International Journal of Research in Pharmacology and Pharmacotherapeutics

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1 44 Available Online at: Print ISSN : Online ISSN: (Research article) Find out the prevalance of various non-variceal diseases producing upper GI bleeding * 1 N.Junior Sundresh, 2 S.Narendran, 3 M.Ramanathan 1 Associate Professor of Surgery, Raja Muthiah Medical College & Hospital, Annamalai University, Chidambaram. 2 Emeritus Professor of Surgery, Raja Muthiah Medical College & Hospital, Annamalai University, Chidambaram. 3 Professor of Surgery Raja Muthiah Medical College & Hospital, Annamalai University, Chidambaram. ABSTRACT International Journal of Research in Pharmacology and Pharmacotherapeutics Non variceal upper G.I bleeding is the bleeding from a source proximal to the ligament of teres. Advances in medical technology particulars the increased availability and application or diagnostic and the operatic endoscopy have been instrumented in evaluated and successful treatment of patients with major bleeding. This study aims to find out various non-variceal diseases producing upper G.I. bleeds and the various modalities of treatment. Keywords: Non variceal upper G.I bleeding, hematemesis, Melena INTRODUCTION Upper GI bleeding is defined as bleeding from a source proximal to the ligament of teres. It is common and potentially deadly condition accounting for approximately 85% of hospital admissions for G.I. bleeding upper GI bleeding presents as hematemesis and it melena. Numerous advances in medical technology, particularly the improved availability and applications of diagnostic and therapeutic endoscopy have been instrumental in the evaluation and successful treatment of patients with major bleeding. The main aim of the study is, To find out the prevalence of various nonvariceal diseases producing upper GI bleed. To study the various modalities of treatment and also to study those cases which will require emergency surgery with special attention to endoscopy. To plan the mode of management with respect to non-variceal upper GI bleeding in the future. * Corresponding author: N.Junior Sundresh, Associate Professor of Surgery, Raja Muthiah Medical College & Hospital, Chidambaram. - Tamilnadu. E.Mail: juniorsundresh@yahoo.com

2 45.Materials and Methods Forty seven cases of upper bleeding were admitted during the period of 3 years of study in RMMCH, Chidambaram. As soon as the patient is admitted a detailed history is taken from the close relatives of the patient to understand the nature and amount of blood loss during the history taking itself. All relevant investigations were done. Results Out of the 47 patients, majority of cases (around 16) were from the age group years. Minimum age incidence was found in the age group years out of the 47 patients 36 were male and 11 were female, the male: female ratio being 3:1 the most common mode of presentation was haematemesis, and least was melena. Erosive gastritis was the most common etiological factor. Most of the cases were managed conservatively. Discussion The total of 47 patients studied, majority was in the age group of years with male prominence. Haematemesis is the predominant presenting symptom with the introduction of upper GI endoscopy. Source of bleeding can be detected in more than 90% of cases. The introduction of proton pump inhibitors and availability of easily endoscopic management has brought down the complication and need for survey in peptic ulcer disease. Through the necessity of emergency surgery has considerably reduced it is still preferred to be the important lifesaving produce for those patients who do not respond to conjunctive line of management. Table: 1 Age Incidence Age in Years No. of cases Percentage % % % % % % %

3 46 Table: 2 Sex Incidence Sex No. of cases Percentage Male % Female % Table: 3 Presenting Symptom Symptom No. of Cases Percentage Haematemesis % Melena % Haematemesis and melena % Table: 4 Presenting Symptom Lesions Identified No. of Cases Percentage Erosive gastritis % Duodenal ulcer % Gastric ulcer % Mallory Weiss tear % Carcinoma stomach % Dieulafoy s lesion % Necrotizing pancreatitis %

