Paradigm shift in Etiology of Upper Gastrointestinal Bleed in Emergency Department

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Tarana Gupta
Sandeep Goyal


Upper gastrointestinal (UGI) bleed, Alcoholic liver disease, peptic ulcer disease


Background and Aims: Acute upper gastrointestinal (UGI) bleed is an emergency requiring immediate intervention. Recent data have shown peptic ulcer disease (PUD) to be commonest cause of UGI bleed. We aimed to evaluate all patients of UGI bleed reporting in emergency department. Methods: A cross-sectional, observational study from a tertiary care centre and evaluated all patients with UGI bleed presenting to outpatient and emergency department between December 2017 and December 2018 conducted. Results: 356 patients with UGI bleed were undertaken for diagnostic and therapeutic endoscopy. Variceal bleed was present in 231 (65%) [cirrhosis 217(61%) vs non-cirrhotic 14 (4%)], non-variceal 93 (26%) [cirrhosis 22(6%) vs non-cirrhotic 71(20%)] and no cause determined in 32 (9%). Among cirrhotic patients, alcoholic liver disease (n=172) was most common followed by cryptogenic (n=32), HCV (n=22) and HBV (n=7) and AIH (n=6) related cirrhosis. Among variceal non-cirrhotic causes, non-cirrhotic portal hypertension was present in 14 patients. In non-cirrhotic non-variceal group, causes of UGI bleed included esophagitis (n=26), erosive gastritis (n=9) and Mallory Weiss Tear (n=7) followed by PUD (n=23), carcinoma stomach (n=3), carcinoma esophagus (n=2) and duodenal polyp (n=1). Non-variceal cirrhotic patients had portal hypertensive gastropathy (n=8), PUD (n=5), duodenal erosions (n=1), esophagitis (n=7), antral varix (n=1). Interestingly, even in non-variceal group, alcohol was the underlying cause of UGI bleed in majority of patients with esophagitis and erosive gastritis. Conclusion: Alcohol was the commonest cause of UGI bleed in majority of cases with or without chronic liver disease followed by PUD in small number in emergency department.


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1. Longstreth GF. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: A population-based study. Am J Gastroenterol. 1995;90:206–10.
2. Silverstain FE, Gilbert DA, Tedesco FJ, Buenger NK, Persing J. The national ASGE survey on upper gastrointestinal bleeding. II Clinical prognostic factors. Gastrointestinal Endosc.1981;27:80–93.
3. Rathi P, Abraham P, Jakareddy R, Pai N. Spectrum of upper gastrointestinal bleeding in Western India. Indian J Gastroenterol. 2001;20(Suppl 2):A37.
4. Gajendra O, Ponsek T, Varghese J, Sadasivan S, Nair P, Narayanan VA. Single center study of upper GI endoscopic findings in patients with overt and occult upper GI bleed. Indian J Gastroenterol. 2009;28:A111.
5. Anand CS, Tandon BN, Nundy S. The causes, management and outcome of upper gastrointestinal haemorrhage in an Indian hospital. Br J Surg. 1983;70:209–11. bjs.1800700407
6. Krishnakumar R, Padmanabhan P, Premkumar, Selvi C, Ramkumar, Joe A. Upper GI bleed – A study of 408 cases. Indian J Gastroenterol. 2007;26(Suppl 2):A133.
7. Sharma V, Jeyaraman P, Rana SS, Gupta R, Malhotra S, Bhalla A, et al. Utility of clinical and complete Rockall score in Indian patients with upper gastrointestinal bleeding. Trop Gastroenterol. 2016;37:276–82.
8. Sarin SK, Kumar A, Chawla YK, Baijal SS, Dhiman RK, Jafri  W, et al. Noncirrhotic portal fibrosis/idiopathic portal hypertension: APASL recommendations for diagnosis and treatment. Hepatol Int. 2007;1(3):398–413. s12072-007-9010-9
9. Merican I, Guan R, Amarapuka D, Alexander MJ, Chutaputti A, Chien RN, et al. Chronic hepatitis B virus infection in Asian countries. J Gastroenterol Hepatol. 2000;15:1356– 61.
10. Liangpunsakul S, Haber P, McCaughan GW. Alcoholic liver disease in Asia, Europe, and North America. Gastroenterology. 2016;150:1786–97.
11. Singh SP, Panigrahi S, Mishra D, Khatua CR. Alcohol-associated liver disease, not hepatitis B, is the major cause of cirrhosis in Asia. J Hepatol. 2019;70:1031–2. http://dx.doi. org/10.1016/j.jhep.2019.01.003
12. Agrawal S, Duseja A, Gupta T, Dhiman RK, Chawla Y. Simple organ failure count versus CANONIC grading system for predicting mortality in acute-on-chronic liver failure. J Gastroenterol Hepatol. 2015;30:575–81. http://dx.doi. org/10.1111/jgh.12778
13. Dhiman RK, Agrawal S, Gupta T, Duseja A, Chawla Y. Chronic liver failure-sequential organ failure assessment is better than the Asia-Pacific Association for the Study of liver criteria for defining acute-on-chronic liver failure and predicting outcome. World J Gastroenterol. 2014;20:14934–41. http://dx.doi. org/10.3748/wjg.v20.i40.14934
14. Gupta T, Dhiman RK, Rathi S, Agrawal S, Duseja A, Taneja S, et al. Impact of hepatic and extrahepatic insults on the outcome of acute-on-chronic liver failure. J Clin Exp Hepatol. 2017;7:9– 15.
15. Wong RJ, Aguilar M, Cheung R, Perumpail RB, Harrison SA, Younossi ZM, et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148:547–55.
16. Bhattarai S, Dewan KR, Shrestha G, Patowary BS. Spectrum of upper gastrointestinal bleed in patients with cirrhosis of liver. JCMS Nepal. 2017;13:318–22. v13i3.17938
17. Romcea AA, Tant¸a?u M, Seicean A, Pascu O. The etiology of upper gastrointestinal bleeding in cirrhotic patients. Clujul Med. 2013;86:21–3.