General evaluation of patients who were admitted to internal medicine clinic with upper gastrointestinal bleeding diagnosis

Upper Gastrointestinal System Bleeding is defined as bleeding at any localization between proximal esophagus and Treitz ligament into the gastrointestinal lumen. Upper gastrointestinal bleeding is a common emergency which has high morbidity and mortality rates. Our study is conducted retrospectively on 143 patients aged 18 and over who were admitted to Erzincan Binali Yıldırım University Faculty Of Medicine Internal Diseases Clinic with the diagnosis of upper gastrointestinal bleeding between January 2015 and October 2020. In this study our aim was to obtain up-to-date data on demographic features, habits, complains at presentation, hemodinamic findings, comorbidities, drug use, laboratory tests, endoscopic findings, treatment of patients and to search for the factors that has an effect on patients's diagnosis. In this study, 43 (30.1%) of our participants were female and 100 (69.9%) of our participants were male and male/female ratio was 2.3. Patients's ages were varied between 19-99 and average age was 67.3±18.8. Average age for female population was 75.4±15.4, mean while average age for male population was 63.8±19.2. 41.3% of subjects was smoker, 2.8% of them was alcohol consumer and 4.9% of them was both smoker and alcohol consumer. The most common complaint on presentation was melena with 74.8%. We have found out that 75.5% of our patients were using a drug which could be a cause for upper gastrointestinal bleeding. Nonsteroid antiinflammatuary drugs and aspirin usage were higher compared to other drugs (eg. clopidogrel, low molecular weight heparin, warfarin, direct oral anticoagulants, corticosteroid). The 80.4% of patients had one or more comorbidity and the most common one was hypertension with 45.5 percentage. Endoscopy was performed on 88.1% of patients and the results showed that 23.8% of patients had gastric ulcer, 15.4% of patients had duodenal ulcer, 55.9% of them had pangastritis, 6.3% of them had v esophageal ulcer, 12.6% of them had esophagitis, 7% of them had esophageal varices, 11.2% of them had malign tumor, 5.6% of them had hiatal hernia, 2.1% of them had anastomosis ulcer and 2.1% of them had Mallory-Weiss Tear. %42.8 percent of the patients with peptic ulcer had Helicobacter pylori infection. 100% of our subjects have been treated with medical treatment while 19.6% of them have been treated with edoscopic treatment modalities. Average time of hospitalization for our patients was 5.9±3.6 days. Mortality rate for the patients in our study is calculated as 2.8%. As a result of our study, we concluded that upper GI bleeding is still an important life-threatening cause of morbidity and mortality and advanced age, smoking, drug use, comorbidities and existence of H.pylori are risk factors for upper GI bleeding. While following an upper GI bleeding patient, besides the scores that calculated via scoring systems that are being used as a predictor for rebleeding, mortality risk, decision on following the patient through out patient clinic or as a hospitalized patient and prognosis, the parameters that takes place on these scoring systems such as age, serum albümin level, serum urea and creatinine levels, CRP might be a significant prognostic factor when they are used alone. We determined that on upper GI bleeding patients, to make a risk assessment with scoring systems is beneficial for follow-up, treatment plan and prognosis and a wider use of scoring systems will decrease the morbidity and mortality of upper GI bleeding.