Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website https://jocmr.elmerjournals.com

Original Article

Volume 17, Number 1, January 2025, pages 22-34


Upper Gastrointestinal Bleeding: A Retrospective, Single-Center Experience on the Role of Endoscopy and Outcomes

Tables

↓  Table 1. Patients’ Sociodemographic Features and Clinical History
 
Sociodemographic features and clinical history N (%)
aMedian age was 54 (interquartile range: 38 - 68 years). N: number; NSAIDs: non-steroidal anti-inflammatory drugs; %: percentage; SBP: systolic blood pressure; SD: standard deviation; SSRI: selective serotonin reuptake inhibitor; UGIB: upper gastrointestinal bleeding.
Age, years (mean ± SD)a 53.9 ± 19.5
Gender
  Female 125 (25.9%)
  Male 358 (74.1%)
Clinical presentation
  Hematemesis 326 (67.5%)
  Melena 240 (49.7%)
  Hematochezia 21 (4.3%)
  Other 40 (8.3%)
Shock (SBP < 90 mm Hg)
  No 431 (89.2%)
  Yes 52 (10.8%)
History of previous UGIB
  No 286 (59.2%)
  Yes 197 (40.8%)
Coexisting medical condition
  Cancer 13 (2.7%)
  Chronic liver disease 283 (58.6%)
  Renal disease 39 (8.1%)
  Others 210 (43.5%)
Drug history
  Anti-platelets 14 (2.9%)
  Anticoagulation 24 (5.0%)
  Corticosteroids 20 (4.1%)
  NSAIDs 40 (8.3%)
  SSRI 5 (1.0%)
  Others 421 (87.2%)
The time interval between the bleeding episodes and endoscopy
  < 24 h 262 (54.2%)
  > 48 h 75 (15.5%)
  24 - 48 h 146 (30.2%)

 

↓  Table 2. Endoscopic Observations, Therapy, and Results of the Patients
 
Endoscopic findings, treatment, and outcome N (%)
APC: argon plasma coagulation; IV: intravenous; N: number; %: percentage; PPI: proton pump inhibitor.
Endoscopy finding
  Gastric ulcer 78 (16.1%)
  Duodenal ulcer 105 (21.7%)
  Esophageal varices 252 (52.2%)
  Gastric varices 41 (8.5%)
  Esophageal erosion 8 (1.7%)
  Mallory-Weiss syndrome 5 (1.0%)
  Angiodysplasia 2 (0.4%)
Endoscopic intervention
  Epinephrine injection + thermal treatment 24 (5.0%)
  Epinephrine injection + endoclips 178 (36.9%)
  Banding 232 (48.0%)
  Sclerotherapy 25 (5.2%)
  Glubran injection 36 (7.5%)
  APC 29 (6.0%)
Medical management
  IV fluid 7 (1.4%)
  IV fluid, octreotide 2 (0.4%)
  IV fluid, PPI 89 (18.4%)
  IV fluid, PPI, octreotide 137 (28.4%)
  Octreotide 1 (0.2%)
  PPI 104 (21.5%)
  PPI, octreotide 143 (29.6%)
Surgical management
  No 466 (96.5%)
  Yes 17 (3.5%)
Transfusion requirement
  > 2 units 68 (14.1%)
  0 unit 288 (59.6%)
  1 - 2 units 127 (26.3%)
Length of the hospital stay
  < 1 day 61 (12.6%)
  > 5 days 122 (25.3%)
  1 - 3 days 210 (43.5%)
  4 - 5 days 90 (18.6%)
Rebleeding within 72 h of hospitalization
  No 449 (93.0%)
  Yes 34 (7.0%)
Discharged disposition
  Died 29 (6.0%)
  Discharge/transfer to another facility 47 (9.7%)
  Discharged home 348 (72.0%)
  Others 59 (12.2%)

 

↓  Table 3. Association Between Sociodemographic Characteristics and Clinical History of Patients Discharged
 
