONCLUSION: Peptic ulcer is the
most common cause of NVUGIB, bleeding is highly associated with Aspirin
and NSAID’s intake. High dose IV esomeprazol, (80 mg then 8 mg/hour),
before EGD decreases the proportion of patients with stigmata of recent
hemorrhage. The mortality and morbidity of NVUGIB in this study is
slightly lower than that found in most previous studies.