The retrospective research of the efficacy of GGK, PT-APTT in patients with gastrointestinal bleeding who resorted to the emergency room

Upper GI bleedings arise from the proximal of the Treitz ligament and are usually due to gastric and duodenal ulcers. Upper GI bleeding is an important cause of mortality and morbidity in patients who present with complaints of hemoptysis, occult blood in the stool or blackening of the stool. Lower GI bleedings arise from the distal of the Treitz ligament. Lower GI bleedings are a frequent problem just as upper GI bleedings in emergency medicine and a life threatining situation unless proven otherwise. In this thesis, we tried to determine the efficiency of the values of FOB and PT, aPTT, INR retrospectively in patients that presented to the emergency room with GI bleeding symptoms who were also endoscopically examined. 274 patients (105 female, 169 male) who are 18 years old and above that presented to the Emergency Deparment of Adnan Menderes University Faculty of Medicine with complaints of GI bleeding between 1 August 2012-1 August 2013 were included in the study. 22 of the patients were GI bleeding melena +, 19 of them were upper GI bleeding endoscopy + melena -, 81 of them were upper GI bleeding endoscopy + melena +, 11 of them had clinical diagnosis of upper GI bleeding, whereas 23 of them of lower GI bleeding, 13 of them had Crohn – Ulcerative Colitis and 105 of them were the other group of patients who did not have GI bleeding. In the patients who were included in the study, in the group that GI bleeding was determined male gender was dominant whereas there was no gender differences in the other group that had no GI bleeding. When the relationship between the age groups and GI bleeding was analyzed, more patients were between 70-79 age group. The sensitivity of the FOB test was calculated as 83.91%, the specificity was 78.26%, PPV was 92.30%, NPV was 61.10%. When statistically analyzed, there was a significant relationship between FOB and GI bleeding (p:<0.05). The sensitivity of the PT test was calculated as 19.37%, specificity 84.14%, PPV 70.45% and NPV was 34.84%. There was no statistically significant relationship between PT and GI bleeding (p=0.97). The sensitivity of the aPTT in detecting the GI bleedings was 14.19%, specificity 89.02%, PPV 71.87% and NPV was 34.43%. There was no statistically significant relationship between aPTT and GI bleeding (p=0.30). The sensitivity of the INR test was 26.25% and NPV was 32.95%. There was no statistically significant relationship between INR and GI bleeding (p=0.83). The sensitivity of the RT value was 79.61%, specificity 92.30%, PPV 96.89% and NPV was 60%. When statistically analyzed, there was a significant relationship between the RT exam and GI bleeding (p<0.05). The relationship was not statistically significant when the hemoglobin values were analyzed (p=0.13). The relationship was not statistically significant when the platelet values were analyzed (p=0.71). In conclusion, in the patients who present to the Emergency rooms with GI bleeding, the FOB test supports the diagnosis of the GI bleeding but it does not seem suitable for use with the aim of exclusion. In the patients who are thought to have GI bleeding in emergency rooms, the routine tests of PT, APTT, INR are not considered to have contribution in the patient management. It seems more suitable to study these in patients with factors that will increase the values of these tests. The results of the RT examination support the endoscopy results. Practicing the RT examination in all patients that have a suspected GI bleeding is an accurate approach that may lead the emergency physician to the diagnosis. Key words: GI bleeding, emergency room, PT, APTT, INR, FOB, RT, Endoscopy