Variable Discharged disposition, N (%) P-value
Died Discharge/transfer to another facility Discharged home Others
*Statistical significance. IQR: interquartile range; N: number; NSAIDs: non-steroidal anti-inflammatory drugs; %: percentage; SBP: systolic blood pressure; SSRI: selective serotonin reuptake inhibitor; UGIB: upper gastrointestinal bleeding.
Sociodemographic characteristics
  Age, median (IQR) 63 (57 - 76) 57 (36 - 67) 52 (38 - 67) 57 (37 - 76) 0.009*
  Gender
    Female 7 (5.6%) 11 (8.8%) 90 (72.0%) 17 (13.6%) 0.927
    Male 22 (6.1%) 36 (10.1%) 258 (72.1%) 42 (11.7%)
Clinical presentation
  Hematemesis 21 (6.4%) 34 (10.4%) 236 (72.4%) 35 (10.7%) 0.451
  Melena 24 (10.0%) 27 (11.3%) 164 (68.3%) 25 (10.4%) 0.001*
  Hematochezia 1 (4.8%) 1 (4.8%) 15 (71.4%) 4 (19.0%) 0.715
  Other 2 (5.0%) 3 (7.5%) 30 (75.0%) 5 (12.5%) 0.988
Shock (SBP < 90 mm Hg) 15 (28.8%) 3 (5.8%) 21 (40.4%) 13 (25.0%) < 0.001*
History of previous UGIB 20 (10.2%) 20 (10.2%) 126 (64.0%) 31 (15.7%) 0.001*
Coexisting medical condition
  Cancer 2 (15.4%) 1 (7.7%) 8 (61.5%) 2 (15.4%) 0.341
  Chronic liver disease 20 (7.1%) 27 (9.5%) 210 (74.2%) 26 (9.2%) 0.076
  Renal disease 11 (27.5%) 3 (7.5%) 23 (57.5%) 3 (7.5%) < 0.001*
  Others 11 (5.2%) 24 (11.4%) 144 (68.6%) 31 (14.8%) 0.255
Drug history
  Anti-platelets 1 (7.1%) 2 (14.3%) 9 (64.3%) 2 (14.3%) 0.729
  Anticoagulation 3 (12.5%) 0 (0.0%) 16 (66.7%) 5 (20.8%) 0.079
  Corticosteroids 8 (40.0%) 2 (10.0%) 10 (50.0%) 0 (0.0%) < 0.001*
  NSAIDs 3 (7.5%) 1 (2.5%) 29 (72.5%) 7 (17.5%) 0.265
  SSRI 0 (0.0%) 1 (20.0%) 3 (60.0%) 1 (20.0%) 0.511
  Others 24 (5.7%) 45 (10.7%) 305 (72.4%) 47 (11.2%) 0.071
The time interval between the bleeding episodes and endoscopy
    < 24 h 14 (5.3%) 21 (8.0%) 193 (73.7%) 34 (13.0%) 0.671
    > 48 h 4 (5.3%) 11 (14.7%) 52 (69.3%) 8 (10.7%)
    24 - 48 h 11 (7.5%) 15 (10.3%) 103 (70.5%) 17 (11.6%)

 

↓  Table 4. Association of Endoscopic Findings, Treatment, and Outcome of the Patients With Discharge Disposition
 
Discharged disposition, N (%) P-value
Died Discharge/transfer to other facility Discharged home Others
*Statistical significance. APC: argon plasma coagulation; IV: intravenous; N: number; %: percentage; PPI: proton pump inhibitor.
Endoscopy finding
  Gastric ulcer 4 (5.1%) 6 (7.7%) 49 (62.8%) 19 (24.4%) 0.010*
  Duodenal ulcer 8 (7.6%) 11 (10.5%) 72 (68.6%) 14 (13.3%) 0.796
  Esophageal varices 14 (5.6%) 25 (9.9%) 191 (75.8%) 22 (8.7%) 0.091
  Gastric varices 2 (4.9%) 6 (14.6%) 29 (70.7%) 4 (9.8%) 0.697
  Esophageal erosion 0 (0.0%) 2 (25.0%) 5 (62.5%) 1 (12.5%) 0.351
  Mallory-Weiss syndrome 1 (20.0%) 0 (0.0%) 4 (80.0%) 0 (0.0%) 0.421
  Angiodysplasia 1 (50.0%) 0 (0.0%) 0 (0.0%) 1 (50.0%) 0.054
Endoscopic intervention
  Epinephrine injection + thermal treatment 3 (12.5%) 1 (4.2%) 12 (50.0%) 8 (33.3%) 0.006*
  Epinephrine injection + enodclips 11 (6.2%) 21 (11.8%) 120 (67.4%) 26 (14.6%) 0.320
  Banding 15 (6.5%) 22 (9.5%) 178 (76.7%) 17 (7.3%) 0.016*
  Sclerotherapy
    Yes 0 (0.0%) 2 (8.0%) 18 (72.0%) 5 (20.0%) 0.465
    No 29 (6.3%) 45 (9.8%) 330 (72.1%) 54 (11.8%)
  Glubran injection 1 (2.8%) 3 (8.3%) 28 (77.8%) 4 (11.1%) 0.961
  APC 0 (0.0%) 2 (6.9%) 14 (48.3%) 13 (44.8%) < 0.001*
Medical management
  IV fluid 0 (0.0%) 1 (14.3%) 6 (85.7%) 0 (0.0%) 0.060
  IV fluid, octreotide 0 (0.0%) 0 (0.0%) 2 (100.0%) 0 (0.0%)
  IV fluid, PPI 6 (6.7%) 6 (6.7%) 55 (61.8%) 22 (24.7%)
  IV fluid, PPI, octreotide 5 (3.6%) 9 (6.6%) 112 (81.8%) 11 (8.0%)
  Octreotide 0 (0.0%) 0 (0.0%) 1 (100.0%) 0 (0.0%)
  PPI 6 (5.8%) 12 (11.5%) 74 (71.2%) 12 (11.5%)
  PPI, octreotide 12 (8.4%) 19 (13.3%) 98 (68.5%) 14 (9.8%)
Surgical management 0 (0.0%) 2 (11.8%) 10 (58.8%) 5 (29.4%) 0.128
Transfusion requirement
  > 2 units 24 (35.3%) 9 (13.2%) 31 (45.6%) 4 (5.9%) < 0.001*
  0 unit 4 (1.4%) 21 (7.3%) 230 (79.9%) 33 (11.5%)
  1 - 2 units 1 (0.8%) 17 (13.4%) 87 (68.5%) 22 (17.3%)
Length of the hospital stay
  < 1 day 0 (0.0%) 15 (24.6%) 45 (73.8%) 1 (1.6%) < 0.001*
  > 5 days 23 (18.9%) 13 (10.7%) 71 (58.2%) 15 (12.3%)
  1 - 3 days 3 (1.4%) 17 (8.1%) 168 (80.0%) 22 (10.5%)
  4 - 5 days 3 (3.3%) 2 (2.2%) 64 (71.1%) 21 (23.3%)
Rebleeding in 72 h of hospitalization 14 (41.2%) 1 (2.9%) 13 (38.2%) 6 (17.6%) < 0.001*