4 47 Table: 5 Diagnosis and Outcome Diagnosis No. of Cases Conservative Surgery Mortality Erosive gastritis % - - Duodenal ulcer % 20 % 10 % Gastric ulcer % - - CA stomach % - - Mallory Weiss tear % - - Dieulafoy s lesion % - - Necrotising Pancreatitis % - - REFERENCE 1. Gilbert, D.A. et al. "The National ASGE survey on upper Gl bleeding. III. Endoscopy in upper grastrointestinal bleeding" Gastrointest. Endosc. 27: Silverstein, F.G. et al. "The National ASGE Survey on UGI bleeding. I. Study design and baseline data". Gastrointest. Endosc : Eastwood, G.I. "Does the patient with upper GI bleeding benefit from endoscopy?" Dig. Dis. Sic : Savary, P.J., Miller et a. "Hand book and Atlas of Endoscopy" Atkinson, ML, Bottrill, M.B. and Edwards A.T., "Mucosal tears at the esophagus gastric junction: Gut 1961; 2: Jordan, S.M and Kiefer E.D. "Complications of peptic ulcer; their prognostic significance." JAMA 1934; 103: Mathewson K., Pugh, S., Northfield T.C. "Which peptic ulcer patients bleed?" Gut 1988; 29: Swain Paul, C. "Pathophysiology of bleeding lesions" Gastroinest. Endosc. 1990; 36: Hunt, P.S., Hansky, J., Korman, MG. "Mortality in patients with haematemesis and melena; a prospective study" Br. Med. J. 1979; 1: Karvoner, Al et al. "Gastric mucosal erosions: AN endoscopic, histological and functional study". Scand. J. Gastroenterol, 1983; 18: Somerville K et al. "Non-steroidal antiinflammtory drugs and bleeding peptic ulcer" Lancet 1986 ; 1: Lud et al. "Gastric aspiration in localization of gastrointestinal haemorhage" JAMA 1979; 241: Cottonm P.B. et a; "early endoscopy of oesophagus, stomach and duodenum in patients with haematemesis ad melaena." Arch. Surg. 1973; 197: Thomas G.E. et al. "Survey of management of acute upper GI haemorrhage." J.R. Soc. Med. 1978; 73: Foster et al. "Stigmata of recent haemorrhage in diagnosis and prognosis of upper GI he Br. Med. J. 1978, 1: Laurence, BH et al "Endoscopic laser photocoagulation for bleeding peptic ulcers". Lancet 1980; 1: Alam, P. et al "Randomised study of massive bleeding from peptic ulceration". Ann. Surg 1965; 162:

5 Swain, CP, Salmon, PR "Gastrointestinal bleeding upper GI tract". Scand. J. Gastoenterol 1984; 19 (Suppl 102): Johnston, J.H. et al. "A comparison of bipolar electrocoagulation and argon laser photocoagulation with coaxial co2 in the treatment of bleeding ulcers". Gastrointest. Endosc. 1978; 28: Goodale, RL et al. "Rapid endoscopic control of bleeding gastric* erosions by laser radiation". Arch. Surg 1970; 101: Swain, CP. et al. "Cyanoacrylate glue fails to stop bleeding from experimental gastric ulcers". Gastroenterology 1977 ; 22: A very- Jones F. Haematemesis and melaena. Br Mod J 1947; 2: Hoerr SO, Dunphy JE, Gray S. Place of surgery in emergency treatment of upper gastrointestinal haemorrhage. Surg Gynecol Obstet 1948 ; 87: Thorne FL, Nyhus LM. Treatment of massive upper gastrointestinal haemorrhage. Am J Surg 1965 ; 31: Gordon-Taylor G. The problem of bleeding peptic ulcer. Br J Surg 1937; 25: Tanner NC, Desmond AM. The surgical treatment of haematemesis and meaena. Postgrad Med J 1950; 26: Tanner NC. The diagnosis and management of massive haematemesis. Br J Surg 1964 ; 51: Hoerr SO. Massive bleeding from peptic uieeration - discussion. Ann Surg 1965; 162: Macleod IA, Mills PR. Factors identifying the probability of further haemorrhage after acute upper gastrointestinal haemorrhage. Br J Surg 1982; 69: Northfield TC. Factors predisposing to recurrent haemorrhage after acute gastrointestinal bleeding. Br Med j 1971; 1: Hunt PD, Hansky J, Korman MG, et al. Bleeding duodenal ulcer: reduction in mortality with a planned approach. Br J Surg 1979; 66: Read RC, Huebl HC, Thai AP. Randomized study of massive bleeding from peptic uieeration. Ann Surg 1966 ; 162: A very-jones G, Hummer JWP. Acute haematemesis and melaena from peptic ulcertation. In Maingot R, ed. Vol 1, 6"' ed. Abdominal operations, Appleton-Century- Crofts, 1980; Himal HS, Perrauly C. Mzabi R. Upper gastrointestinal haemorrhage: aggressive management decreases mortality. Surgery 1978; 84: Foster DN, Miloszewski KJA, Losowsky MS. Stigmata of recent haemorrhage in diagnosis and prognosis of upper gastrointestinal bleeding. Br Med J 1978; 1: Griffiths WJ, Neumann DA, Welsh JD. The visible vessel as an indicator of uncontrolled or recurrent gastrointestinal haemorrhage. NEngl JMed 1979; 300: Eastwood GL. Does early endoscopy benefit the patient with upper gastrointestinal bleeding, Gastroenterology 1977; 72: Cotton PB, Russell RC. Disease of the alimentary system haematermesis and melaena. Br Med J 1977; 1: Venebles CW. Gastroduodenal surgery, In Dykes PW, Keighley MRB, eds. Gastrointestional Haemorrhage, Brisfol: Wright PSg, 1981; Surgery. Jn H Dudley, ed. The abdomen. Butterworths Lond, 1982; in press. 41. Hunt PS, Hansku J, Korman MG. Bleeding carcinomatous ulcer of the stomach. Med J Aus 1982; 1: Rockall TA et al. (1996) Risk assessment after upper gastrointestinal haemorrhage. Gut 38: Vreeburg EM et al. (1999) Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut 44: Barkum A et al ) Consensus recommendations for managing patients with nonvaricela upper gastrointestional bleeding. Ann Intern Med 139: Levine JE et al. (2002) Meta-analysis: the efficacy of intravenous H 2 -receptor antagonists in bleeding peptic ulcer. Aliment Pharmacol Ther 16(6): Collins R and Langman M (1985) Treatment with histamine H 2 antognists in acute upper gastrointestinal hemorrhage N Engl J Med 131: Daneshmend TK et al. (1992) Omeprazole versus placebo for acute upper gastrointestinal bleeding: randomized double-blind controller trial. Br Med J 304: Lau JY et al. (2000) Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. NEnglJ Med 343: Leontiaids GI et ai. (2004) Proton pump inhibitor treatment for acute peptic ulcer bleeding. The Cochrane Database of Systematic Reviews, Issue 3, Art. No. CD Barkun A et al. (2004) Prevention of peptic ulcer rebleeding using continuous infusion of pantoprazole vs ranitidine: a mulcicenter, multinational, randomized, double-blind, parallel group comparison [abstract]. Gastroenterol 126 (Suppl 4): A Sacks HS et al. (1990) Endoscopic hemostasis: an effective therapy for bleeding peptic ulcers. JAMA 264: Cook DJ et al. (1992) Endoscopic therapy for acute non-variceal upper gastrointestinal hemorrhage - a meta-analysis. Gastrointest Endosc 60:

