UPPER GASTROINTESTINAL BLEEDING: ASSOCIATED RISK FACTORS AND OUTCOMES IN BRUNEI DARUSSALAM.
Sumitro KOSASIH, Adli METUSSIN, Anand JALIHAL, Maliakel John ALEXANDER, Aza Feroena JAMALUDDIN, Taufique AHMED, Dewi Norwani BASIR, Vui Heng CHONG.
Gastroenterology & Hepatology Unit, Department of Internal Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei Darussalam.
Background: Upper gastrointestinal bleeding (UGIB) is a common cause for hospitalizations and remains an important cause of morbidity and mortality. This study reports on our experience with UGIB in a tertiary center. Material and Methods: All patients with UGIB (hematemesis, coffee ground vomitus, melena, with significant drop of hemoglobin >2gm/dL or needing blood transfusion) admitted between July 2017 and November 2018 were included. Results: There were 151 patients (male 62.3%) with mean age 62.1 ± 15.2 years included in the study. Majority had comorbid conditions and one in five were using medications associated with UGIB. Over 88.1% required transfusions and 88.7% had early endoscopy (<24 hours) from time of admissions/referrals. Most common etiology was ulcers and 45% required endoscopic interventions. The median Rockall score was 4.6 ± 2.1. Rebleeding occurred in 9.9% and mortality in 20.9% (inpatient [12.6%] and post-discharge [7.3%]). Female patients had less H. pylori infection (p=0.001), but higher post-discharge mortality (p=0.030) and older group (>60 years) had lower H. pylori infection (p=0.002) and higher Rockall score (p=0.016). Higher Rockall score (>2) was associated with higher rates of rebleeding (p=0.027) and mortality (p=0.035). The Rockall score positively correlated with length of hospitalization. There was no correlation between treatment modality and rebleeding rate, and there was no correlation between time of endoscopy and treatment modality with morality. Conclusion: Among our patients with UGIB, rebleeding rate and mortality rates remains high. High post-discharge mortality rates are due to significant comorbid conditions. Higher Rockall score was associated with higher rates of rebleeding and mortality and correlated with length of hospitalization.
Keywords: Brunei Darussalam, Endoscopy, Gastrointestinal haemorrhage, Upper, Helicobacter pylori, Mortality.
Corresponding author: Sumitro KOSASIH, MMed, Gastroenterology & Hepatology Unit, Department of Internal Medicine, Raja Isteri Pengiran Saleha Hospital, Jalan Putera Al-Muhtadee Billah, Bandar Seri Begawan BA1712, Brunei Darussalam.
Brunei Int Med J.2022;18:20-28