 

↓  Table 5. Association Between Sociodemographic Characteristics and Clinical History of Patients With Rebleeding
 
Rebleeding in 72 h of hospitalization, N (%) P value
Yes No
*Statistical significance. IQR: interquartile range; N: number; NSAIDs: non-steroidal anti-inflammatory drugs; %: percentage; SBP: systolic blood pressure; SSRI: selective serotonin reuptake inhibitor; UGIB: upper gastrointestinal bleeding.
Age, median (IQR) 58 (40 - 74) 54 (38 - 68) 0.234
Gender
  Female 9 (7.2%) 116 (92.8%) 0.935
  Male 25 (7.0%) 333 (93.0%)
Clinical presentation
  Hematemesis 26 (8.0%) 300 (92.0%) 0.246
  Melena 23 (9.6%) 217 (90.4%) 0.030*
  Hematochezia 1 (4.8%) 20 (95.2%) 1.000
  Other 3 (7.5%) 37 (92.5%) 0.754
  Shock (SBP < 90 mm Hg) 18 (34.6%) 34 (65.4%) < 0.001*
  History of previous UGIB 21 (10.7%) 176 (89.3%) 0.010*
Coexisting medical condition
  Chronic liver disease 19 (6.7%) 264 (93.3%) 0.739
  Renal disease 12 (30.8%) 27 (69.2%) < 0.001*
  Cancer 2 (15.4%) 11 (84.6%) 0.231
  Others 15 (7.1%) 195 (92.9%) 0.938
Drug history
  Anti-platelets 2 (14.3%) 12 (85.7%) 0.258
  Anticoagulation 7 (29.2%) 17 (70.8%) < 0.001*
  Corticosteroids 4 (20.0%) 16 (80.0%) 0.044*
  NSAIDs 3 (7.5%) 37 (92.5%) 0.754
  SSRI 0 (0.0%) 5 (100.0%) 1.000
  Others 27 (6.4%) 394 (93.6%) 0.180
Time interval between the bleeding episodes and endoscopy
  < 24 h 13 (5.0%) 249 (95.0%) 0.151
  > 48 h 7 (9.3%) 68 (90.7%)
  24 - 48 h 14 (9.6%) 132 (90.4%)

 

↓  Table 6. Association of Endoscopic Findings, Treatment, and Outcome of Patients With Rebleeding
 
