| ObjectiveThis study is a retrospective analysis based on the clinical data of the upper gastrointestinal bleeding cases admitted to the department of gastroenterology and emergency department of our hospital from January 2018 to January 2020.By analysing the clinical data,comparing the upper gastrointestinal bleeding patients who was associated with nonsteroidal anti-inflammatory drugs(NSAIDs)and those did not take NSAIDs,we aimed to summarize the clinical characteristics and the incidence characteristics of the upper gastrointestinal bleeding in recent 2 years.Another significant objective is to explore the clinical characteristics of NSAIDs-related upper gastrointestinal bleeding.MethodsThere were 255 cases of clinical data that met the inclusion criteria.Their etiologies,inducements,clinical manifestations,endoscopy results,laboratory examinations,treatment and prognosis were retrospectively analyzed.According to whether or not NSAIDs had been taken in the 10 days before the onset of bleeding symptoms,the etiologies which were acute gastric mucosa and peptic ulcer were divided into NSAIDs group and non-NSAIDs group.We aimed to analyze the reasons,types,time of taking NSAIDs,the combined use of proton pump inhibitor(PPI),and aimed to compare clinical features,treatment,prognosis between the two groups.Results1.Retrospective analysis of 255 cases of upper gastrointestinal bleeding(1)Basic information: 187 were male and 68 were female,with a male to female ratio of 2.75:1.The age ranged from 22 to 97 years old,with a mean age of 59.36±15.27 years old.Most of them were in the 50～59 and60～69 age groups,accounting for 27.84% and 20.40% respectively.In the past medical history,hypertension(91 cases,35.69%)was the most common,followed by gastrointestinal diseases(66 cases,25.88%),coronary heart disease(50 cases,19.60%)and diabetes(46 cases,18.04%).The length of hospitalization was mainly less than 2 weeks,with an average length10.21±6.33 days.(2)Clinical features: Drug use was a significant factor,which accounted for a large proportion of inducements(103 cases,74.11%),among which NSAIDs were the most common(91 cases,88.35%).The second factor was diet(24 cases,17.27%).The most common starting symptom was melena(125 cases,49.02%).The accompanying symptoms were mainly hypovolemic(68 cases,60.18%).Most cases(183 cases,85.92%)were positive for Helicobacter Pylori(Hp).(3)Gastroscopy: The etiologies were acute erosive hemorrhagic gastritis(83 cases,32.55%),peptic ulcer(68 cases,26.67%),gastric cancer(53 cases,20.78%),esophageal and gastric variceal bleeding(23 cases,9.02%),Mallory-Weiss syndrome(14 cases,5.50%),Dieulafoy disease(10cases,3.91%)and other causes(4 cases,1.57%)in turns.Hemorrhage locations were distributed as follows: esophagus 22 cases(8.63%),stomach 197cases(77.25%),there were extensive gastric mucosa 76 cases(29.80%),gastric antrum 41 cases(16.07%),gastric body 33 cases(12.94%),cardia 21 cases(8.23%),fundus 20 cases(7.84%),gastric angel 18 cases(7.05%),pylorus 5 cases(1.96%),constant diameter artery 4 cases(1.57%),duodenum 51 cases(20.00%),there were duodenal bulb 48 cases(18.82%),descending part of the duodenum 6 cases(2.35%).38 cases had 2 or more hemorrhage locations of the whole cases.In addition to extensive gastric mucosa injury,there were relatively more hemorrhage locations in gastric antrum and duodenal bulb.(4)Treatment and prognosis: 208 cases(81.57%)received conventional medication treatment;47 cases(18.43%)received conventional medication combined with invasive hemostasis treatment.114 cases(44.70%)received blood transfusion treatment due to excessive blood loss;37 cases(32.46%)among them received 1～2u or more than 6u blood transfusion respectively,accounting for the majority.Most of the patients(240 cases,94.11%)recovered after active treatment and were discharged from hospital,however15 cases(5.89%)died in hospital due to multiple organ failure caused by hemorrhagic shock.2.Clinical features of NSAIDs-related upper gastrointestinal bleeding cases(1)The incidence trend of NSAIDS-related upper gastrointestinal bleeding: NSAIDS-related upper gastrointestinal bleeding showed an increasing trend in the recent two years(composition ratio: 15.97% vs33.82%).(2)Explanations,types,time and the combined use of PPI in NSAIDs group: Coronary heart disease was the most common reason for drug use(39cases,60.00%).Aspirin enteric-coated tablet was the most widely used type among the medicine(47 cases,72.31%).The duration of medication was more than half a year(35 cases,53.85%).73.85% of patients taking NSAIDs did not use PPI proactively.(3)Comparison of general conditions between the NSAIDs group and the non-NSAIDs group: There were no statistically significant differences in the sex ratio and the length of hospital stay between the two groups(P>0.05).The mean age and age of onset above 60 years old in NSAIDs group were higher than those in the non-NSAIDs group(P<0.05).The prevalence of coronary heart disease,hypertension and cerebral infarction were higher than those in the non-NSAIDs group(P<0.05).(4)Comparison of clinical features between NSAIDs group and non-NSAIDs group: There were no statistically significant differences in the starting symptoms and etiology between the two groups(P>0.05).The performance of hypovolemia,the positive rate of Hp and the proportion of hemoglobin levels below 80g/L in NSAIDs group were higher than those of non-NSAIDs group,while the abdominal pain and the average hemoglobin level were lower than those of non-NSAIDs group(P < 0.05).(5)Comparison of treatment and prognosis between the NSAIDs group and the non-NSAIDs group: There were no statistically significant differences in treatment and outcomes between the two groups(P>0.05).The proportion of patients receiving nosocomial blood transfusion treatment in NSAIDs group was higher than that in the non-NSAIDs group(P<0.05).Conclusion1.Upper gastrointestinal bleeding is the most common in the 50～69years old group,often associated with basic diseases such as hypertension,coronary heart disease,diabetes and other basic diseases.Most of the cases are induced by drug uses or dietary habits,and the etiologies are mainly acute erosive hemorrhagic gastritis and peptic ulcer.Conventional medication treatment is effective for most patients.2.NSAIDs is an important cause of upper gastrointestinal bleeding.NSAIDs-related upper gastrointestinal bleeding has a higher incidence rate,which is increasing year by year.Previous history of hypertension,coronary heart disease,cerebral infarction,and advanced age,Hp infection are more likely to cause upper gastrointestinal bleeding.3.NSAIDs-related upper gastrointestinal bleeding is insidious onset,with more blood loss,more obvious hemoglobin decrease.It is more prone to hypovolemic performance,therefore requires more blood transfusion.The prognosis is better after active drug treatment.4.NSAIDs and Hp infection may be two independent risk factors for upper gastrointestinal bleeding. |
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