DOI: http://dx.doi.org/10.18203/2349-3933.ijam20190114

Study of clinical and endoscopic profile of dyspepsia and upper gastrointestinal bleed

Akash Rajender, Priyanka Choudhary, Saumya Mathur, Rajat Bhargava, Shalini Upadhyay, Subhash Nepalia

Abstract


Background: Upper gastrointestinal bleed (UGIB) and dyspepsia are the commonest indications for an upper GI endoscopy (UGIE), which has the potential to provide both diagnostic and therapeutic intervention. Alarm symptoms in patients with dyspepsia need proper evaluation.

Methods: In an observational hospital-based study, 5117 patient undergoing upper GI endoscopy were evaluated at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India. Detailed clinical and endoscopic profile was evaluated for subjects with dyspepsia and UGIB. Statistical analysis was done using SPSS version 21.0.

Results: Dyspepsia (2887, 56.41%) followed by upper GI bleed (1124, 21.97%) were the most common indications for UGIE. In subjects presenting with UGIB, most patients had both hematemesis with Malena (48.04%), 48.93% were chronic alcoholics and nearly one fourth (26.96%) were on NSAIDS. Variceal bleeding (52.94%), followed by peptic ulcer bleed (13.43%) were the most common causes of bleed. In subjects undergoing UGIE for dyspepsia, 37.41% revealed no endoscopic lesion followed by gastro-duodenitis (25.01%). Peptic ulcer was cause of dyspepsia in 18.05% and was significantly more in those with alarm symptoms (<0.001). Alarm symptoms in dyspepsia has a significant high likelihood of finding a malignant lesion on endoscopic evaluation (p 0.013).

Conclusions: Variceal bleed is the most common cause of UGIB in the adult Indian population. In patients with dyspepsia, presence of alarm symptoms is significantly associated with organic lesion on endoscopy. Although the incidence of malignancy is low, endoscopy in more than 50years subjects presenting with dyspepsia may help in early diagnosis and reducing morbidity.

Keywords


Dyspepsia, Endoscopy, Hematemesis, Malena

Full Text:

PDF

References


Longstreth GF. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population--based study. Am J Gastroenterol. 1995;90(2).

Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38(3):316-21.

Colin-Jones DG. Practical guidelines for the management of dyspepsia. Lancet. 1990;336(8710):301-2.

Locke III GR. Nonulcer dyspepsia: what it is and what it is not. In: Mayo Clinic Proceedings. Elsevier: 1999; 74(10): 1011-1015.

Sarwar S, Dilshad A, Khan AA, Alam A, Butt AK, Tariq S, et al. Predictive value of rockall score for rebleeding and mortality in patients with variceal bleeding. JCPSP. 2007;17(5):253-6.

Singh SP, Panigrahi MK. Spectrum of upper gastrointestinal hemorrhage in coastal Odisha. Tropical Gastroenterol. 2013;34(1):14-7.

Anand CS, Tandon BN, Nundy S. The causes, management and outcome of upper gastrointestinal haemorrhage in an Indian hospital. Brit J Surg. 1983;70(4):209-11.

Rao TH, Pande GK, Sahni P, Nundy S. The management of upper gastrointestinal haemorrhage in a tropical country. Arch Emergency Med. 1991;8(3):169.

Hearnshaw SA, Logan RF, Lowe D, Travis SP, Murphy MF, Palmer KR. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut. 2011;60(10):1327-35.

Bhattarai J, Acharya P, Barun B, Pokharel S, Uprety N, Shrestha NK. Comparison of endoscopic findings in patients from different ethnic groups undergoing endoscopy for upper gastrointestinal bleed in eastern Nepal. Nepal Med Coll J. 2007;9(3):173-5.

Kashyap R, Mahajan S, Sharma B, Jaret P, Patial RK, Rana S, et al. A clinical profile of acute upper gastrointestinal bleeding at moderate altitude. J Indian Acad Clin Med. 2005;6(3):225.

Cotton PB, Rosenberg MT, Waldram RP, Axon AT. Early endoscopy of oesophagus, stomach, and duodenal bulb in patients with haematemesis and melaena. Brit Med J. 1973;2(5865):505-9.

Dewan KR, Patowary BS, Bhattarai S. A study of clinical and endoscopic profile of acute upper, gastrointestinal bleeding. Kathmandu Univ Med J. 2014;12(45):21-5.

Albeldawi M, Qadeer MA, Vargo JJ. Managing acute upper GI bleeding, preventing recurrences. Cleve Clin J Med. 2010;77(2):131-42.

Sumathi B, Navaneethan U, Jayanthi V. Appropriateness of indications for diagnostic upper gastrointestinal endoscopy in India. Singapore Med J. 2008;49(12):970-6.

Kumar S, Pandey HI, Verma A, Pratim P. Prospective analysis of 500 cases of upper GI endoscopy at Tata Main Hospital. IOSRJDMS. 2014;13(1):21-5.

Manes G, Balzano A, Marone P, Lioniello M, Mosca S. Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open‐access endoscopy system: a prospective observational study based on the Maastricht guidelines. Alimentary Pharmacol Therapeutics. 2002;16(1):105-10.

Gado A, Ebeid B, Abdelmohsen A, Axon A. Endoscopic evaluation of patients with dyspepsia in a secondary referral hospital in Egypt. Alexandria J Med. 2015;51(3):179-84.

Thomson AB, Barkun AN, Armstrong D, Chiba N, White RJ, Daniels S, et al. The prevalence of clinically significant endoscopic findings in primary care patients with un-investigated dyspepsia: the Canadian adult dyspepsia empiric treatment–prompt endoscopy (CADET–PE) study. Alimentary Pharmacol Therapeutics. 2003;17(12):1481-91.