Pustaka Ilmiah Universitas Padjadjaran

Abstrak

Upper Gastrointestinal Bleeding in Hasan Sadikin General Hospital ; Analysis of 406 patients during periode 1996 – 1997

Background:Indonesia is a country with high prevalence of chronic liver diseases (CLD).It may have a specific picture in morbidity and mortality of Upper Gastrointestinal (UGI) bleeding.The aim of this study are to get clinical and endoscopic picture of patients who had history of haematemesis and or melena.

Material and Methods:Retrospective study was done to medical record of all patients admitted to Hasan Sadikin General Hospital Bandung Indonesia withUGI bleeding from January 1996 to December 1997.

Result and Discusion:Between January 1996 to December 1997,406 patients with history of hematemesis and or melena had performed endoscopic procedure,288 of them were male and 118 were female.Among 406 bleeding patients,51.7% was found CLD Male to female ratio were 3 in CLD and 2 in non CLD.Patients¡¦ age ranged from 14 to 84 years.The mean age was 55.75„b13.15 years.The number of patients whose age > 55 years was 61.2%.Total mortality was 17.2% ;68.6%of them were > 55 years, mortality rate was same in both sex. Mortality was25.2% in CLD and 8.7% in non CLD(p<0.001).Mortality was related with age, systolic blood pressure, Hb concentration and red colour in nasogastric tube on admission. Sources of bleeding were esophageal varices (EV) 29.2%, gastroduodenal erosions 24.1%,ulcers 17%, portal-hypertensive gastropathy 8.4%,malignacies 6.2%,gastric varices 4.9%,esophagitis 2.2%,others 1%,no bleeding lesion in UGI 3.4% and difficulty identifying the source of bleeding 3%.

Endoscopic hemostasis were performed in 74 patients with active bleeding(59 EV and 19 ulcers).Early hemostasis were achieved equally between sclerotheraphy and ligation(p>0.05).Rebleeding occurred in 10/70(14.9%)of patients .The causes of death in CLD were bleeding 35.8%,hepatic encephalopathy 35.8%. The causes of death in non CLD were pneumonia 41.2%,cardiovascular 36.3% and bleeding 17.6%.

Conclusion:UGI bleeding in male was 2.4 times more than in female. Mortality increased with age.Mortality in CLD was 3 fold greater than in non CLD. The major causes of bleeding were rupture of EV and erosions. The causes of death in CLD were bleeding and encephalopathy but in non CLD was not the actual bleeding.