Rebleeding in 72 h of hospitalization, N (%) P value
Yes No
*Statistical significance. APC: argon plasma coagulation; IV: intravenous; N: number; %: percentage; PPI: proton pump inhibitor.
Endoscopic findings
  Gastric ulcer 5 (6.4%) 73 (93.6%) 0.521
  Duodenal ulcer 12 (11.4%) 93 (88.6%) 0.047*
  Esophageal varices 13 (5.2%) 239 (94.8%) 0.092
  Gastric varices 3 (7.3%) 38 (92.7%) 1.000
  Esophageal erosion 2 (25.0%) 6 (75.0%) 0.103
  Mallory-Weiss syndrome 3 (60.0%) 2 (40.0%) 0.003*
  Angiodysplasia 1 (50.0%) 1 (50.0%) 0.136
Endoscopic intervention
  Epinephrine injection + thermal treatment 2 (8.3%) 22 (91.7%) 1.000
  Epinephrine injection + enodclips 19 (10.7%) 159 (89.3%) 0.017*
  Banding 13 (5.6%) 219 (94.4%) 0.236
  Sclerotherapy 0 (0.0%) 25 (100.0%) 0.178
  Glubran injection 1 (2.8%) 35 (97.2%) 0.355
  APC 2 (6.9%) 27 (93.1%) 1.000
Medical management
  IV fluid 1 (14.3%) 6 (85.7%) 0.438
  IV fluid, octreotide 0 (0.0%) 2 (100.0%)
  IV fluid, PPI 10 (11.2%) 79 (88.8%)
  IV fluid, PPI, octreotide 9 (6.6%) 128 (93.4%)
  Octreotide 0 (0.0%) 1 (100.0%)
  PPI 7 (6.7%) 97 (93.3%)
  PPI, octreotide 7 (4.9%) 136 (95.1%)
Surgical management 2 (11.8%) 15 (88.2%) 0.622
Transfusion requirement
  > 2 units 19 (27.9%) 49 (72.1%) < 0.001*
  0 unit 6 (2.1%) 282 (97.9%)
  1 - 2 units 9 (7.1%) 118 (92.9%)
Length of the hospital stay
  < 1 day 0 (0.0%) 61 (100.0%) < 0.001*
  > 5 days 23 (18.9%) 99 (81.1%)
  1 - 3 days 5 (2.4%) 205 (97.6%)
  4 - 5 days 6 (6.7%) 84 (93.3%)

 

↓  Table 7. OR for Development of Rebleed With Regard to Multiple Potential Risk Factors
 
Factors that may predispose for rebleeding within 72 h OR (95% confidence interval) P-value
*Statistical significance. aIncluding platelet inhibitors and anticoagulants. b< 24 h, 24 - 48 h and > 48 h. c0 units, 1 - 2 units and > 2 units. ASA: acetylsalicylic acid; NSAID: non-steroidal anti-inflammatory drug; OR: odds ratio; UGIB: upper gastrointestinal bleeding.
Age 0.988 (0.966 - 1.010) 0.293
Presentation with shock 6.638 (2.456 - 17.945) < 0.0001*
History of UGIB 1.502 (0.621 - 3.636) 0.367
Renal disease 4.155 (1.405 - 12.285) 0.010*
Liver disease 2.146 (0.493 - 9.341) 0.309
Cancer 1.722 (0.280 - 10.586) 0.558
Blood thinnersa 1.395 (0.454 - 4.287) 0.561
NSAID excluding ASA 1.080 (0.235 - 4.960) 0.921
Steroids 0.635 (0.145 - 2.793) 0.548
Time to endoscopyb 1.627 (0.945 - 2.800) 0.079
Esophageal varices 0.493 (0.041 - 5.966) 0.578
Gastric varices 0.603 (0.023 - 15.548) 0.760
Non-variceal gastroduodenal bleed 2.014 (0.246 - 16.463) 0.514
Non-variceal esophageal bleed 9.347 (0.663 - 131.769) 0.098
Transfusion requirementc 2.702 (1.470 - 4.967) 0.001*

 

↓  Table 8. OR for Mortality With Regard to Multiple Potential Risk Factors
 
Factors that may predispose for mortality OR (95% confidence interval) P-value
*Statistical significance. aIncluding platelet inhibitors and anticoagulants. b< 24 h, 24 - 48 h and > 48 h. c0 units, 1 - 2 units and > 2 units. ASA: acetylsalicylic acid; NSAID: non-steroidal anti-inflammatory drug; OR: odds ratio; UGIB: upper gastrointestinal bleeding.
Age 1.020 (0.991 - 1.051) 0.174
Presentation with shock 1.355 (0.384 - 4.780) 0.636
History of UGIB 2.245 (0.729 - 6.914) 0.159
Renal disease 3.460 (0.821 - 14.586) 0.091
Liver disease 5.060 (0.862 - 29.713) 0.073
Cancer 0.354 (0.023 - 5.415) 0.455
Blood thinnersa 0.219 (0.034 - 1.408) 0.110
NSAID excluding ASA 1.076 (0.196 - 5.905) 0.933
Steroids 7.099 (1.718 - 29.330) 0.007*
Time to endoscopyb 0.894 (0.451 - 1.770) 0.748
Esophageal varices 0.076 (0.006 - 1.004) 0.051
Gastric varices 0.061 (0.001 - 3.004) 0.160
Non-variceal gastroduodenal bleed 0.183 (0.019 - 1.749) 0.140
Non-variceal esophageal bleed 0.048 (0.001 - 2.148) 0.118
Transfusion requirementc 4.996 (2.165 - 11.528) < 0.0001*
Rebleeding 7.936 (2.100 - 29.995) 0.002*