Analysis Of Etiological And Related Factors Of Acute Upper Gastrointestinal Hemorrhage

Objective To retrospective analysis of the common etiological and related factors ofAUGIH, and to evaluate the influences of NSAIDs and other drugs on AUGIH and theclinical efficacy and prognosis of PPI or PPI combined with somatostatin on patients withnon-variceal bleeding, in order to provide clinical evidence based medicine to investigate theetiology and guide treatment of AUGIH.Methods Collected inpatients who coincided clinical diagnosis of AUGIH and etiologicaldiagnosis by endoscopy between January2002and December2011at the China-Japaneseunion Hospital of Jilin University. Statistic the percentage of different causes to investigatethe distribution of the causes of AUGIH, and analyze the variation on the common causes ofAUGIH in10years and their relationships with gender and age. Compare the features ofAUGIH which taking NSAIDs, warfarin and clopidogrel drugs to explore the impacts ofthese drugs on AUGIH. All the patients were divided into four groups according to theduration from incidence of AUGIH to underwent endoscopy, to analyze performance of thegastroscope under different times. According to the different treatment programs, classifiedthe patients who applicated PPI combined with somatostatin as PPI combined withsomatostatin treatment group, classified others not combined with somatostatin as alone PPItreatment group, compared the differences in post-Blatchford score of patients with differenttreatment in each group, analyze the influence of PPI or PPI combined with somatostatintreatment on Blatchford score of non-variceal bleeding.Results (1) A total of4109patients with diagnosis of AUGIH in10years, the mostcommon causes followed by peptic ulcer (48.4%), esophageal varices(24.3%), acute gastricmucosal lesion (9.9%) and gastric cancer (4.9%).(2) In the past10years, the proportion ofAUGIH which caused by peptic ulcer show a declining trend, gradually from63.9%in2002to37.9%in2011(P<0.05); and the proportion of esophageal varices bleeding show aincreasing trend year by year, gradually rose to28.4%in2011from16.1%in2002(P<0.05).(3) The ratio of male to female patients was2.6:1. There was a higher mean age of diseaseonset in male than in female(P<0.01), Esophageal varices and gastric cancer arepredominantly in male among the total (P<0.05).(4) AUGIH caused by peptic ulcer mostcommon in patients aged40to49; esophageal varices bleeding most common in50to59 years-old patients; acute gastric mucosal lesion show two incidence peaks in30to39years-old and60to69years-old; and gastric cancer seen in60to69-year-old patients.(5)The patients who taking NISADs or combines with warfarin, clopidogrel and other drugsboth most common in gastric ulcer, accounting for47.8%and29.8%(P<0.05); followed byacute gastric mucosal lesion, accounting for40.6%and14.9%respectively (P<0.05).(6)With the prolongation of PPI or PPI combined with somatostatin treatment of non-varicealbleeding, the proportion of patients with Blatchford score is0points showed a significantlyincreasing trend (P<0.05), And PPI combined with somatostatin treatment group was betterable to improve its Blatchford score than PPI treatment group (P<0.01).Conclusion The analysis about4109AUGIH cases in10years shown: the most commoncauses of AUGIH followed by peptic ulcer, esophageal varices, acute gastric mucosal lesionand gastric cancer. The proportion of AUGIH which caused by peptic ulcer show a decliningtrend, and the proportion of esophageal varices bleeding show a increasing trend year byyear. The ratio of male to female patients was2.6:1. There was a higher mean age of diseaseonset in male than in female, Esophageal varices and gastric cancer are predominantly inmale among the total, while no significant gender differences in peptic ulcer and acutegastric mucosal lesion. Different causes of AUGIH have different age distribution, caused bypeptic ulcer most common in patients aged40to49; esophageal varices bleeding mostcommon in50to59years-old patients; acute gastric mucosal lesion show two incidencepeaks in30to39years-old and60to69years-old; and gastric cancer seen in60to69-year-old patients. Taking NSAIDs alone or combination with warfarin, clopidogrel andother drugs-induced AUGIH mainly due to gastric ulcer and acute gastric mucosal lesion,especially more common with gastric ulcer. PPI combined with somatostatin treatment withnon-variceal bleeding compared to simple application of the PPI better able to improve itsBlatchford score, reducing the chance of treatment need endoscopy.