| Background and Objective:Acute upper gastrointestinal hemorrhage is a common acute and severe disease in clinic practice. It is very necessary to investigate the etiological structure of this disease, which may provide evidence of evidence-based medicine for its clinical treatment and prognosis. This paper retrospectively summarized and analyzed the common causes of acute upper gastrointestinal hemorrhage and disease-related factors, and estimated the effect of Helicobacter Pylori(HP) infection and administration of non-steroidal anti-inflammatory drugs(NSAIDs) on upper gastrointestinal hemorrhage. For therapy, based on even administration of vasoactive and hemostatic drugs, we analyzed the clinical and prognostic advantage of applying proton pump inhibitor(PPI) combined with somatostatin in the treatment of upper gastrointestinal hemorrhage characterized by esophageal and gastric varices.Methods:In this paper, we consulted and collected 890 cases of acute upper gastrointestinal hemorrhage diagnosed in the Third People’s Hospital of Henan Province during January 2008 and December 2012, the disease causes of whom had been clearly identified by gastroscopy. We investigated the etiological structure of acute upper gastrointestinal hemorrhage by statistic analysis of the percentages of its different causes, and analyzed the regularity of acute upper gastrointestinal hemorrhage by statistic analysis of the percentages of multiple common types of digestive ulcer in total digestive ulcer cases. We analyzed the change regularity of upper gastrointestinal hemorrhage caused by common etiological factors of digestive ulcer, common etiological factors of acute gastric mucosal lesion hemorrhage and four common causes of upper gastrointestinal hemorrhage during this five years, and effectively investigated the relation of the four common causes of upper gastrointestinal hemorrhage with gender and age. We analyzed the influence of Helicobacter Pylori(HP) infection on upper gastrointestinal hemorrhage. We made a statistic analysis of the ratio of different disease causes of upper gastrointestinal hemorrhage after NSAIDs administration, and analyzed the influence degree of NSAIDs on upper gastrointestinal hemorrhage. Patients were subjected to two groups by different medications according to different therapeutic schemes and the basic even administration of vasoactive and hemostatic drugs. One group was PPI combined with somatostatin treatment group, and the other was simple PPI treatment group. After different treatment durations, we rated the Blatchford score of all the patients in two groups, and assessed the advantage of PPI combined with somatostatin in the treatment of upper gastrointestinal hemorrhage characterized by esophageal and gastric varice.Results:1. 890 cases of acute upper gastrointestinal hemorrhage had all been clearly diagnosed and identified by gastroscopy. The first cause was digestive ulcer(49.1%), the second cause was esophageal and gastric varices(20.9%), the third cause was acute gastric mucosal lesion(12.8%), and the last cause was gastric cancer(4.7%). Helicobacter Pylori(HP) infection was the main cause among the digestive ulcer patients.2. By longitudinal comparison, we discovered that the primary cause of upper gastrointestinal hemorrhage was digestive ulcer all along in the 5 years, however, the rate of this cause declined year by year from 43.1%(2008) to 38.7%(2012)(p<0.05). On the contrary, the rate of the second cause, esophageal and gastric varices, increased year by year from 22.6%(2008) to 30.6%(2012)(p<0.05). During the 5 years, the rates of acute gastric mucosal lesion and gastric cancer had no significant change. 3. The proportions of male and female patients who suffered acute upper gastrointestinal hemorrhage caused by the four common causes was 2.5:1. There were 222 female cases, in which 134 cases caused by digestive ulcer, 39 cases caused by esophageal and gastric varices, 49 cases caused by acute gastric mucosal lesion and 9 cases caused by gastric cancer. Meanwhile, there were 557 male cases, in which 303 cases caused by digestive ulcer, 147 cases caused by esophageal and gastric varices, 65 cases caused by acute gastric mucosal lesion and 33 cases caused by gastric cancer. By statistical analysis, we indicated that gender difference showed in causes of the gastric cancer and esophageal and gastric varices which more frequently occurred in male patients(p<0.05), and no difference showed in causes of acute gastric mucosal lesion and digestive ulcer(p>0.05). 4. For the four common causes, digestive ulcer frequently showed in 40~49 age group, esophageal and gastric varices frequently showed in 50~59 age group, acute gastric mucosal lesion frequently showed in 30~39 and 60~69 groups, and gastric cancer frequently showed in 60~69 group. 5. The most common cause of acute upper gastrointestinal hemorrhage induced by NISADs administration was acute gastric mucosal lesion(48.1%), and the second common cause was gastric ulcer(37.8%). 6. For therapy, based on even administration of vasoactive and hemostatic drugs, there was obvious advantage of applying PPI combined with somatostatin in comparison with simply applying PPI. Application of PPI combined with somatostatin can improve the Blatchford score of patients and increase the number of patients with Blatchford score 0, which achieved certain advantage.Conclusion:The analysis results of the 890 acute upper gastrointestinal hemorrhage cases diagnosed in the Third People’s Hospital of Henan Province in a 5 year duration showed that: 1) the primary cause of upper gastrointestinal hemorrhage was digestive ulcer all along in the 5 years, however, the rate of this cause declined year by year; the second cause was esophageal and gastric varices, and the rate of this cause increased year by year. 2) Upper gastrointestinal hemorrhage caused by esophageal and gastric varices and gastric cancer occurred more frequently in male patients than in female patients, while upper gastrointestinal hemorrhage caused by acute gastric mucosal lesion and digestive ulcer showed no difference in male and female groups. 3) Acute upper gastrointestinal hemorrhage induced by HP infection was mainly caused by digestive ulcer, while acute upper gastrointestinal hemorrhage induced by NSAIDs was mainly caused by gastric ulcer and acute gastric mucosal lesion. 4) The common causes were different in various age groups of acute upper gastrointestinal hemorrhage. Digestive ulcer frequently showed in young- and middle-age groups. Gastric cancer frequently showed in old-age group, and the proportion of gastric cancer had an increase tendency. 5) For therapy, based on even administration of vasoactive and hemostatic drugs, there was certain advantage of applying PPI combined with somatostatin in comparison with simply applying PPI, which could increase the ratio of patients with Blatchford score 0. |
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