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Abstract. Emergency upper gastrointestinal bleeding is a major cause of morbidity and mortality. Internationally, the three most common causes are peptic ulcer disease, erosive gastritis and esophageal varies. This is a seven-year retrospective analysis of the presentations and endoscopic diagnoses of patients admitted to King Abdulaziz University Hospital with emergency upper gastrointestinal bleeding. A total of 1149 patients were included, the majority were males (76.5%). Most patients (82.6%) had hematemesis, while 14.5% had melena; the remaining had both. Bleeding esophageal varies was the most common cause (37.6%), followed by peptic ulcer disease (23.7%) and gastritis (11.3%). Portal hypertension was found to be a major risk factor as Saudi Arabia is endemic for chronic Hepatitis B and C, with a high prevalence of intestinal schistosomiasis. Emergency upper gastrointestinal endoscopy is effective for diagnostic and therapeutic purposes. Those findings were compatible with the results published by other local authors, although 61.4% of our patients were non-Saudis.
Keywords: Emergency upper gastrointestinal bleeding, Peptic ulcer, Esophageal varices, Hematemesis, Melena.
Introduction
Upper gastrointestinal bleeding (UGIB) is a major cause of mortality and morbidity. Despite all major recent advances in therapeutic endoscopy, it is still a cause of high morbidity with an overall mortality approaching 10%[1]. Its incidence is approximately 100 cases per 100,000 population per year[1,2]. It is more frequently reported in males than females[2]. The presence of co-morbid diseases increases mortality up to 73-76%[3-5]. Large-volume hospitals have a higher rate of admission of patients with UGIB. The most common causes of UGIB are peptic ulcer disease, gastritis, and variceal bleeding[1,5,6]. The causes of UGIB are variable among different geographical locations[5,6]. Saudi Arabia is an endemic area for chronic hepatitis B, chronic hepatitis C and bilharzial liver disease, which leads to portal hypertension resulting in high rates of variceal bleeding[6-8]. Severe co-morbid chronic illnesses in the aging population and the use of non-steroidal anti-inflammatory medications are important risk factors for peptic ulcer-related UGIB[3-5,9]. Other less-common causes include gastric or esophageal cancers, benign tumors, gastroesophageal reflux disease, angiodysplasia and post-endoscopic or post-operative complications[1,5-8]. The presenting symptoms include either hematemesis, melena or both[5,6,8,10,11] , but in some patients with severe UGIB, hematochezia might be the presenting symptom[11]. Emergency endoscopy is essential for patients with UGIB for both diagnostic and therapeutic...