6 Park CH et al. (2004) Optimal injection volume of epinephrine for endoscopic prevention of recurrent peptic ulcer bleeding. Gastrointest Endosc 60: Gevers AM et al. (2002) A randomized trial comparing injection therapy with hemoclip and with injection combined with hemoclip for bleeding ulcers. Gastrointest Endosc 55: Lau JYW et al. (1999) Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. N Engl J Med 340: Graham FY et al ) Treatment of Helicobacter pylori reduces the rate of rebleeding in peptic ulcer disease. Scan J Gastroenterol 28: Green FW Jr, Kaplan MM, Curtis LE, Levine PH. Effect of acid and pepsin on blood coagulation and platelet aggregation: a possible contributor prolonged gastroduodenal mucosal hemorrhage. Gastroenterology 1978; 74: Labenz J, Peitz U, Leusing C, Tillenbrug B, Blum AL, Borsch G. Efficacy of primed infusions with high dose ranitidine and omeprazole to maintain higher intragastric ph in patients with pepetic ulcer bleeding: a prospective randomized controlled study. Gut 1997; 40: Villanueva, C, Balanzo J, Torras X, et al. Omeprazole versus ranitidine as adjunct therapy to endoscopic injection in actively bleeding ulcers: a prospective and randomized study. Endoscopy 1995; 27: Lin HJ, Lo WC, Lee FY, Perng CL, Tseng GY. A prospective randomized comparative trial showing that omeprazole prevents rebleeding in patients with bleeding peptic ulcer after successful endoscopic therapy. Arch Intern Med 1998; 158: Andriulli A, Annese V, Camso M, eta 1. Proton pump inhibitors and outcome of endoscopic haemostasis in bleeding peptic ulcer: a series of meta-analyses. American Journal of Gastroenteology 2005; 100: Chan FK, Ching JY, Hung LC, et al. Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. N Engl J Med 2005; 352: Steffs C, Fromm D. The current diagnosis and management of upper gastrointestinal bleeding. Adv Surg 1992; 25: Larson DE, Farnell MB.Upper gastrointestinal haemorrhage. Mayo Clinic Proc 1983; 58: Jones SC, Axon AT. Bleeding peptic ulcer - endoscopic and pharmacologic management. Postgrad Med J 1991; 67: Bornman PC, Graham SM, Dunn IP. Complications of peptic ulcer and their management, in: Taylor TV, Watson A, Williamson RCN, (eds). Upper Digestive Surgery. 1st ed. London: WB Saunders Co, 1999; Welch M, Hoare EM. The Dieuifoy gastic malformation: an under-recognized cause of massive upper gastrointestinal haemorrhage. Postgrad Med J 1991; 67: Langman MJS. Upper gastrointestinal bleeding. In: Pounder RE (ed). Recent advances in gastroenterology, vol. 6, NewYork: Churchchill Livingstone, 1986: Valle JD. Peptic ulcer disease and relate disorders. In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jamesson JL. (eds). Harrison's Principles of internal Medicine. 15th ed. New York: Me Graw Hill, 2001:

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